Table 1.
Characteristics of the included studies.
| Author Year Country |
Sample Size Study Population |
Type of Device | Type of Intervention, Duration, Frequency |
Comparison | Main and Secondary Outcomes |
Results | Quality |
|---|---|---|---|---|---|---|---|
| Apinaniz et al., 2019 Spain [38] |
110, 54 intervention and 56 controls; 38.5 ± 5 years; 72% F and 28% M; BMI 32.7 ± 4.9 kg/m2 | Smartphone app AKTIDIET | The AKTIDIET app on patients’ smartphones provided reinforced health advice, including exercise programs, food intake tracking and instructional videos. Patients followed up at 1, 3 and 6 months. The program required daily self-reporting of diet and exercise, with personalized feedback and weekly assignments. The examination was repeated at 16 and 38 weeks | Usual care and motivational advice including recommendations on diet and physical exercise | Body weight after 6 months and adherence to dietary and exercise recommendations | There were no significant differences in weight change, nor in the adherence to dietary or physical exercise recommendations | 6 Yes, 3 No, 1 Unclear; Medium Bias Risk |
| Balk-Møller et al., 2017 Denmark [39] |
566, 355 intervention and 211 controls; 47 ± 10 years; 92.2% F and 7.8% M; BMI 73.8 ± 15.4 kg/m2 | Web and smartphone app SoSu-life | Daily self-reporting of diet and exercise, personalized feedback about specific health issues related to the chosen pledge, with weekly assignments and challenges. The examination was repeated at 16 and 38 weeks | No activities | Change in body weight and anthropometric markers | The SoSu-life group had a larger decrease in body weight (−1.01 kg, p = 0.03), body fat percentage (−0.78%, p = 0.03), and WC (−1.79 cm, p = 0.007) after 38 weeks compared with the control group. The SoSu-life group had a larger decrease in body weight (−1.54 kg, p < 0.001) and a decrease in body fat percentage of −0.81% (p = 0.003) compared with the control group during the first 16 weeks | 9 Yes, 0 No, 1 Unclear: Low Bias Risk |
| Beatty et al., 2020 USA [40] |
72, 37 intervention and 35 controls; 37.7 ± 15.3 years, 65.3% F and 34.7% M; BMI 31.3 ± 3.2 kg/m2 | A wrist-worn ELMM device capable of tracking bites, displayed after each meal, as well as the number of steps taken by the user. |
WD for 8 weeks. Workbook offered education regarding eating rate, energy intake and energy expenditure. | WO | Weight loss | No significant difference between WD and WO groups with respect to weight change [−0.46 (1.11) vs. 0.26 (0.82) kg, respectively, p = 0.40] | 4 Yes, 2 No, 4 Unclear; High Bias Risk |
| Block et al., 2015 USA [41] |
339, 163 intervention and 176 controls; 55 ± 8.9 years; 31.3% F and 68.7%; BMI 31.2 ± 4.4 kg/m2 | Alive-PD program via Web, smartphone and automated phone calls | The program offered personalized dietary and PA goals, tracking tools, health information, quizzes, social support, feedback and reminders via web, email, IVR phone calls and mobile. The program lasted for a year, with regular goal setting and contact. Users received goals weekly for the first six months and bi-weekly thereafter, plus midweek reminders. | No contact from Alive-PD system except reminders to complete a 3-month and 6-month online follow-up questionnaire | Changes in body weight, BMI, WC | Reductions in weight, BMI and WC were all significantly greater in the intervention group than the control group (p = 0.01) | 9 Yes, 0 No, 1 Unclear; Low Bias Risk |
| Burke et al., 2022 USA [42] |
502, 251 intervention and 251 controls; 45.0 ± 14.4 years; 79.5% F and 20.5% M; BMI 33.7 ± 4.0 kg/m2 | Fitbit Charge 2, smartphone app | SM+FB of diet, PA and weight in a behavioral weight-loss intervention at 6 and 12 months. The calorie goal was determined based on the person’s baseline body weight and real-time synced SM data to send messages that were responsive to the participants’ SM entries; wrist-worn Fitbit Charge 2 was used to self-monitor PA with an aim of 150 min/week by 12 weeks. Participants weighed themselves daily. In-app messages were sent 3 times daily over the 12-month intervention | SM | Weight loss and changes in BMI from baseline to 6 months, percentage of body fat, WC | At 6 months, there was a significant percentage of weight change in both groups (SM+FB: −3.16%, 95% CI: −3.85% to −2.47%, p < 0.0001; SM: −3.20%, 95% CI: −3.86% to −2.54%, p < 0.0001) but no significant between-group mean difference (−0.04%, 95% CI: −0.99% to 0.91%, p = 0.940). | 9 Yes, 0 No, 1 Unclear; Low Bias Risk |
| Cho et al., 2020 Republic of Korea [43] |
129, 88 intervention and 41 controls; 49.2 ± 7.7 years; 51.2% F and 48.8% M; BMI 26.3 ± 3 kg/m2 | Smartphone app | An app-based diet and exercise self-logging group (app only), or app-based self-logging and personalized coaching from professional dieticians and exercise coordinators group. The app delivered structured health-related curricula and personalized feedback based on reviews of the user’s logs. Assessments were performed at baseline, week 6, week 12 and week 24 | Baseline education; no apps | Weight changes, body fat mass, WC between baseline and follow-up assessments | Those using the app with the personalized coaching group had greater body weight reductions (control −0.12 ± 0.30 kg; app only −0.35 ± 0.36 kg, p = 0.67; app with personalized coaching −0.96 ± 0.37 kg, p = 0.08), specifically by body fat mass reduction (control −0.13 ± 0.34 kg; app only −0.64 ± 0.38 kg, p = 0.22; app with personalized coaching −0.79 ± 0.38 kg, p = 0.08) | 9 Yes, 0 No, 1 Unclear; Low Bias Risk |
| Duncan et al., 2020 Australia [44] |
116, 39 Enhanced, 41 Traditional and 36 Control; 44.5 ± 10.4 years; 70.7% F and 29.3% M; BMI 31.7 ± 3.9 kg/m2 | Smartphone app Balanced, Fitbit, Accelerometer (Geneactiv) | In a 6-month intervention, Enhanced and Traditional group participants received personalized dietary recommendations, access to the ‘Balanced’ smartphone app, a calorie-counting platform, a face-to-face dietary consultation, a Fitbit activity tracker, body weight scales and a handbook. | The waitlist control group was asked to maintain current weight, PA and dietary intake | Weight change | At 6 months, weight was not significantly different between the pooled intervention groups and control group (difference = −0.92, 95% CI (−3.33, 1.48)) or 12 months (difference = 0.00, 95% CI (−2.62, 2.62)). |
8 Yes, 2 No, 0 Unclear; Low Bias Risk |
| Farage et al., 2021 USA [45] |
191, 103 intervention and 88 controls; 34.8 ± 7.6 years; 51.8% F and 48.2% M; BMI 46% 25–30 and 54% over 30 kg/m2 | Smartphone app Lose it! | Electronic diet and exercise self-monitoring and weight loss interventions on 4- and 12-month weight loss; 28 phone calls over 12 months with counselors, regular feedback through email and weight monitoring using the BodyTrace e-scale. In addition, the participants received a personalized exercise plan based on their self-reported baseline PA. They were asked to gradually increase aerobic exercise from their baseline level until reaching 225–250 min weekly | Self-paced participants received assistance upon request | Weight change | At 4 months, the counselor-initiated treatment group lost an average of 3.7 kg (SD 3.6), and the self-paced treatment group lost 0.6 kg (SD 3.1). At 12 months, the counselor-initiated treatment lost 2.4 kg (SD 5.0) on average and the self-paced treatment group gained 0.2 kg (SD 5.1). | 7 Yes, 2 No, 1 Unclear; Medium Bias Risk |
| Fukuoka et al., 2015 USA [46] |
61, 30 intervention and 31 controls; 55.2 ± 9.0 years; 77% F and 23% M; BMI 33.3 ± 6.0 kg/m2 | Smartphone app and Omron pedometer | The intervention lasted 5 months and consisted of six in-person sessions and a home-based exercise program. A study-developed mobile phone app and pedometer augmented the intervention and providing self-monitoring tools (recording weight, activity and caloric intake). It was also used to deliver interactive intervention content through daily messages, video clips and quizzes | The control group used the pedometer, but the settings were changed to display the number of steps. No specific step goals were provided. Research staff removed the run-in mobile app from the participant’s iPhone or collected the iPhone if one had been provided | Percentage change in weight and BMI from baseline to 5-month follow-up, hip circumference, objectively measured (via pedometer) PA | The intervention group (n = 30) lost an average of 6.2 (5.9) kg (−6.8% [5.7%]) between baseline and 5-month follow-up compared to the control group’s (n = 31) gain of 0.3 (3.0) kg (0.3% [5.7%]) (p < 0.001). The intervention group had greater reductions in hip circumference (p < 0.001) | 6 yes, 2 no, 2 unclear; Medium Bias Risk |
| Hernández-Reyes et al., 2020 Spain [47] |
90, 45 intervention and 45 controls; 41.5 ± 11.3 years; 100% F; BMI 31.8 ± 5.3 kg/m2 | Automatic push notifications | Objectives for diet and PA through exclusive access to specific functionalities of the app and automatic push notifications on specific days with personalized health-related and motivational messages | No access to functionalities related to the self-monitoring of weight at home, gamification or prescription of PA | Body fat loss, muscle mass and weight loss at 6 months | Receiving notifications during the intervention increased body fat loss (mean −12.9% [SD 6.7] in the intervention group vs. mean −7.0% [SD 5.7] in the control group; p < 0.001) and helped to maintain muscle mass (mean −0.8% [SD 4.5] in the intervention group vs. mean −3.2% [SD 2.8] in the control group; p < 0.018). These variations between groups led to a non-significant difference in weight loss (mean −7.9 kg [SD 3.9] in the intervention group vs. mean −7.1 kg [SD 3.4] in the control group; p > 0.05). | 4 Yes, 3 No, 3 Unclear; High Bias Risk |
| Hong et al., 2022 Republic of Korea [48] |
29, 12 intervention and 17 controls; 80 ± 3.3 years; 100% F; Weight 58.63 ± 8.17 kg | Smartphone, 24-inch LCD display monitor and a smartphone mirroring device (Miracast MRC-01, Actto) | Smartphone mirroring-based telepresence exercise Program with exercise instructor who had a major in exercise physiology, in which participants exercised in their homes for 20–40 min three times a week for 12 weeks. Nutrition advice and fitness monitoring once a month. |
Same exercise program at the senior citizen center | Weight loss, body composition and physical function | Weight (p = 0.006) significantly decreased in the control group, body fat percentage decreased significantly in the intervention (p = 0.026) and in the control (p = 0.001) groups, and skeletal muscle mass (p = 0.44) significantly increased in the control group. Two-way repeated-measures ANOVA revealed no significant interaction effects on all variables. |
8 Yes, 0 No, 2 Unclear; Low Bias Risk |
| Hurkmans et al., 2018 Belgium [49] |
102, 80 intervention and 22 controls; 45.5 ± 10.3 years; 70% F and 30% M; BMI 32 ± 2.0 kg/m2 | Smartphone app | All intervention groups received the same advice from a registered dietician and a qualified PA coach during a 12-week period. The methods used included a conventional face-to-face weight loss program, a weight loss app program (app group) and a partial face-to-face and partial app program (combi group) | The control group did not receive any information during the same period | Weight reduction (5% decrease), BMI, metabolic risk factors, dietary pattern and PA | In the conventional group, app group, and combi group, BMI decreased significantly (p = 0.004, p = 0.005, and p < 0.001, respectively), no significant decrease was found in the control group. A significant time x group effect was found for BMI (p = 0.006), with the control group being significantly different compared with all other intervention groups. No significant differences were found between the conventional group and the app group and between the conventional group and the combi group (p = 0.41). However, the combi group had significantly higher decrease in BMI compared with the app group (p = 0.03). |
8 Yes, 0 No, 2 Unclear; Low Bias Risk |
| Hutchesson et al., 2018 Australia [50] |
57, 29 intervention and 28 controls; 27.1 ± 4.7 years; unspecified gender; BMI 29.4 ± 2.5 kg/m2 | Advice via smartphone app, SMS, emails and website | Six-month weight loss program delivered using e-Health technologies only, comprising five delivery modes (website, app, email, text messages and social media) and using social cognitive theory and control theory theoretical frameworks. Participants received automated personalized email feedback from their accredited practicing dietitian. Individualized energy intake and energy expenditure goals were set for each participant based on their estimated energy expenditure and creating a 2500 kJ/day energy deficit to help facilitate a 0.5–1 kg weight loss/week, goals to be achieved by modifying eating and physical habits | No intervention for six months: they were instructed to continue their usual eating and PA habits | Weight change at six months | No significant between-group differences were observed for weight (p > 0.05); significant mean difference favoring the intervention group was observed for body fat (kg) (−3.10 (−5.69, 0.52), p = 0.019). | 8 Yes, 0 No, 2 Unclear; Low Bias Risk |
| Jakicic et al., 2016 USA [51] |
471, 237 intervention and 234 controls; mean 30.9 years; 71% F and 29% M; mean BMI 31.2 kg/m2 | Wearable device and web interface | Low-calorie diet, PA, and group counseling sessions. At 6 months, telephone counseling sessions and text message prompts were added to the interventions, with self-monitoring of diet and PA using a website (standard intervention) or a wearable device (enhanced intervention). Group-based sessions were scheduled weekly for the initial 6 months and monthly between months 7 and 24. | Same intervention but only with self-monitoring; no website or wearable devices | Weight change, body composition | At 24 months, weight loss was 2.4 kg (95% CI, 1.0 to 3.7) lower in the enhanced intervention group compared with the standard intervention group (p = 0.002). In post hoc analysis, the percent weight loss differed significantly between the standard intervention and enhanced intervention groups (p < 0.001). Both groups had significant improvements in body composition, with no significant difference between groups. | 9 Yes, 0 No, 1 Unclear; Low Bias Risk |
| Jiang et al., 2021 China [52] |
272, 136 intervention and 136 controls; 31.8 ± 5 years; 41.2% F and 58.8% M; BMI 32.5 ± 3.5 kg/m2 | Smartphone app and daily online instructions | Six-month intervention. Companion-Intensive Multi-aspect Weight Management (CIMWM) strategy focusing on a combination of online and offline medical interventions with daily lifestyle supervision and guidance of diet and exercise. Participants received an individualized calorie-restricted diet which was developed by registered dietitians. Individualized exercise plans were created by health managers for each participant based on their health status and exercise capacity. Participants in the CIMWM group were provided with two Fit Nutrition Bars daily as well as monthly face-to-face guidance and daily online instructions via the mobile application “Medical Weight Management”, which allowed them to upload data regarding their daily weight, as well as food diaries, lifestyle supervision and guidance of diet and exercise. | Traditional multi-aspect weight management was required to complete daily self-monitoring instead of being offered as daily online instructions | Clinically significant weight loss (defined as weight loss ≥ 5%), anthropometric measures and determination of metabolic indexes | Significant changes in BMI, body fat and skeletal muscle mass-to-visceral fat area ratio from baseline to 6 months were observed between two groups (p < 0.05). | 5 Yes, 2 No, 3 Unclear; Medium Bias Risk |
| Johnson et al., 2019 USA [53] |
30, 20 intervention and 10 controls; 43.2 ± 11 years; BMI 36.1 ± 6.8 kg/m2 | Wireless watches and weight scales to sync with personal smartphones | Participants assigned to the VCIP group received individualized health coaching by a multidisciplinary team (registered dietitian, exercise physiologist, certified athletic trainer and medical doctor) based on data uploaded over the 12-week intervention period | m-health devices; no health coaching sessions, nor team member feedback on steps per day nor calories uploaded |
Weight change | There was a significant (p < 0.001) difference for post-intervention weight loss between VC (8.23 kg) compared to IP (3.2 kg) and CG (2.9 kg) |
7 Yes, 1 No, 2 Unclear; Medium Bias Risk |
| Johnston et al., 2013 USA [54] |
292, 147 intervention and 145 controls; 46.5 ± 10.5 years; 90% F and 10% M; BMI 33 ± 3.6 kg/m2 | WW smartphone application and WW online tools | WW program based on food and activity plan, group support and skills to change behavior, followed through weekly meetings. Weights and self-reported use of access modes were measured at baseline and at 3 and 6 months | Self-help group with publicly available printed materials explaining basic dietary and exercise guidelines for safe weight loss | Reductions in BMI and weight | WW subjects lost 4.6 kg and self-help subjects lost 0.6 kg at 6 months. Participants in the WW group significantly decreased their weight (F = 34.5, p < 0.001) and BMI at 6 months (F = 36.7, p < 0.001) compared with those in the self-help group |
6 Yes, 3 No, 1 Unclear; Medium Bias Risk |
| Laing et al., 2014 USA [55] |
212, 105 intervention and 107 controls; 43.1 ± 14.5 years; 73.1% F and 26.9% M; BMI 33.4 ± 7.09 kg/m2 | Smartphone app | 6 months of usual care without (n = 107) or with (n = 105) MyFitnessPal; dietary intake, PA and weight self-monitoring, goal setting, and feedback | Control group patients were free to “choose any activities you’d like to lose weight,” without specifying any particular interventions | Weight loss at 6 months, 3 self-reported behavioral mediators of weight loss (exercise, diet and self-efficacy in weight loss) at baseline and at 3 and 6 months | At 3 months, participants in the control group gained an average of 0.24 kg, whereas those in the intervention group lost 0.03 kg (between-group difference 0.27 kg [95% CI, 1.13 to 0.60 kg]; p = 0.53). At 6 months, participants in the control group gained an average of 0.27 kg and those in the intervention group lost 0.03 kg (between-group difference 0.30 kg [CI, 1.50 to 0.95 kg]; p = 0.63) | 7 Yes, 1 No, 2 Unclear; Medium Bias Risk |
| Lugones-Sanchez et al., 2020 Spain [56] |
440, 231 intervention and 209 controls; 48.1 ± 10 years; 69.3% F and 30.7% M; BMI 32.8 ± 3.4 kg/m2 | Smartphone app (EVIDENT 3 APP) and Smart band (Mi Band 2, Xiaomi) | 3-month intervention with counseling, smartphone app and smart band (Mi Band 2, Xiaomi). After 7 days, subjects were trained to use the device and the app to allow the dietary intake to be self-reported daily and PA data were collected automatically from the smart band. Once all of the daily information was collected, the app integrated the data to create personalized recommendations based on the subjects’ characteristics and specific objectives and goals for weight loss. | Controls only had counseling | Weight loss and changes in some parameters of body composition at baseline and 3 months | The mHealth intervention produced a greater loss of body weight (−1.97 kg, 95% CI −2.39 to −1.54) relative to standard counseling at 3 months (−1.13 kg, 95% CI −1.56 to −0.69): p < 0.01. A significant between-group difference was noted only in BMI (−0.54 kg/m2, 95% CI −0.84 to –0.24); p < 0.01. |
8 Yes, 1 No, 1 Unclear; Low Risk of Bias |
| Lugones-Sanchez et al., 2022 Spain [57] |
650, 318 intervention and 332 controls; 48.3 ± 9.6 years; 68.5% F and 31.5% M;BMI 33.04 ± 3.5 kg/m2 | Smartphone app, wristband, brief counseling | The intervention group received training to use the app and the smart band for 3 months; self-monitoring, tailored feedback and a PA record. The app integrated the data to create personalized healthy food recommendations. The smart band was set to congratulate the user when reaching 10,000 steps/day, and the app displayed this step recommendation | Brief counseling | Weight loss, body composition | At 12 months, significant mean differences were found between groups for weight −0.26 (−1.21 to 0.70), BMI −0.06 (−0.41 to 0.28), waist circumference −0.48 (−1.62 to 0.66), hip circumference −0.69 (−1.62 to 0.25) and body adiposity index −0.33 (−0.77 to 0.11) | 8 Yes, 1 No,1 Unclear; Low Bias Risk |
| Martin et al., 2015 USA [58] |
40, 20 intervention and 20 controls; 44.4 ± 11.8 years; 82.5% F and 17.5% M; BMI 29.8 ± 2.9 kg/m2 | Smartphone app Smartloss and accelerometer | SmartLoss participants (n = 20) were prescribed a 1200 to 1400 kcal/d diet and were provided with a smartphone, body weight scale and accelerometer that wirelessly transmitted body weight and step data to a website. Participants received feedback and treatment recommendations once a week based on their weight graph, while counselors educated each participant that the weight graph was used to objectively quantify adherence to the calorie prescription and to guide counseling and treatment recommendations | Attention-matched health education with health tips on smartphone | Change in body weight and waist circumference | Weight loss was significantly larger in the SmartLoss (least squares mean ± SEM: −9.4 ± 0.5%) compared with the Health Education group (−0.6 ± 0.5%), p < 0.001; Mean ± SEM waist circumference change for the SmartLoss group was 21.6 ± 1.00, 25.3 ± 1.01, and 26.9 ± 1.00 cm while in the Health Education group was 1.3 ± 1.04, 1.7 ± 1.04, and 1.7 ± 1.00 cm at weeks 4, 8, and 12, respectively, p < 0.05. |
6 Yes, 1 No, 3 Unclear; Medium Bias Risk |
| Martínez-Rodríguez et al., 2022 Spain [59] |
80, 40 intervention and 40 controls; 45.7 ± 8.5 years; BMI 32.9 ± 5.1 kg/m2 | Smartphone app | Dietary and activity recommendations provided with a wearable device (Fitbit Charge 2) and the dietary supplement Metabolaid®+ an activity bracelet for monitoring+ smartphone app | Dietary and activity recommendations provided with Fitbit Charge 2 and the dietary supplement + an activity bracelet for monitoring | Weight loss, body composition, anthropometric measurements | Both groups lost a significant amount of body weight (p < 0.001), while the group using the app also lowered their fat mass (p < 0.005). | 3 Yes, 4 No, 3 Unclear; High Bias Risk |
| Nakata et al., 2022 Japan [60] |
141, 72 intervention and 69 controls; 43.2 ± 9.3 years; 26% F and 74% M; BMI 27.6 ± 3.5 kg/m2 | Smartphone app Healthcare, CALO mama Plus | 3-month intervention. Smartphone healthcare application CALO mama Plus registered daily diet, exercise, calculated dietary intake and provided advice using artificial intelligence technology. The participants wore the device for at least 10 h/day for more than 3 days |
No intervention; they continued their current lifestyle without any dietary apps | Body weight change over 3 months | The change in body weight was −2.4 ± 4.0 kg and −0.7 ± 3.3 kg in the intervention and control groups, respectively, with a significant between-group difference in body weight change (−1.60 kg; 95% confidence interval −2.83 to −0.38; p = 0.011). |
6 Yes, 3 No, 1 Unclear; Medium Bias Risk |
| Roth et al., 2023 Finland [61] |
150, 77 intervention and 73 controls; 43.4 ± 10.9 years; 91.3% F and 8.7% M; BMI 35.8 ± 3.2 kg/m2 | Smartphone app | 12 months of healthy lifestyle that supported sustainable weight loss through physical therapy and proper nutrition | No app or electronic devices | Weight loss and changes from baseline to 12 months in body fat distribution | The intervention group lost, on average, 7.75% (95% CI: 9.66% to 5.84%) of their initial body weight after 12 months, whereas the weight of the controls did not change (mean = 0.00% [95% CI: 1.98% to 1.99%]); p < 0.001. |
6 Yes, 3 No, 1 Unclear; Medium Bias Risk |
| Saldivar et al., 2021 USA [62] |
371, 185 intervention and 186 controls; 54.1 ± 10.5 years; 82.8% F and 17.2% M; BMI 43.1 ± 9.53 kg/m2 | Smartphone app and text messages | 12-week and 20-week texting program—POWER Program with three text messages per week, which included appointment reminders, health and wellness tips and educational information related to care and disease management. The 12- and 20-week programs allowed patients to set goals around exercise or nutrition. The 20-week program also included motivational, mental health and stress management messages to help encourage healthy lifestyle changes | Only medical group visits without any text messages | Weight loss | Both POWER and POWER + 20-week texting groups had a significant reduction in weight at their final group visit compared to their baseline (POWER, 114 ± 27 kg vs. 112 ± 26 kg, p < 0.001; POWER + 20-week texting, 111 ± 28 kg vs. 109 ± 28 kg, p < 0.01), but not the 12-week texting group (114 ± 29 kg vs. 113 ± 29 kg, p = 0.22), with no differences between the groups. | 3 Yes, 2 No, 5 Unclear; High Bias Risk |
| Spring et al., 2017 USA [63] |
96, 32 Standard, 32 Technology supported, 32 Self-guided; 39.3 ± 11.7 years, 84.4% F and 15.6% M; BMI 34.6 ± 3.0 kg/m2 | Smartphone app ENGAGED and wireless accelerometer | 6 month intervention. STND and TECH groups received eight 90 min in-person weekly group sessions. TECH used a smartphone application with social networking features and wireless accelerometer, and received 2 to 4 personalized messages per week by trained coaches with at least a bachelor’s degree who reviewed the self-monitoring and goal attainment and helped participants solve problems. If fidelity fell below 90%, the coach was retrained by a doctoral-level staff member | Self-guided (SELF) and Standard (STND) used paper diaries to self-monitor diet, activity and weight | Primary weight loss and behavioral adherence | Weight loss was greater for TECH and STND than SELF at 6 months (25.7 kg [95% confidence interval: 27.2 to 24.1] vs. 22.7 kg [95% confidence interval: 25.1 to 20.3], p < 0.05) but not at 12 months. TECH and STND did not differ except that more STND (59%) than TECH (34%) achieved 5% weight loss at 6 months (p < 0.05). |
9 Yes, 1 No, 0 Unclear; Low Bias Risk |
| Stephens et al., 2017 USA [64] |
62, 31 intervention and 31 controls; median 20 years; 71% F and 29% M; BMI 28.5 kg/m2 | Smartphone app | Smartphone application + health coach intervention and counseling sessions, providing health coach with the ability to monitor and track all participant progress on a real-time basis and text messages focused on current diet or PA status. Participants were encouraged to exercise at least 150 min/week at moderate intensity | Counseling session | Weight, BMI, WC, dietary habits, PA habits and self-efficacy for healthy eating and PA at 3 months | The control group gained a slight amount of weight (0.3 kg) from baseline to 3 months, while participants in the Smartphone + Health Coach group lost a significant amount (−1.8 kg, p < 0.01); the difference in weight change between groups was statistically significant (p = 0.026). The smartphone group also had a significant decrease in BMI (p < 0.01) and WC (p < 0.01) | 3 Yes, 2 No, 5 Unclear; High Bias Risk |
| Thomas et al., 2020 USA [65] |
146, 72 intervention and 74 controls; 58.3 ± 10.3 years; 78.1% F and 21.9% M; BMI 91.4 ± 15.6 kg/m2 | Website and smartphone app | 6 months of no-cost access to the online web-based virtual reality program, accessible via website and mobile app. Half of the participants were randomized to also receive the ES) program, which consisted of four separate ‘scenarios’ focused on challenges at home, the workplace, the gym and social gatherings that were made available to participants at weeks 2, 4, 6 and 8, respectively, with daily points goals personalized according to sex, age, starting weight and activity level | Online weight management program alone (WW) | Body weight loss, satisfaction with the weight-loss program | Both groups achieved statistically significant weight loss across the trial, with no difference in mean ± standard error weight loss between WW and WW + ES at 3 months (2.7 ± 1.1 kg vs. 4.2 ± 1.1 kg, respectively; p = 0.086) but greater weight loss in WW + ES at 6 months (2.6 ± 1.3 kg vs. 4.9 ± 1.3 kg, respectively; p = 0.042) | 8 Yes, 0 No, 2 Unclear; Low Bias Risk |
| Thorgeirsson et al., 2022 Iceland [66] |
146, 95 intervention and 51 controls; 46.8 ± 11.7 years; 92.5% F and 7.5%; BMI 36.3 ± 5.2 kg/m2 | Smartphone app Sidekick | Standard treatment supplemented with a digital therapeutic mobile application designed to increase frequency of healthy behaviors through goal-setting, self-monitoring and completion of health-related tasks in nutrition, PA and stress management for 4 months | Standard weekly coaching sessions for 4 months | BMI at 4 months | The weight loss was 3.6% among those treated per-protocol (n = 70), and 1.5% among those not treated per-protocol (n = 76) (p < 0.0001). BMI reductions of 1.4 kg/m2 (treated per-protocol) and 0.5 kg/m2 (not treated per-protocol) (p < 0.0001) were achieved. |
5 Yes, 3 No, 2 Unclear; Medium Bias Risk |
| Vaz et al., 2021 USA [67] |
28, 13 intervention and 15 controls; 43.25 ± 2.48 years; 86% F and 14% M; BMI 34.40 ± 0.96 kg/m2 | A wrist-worn three-axis accelerometer (Fitbit Charge Heart Rate™), a smartscale (Fitbit Aria™) smartphone app Fitbit™ and commercially available messaging and photo-sharing apps | Participants were instructed to step on the smartscale every morning. The app was programmed to automatically send out a reminder to motivate participants to meet the target for PA for that day, based on continuous activity data obtained from the wearable activity tracker, with remote professional coaching by the physician. Participants were instructed to wear the activity tracker as close as possible to 24 h per day, 7 days per week, and any day with <500 recorded steps indicated a tracking problem. They received conventional outpatient weight-management visits every 3 months for 6 months of the duration of the intervention | Controls received only weight-management visits | Change in weight at 6 months, changes in waist circumference | At 6 months, the intervention group experienced a statistically significant weight change of −7.16 ± 1.78 kg (mean ± SE, 95% CI −11.05 to −3.26, p < 0.01), which differed from the weight change in controls (−3.00 ± 1.05 kg (95% CI −5.27 to −0.73, p < 0.05) by −4.16 ± 2.01 kg (95% CI −8.29 to −0.02, p < 0.05). Waist circumference significantly improved (intervention vs. control: p < 0.01). | 6 yes, 2 no, 2 unclear; Medium Bias Risk |
| Zhang et al., 2023 China [68] |
642, 440 intervention and 202 controls; 46.1% F and 53.9% M; 70.1 ± 5.3 years; BMI 27.67 ± 2.63 kg/m2 | Smartphone app | The remote dietary and PA intervention group (group DPI), and the remote PA intervention group (group PI) used the app for health information collection, health assessment, guidance and feedback and follow-up. The treatment duration was 3 months. Nutritional professionals provided one-on-one personalized dietary guidance and feedback to the participants according to their age, gender, weight, food intake, chronic disease situation, choice of food type, and portion size, 3 to 5 times a week | Health education book on a reasonable diet | Weight at day 45 (time 2), and day 90 (time 3) | Compared with groups PI and controls, group DPI showed a significant decrease in weight (−1.56 vs. −0.86 kg and −1.56 vs. −0.66 kg, respectively; p < 0.05) and BMI (−0.61 vs. −0.33 kg/m2 and −0.61 vs. −0.27 kg/m2, respectively; p < 0.05) at time 2. Compared with groups PI and controls, group DPI showed a significant decrease in body weight (−4.11 vs. −1.01 kg and −4.11 vs. −0.83 kg, respectively; p < 0.05) and BMI (−1.61 vs. −0.40 kg/m2 and −1.61 vs. −0.33 kg/m2, respectively; p < 0.05) at time 3. |
9 Yes, 0 No, 1 Unclear; Low Bias Risk |
Eat Less, Move More (ELMM); workbook plus device (WD); workbook only (WO); self-monitoring (SM); feedback (FB); videoconferencing (VC); in-presence (IP); Weight Watchers (WW); MyFitnessPal app (MyFitnessPal); preventing obesity with eating right (POWER); standard (STND); technology-supported (TECH); experience success (ES); Automated Interactive Voice Response (IVR); body mass index (BMI); confidence interval (CI); physical activity (PA); standard deviation (SD); waist circumference (WC).