Abstract
Introduction:
Obesity among military personnel has become a serious issue. This study aimed to verify the effectiveness of an obesity management program based on an information-motivation-behaviour skills model using a mobile application and social media among military personnel with obesity in the Republic of Korea.
Methods:
A one-group pretest-posttest design was employed to investigate the effects of the program. Thirty individuals participated in an obesity management program for 12 weeks. Body mass index, body fat percentage, and waist circumference were measured, and dietary practices, physical activity, perceived health status, and depressive symptoms were assessed using self-report questionnaires. Analysis was performed using a generalized estimating equation.
Results:
Dietary practices (β = 0.674, p = 0.002) and health status (β = 0.330, p ≤ 0.001) increased, whereas body mass index (β = −0.303, p = 0.001), fat percentage (β = −0.599, p = 0.005), and waist circumference (β = −0.936, p = 0.023) decreased over time during the program.
Discussion:
The program effectively improved target health behaviours and outcomes in obesity management and, therefore, could be used as a practical obesity management strategy for military personnel with obesity, regardless of time and location restrictions.
Key words: health, mHealth, military personnel, mobile application, obesity, obesity management, smartphone, social media, the Republic of Korea
Lay Summary
This study aimed to verify the effectiveness of an obesity management program based on an information-motivation-behaviour skills model using a mobile application and social media among military personnel with obesity in the Republic of Korea. As a result of analyzing the effect of the intervention, dietary practices and health status increased, whereas body mass index, fat percentage, and waist circumference decreased over time. The program effectively improved target health behaviours and outcomes in obesity management. Further studies are necessary to confirm the effects of the obesity management program using a randomized controlled trial design including a control group.
Abstract
Introduction :
L’obésité est devenue un problème grave au sein du personnel militaire. Cette étude visait à vérifier l’efficacité d’un programme de prise en charge de l’obésité à partir d’un modèle d’habiletés en matière d’information, de motivation et de comportement reposant sur une application mobile et sur les réseaux sociaux, déployé auprès du personnel militaire obèse de la République de Corée.
Méthodologie :
Une méthodologie prétest-post-test sans groupe de contrôle a été privilégiée pour explorer les effets du programme de prise charge de l’obésité, auquel 30 personnes ont participé pendant 12 semaines. L’indice de masse corporelle, l’indice de masse grasse et le tour de taille ont été mesurés, et les pratiques alimentaires, l’activité physique, l’état de santé perçu et les symptômes dépressifs ont été évalués au moyen de questionnaires d’autoévaluation. L’analyse a fait appel à une équation d’estimation généralisée.
Résultats :
Les pratiques alimentaires (β = 0,674, p = 0,002) et l’état de santé (β = 0,330, p ≤ 0,001) se sont améliorés, tandis que l’indice de masse corporelle (β = −0,303, p = 0,001), l’indice de masse grasse (β = −0,599, p = 0,005) et le tour de taille (β = −0,936, p = .023) ont diminué au fil du programme.
Discussion :
Le programme a réussi à susciter les meilleurs comportements et les meilleurs résultats de santé ciblés par la prise en charge de l’obésité et, par conséquent, pourrait devenir une stratégie pratique de prise en charge de l’obésité auprès du personnel militaire obèse, quels que soient le moment et les restrictions locales.
Mots-clés : application mobile, obésité, personnel militaire, prise en charge de l’obésité, République de Corée, santé, santé mobile, téléphone intelligent, réseaux sociaux
Introduction
Obesity is becoming increasingly prevalent worldwide. The association of obesity with the risk of numerous diseases, including diabetes mellitus, cardiovascular disease, and various cancers, highlights the importance of obesity management.1,2 Besides general obesity, obesity among military personnel in the Republic of Korea has become a serious issue. According to a 2014 health examination report, the prevalence of obesity among military officers based on body mass index (BMI) criteria was 42.7%.3 Moreover, obesity based on BMI and abdominal obesity, and based on waist circumference, was 42.1% and 28.1%, respectively, in a study of male army officers conveniently sampled from four military units.3 These findings are similar to those of the 2019 Korea National Health and Nutrition Examination Survey, which reported BMI-based obesity in the Korean adult male population at 43.1%.4 Furthermore, the BMIs of career military personnel are increasing, with an increase of 1.16 kg/m2 in those aged 20–29 years, 0.61 kg/m2 in those aged 30–39 years, and 0.05 kg/m2 in those aged 40–49 years in 2008 as compared with 2002.5
Obesity management by military personnel is directly linked to national defence by promoting maximum combat power. As most young men in the Republic of Korea serve in the military at some point in their lives, the importance of obesity management is further emphasized to promote health in this population.6 Thus, military personnel have been designated as a priority group for health management in Korea’s Health Plan 2030, and the Ministry of National Defence has presented an appropriate BMI (18.5 ≤ BMI < 25) as one of the major indices targeted for improving health behaviours in the military.7 Furthermore, the Ministry of National Defence specified the implementation of various health-promoting projects pertinent to obesity, including nutrition, improved physical fitness, and prevention of lifestyle diseases, as the responsibility of military staff in charge of health promotion to establish an institutional framework for obesity management. In addition, military personnel must undergo a physical examination and physical fitness test every year and are given one hour of personal time each day for physical training.
However, the practical supportive methods for managing military obesity remain inadequate. Although implementation of an obesity management program for military personnel with obesity is included as a major task in Health Plan 2030 in the Republic of Korea, the development and implementation of a systematic program is still lacking.8 Military personnel are placed in diverse regions on the front and rear lines. Because of the nature of their duties and training, it is difficult for them to pursue personal goals, which further hinders access to obesity management programs, despite their high needs. Thus, it is important to develop obesity management programs using platforms not bound by time and place, such as mobile applications and social media, which also increase the self-efficacy of military personnel with obesity, in contrast to existing provider-oriented health promotion programs. Recent studies reported obesity management programs using mobile apps or social media have a significant effect on improving obesity-related outcomes and physical activity,9,10 but there is a lack of research evaluating the effectiveness of these interventions for military personnel in Korea. Thus, this study evaluated the effectiveness of obesity management programs using mobile apps and social media for military personnel and attempted to provide useful basic data for service development that overcomes current time and location constraints.
The information-motivation-behavioural (IMB) model is a psychological model that presents information, motivation, and behavioural skills as key factors in the practice of health behaviours. Following the introduction of the IMB model, Fisher et al.11,12 applied the model to understand anti-retroviral therapy adherence among people living with HIV. Researchers proposed improving medication adherence would positively impact the health outcomes of people living with HIV. Since then, the IMB model has been used in various disciplines to explain and predict changes in health behaviours.13 Thus, this study applied the IMB model to establish and evaluate the effects of an obesity management program on military personnel with obesity.
The most important areas requiring intervention in obesity management are diet and physical activity. BMI, waist circumference (WC), and body fat percentage are used when evaluating obesity.14 According to the guidelines in Korea, obesity is diagnosed if BMI is 25 kg/m2 or higher and WC is ≥ 90 cm in men and ≥ 85 cm in women.14 Obesity is linked to other chronic diseases such as cardiovascular diseases and cancer and is also highly related to mental health.15 Therefore, when evaluating the effectiveness of an obesity management program, it is necessary to consider variables related to health status and mental health along with diet, physical activity, BMI, WC, and body fat percentage.
This study aimed to evaluate the effects of an obesity management program using a mobile application and social media, developed based on the IMB model for obesity management among military personnel with obesity. The specific objectives were as follows: 1) to evaluate the effects of the obesity management program on the body composition (BMI, body fat percentage, and WC) of military personnel with obesity, 2) to evaluate the effects of the obesity management program on the health behaviours (diet and exercise) and health outcomes (perceived health status and depressive symptoms) of military personnel with obesity, and 3) to survey participants’ satisfaction with the program and attempt to identify areas in the program that need improvement.
Methods
Study design
This study used a one-group pretest-posttest design to investigate the effects of an obesity management program using a mobile application and social media on obesity management among military personnel with obesity.
Study population and sampling
Convenience sampling was used to select samples from military personnel at the air force unit located in Seongnam City, Republic of Korea. Before selecting research participants, the researcher obtained approval from the military to conduct the study, ensure there were no security issues, and recruit participants. The study’s purpose and the program’s contents were announced through an official notice to the unit, and those who wished to participate were recruited. The inclusion criteria were 1) active duty servicemen and women, 2) adults aged 19 years or older, and 3) BMI ≥ 25 kg/m2. For Asian individuals, the cutoff point for obesity based on BMI is 25 kg/m2.16 Therefore, in this study, obesity was defined as a BMI of 25 kg/m2 or higher. Exclusion criteria were as follows: 1) current use of anti-obesity medications and 2) medical diagnosis (e.g., orthopedic conditions that limit movement) deemed to influence the study outcomes. As a result of recruitment, 30 military personnel participated in this study. Previous research17 suggests that, to maintain a type 1 error below 5% and power above 80% when analyzing generalized estimating equations (GEE), a sample size of at least 20 people is necessary.
Study instruments
Body mass index
BMI was calculated by dividing weight (kg) by height squared (m2). Height was measured once at baseline, whereas weight was measured at baseline, midpoint, and post-intervention to calculate the BMI at each time point.
Body fat percentage
Body fat percentages were measured using the InBody 270 body composition analyzer (InBody Co., Ltd., Seoul, Republic of Korea). The device was placed on a firm, flat surface and calibrated before measurement. To enhance the accuracy of measurements, participants removed thick clothing and socks and emptied their pockets before standing on the device for measurements. Measurements were taken at similar times and instructions regarding water or meal consumption were provided before testing to ensure similar conditions across measurements.
Waist circumference
Waist circumference was measured using a tape measure. The tape measure was placed around the midpoint of the lowest rib and upper iliac crest, with both arms relaxed naturally. When measuring waist circumference, the researcher placed the tape measure horizontally on the skin surface and did not press the skin to measure the accurate waist circumference.
Dietary practice
Dietary practice was measured using 10 items presented in the counselling manual for nutrition consultation by the Ministry of Health and Welfare of Korea.18 This scale consists of questions pertaining to dietary habits, such as the frequency and quantity of meals, salt intake, and the variety of foods consumed (including vegetables, meat, fruit, fish, tofu or soy products, dairy products, and seaweed).18 Participants were asked to choose one of three responses (0–1, 2–4, or 5–7 days) on 10 items about dietary practices; 0–1 and 2–4 days were each assigned a score of 0, and 5–7 days were assigned a score of 1. A higher total score indicated better dietary practices.
Exercise
Seven items from the Korean version of the self-reported physical activity (PA) questionnaire of the International Physical Activity Questionnaire (IPAQ) were used.19,20 The duration of vigorous PA, moderate-intensity PA, walking, and sedentary time in the past seven days was measured using the instrument. PA was classified into three levels (low, moderate, and high) according to the IPAQ scoring guidelines.21 High levels were defined as 1) at least three days and accumulating at least 1,500 metabolic equivalents of task (MET) minutes per week, or 2) seven or more days of any combination of walking, moderate-intensity, or vigorous-intensity activities, achieving a minimum of 3,000 MET minutes per week. Moderate level was defined as any one of the following three criteria: 1) three or more days of vigorous activity of at least 20 minutes per day, 2) five or more days of moderate-intensity activity or walking for at least 30 minutes per day, or 3) five or more days of any combination of walking, moderate-intensity, or vigorous-intensity activities achieving at least 600 MET minutes per week. Low level represents the lowest level of PA, which was neither moderate nor high. In the study by Oh et al., Spearman rho coefficients and kappa values of test-retest reliability were 0.427–0.646 (median 0.542) and 0.365–0.620 (median 0.471), respectively.20
Perceived health status
Perceived health status was measured using one question (“How would you rate your health?”) on a 5-point scale consisting of 1 (very poor), 2 (poor), 3 (fair), 4 (good), and 5 (very good).
Depressive symptoms
Depressive symptoms were measured using 9 items from the Korean version of the Patient Health Questionnaire-9 (PHQ-9) developed by Kroenke et al.22 Each item was rated on a 4-point Likert scale ranging from 0 (not disturbed at all) to 3 (disturbed almost every day). A higher total score indicated a higher level of depressive symptoms, and a score of 10 or higher reflected a depressed state. In the instrument validation study of the Korean version of PHQ-9, Cronbach alpha was 0.81 and the test-retest correlation coefficient was 0.89.23
Participant characteristics
The characteristics of the participants included age, sex (male or female), marital status, education level, military rank, smoking, drinking, and number of chronic diseases.
Perceived need and satisfaction for the program
Perceived need for and satisfaction with the program was measured using a self-report questionnaire, referring to previous research.24 The perceived need for the program was evaluated using one item: “Do you think this program is necessary for military personnel with obesity?” Satisfaction with the program was evaluated using 6 items, and the degree of satisfaction with various program attributes was evaluated. Each question was evaluated using a 10-point Likert scale, with higher scores indicating higher necessity or satisfaction.
Obesity management program
The program was designed using a conceptual framework based on the IMB model (Figure 1). The questionnaire was provided and managed by a researcher (a nurse officer) at the health promotion centre of the air force unit. The initial consultation and baseline survey, midpoint survey at week 6, and final survey at week 12 were administered in person on a one-on-one basis, while all remaining program content was provided online through a mobile app or social media. The mobile app used for the obesity management program was a DASHIN (2021; Funnym Inc., Seoul, Republic of Korea), and a group chat room was created on KakaoTalk (2021; Kakao Corporation, Seoul, Republic of Korea). DASHIN is a free mobile application for obesity management. KakaoTalk is a free social network service that provides mobile messaging service, and is the most famous social network service in the Republic of Korea.
Figure 1.
Conceptual framework of this study
The obesity management program was structured as follows: An initial consultation and baseline survey were conducted one-on-one in person. During this session, the researcher measured obesity-related indicators such as BMI, body fat mass, and WC of the subjects, and assessed obesity management behaviours such as dietary practice and exercise. Afterward, participants were advised of and counselled on their current status and provided with knowledge about obesity management to foster a positive attitude and belief in obesity management. Furthermore, the program administrator attempted to provide motivation through individually tailored goals for weight loss and behaviour modification.
For the next 12 weeks, participants engaged in an obesity management program based on a mobile app and social media designed to provide information, motivation, and behavioural skills for obesity management. Participants logged their daily diets and exercise in a health diary on the app and used the records to self-monitor daily caloric (kcal) intake and consumption. The participants were asked to use home training videos about exercises targeting different body parts uploaded on the mobile app. The program administrator provided learning materials on obesity management and missions every week in the social media group chat room, encouraging participants to post whether they completed the missions. These missions focused on exercising regularly (weeks 1–4), changing dietary habits (weeks 5–8), and combining exercise with dietary practices (weeks 9–12). Throughout the program, participants encouraged each other and received answers to questions in a group chat room on social media.
Data collection
Prior to data collection, this study was approved by the institutional review board of the Armed Force Medical Command (IRB No. AFMC-20048-IRB-20–048). The authors explained the study’s purpose, methods, and duration to participants and obtained written informed consent before participating in the study. A self-report questionnaire was administered, and BMI, body fat percentage, and WC were measured between August and November 2020 at a health promotion centre in an air force unit in Seongnam city. The questionnaire and anthropometric measurements were performed three times: at baseline (before the program), midpoint (Week 6), and post-intervention (after completion of the 12-week program). All 30 participants completed the baseline and midpoint surveys and measurements, whereas only 26 completed the post-intervention survey and measurements. All the participants were given small health-related gifts (worth $5 after each survey) as a token of appreciation for their participation.
Data analysis
Data were analyzed using Stata/SE (version 17.0; StataCorp, College Station, TX, USA) software with the following statistical tests. First, participant characteristics and program satisfaction were analyzed using descriptive statistics. Second, changes in health behaviours and outcomes over time were analyzed using GEE. GEE is a statistical analysis method used to analyze repeated measures data instead of repeated measures ANOVA.18 Unlike repeated measures ANOVA, GEE has the advantage of being applicable even if the distribution of variables is not normal.18 In addition, even if there is no complete response at all timepoints, analysis is possible as long as there is any pair of responses.18 Therefore, it is possible to prevent a decrease in power that may occur due to subject dropout, and all 30 participants were included in the analysis in this study.
Results
Participant characteristics
Table 1 presents general participant characteristics. The mean age was 28.9 years (standard deviation [SD] 8.17 years), and the majority were male (27, 90%). Most participants were single (22, 73.3%) and the most common educational level was college or higher (19, 63.3%). Among the participants, there were 17 non-commissioned officers (17, 56.7%), 5 commissioned officers (5, 16.7%), 5 enlisted airmen (16.7%), and 3 civilian workers (10.0%). A total of 7 participants (23.3%) were smokers and 21 (70.0%) drank alcohol. Most participants (73.3%) did not have any diagnosed chronic diseases, while 7 (23.3%) and 1 (3.3%) participants were diagnosed with one or two chronic diseases, respectively.
Table 1.
Participant characteristics (N = 30)
| Variables | No. (%)* |
|---|---|
| Age, y, mean (SD) | 28.9 (8.17) |
| Age group, y | |
| < 30 | 18 (60.0) |
| 30–39 | 8 (26.7) |
| 40–49 | 4 (13.3) |
| Sex | |
| Males | 27 (90.0) |
| Females | 3 (10.0) |
| Marital status | |
| Single | 22 (73.3) |
| Married | 8 (26.7) |
| Education level | |
| High school | 9 (30.0) |
| In college/university | 2 (6.7) |
| College or higher | 19 (63.3) |
| Rank | |
| Enlisted airman | 5 (16.7) |
| Non-commissioned officer | 17 (56.7) |
| Commissioned officer | 5 (16.7) |
| Civilian workers in the military | 3 (10.0) |
| Smoking | |
| Yes | 7 (23.3) |
| No | 23 (76.7) |
| Drinking | |
| Yes | 21 (70.0) |
| No | 9 (30.0) |
| No. of chronic diseases | |
| 0 | 22 (73.3) |
| 1 | 7 (23.3) |
| 2 | 1 (3.3) |
* Unless otherwise specified.
Changes in health behaviours and health outcomes over time
Table 2 and Figure 2 show participant health behaviour and outcomes changes over time. Desirable dietary practices (p = 0.002) and perceived health status (p < 0.001) significantly improved over time, whereas BMI (p = 0.001), body fat percentage (p = 0.005), and WC (p = 0.023) significantly decreased over time. Meanwhile, there were no statistically significant changes in exercise (p = 0.795) and depressive symptoms (p = 0.669).
Table 2.
Changes in scores of health behaviours and health outcomes (N = 30)
| Outcome | Estimated marginal means |
Estimate (95% CI) | ||
|---|---|---|---|---|
| T0 | T1 | T2 | ||
| Health behaviour | ||||
| Diet | 2.0 | 3.4 | 3.3 | 0.674 (0.241–1.108) |
| Exercise | 2.2 | 2.5 | 2.2 | 0.021 (−0.140 to −0.183) |
| Health outcome | ||||
| Body mass index | 28.6 | 27.9 | 28.0 | −0.303 (−0.489 to −0.117) |
| Body fat percentage | 28.8 | 28.1 | 27.6 | −0.599 (−1.015 to −0.184) |
| Waist circumference | 92.5 | 90.2 | 90.7 | −0.936 (−1.742 to −0.131) |
| Perceived health status | 2.9 | 3.3 | 3.6 | 0.330 (0.184 to 0.475) |
| Depressive symptoms | 2.8 | 2.1 | 2.6 | −0.118 (−0.660 to 0.424) |
Note: T0: baseline (before the program), T1: midpoint (week 6), T2: post-intervention (week 12).
Figure 2.
Changes in scores for health behaviours and health outcomes: (a) dietary practices; (b) perceived health status; (c) body fat percentage; and (d) waist circumference.
Note: T0: baseline (before the program), T1: midpoint (week 6), T2: post-intervention (week 12).
Perceived need for and satisfaction with the program
The mean perceived need for the program was 8.9 points out of 10 points (SD 1.31). The program satisfaction results are shown in Table 3; satisfaction scores were highest for acquiring knowledge about obesity management and acquiring behavioural skills for obesity management (both, 8.3 out of 10 points).
Table 3.
Satisfaction with the intervention program (N = 26)
| Item | Score |
|
|---|---|---|
| Range | Mean (SD) | |
| The program helped to gain knowledge about obesity management. | 5–10 | 8.3 (1.70) |
| The program helped to learn behavioural skills (e.g., diet management and exercise) for obesity management. | 5–10 | 8.3 (1.60) |
| Mental health (e.g., relieving depressive symptom) improved through the program. | 3–10 | 8.1 (1.94) |
| The program positively changed my attitude and beliefs about obesity management. | 5–10 | 8.0 (1.85) |
| Physical health improved through the program. | 5–10 | 7.9 (1.82) |
| The program helped to increase communication with participants and support for each other. | 0–10 | 6.8 (2.87) |
| Total | 7.9 (2.03) | |
Discussion
This study assessed the effects of a mobile app and social media-based obesity management program on the health behaviours, body composition, and health outcomes of military personnel with obesity. A previous study reported a face-to-face psychoeducational program was effective in improving obesity-related health outcomes in military personnel with obesity.25 However, it is difficult to find studies using online interventions for military personnel with obesity. This program was not bound by time and location restrictions because it used a mobile app and social media and effectively improved obesity-related health behaviours and health outcomes in military personnel.
The program improved the BMI, body fat percentage, and WC of military personnel in the Republic of Korea with obesity. Results were similar to those of previous studies in which obesity management programs using mobile apps or social media were effective in improving obesity.26–28 In this study, participants had statistically significant improvements in dietary practices and high satisfaction with acquiring knowledge and behavioural skills for obesity management. The weekly presentation of information about obesity management via group chats and promoting self- monitoring of behaviours, such as diet, and using the mobile app following individual goal setting, contributed substantially to these results. Thus, future obesity management programs using mobile apps or social media should employ these strategies to boost program accessibility for military personnel with obesity and maximize their effectiveness in resolving obesity.
This program effectively improved the perceived health status of military personnel with obesity. In a study that analyzed perceived health status according to weight in Korean adults, the mean baseline perceived health score among all participants was 2.9, which was lower than that of the group with obesity (mean 3.14) but higher than that of the severely obese group (mean 2.56).29 Participants in this study perceived that their health status progressively improved throughout the program, from 3.3 (week 6, midpoint survey) to 3.6 (week 12, final survey). Perceived health status is significantly associated with healthy lifestyles, including PA, and daily fruit and vegetable consumption.30 Thus, interventions that aim to improve health behaviours, such as this obesity management program, could improve the perceived health of military personnel with obesity.
Findings of this study showed this program did not significantly improve PA. A meta-analysis of exercise interventions for patients with Type 2 diabetes proposed that total contact and face-to-face counselling significantly contributed to improvements in PA.31 A previous study suggested online social networking may be an added benefit for walking programs.32 Although participants were given information and instructions about exercise through a mobile app and social media platform, additional contact or counselling should be considered to improve their practice. Recent studies attempted to improve PA through real-time exercise monitoring and coaching33 and objectively assess the amount of PA using wearable devices.34 Future studies should employ these strategies to implement more active interventions to improve PA among military personnel with obesity.
The program was ineffective in improving depressive symptoms among military personnel with obesity. Obesity is positively correlated with depression,35 and an exercise-focused program effectively improves depression and the quality of life of overweight adults including those with obesity.36 However, it should be noted participants in this study had low levels of depressive symptoms (mean baseline depressive symptom score 2.8). This limited assessment of this obesity management program for depressive symptoms, and subsequent studies should re-evaluate the effects of this program on individuals who are severely depressed.
Limitations
This study has several limitations. First, it used a one-group pretest-posttest design, which undermined the rigor of the study design. Research designs that lack random assignment and control groups should be interpreted with caution, as they are unable to control for potential biases that could affect research results. Thus, enhanced obesity management programs should be developed based on these findings and evaluated using a more rigorous study design involving a control group, such as a randomized controlled trial. Second, because this study used convenience sampling and the sample size was small, results should be generalized with caution. In particular, sex is an important characteristic to consider in obesity,37 but this study could not consider it due to the small number of females in the sample. Additional research considering sex is needed in the future. Third, this study was unable to collect data on participants’ mobile app use. In future research, additional analysis is needed on the degree of change in outcome variables depending on the degree of mobile app use.
Conclusion
This study assessed the effects of a mobile app and social media-based obesity management program on body composition, health behaviours, and health outcomes in military personnel with obesity. This program was developed based on the IMB model to improve the knowledge, motivation, and behavioural skills related to obesity management in military personnel with obesity, and the elements necessary for behaviour change were systematically included in the program. In addition, the mobile application enabled participants to self-monitor their health behaviour, and social media was used to provide behaviour change missions. The program significantly improved BMI, body fat percentage, WC, dietary practices, and perceived health status. Furthermore, participants were highly satisfied with their acquired knowledge and behavioural skills for obesity management. The obesity management program tested in this study provided a useful intervention for obesity that was not constrained by time or location, owing to its use of mobile apps and social media. Further studies are necessary to evaluate the effects of the obesity management program using a randomized controlled trial design.
Acknowledgments
The authors thank the participants of this study.
Competing Interests
The authors have nothing to disclose.
Ethics Approval
This study was approved by the Institutional Review Board of the Armed Force Medical Command, Sungnam, Gyeonggi, Republic of Korea, on June 23, 2020 (IRB No. AFMC-20048-IRB-20–048).
Informed Consent
The authors confirm that informed patient consent has been secured.
Registry and Registration no. of the Study/Trial
N/A
Animal Studies
N/A
Peer Review
This manuscript has been peer reviewed.
Biographies
Gaya Kim, who served as a nursing officer in the Republic of Korea Air Force for six years, cultivated a passion for health promotion and digital health. After working as an ER nurse at a level 1 trauma center in New York, she is currently a Patient-centered medical home Nurse at Brian D. Allgood Army Community Hospital. She aims to contribute to research in health promotion within community settings through informatics and digital health.
Mi-So Shim is currently an assistant professor at Keimyung University, specializing in community health nursing. Having served as a nursing officer in the Republic of Korea Air Force for seven years, she brings a wealth of practical experience to her academic pursuits. Her research interests include health promotion, health behaviours, self-management of patients with chronic diseases, HIV infection, and health problems among community-dwelling older adults.
Funding Statement
This work was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF), funded by the Ministry of Education (Grant NRF-2021R1I1A1A01040306).
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