1. In this randomized controlled trial, wearable fitness technology added to multiple behavioral interventions resulted in significantly less weight loss than behavioral intervention alone after 24 months.
2. There were no significant differences in diet, physical activity, fitness, or adverse events between groups.
Evidence Rating Level: 1 (Excellent)
Study Rundown: A high BMI is associated with increased risks for numerous diseases, but achieving and maintaining a healthy weight has proven difficult for many Americans. Therefore, research investigating the most effective long-term weight loss strategies has been increasingly emphasized. In this 24 month, randomized controlled trial, young adult participants were divided into a standard intervention group—receiving individual and group behavioral intervention for weight loss—and an enhanced intervention group—receiving the same interventions as the standard group with the addition of wearable fitness technology after 6 months. Weight loss was similar between the groups for the first 6 months. Surprisingly, after receiving their wearable technology, the enhanced intervention group had significantly less weight loss at 12, 18, and 24 months than their counterparts in the standard group. Notably, measures of dietary intake, percent body fat, bone mineral content and density, physical activity, fitness, and adverse events did not differ between groups.
Though the significant difference between groups in weight loss was robust, remaining even after sensitivity analyses, the reason for this unexpected result is unclear as all other measures between groups were similar. However, while short-term studies that have implemented wearable devices in lieu of behavioral interventions have shown benefit, it has been reported that wearable devices do not increase weight loss when group based treatment is also implemented. It seems likely that a ceiling effect obscures the effect of wearable technology for weight loss when implemented with behavioral interventions. In addition, while wearable technology may be a motivational tool when beginning a weight loss regimen, it seems clear that addition of it many months later does not enhance maintenance of a healthy weight.
In-Depth [randomized controlled trial]: A total of 470 participants (28.9% non-white; 77.2% women) aged 18-35 years were recruited for this 24 month, randomized, controlled trial at the University of Pittsburgh as part of the Innovative Approach to Diet, Exercise, and Activity (IDEA) trial. Participants were randomly sorted into standard and enhanced intervention groups and roughly 75% completed the study in each group. The standard intervention group received behavioral interventions, weekly text messages, and monthly phone consultations while the enhanced group received the same treatments plus the addition of wearable fitness technology after 6 months. Unexpectedly, the standard intervention group had greater weight loss at 24 months than the enhanced intervention group (difference 2.4kg; CI95 1.0 to 3.7). This difference in weight loss was not detected at 6 months, which was before the wearable devices were implemented, but was significant at 12 and 18 months as well (p < 0.05). There were no significant differences in fat mass, lean mass, percent body fat, bone mineral content, bone density, cardiovascular fitness, physical activity, dietary intake, sedentary time, safety alerts, non-serious adverse events, or serious adverse events (p > 0.05).
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