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It is widely recognized that the prevalence of obesity and comorbidities including prediabetes and type 2 diabetes continue to increase worldwide. Results from a 24-week Diabetes Prevention Program (DPP) fully mobile pilot intervention were previously published showing promising evidence of the usefulness of DPP-based eHealth interventions on weight loss.
This pilot study extends previous findings to evaluate weight loss results of core (up to week 16) and maintenance (postcore weeks) DPP interventions at 65 weeks from baseline.
Originally, 140 participants were invited and 43 overweight or obese adult participants with a diagnosis of prediabetes signed up to receive a 24-week virtual DPP with human coaching through a mobile platform. At 65 weeks, this pilot study evaluates weight loss and engagement in maintenance participants by means of repeated measures analysis of variances and backward multiple linear regression to examine predictors of weight loss. Last observation carried forward was used for endpoint measurements.
At 65 weeks, mean weight loss was 6.15% in starters who read 1 or more lessons per week on 4 or more core weeks, 7.36% in completers who read 9 or more lessons per week on core weeks, and 8.98% in maintenance completers who did any action in postcore weeks (all
In comparison to eHealth programs, this pilot study shows that a fully mobile DPP can produce transformative weight loss. A fully mobile DPP intervention resulted in significant weight loss and high engagement during the maintenance phase, providing evidence for long-term potential as an alternative to in-person DPP by removing many of the barriers associated with in-person and other forms of virtual DPP.
It is widely recognized that the prevalence of obesity and comorbidities such as prediabetes and type 2 diabetes continue to increase worldwide [
A recent review of DPP-based lifestyle interventions via electronic, mobile, and telehealth or eHealth interventions with remote counseling up to 15 months from baseline, looking at predominantly white and educated samples, found mean sustained weight loss of 4.31% compared to 4.65% with a counselor in-person [
We previously reported findings from a 6-month fully mobile DPP intervention in a group of overweight and obese hyperglycemic adults [
A detailed intervention description was previously published [
Men and women with an HbA1c of 5.7% to 6.4% between the ages of 18 and 75 years who signed up for Noom’s NDPP program (
During the first week of the study, participants received orientation on what the DPP program entails, learned how to use the Noom app, how to interact with their coach, and the importance of maintaining motivation throughout the program. The Noom Coach app (
Participants engaged in the program by completing actions that included meals logged (meals per week), green foods logged (logged per week), exercise logged (times per week), exercise time registered (minutes per week), steps recorded (steps per week), weigh-ins logged (times per week), articles read (articles per week), group posts (posts per week), group comments (comments per week), messages sent to their coach (messages per week), and group likes (likes per week). This pilot study reports 65-week results including the maintenance DPP phase.
Flowchart for study recruitment, starting, and completion or core and maintenance status.
The Noom Coach app's interactive interface with coach-user messaging, group messaging, daily challenges, food logging with color coding and automated feedback based on food choices.
Descriptive statistics, expressed as means and standard deviations or frequencies and percentages for continuous and categorical variables, respectively, were calculated for subject baseline characteristics. Mean weekly in-app action variables were calculated as means and standard deviations from baseline to 65 weeks for starters, completers, and maintenance completers. Last observation carried forward was utilized for endpoints. Repeated measures analysis of variance examined the effect size of the change in weight and body mass index (BMI) from baseline to 24 weeks and 65 weeks in starters, completers, and maintenance completers based on the CDC standards [
At baseline, 81% (48/59) of the sample was female with a mean BMI of 34 kg/m2 and mean age of 51 years (
In maintenance completers, mean body weight decreased significantly by 7.64 kg between baseline and 24 weeks and was sustained over time by 8.77 kg from baseline to 65 weeks (both
Mean in-app engagement variables are shown in
Baseline characteristics of study starters, completers, and maintenance completers. BMI: body mass index.
Characteristics | Starters (n=59) | Completers (n=47) | Maintenance completers (n=32) |
Gender, female, n (%) | 48 (81) | 37 (79) | 26 (81) |
Age, years, mean (SD) | 51.27 (9.25) | 51.45 (9.47) | 51.34 (9.55) |
Height, cm, mean (SD) | 166.75 (9.38) | 167.62 (9.16) | 167.44 (9.04) |
Weight, kg, mean (SD) | 95.36 (22.11) | 95.66 (23.10) | 96.83 (24.94) |
BMI, kg/m2, mean (SD) | 34.19 (6.75) | 33.90 (6.83) | 34.39 (7.41) |
Weight loss from baseline to 65 weeks,
Characteristics | Starters (n=59) | Completers (n=47) | Maintenance completers (n=32) |
Weight change, kg, mean (SD) | –5.93 (6.78) | –7.05 (7.10) | –8.78 (7.71) |
Weight change, %, mean (SD) | –6.15 (6.50) | –7.36 (6.67) | –8.98 (7.12) |
BMI change, kg/m2, mean (SD) | –2.12 (2.43) | –2.53 (2.54) | –3.14 (2.76) |
Weight change from baseline to 24 weeks and 65 weeks in maintenance completers (n=32). BMI: body mass index.
Characteristics | Baseline | 24 weeks | 65 weeks | ||
Weight, kg, mean (SD) | 96.83 (4.41) | 89.18 (4.29) | <.001 | 88.06 (4.27) | .29 |
BMI, kg/m2, mean (SD) | 34.39 (7.41) | 31.66 (7.22) | <.001 | 31.24 (7.11) | .28 |
aChange from baseline to 24 and 65 weeks.
bChange from 24 weeks to 65 weeks.
Mean in-appa weekly engagement variables over 65 weeks.
Weekly engagement variable | Starters (n=59) | Completers (n=47) | Maintenance completers (n=32) | |||
nb | mean (SD) | n | mean (SD) | n | mean (SD) | |
Meals logged (meals/week)c | 57 | 15.28 (3.99) | 45 | 15.89 (3.87) | 30 | 16.39 (3.26) |
Green foods (logged/week)d | 59 | 0.27 (.13) | 47 | 0.27 (0.13) | 32 | 0.29 (0.14) |
Exercise (times/week) | 57 | 4.52 (2.70) | 47 | 4.60 (2.34) | 32 | 4.70 (2.07) |
Time exercised (minutes/week) | 57 | 169.68 (113.93) | 47 | 175.06 (111.06) | 32 | 188.65 (119.18) |
Steps recorded (steps/week) | 52 | 23,427.95 (14,709.14) | 43 | 24,397.80 (15,311.71) | 29 | 23,696.13 (13,845.60) |
Number of weigh-ins (times/week)e | 59 | 1.40 (0.85) | 47 | 1.48 (0.93) | 32 | 1.53 (0.99) |
Articles read (articles/week) | 59 | 8.12 (3.34) | 47 | 8.59 (2.97) | 32 | 8.56 (2.73) |
Group posts (posts/week)f | 53 | 1.88 (1.10) | 43 | 1.91 (1.13) | 30 | 1.93 (1.14) |
Group comments (comments/week)g | 53 | 2.85 (1.52) | 44 | 2.90 (1.46) | 30 | 3.08 (1.40) |
Messages to coach (messages/week) | 56 | 3.92 (1.67) | 45 | 4.09 (1.96) | 31 | 4.48 (1.83) |
Group likes (likes/week)h | 49 | 2.34 (1.46) | 42 | 2.28 (1.55) | 30 | 2.33 (1.76) |
aIn Michaelides et al [
bn represents the number of starters, completers, or maintenance completers that engaged in with the app feature.
cMeals logged refers to the times breakfast, lunch, snack, and dinner were logged per week.
dGreen foods refers to food items logged that contain low calorie density (calories per grams in a serving).
eNumber of weigh-ins refers to times per week of in-app weight self-reports.
fGroup posts refers to times per week a participant posted to their group in an in-app common conversation.
gGroup comments refers to responses to group posts per week.
hGroup likes refers to times per week a participant liked a group comment.
This 65-week pilot study shows that a mobile DPP intervention is capable of producing weight loss outcomes that are comparable to those seen in in-person NDPP or similar virtual programs [
While there has been extensive research on eHealth approaches to diabetes prevention [
At 65 weeks, maintenance completers lost 8.98% of their starting weight, which exceeds the CDC’s NDPP requirement of 5% loss of body weight at 6 months and 12 months [
Furthermore, in comparison with recent in-person DPP trials, which have scalability and cost-effectiveness challenges [
While the results are promising, there are limitations to this pilot study. As this is a pilot study, the sample size is small (n=59). Furthermore, this was an observational study; thus, the participants were self-selected and likely highly motivated individuals, resulting in limited generalizability. Nonetheless, per observational study design, participants were both self-selected and self-monitored, which mimics real-world applications of a virtual DPP program. An additional limitation is the lack of HbA1c values. However, the main outcome of the DPP is weight loss above the transformative value of 5% as established by the CDC. Medication history, which could influence weight loss, was not collected. Participant/coach and group interactions were assessed quantitatively, which could have provided more insight into participant attitudes and behaviors and better explain weight loss and behavior change, instead of qualitatively. To validate the findings of this pilot study, future long-term randomized controlled trials should aim to include biometric data such as HbA1c level and quality of life metrics.
This pilot study of a fully mobile DPP intervention found significant weight loss and high engagement during the maintenance phase, providing evidence for long-term potential as an alternative to in-person DPP by removing many of the barriers associated with in-person and other forms of virtual DPP.
Raw weight change data at baseline, 24 weeks, and 65 weeks for maintenance completers.
Backward multiple linear regression of engagement variables as predictors of weight loss in maintenance completers.
body mass index
Centers for Disease Control and Prevention
diabetes prevention program
hemoglobin A1c
National Diabetes Prevention Program
The authors would like to thank all the participants in this study. We also thank the coaches who guided all participants. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
TTR, JM, AM, EP, and YK cowrote the manuscript, and TTR and AM conducted data analyses. AM is the principal investigator. AM is also the guarantor of this work and, as such, had full access to all data in the study and takes responsibility for the integrity of the data and accuracy of the data analysis. MW is the research coordinator, reviewed the manuscript, and oversaw the conduct of the study. MW is also the coach manager and provided oversight to coaching and training with AM.
All authors are employed by Noom, Inc, and receive a salary and stock options. AM and MW hold a patent pending (3492.004US1) with Noom, Inc. Noom Coach is a mobile application owned by Noom, Inc.