Cell phone intervention for you (CITY): A randomized, controlled trial of behavioral weight loss intervention for young adults using mobile technology.

Abstract

Objective

To determine the effect on weight of two mobile technology-based (mHealth) behavioral weight loss interventions in young adults.

Methods

Randomized, controlled comparative effectiveness trial in 18- to 35-year-olds with BMI ≥ 25 kg/m(2) (overweight/obese), with participants randomized to 24 months of mHealth intervention delivered by interactive smartphone application on a cell phone (CP); personal coaching enhanced by smartphone self-monitoring (PC); or Control.

Results

The 365 randomized participants had mean baseline BMI of 35 kg/m(2) . Final weight was measured in 86% of participants. CP was not superior to Control at any measurement point. PC participants lost significantly more weight than Controls at 6 months (net effect -1.92 kg [CI -3.17, -0.67], P = 0.003), but not at 12 and 24 months.

Conclusions

Despite high intervention engagement and study retention, the inclusion of behavioral principles and tools in both interventions, and weight loss in all treatment groups, CP did not lead to weight loss, and PC did not lead to sustained weight loss relative to Control. Although mHealth solutions offer broad dissemination and scalability, the CITY results sound a cautionary note concerning intervention delivery by mobile applications. Effective intervention may require the efficiency of mobile technology, the social support and human interaction of personal coaching, and an adaptive approach to intervention design.

Department

Description

Provenance

Citation

Published Version (Please cite this version)

10.1002/oby.21226

Publication Info

Svetkey, Laura P, Bryan C Batch, Pao-Hwa Lin, Stephen S Intille, Leonor Corsino, Crystal C Tyson, Hayden B Bosworth, Steven C Grambow, et al. (2015). Cell phone intervention for you (CITY): A randomized, controlled trial of behavioral weight loss intervention for young adults using mobile technology. Obesity (Silver Spring, Md.), 23(11). pp. 2133–2141. 10.1002/oby.21226 Retrieved from https://hdl.handle.net/10161/29949.

This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.

Scholars@Duke

Svetkey

Laura Pat Svetkey

Professor Emeritus of Medicine

Laura P. Svetkey, MD MHS is Professor of Medicine/Nephrology, Vice Chair for Faculty Development and Diversity in the Department of Medicine. She is also the Director of Duke’s CTSA-sponsored internal career development award program (KL2) and the Associate Director of Duke’s REACH Equity Disparities Research Center, in which she also leads the Investigator Development Core.

Dr. Svetkey has over 30 years of experience in the investigation of hypertension, obesity, and related areas, conducting NIH-sponsored clinical research ranging from behavioral intervention trials to metabolomics and genetics, with a consistent focus on prevention, non-pharmacologic intervention, health disparities and minority health. Her research has affected national guidelines, having served on the 2013 national Hypertension Guideline Panel (JNC) and the Lifestyle Guideline Working Group. She is an American Society of Hypertension certified hypertension specialist, and a member of the Association of American Physicians (AAP). She is the Associate Director, Core Director and Project PI of Duke’s NIH-sponsored REACH Equity Disparities Research Center (PI: Kimberly Johnson).

As Department of Medicine Vice Chair for Faculty Development and Diversity, she implements a wide range of programs to enhance the experience and advancement of faculty and trainees, with particular emphasis on those from racial and ethnic groups under-represented in medicine, and women.

Batch

Bryan Courtney Batch

Professor of Medicine

Type 2 Diabetes, Obesity/Overweight, Behavior change, Non-pharmacologic intervention, Health disparities

Lin

Pao-Hwa Lin

Professor in Medicine

My research interest lies generally in the area of dietary patterns and chronic diseases including hypertension using controlled feeding study and lifestyle intervention designs.

Two major controlled feeding clinical trials that I was involved in include the Dietary Approaches to Stop Hypertension (DASH) Study and the Dietary Approaches to Stop Hypertension-Sodium (DASH-Sodium) Study. In addition to being an active member for the diet committee for DASH, I also function as the chair of the diet committee for the DASH-Sodium study.  I am familiar with the development and operation of a controlled feeding study, which means the process of study design, development of questionnaire/forms for data collection/monitoring, development of quality assurance procedure, and data analysis.

I've also helped with the design and implementation of the lifestyle behavioral intervention program for the Hypertension Improvement Project (HIP), PREMIER clinical trial, Weight Loss Maintenance trial (WLM), ENCORE study, and the Cell Phone Intervention for You (CITY) trial.

Key words: Diet, controlled feeding study, mineral, blood pressure, nutrition.

Corsino

Leonor Corsino

Associate Professor of Medicine

Dr. Leonor Corsino is a Board- Certified Adult Endocrinologist, an experienced physician-scientist, and an organizational and health professional education leader. She offers an extensive and diverse leadership background with successfully implementing innovative clinical, research, and workforce development and education programs. Her expertise and strengths lie in her diverse portfolio that expands from basic science to clinical and community-engaged research, innovative curriculum development, successful clinical program implementation, and collaborations.

Dr. Corsino's research focuses on diabetes, obesity, and related complications and health disparities, with a particular interest in Hispanic/Latino populations. She has successfully led and extensively collaborated with investigators locally, nationally, and internationally. Her research and contribution have been recognized locally and nationally with many awards, including the NIH/NIDDK Network of Minority Health Research Investigators medallion.

Dr. Corsino has extensive leadership experience, including her current roles as a member of the Executive Committee Member and Associate Director of the Duke School of Medicine Masters of Biomedical Sciences (MBS), Co-Director for the Duke Clinical and Translational Science Institute - Community Engagement Core / Community-Engaged Research Initiative (CERI) and Associate Dean for Students Affairs/Advisory Dean Duke School of Medicine MD program.

She is the former Co-Director, Education and Training Sub-core of the Duke Center for REsearch to AdvanCe Healthcare Equity, Director of the Duke Population Health Improvement Initiative Program, Associate Chair for the Department of Medicine Minority Recruitment and Retention Committee, and Associate Director for the Duke School of Medicine Office of Faculty Mentoring Training.

Dr. Corsino's leadership led to the successful development and implementation of unique and innovative programs, including the Duke MBS program selective curriculum, the REACH Equity Summer Undergraduate Research Program, the CTSI/CERI Population Health Improvement Award, E-library, consultation services, and the interactive platform for the Duke Population Health Improvement Program.

Her visionary and innovative initiatives have enhanced patient care, population health, and the recruitment, training, development, and support of health professions students, residents, fellows, and junior faculty, having a significant, palpable, impact on the diversity of health profession workforce and health disparities research.

 

 

Tyson

Crystal Cenell Tyson

Assistant Professor of Medicine

As a board-certified nephrologist and a certified clinical hypertension specialist (ASH-SCH), I take care of patients with kidney disorders and/or high blood pressure. Patients with chronic kidney disease and high blood pressure have an increased risk for developing complications of cardiovascular disease, such as heart attacks, congestive heart failure, strokes, kidney failure requiring dialysis or a kidney transplant, and a shortened lifespan. My clinical focus is to slow the progression of chronic kidney disease and reduce complications from cardiovascular disease with lifestyle modification. I particularly enjoy treating patients with severe or difficult to control high blood pressure by focusing on finding an effective medication regimen that provides the least side effects, eliminating ineffective medications, simplifying medication schedules, and promoting healthy lifestyle behavior. I see patients 2 days per week in the Duke Nephrology Clinic and the Duke Nephrology Hypertension Clinic.

My research interests are to reduce racial and health disparities among patients with hypertension and chronic kidney disease using lifestyle modifications. My past and current research investigates the effects of diet (i.e., the DASH diet, sodium reduction), exercise, and weight loss on blood pressure and kidney function, as well as the effect of bilateral renal artery denervation on blood pressure.

Bosworth

Hayden Barry Bosworth

Professor in Population Health Sciences

Dr. Bosworth is a health services researcher and Deputy Director of the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT)  at the Durham VA Medical Center. He is also Vice Chair of Education and Professor of Population Health Sciences. He is also a Professor of Medicine, Psychiatry, and Nursing at Duke University Medical Center and Adjunct Professor in Health Policy and Administration at the School of Public Health at the University of North Carolina at Chapel Hill. His research interests comprise three overarching areas of research: 1) clinical research that provides knowledge for improving patients’ treatment adherence and self-management in chronic care; 2) translation research to improve access to quality of care; and 3) eliminate health care disparities. 

Dr. Bosworth is the recipient of an American Heart Association established investigator award, the 2013 VA Undersecretary Award for Outstanding Achievement in Health Services Research (The annual award is the highest honor for VA health services researchers), and a VA Senior Career Scientist Award. In terms of self-management, Dr. Bosworth has expertise developing interventions to improve health behaviors related to hypertension, coronary artery disease, and depression, and has been developing and implementing tailored patient interventions to reduce the burden of other chronic diseases. These trials focus on motivating individuals to initiate health behaviors and sustaining them long term and use members of the healthcare team, particularly pharmacists and nurses. He has been the Principal Investigator of over 30 trials resulting in over 400 peer reviewed publications and four books. This work has been or is being implemented in multiple arenas including Medicaid of North Carolina, private payers, The United Kingdom National Health System Direct, Kaiser Health care system, and the Veterans Affairs.

Areas of Expertise: Health Behavior, Health Services Research, Implementation Science, Health Measurement, and Health Policy

Grambow

Steven C. Grambow

Associate Professor of Biostatistics & Bioinformatics

I am an academic statistician with a focus on educational leadership and administration, teaching, mentoring, and collaborative clinical research. I serve as the director of multiple education programs, both formal degree programs and certificate-based training programs. I also provide administrative oversight of multiple graduate degree programs and educational initiatives focusing on clinical and translational science workforce development at the student, staff, and faculty levels.

I have many years of experience with in-person and online teaching across a variety of teaching venues (formal degree programs, domestic and international certificate-based training programs, faculty development seminars, residency/fellowship training programs) and health sciences audiences (medical students, residents, fellows, faculty, and other health professionals), including more than 21 years as a statistics course director in the Duke Clinical Research Training Program.

As a collaborative scientist I have experience with a broad range of clinical research areas and clinical research designs, including observational studies, epidemiology investigations, and randomized clinical trials, including those utilizing web, mobile, and telemedicine-based health behavior interventions. I have collaborated on projects spanning a broad range of clinical research areas, including amyotrophic lateral sclerosis (ALS), post-traumatic stress disorder (PTSD), Prader-Willi syndrome (PWS), prostate cancer, quality of colorectal cancer care, osteoarthritis, lifestyle modification through weight loss, CVD risk reduction through hypertension control, smoking cessation, and substance abuse recovery.

Gallis

John Gallis

Biostatistician, Senior

Overview
John currently collaborates with researchers and methodologists at the Duke Global Health Institute and the Duke Department of Biostatistics & Bioinformatics.  His varied research experience includes design and analysis of weight loss-related randomized controlled trials (RCTs), design and analysis of cluster randomized trials (CRTs), and implementation of the multiphase optimization strategy (MOST).  Recently, he has primarily worked with researchers examining the effects of interventions on maternal mental health and child health and development.  His research interests include the design of CRTs and analysis methods for clustered data, among many other interests.

Education
Master of Science (Sc.M.) in Biostatistics. Johns Hopkins Bloomberg School of Public Health               
Bachelor of Science (B.S.) in Mathematics: Southern Utah University

Links:
LinkedIn Profile: https://www.linkedin.com/in/john-gallis-2258b843/
Duke website: https://sites.duke.edu/johngallis/

Bennett

Gary G. Bennett

Dean of Trinity College of Arts & Sciences

Gary G. Bennett, Ph.D., is dean of the Trinity College of Arts & Sciences at Duke University.  

As dean, Dr. Bennett is responsible for defining and articulating the strategic mission of Trinity College, ensuring a world-class liberal arts education in a research environment for all students, and attracting, retaining, and nurturing a diverse community of distinguished faculty.

Dr. Bennett is a professor of psychology & neuroscience, global health, medicine, and nursing, and is the founding director of the Duke Digital Health Science Center.  He is a global leader in designing, testing, and disseminating digital behavior change interventions. Dr. Bennett developed the interactive obesity treatment approach (iOTA); his recent work demonstrates the effectiveness of digital strategies in treating obesity in the primary care setting.

Nearly 20 years ago, Dr. Bennett created one of the first digital health research programs. His laboratory has since become a global leader in designing, testing, and disseminating digital behavior change interventions, especially for medically vulnerable populations. Dr. Bennett has authored nearly 200 scientific papers, and the National Institutes of Health have continuously funded his research program with more than $20m in grant support.  From 2018-2019, Dr. Bennett served as president of the Society of Behavioral Medicine, the nation's largest organization of behavioral change scientists. Dr. Bennett is an elected Academy of Behavioral Medicine Research and Behavioral Medicine Research Council member. 

Before assuming his role as dean of Trinity College in February 2023, Dr. Bennett served as vice provost for undergraduate education. He provided strategic vision and leadership for Duke’s undergraduate experience.  As vice provost, he oversaw the Office of Undergraduate Education, comprising 15 units that enrich Duke's undergraduate academic experience through academic advising, academic support, nationally competitive scholarships, merit scholar programs, financial aid, study abroad, and several co-curricular programs.  Under Bennett’s leadership, Duke introduced several advancements to make the undergraduate experience more enriching and equitable for all students, including the DukeLIFE program to support first-generation and low-income students, and QuadEx, Duke’s inclusive living and learning model that integrates undergraduates’ social, residential and intellectual experiences.

Dr. Bennett is a member of Duke's Bass Society of Fellows and is the founding director of Duke's undergraduate major in global health. He has served on committees to examine Duke's undergraduate curriculum and develop the university's strategic plan and has co-led the Board of Trustees Undergraduate Education Committee since 2018. His students' course ratings have repeatedly placed Dr. Bennett in the top 5% of Duke's undergraduate instructors.

Dr. Bennett has also co-founded three digital health ventures. Crimson Health Solutions developed digital disease management interventions and was acquired by Health Dialog in 2007. In 2014, he co­ founded Scale Down, a digital obesity treatment startup based on the science of daily self-weighing. Scale Down was acquired by Anthem in 2017. He is a co-founder of Coeus Health, a leading provider of health APIs. Dr. Bennett advises leading digital health and consumer electronic organizations on the science of health behavior change.

Before joining Duke in 2009, Dr. Bennett served on the Harvard School of Public Health and the Dana-Farber Cancer Institute faculties. Dr. Bennett earned a bachelor's degree at Morehouse College, an AM and PhD in clinical health psychology at Duke University, completed a clinical internship in medical psychology at the Duke University Medical Center, and was the Alonzo Yerby postdoctoral fellow in social epidemiology at the Harvard School of Public Health.

Dr. Bennett lives in Raleigh with his wife (also a Duke alum) and his two daughters.


Unless otherwise indicated, scholarly articles published by Duke faculty members are made available here with a CC-BY-NC (Creative Commons Attribution Non-Commercial) license, as enabled by the Duke Open Access Policy. If you wish to use the materials in ways not already permitted under CC-BY-NC, please consult the copyright owner. Other materials are made available here through the author’s grant of a non-exclusive license to make their work openly accessible.