Impacts of Behavioral Compliance on Weight-Loss and Metabolic Profile in a Smartphone App-Based Lifestyle Intervention or Plus Dietitian Supporting: A Randomized and Controlled Trial Among Chinese

Xue Li; Ling Lu; Liang Sun; Yunxia Xie; Kang Huang; Changzheng Yuan; Liying Chen; Xu Lin

doi:10.1007/s43657-024-00162-0

Impacts of Behavioral Compliance on Weight-Loss and Metabolic Profile in a Smartphone App-Based Lifestyle Intervention or Plus Dietitian Supporting: A Randomized and Controlled Trial Among Chinese

Phenomics. 2025 Jan 30;5(2):154-168. doi: 10.1007/s43657-024-00162-0. eCollection 2025 Apr.

Authors

Xue Li^#¹, Ling Lu^#¹, Liang Sun², Yunxia Xie³, Kang Huang¹, Changzheng Yuan^{4

5}, Liying Chen^#⁶, Xu Lin^#^{1

7}

Affiliations

¹ Key Laboratory of Systems Health Science of Zhejiang Province, School of Life Science, Hangzhou Institute for Advanced Study, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Hangzhou, 310024 China.
² Ministry of Education Key Laboratory of Public Health Safety, School of Public Health, Institute of Nutrition, Fudan University, Shanghai, 200032 China.
³ Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016 China.
⁴ School of Public Health, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310058 China.
⁵ Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, 02115 USA.
⁶ Department of General Practice, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016 China.
⁷ Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, 320 Yue-yang Rd., Shanghai, 200031 China.

^# Contributed equally.

Abstract

Mobile health technologies provided innovative solutions for lifestyle interventions and offered reliable methods to evaluate behavioral phenotypes during such interventions. To systematically quantify the impacts of behavioral compliance on weight-loss and metabolic profiles during lifestyle intervention, a total of 395 Chinese adults with overweight/obesity (BMI ≥ 24 kg/m²) or central obesity (waistline ≥ 90 cm for men or ≥ 80 cm for women) were randomly assigned to a smartphone app-based arm (SAA, n = 197) or smartphone app plus dietitian arm (SADA, n = 198) for 6 months. Compliance scores (0-5) were determined based on fulfilling five behavioral tasks: completing online courses, wearing a smart band, and recording weight, food intake, and blood pressure. SADA had greater weight-loss (- 4.94% vs. - 2.28%, p < 0.001) and lower triglyceride, but higher HDL-C levels (both p < 0.05) than SAA after six months. Between-group weight-loss differences were attenuated at compliance scores ≥ 3 (SADA: - 6.30% vs. SAA: - 4.79%, p = 0.07). Mediation analysis suggested that compliance scores explained approximately 30% of the additional weight loss in the SADA (p < 0.001), and self-weighing was the primary mediator (p < 0.05). Higher educational levels, greater initial weight loss, self-perceived simplicity, and satisfaction with the program were potential determinants of intervention compliance. Overall, the superior weight loss and metabolic improvements in the SADA group could be mediated by behavioral compliance, which was possibly influenced by some demographic and intervention response features. Our findings highlighted the roles of behavioral phenotypes and adherence in app-based lifestyle interventions, and added evidence for the future development of more precise strategies in long-term weight management.

Supplementary information: The online version contains supplementary material available at 10.1007/s43657-024-00162-0.

Keywords: Behavioral phenotypes; Compliance; Randomized controlled trial; Smartphone app-based lifestyle intervention; Weight loss.