Photo Credit: Antonio_Diaz
An app-based behavioral change program for obesity led to sustained weight loss by changing participants’ perceptions of hunger and satiety.
A smartphone-based behavioral program led to sustained weight loss by changing participants’ perceptions of feeling sated after eating, according to study results published in Applied Psychology: Health and Well-Being.
Study author Ewelina K. Wardzinski and colleagues noted that only about one-fifth of overweight people maintain weight loss of 10% of their original body weight for one year after concluding weight loss programs. One reason patients may be unable to sustain their weight loss is that many programs neglect to consider feelings of hunger and satiety. In addition, restrictive eating as part of a diet plan is a risk factor for emotional eating and is linked to weight regain.
“Diet plans give instructions on the choice of food, the number of calories, and the exact time when to eat. In contrast, physiological food intake control regulated by hunger, satiety, and specific taste preferences is mostly not considered, which inevitably leads to a return to previous eating habits and, in the end, body weight regain,” Wardzinski and colleagues wrote.
Therefore, the researchers conducted a prospective study to investigate a phone app that avoided diet and exercise instructions in favor of helping participants re-learn their perception of hunger, satiety, and emotion regulation.
Program Design
The study included 75 adult German participants with obesity. The participants were an average age of 50.09 ±1.56 years, 55% (n=41) were women, and the average BMI was 35.44 ±0.47 kg/m2.
The cohort used the NUPP app for a full 3-month therapy cycle, and the researchers recorded patient outcomes directly before the program’s start, after 1 month of usage, after 3 months when the program ended, and at 6- and 12-month follow-up.
The 3-month cycle was structured in three modules: Rule, Emotion, and Daily. Rule offered patients weekly behavioral instructions, such as conscious chewing, that could be maintained long-term. In the Emotion module, participants answered questions related to psychological support, including coping skills for stress. Daily provided daily push notifications to keep participants informed or offer them behavioral support.
“In addition, the program includes a gamification element to activate the users’ reward system and distract them in case of a crisis such as food cravings,” the researchers noted.
The investigators used questionnaires to assess participants’ compliance with Rules and perceptions of hunger and satiety. They also used a modified subscale from the German version of the Dutch Eating Behavior Questionnaire to assess emotional eating.
Weight Loss Results
Participants reported increased satiety perception, with significant improvements at 3, 6, and 12 months compared with baseline (Table). Food cravings and emotional eating also decreased significantly throughout the study. The researchers reported that improvements in satiety perception, food cravings, and emotional eating significantly correlated with higher Rule compliance.
Participants also experienced a gradual reduction in body weight, with an average weight loss of 2.54 kg after 3 months and 5.28 kg after 12 months. This weight loss correlated negatively with Rule compliance, highlighting the program’s effectiveness. The investigators found a significant reduction in BMI over the 12 months, with the most substantial changes occurring within the first 6 months.
The researchers also analyzed body composition. They found a decrease in fat mass percentage and an increase in muscle mass, with a corresponding decrease in the fat-to-muscle ratio. Wardzinski and colleagues concluded that Rule compliance improved weight loss and body composition.
“Strikingly, in contrast to prevailing conventional weight loss programs, which mostly display body weight regain after ending of the intervention, the psychological app program even causes persistent reductions of body weight for at least 9 months after program cessation,” Wardzinski and coauthors wrote.
The study was limited by its lack of a control group, although the authors noted that including one would raise ethical concerns since the participants would be required to abstain from weight loss treatment despite having a medical need. The drop-out rate at the 12-month follow-up may also be a limitation, as participants often dropped out due to being unable to lose or maintain body weight. In addition, the researchers ensured anonymity and confidentiality during interviews, but some degree of social-desirability bias may have influenced participants’ responses.
Nevertheless, Wardzinski and colleagues concluded that “psychological relearning of satiety perception may outclass dietary approaches in terms of long-term efficiency…Our results demonstrate that psychological aspects underlying overeating must compellingly be addressed in weight loss concepts to succeed in the long run.”
