Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: May 25, 2019
Open Peer Review Period: May 29, 2019 - Jul 24, 2019
Date Accepted: Feb 9, 2020
Date Submitted to PubMed: May 1, 2020
(closed for review but you can still tweet)
Multi-dimensional cognitive behavior therapy for obesity applied by clinical psychologist using digital platform: an open-label, randomised controlled trial
ABSTRACT
Background:
Developing effective weight management programs that are widely useful is a priority for the healthcare industry because obesity is a major health problem.
Objective:
The aim of the present study is to develop and validate the efficacy of a new, comprehensive multi-factorial, intensive, daily-based, clinical psychologist’ coaching based on cognitive behavioral therapy (CBT) modules via the digital healthcare mobile services Noom Coach and InBody.
Methods:
This was an open-label, active comparator randomised controlled trial. Seventy female participants whose body mass index (BMI) scores were above 24kg/m² and who had no other clinical problems except obesity were randomised into experimental and control groups. Forty-five people in the experimental group (digital CBT group) were connected with a therapist intervention using a digital healthcare service that provided daily feedback and assignments for 8 weeks. Twenty-five people in the control group also used the digital healthcare service, but they were asked to do self-care without therapist intervention. The main outcomes of this study were objectively measured: weight in kg as well as other body compositions at 0, 8, and 24 weeks. The differences between the groups were evaluated using independent t-test and per-protocol framework.
Results:
Weight loss at 8 weeks in the digital CBT group was significantly higher than in the control group (-3.1 (4.5%) vs. -0.7 (3.4%), P = 0.036). Fat mass in the digital CBT group at 8 weeks was also significantly decreased compared to that in the control group (-6.3 (8.8%) vs. -0.8 (8.1%), P = 0.021). Leptin and insulin resistance in the digital CBT group at 8 weeks significantly declined compared to the control group (-15.8 (29.9%) vs. 7.2 (35.9%), P = 0.013 and -7.1 (35.1%) vs. 14.4 (41.2%), P = 0.044). Emotional eating behavior measured by the questionnaire (Dutch Eating Behavior Questionnaire) at 8 weeks in the digital CBT group significantly recovered compared to the control group (-2.8 (34.4%) vs. 21.6 (56.9%), P = 0.048). Snack calorie intake in the digital CBT group during the intervention period was significantly lower than in the control group (135.9 (86.4 kcal) vs. 208.2 (166.3 kcal), P = 0.020). Last, the level of depression, anxiety, and self-esteem at the baseline could significantly predict clinical outcomes at long term (24 weeks), while the level of motivation at the baseline could significantly predict clinical outcomes at both short term (8 weeks) and long term.
Conclusions:
These findings lend further support to the notion that obesity is closely related to psychological problems that require psychological intervention to manage weight for a healthy lifestyle. This study is innovative in that it provides a new CBT approach with a multi-disciplinary team based on digital technologies rather than conventional methods by successfully developing and verifying its effects. Clinical Trial: The trial was registered with ClinicalTrials.gov NCT03465306.
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