Duration of Treatment in a Weight Loss Program Using a Mobile App is Associated with Successful Weight Loss During the COVID-19 Pandemic

Figures & data

Figure 1 Flow diagram of the enrollment of study subjects.

Abbreviation: VGH, Veteran General Hospital.

Figure 2 Circuit of mobile weight management program on the app.

Figure 3 Proportions of patients categorized by weight loss of their baseline body weight.

Table 1 Baseline Characteristics of the Enrolled Patients

Baseline Characteristic	Total	Weight Loss ≥ 5%	Weight Loss < 5%	P value
	(n=45)	(n=21)	(n=24)
Age (years)	40.4 (12.0)	37.4 (11.2)	43.1 (12.3)	0.108
Female, n (%)	28 (62.2%)	10 (47.6%)	18 (75%)	0.114
Weight, kg	87.5 (19.2)	87.5 (17.3)	87.4 (21.1%)	0.909
BMI (kg/m^2)	31.7 (5.7)	31.3 (5.3)	32.0 (6.1)	0.690
BMI categories — no. (%)
24≤BMI<27	8 (17.8%)	2 (9.5%)	6 (25%)	0.252
27≤BMI<30	10 (22.2%)	6 (28.6%)	4 (16.7%)	0.476
30≤BMI<35	17 (37.8%)	10 (47.6%)	7 (29.2%)	0.334
BMI≥35	10 (22.2%)	3 (14.3%)	7 (29.2%)	0.296
Waist circumference (cm)	100.9 (13.3)	100.3 (11.3)	101.6 (15.3)	0.900
Hip circumference (cm)	109.5 (10.7)	109.5 (9.4)	109.5 (11.8)	0.716
Body fat mass (kg)	35.1 (11.3)	33.2 (10.7)	36.7 (11.9)	0.260
Skeletal muscle mass (kg)	29.3 (6.9)	30.5 (6.5)	28.2 (7.1)	0.158
Body fat mass percentage (%)	39.7 (6.8)	37.5 (6.9)	41.6 (6.3)	0.032
Fat-free mass (kg)	52.4 (11.3)	52.9 (10.2)	50.7 (11.8)	0.145
Type 2 diabetes, n (%)	13 (28.9%)	4 (19.1%)	9 (37.5%)	0.302
Pre-diabetes, n (%)	25 (55.6%)	12 (57.1%)	13 (54.1%)	0.999
Hypertension, n (%)	7 (15.6%)	2 (9.5%)	5 (20.8%)	0.422
Antidiabetic drug history, n (%)	11 (24.4%)	4 (19.1%)	7 (29.2%)	0.660
Metformin, n (%)	9 (20%)	3 (14.3%)	6 (25%)	0.370
SGLT2 inhibitors, n (%)	7 (15.6%)	2 (9.5%)	5 (20.8%)	0.422
Insulin, n (%)	1 (2.2%)	1 (4.8%)	0 (0%)	0.467
SU, n (%)	2 (4.4%)	1 (4.8%)	1 (4.2%)	0.999
TZD, n (%)	1 (2.2%)	0 (0%)	1 (4.2%)	0.999
Educational status, n (%)
Below college	11 (24.4%)	2 (9.5%)	9 (37.5%)	0.067
College or above	34 (75.6%)	19 (90.5%)	15 (62.5%)
Marital status, n (%)
Single	22 (48.9%)	12 (57.1%)	10 (41.7%)	0.461
Married	23 (51.1%)	9 (42.9%)	14 (58.3%)
Fertility status, n (%)
Having no child	26 (57.8%)	14 (66.7%)	12 (50.0%)	0.408
Having child	19 (42.2%)	7 (33.3%)	12 (50.0%)
History of weight loss, n (%)
Negative	8 (17.8%)	4 (19.0%)	4 (16.7%)	1.000
Positive	37 (82.2%)	17 (81.0%)	20 (83.3%)
Exercise habit, n (%)
Negative	17 (37.8%)	7 (33.3%)	10 (41.7%)	0.789
Positive	28 (62.2%)	14 (66.7%)	14 (58.3%)
Snacking habit, n (%)
Negative	22 (48.9%)	13 (61.9%)	9 (37.5%)	0.182
Positive	23 (51.1%)	8 (38.1%)	15 (62.5%)
Times of eating out per week, n (%)
≤7 times	31 (68.9%)	14 (66.7%)	17 (70.8%)	0.999
≥8 times	14 (31.1%)	7 (33.3%)	7 (29.1%)

Note: Continuous data are expressed as means (SD) and categorical data are expressed as numbers (percentages).

Abbreviations: BMI, body-mass index; SD, standard deviation; SGLT2, sodium-glucose cotransporter 2; SU, sulfonylurea; TZD, thiazolidinedione.

Table 2 The Clinical Practice in the Weight Loss Program

	Total (n=45)	Weight Loss ≥ 5% (n=21)	Weight Loss < 5% (n=24)	P value
Duration of treatment (weeks)	11 (7.3)	14.6 (6.5)	6.9 (6.0)	<0.001
Number of dietary records	80.2 (76.3)	109.2 (84.7)	54.7 (58.8)	0.002
Number of dietary records per week	7.6 (4.6)	7.9 (4.3)	7.4 (4.3)	0.641
Days of weight record (days)	15.1 (33.8)	25.6 (41.8)	6 (21.8)	0.264
Completion ratio of daily weight record (%)	14.8% (27%)	21.9% (34.6%)	8.5% (16%)	0.540
Categories of completion ratio of daily weight record
<10%, n (%)	31 (68.9%)	13 (61.9%)	18 (75%)	0.533
10%‒49%, n (%)	9 (20%)	4 (19.0%)	5 (20.8%)	1.000
≥50%, n (%)	5 (11.1%)	4 (19.0%)	1 (4.2%)	0.169
Number of outpatient visits	4.8 (2.8)	6.1 (2.7)	3.7 (2.3)	<0.001
Interval of outpatient visits (weeks)	2.1 (1.0)	2.5 (1.1)	1.8 (0.9)	0.003

Note: Continuous data are expressed as means (SD) and categorical data are expressed as numbers (percentages).

Abbreviation: SD, standard deviation.

Table 3 Changes in Anthropometric Outcome Measures

Outcome Measure	Total (n=45)	Weight Loss ≥ 5% (n=21)	Weight Loss < 5% (n=24)	P value
Weight loss (%)	4.7 (4.7)	8.6 (3.4)	1.3 (2.4)	<0.001
Weight loss (kg)	4.1 (4.4)	7.6 (3.4)	1.1 (2.4)	<0.001
BMI reduction (kg/m^2)	1.5 (1.5)	2.7 (1.1)	0.4 (0.8)	<0.001
Waist circumference reduction (cm)	4.3 (4.2)	7.0 (3.7)	1.9 (3.2)	<0.001
Hip circumference reduction (cm)	2.9 (4.0)	5.4 (3.4)	0.7 (3.3)	<0.001
Body fat mass reduction (kg)	3.5 (3.4)	6.2 (3.0)	1.0 (1.1)	<0.001
Skeletal muscle mass reduction (kg)	0.4 (1.2)	0.9 (1.1)	0 (1.1)	0.018
Body fat percentage reduction (%)	2.4 (2.9)	4.4 (3.0)	0.7 (1.1)	<0.001
Fat-free mass reduction (kg)	0.7 (2.0)	1.5 (1.9)	0.1 (1.9)	0.021

Note: Data are expressed as means (SD).

Abbreviations: SD, standard deviation; BMI, body-mass index.

Table 4 Univariate and Backward Multivariate Logistic Analysis Showing Odds Ratios for Successful Weight Loss

	Univariate			Multivariate
	OR	(95% CI)	P	OR	(95% CI)	P
Age (year)	0.96	(0.91–1.01)	0.118
Sex (male vs female)	3.30	(0.94–11.63)	0.063
Weight (kg)	1.00	(0.97–1.03)	0.988
BMI (kg/m^2)	0.98	(0.88–1.09)	0.693
Waist circumference (cm)	0.99	(0.95–1.04)	0.739
Hip circumference (cm)	1.00	(0.95–1.06)	0.996
Body fat mass (kg)	0.97	(0.92–1.03)	0.297
Skeletal muscle mass (kg)	1.05	(0.96–1.15)	0.260
Body fat mass percentage (%)	0.91	(0.83–1.00)	0.055
Fat-free mass (kg)	1.03	(0.98–1.09)	0.281
Type 2 diabetes (yes or no)	0.39	(0.10–1.54)	0.180
Pre-diabetes (yes or no)	1.13	(0.35–3.67)	0.841
Hypertension (yes or no)	0.40	(0.07–2.32)	0.307
Antidiabetic drug history (yes or no)	0.57	(0.14–2.32)	0.433
Metformin (yes or no)	0.50	(0.11–2.31)	0.375
SGLT2 inhibitors (yes or no)	0.40	(0.07–2.32)	0.307
SU (yes or no)	1.15	(0.07–19.60)	0.923
Educational status (high vs low)	5.70	(1.07–30.43)	0.042	9.812	(0.93–103.88)	0.058
Marital status (married vs single)	0.54	(0.16–1.75)	0.302
Fertility status (have child vs no child)	0.50	(0.15–1.68)	0.261
Weight loss history (yes or no)	0.85	(0.18–3.92)	0.835
Exercise habit (yes or no)	1.43	(0.42–4.83)	0.566
Snacking habit (yes or no)	0.37	(0.11–1.24)	0.106
Eat out per week (≥8 times vs ≤7 times)	1.21	(0.34–4.30)	0.763
Number of diet record per participant (n)	1.01	(1.00–1.02)	0.028
Number of diet record per week per participant (n)	1.03	(0.90–1.18)	0.675
Days of weight record per participant (days)	1.02	(1.00–1.05)	0.092
Completion ratio of daily weight record (%)	8.20	(0.59–113.19)	0.116
Duration of treatment (weeks)	1.21	(1.07–1.37)	0.002	1.23	(1.08–1.41)	0.003
Number of outpatient visits (n)	1.48	(1.12–1.97)	0.007
Interval of outpatient visits (weeks)	2.48	(1.13–5.46)	0.024

Notes: Parameters that were significantly associated with successful weight loss in univariate logistic regression analysis were entered into the backward multivariate logistic regression analysis. Successful weight loss was defined as a weight loss ≥ 5% of baseline weight.

Abbreviations: BMI, body-mass index; SGLT2, sodium-glucose cotransporter 2; SU, sulfonylurea.