1. S.Yednak, G. Strano, S.Distefano, A. Charny
Registered Dietitians Performing as E-coaches to Help Facilitate Weight Loss Post Bariatric Surgery: A new technological approach to educating the client
S.Yednak, G. Strano, S.Distefano, A. Charny
ARAMARK Dietetic Internship
ABSTRACT
METHODOLOGY
RESULTS
DISCUSSION
Advancements in technology have emerged as an innovative way of educating a client and promoting weight loss with adherence to a dietary regimen. The use of smart phone applications to enhance weight loss in bariatric patients post operatively is discussed. The bariatric patient’s success depends on strict adherence to their dietary regimen. This eight week non-randomized interventional study began in October of 2011 and concluded in March of Participants were divided into two groups based on inclusion criteria of having smart phone access. Intervention participants received weekly personalized s from a nutrition professional to encourage weight loss and motivate the participants. Comparison data was gathered at random and a student’s t test was used to compare the two groups. Major findings showed that participants within the intervention group displayed greater weight loss, reduction in BMI and larger percent weight change. The use of a smart phone application to encourage weight loss in bariatric patients proved worthwhile.
Study Design
Non-randomized clinical trial
The groups were non-randomized due to the inability to assign the intervention to the entire selected population due to inclusion criteria.
The study affords two groups, the experimental group (independent variable) and the comparison group.
All baseline participant data was collected though patient charts and included height and weight which was then used to calculate BMI
Recruitment and Participants
Gathered during an 8 week recruitment process commencing December 2011
The study was advertised through circulating flyers in the office, announcements made at support group meetings and class gatherings, as well as individual counseling sessions
Inclusion criteria to be met were post-op weight loss surgery clients within the associated bariatric practice at SOMC with smart phone capabilities.
Those excluded from the study did not have smart phone access, or those who were still awaiting surgical appointment.
Comparison data collected though sign-in sheets, appointment lists and attendance from class rosters within the same eight week period
Patients’ charts were pulled randomly from these lists and identical baseline data with most recent height, weight and BMI were collected.
The comparison group contained the same number of participants as the intervention group, and was not exposed to any treatment.
Program Execution
Consent obtained from intervention participants through survey completion
Participants then accepted an invitation from Meallogger.com,
Each participant also downloaded a free Meal Logger smart phone application to their mobile phone.
Participants snapped pictures of each meal eaten and then uploaded the photo through the phone application, where visual transcription of the meal was relayed to a Meal Logger website account, accessed only by the e-coach.
The study participant’s meals were then analyzed weekly by the e-coach and client- tailored feedback was sent to each participant
The comparison group had no responsibilities and their charts were checked for appointments and weight measurements during the same time period.
Outcomes Measured
Weight and BMI were compared at completion of the study among active participants and randomized collection data.
Percent weight change between the two groups was also analyzed to identify significance.
Upon study completion, data analysis showed that the intervention participants achieved a greater total percent weight change at 74.76% compared to the randomized data of 61.92%. Furthermore, greater mean percent weight loss was seen in the intervention group at 5.96% compared to 5.16% seen in the randomized data. This amounts to an average of pounds lost and a 4.89 reduction in BMI in the intervention group, compared to the randomized data demonstrating an average of pounds lost and a BMI reduction of 1.99.
This study demonstrated the accessibility and efficacy of using an online tool to aid in weight management in the bariatric patient population. The results of this study show that the use of an e-coach educational approach resulted in increased weight loss correlating to a greater reduction in Body Mass Index and larger percent weight change. This reinforces Gabriele et al’s findings of increased effectiveness of a weight loss intervention with the use of an online program to encourage weight loss in post -op patients (3).
The e-coach approach proved to be a positive educational technique that helped foster behavioral changes in the patient. The client- tailored s were very specific and provided both positive and constructive feedback to be used for support and motivation. After survey review, 66 % of the study participants discovered that visually documenting their meals kept them highly motivated and felt reporting the meals provided an increased level of consciousness regarding dietary habits.
Table 1: Means, standard deviations of statistically tested parameters
Intervention Group (n=12)
Untreated Random Group (n=12) Ẋ SD
BMI
38.15
11.01
35.96
4.97
Weight lost
14.16
13.76
11.83
8.01
BACKGROUND
CONCLUSION
As the obesity rate continues to reach epidemic proportions, more people are looking to bariatric surgery The registered dietitian’s primary role within this setting is to instill fundamental nutritional knowledge by using Medical Nutrition Therapy to assist the patient in achieving and maintaining their weight loss goals while preventing malnutrition (1). Both pre- and post educational techniques are used to foster client success.
Using the latest technology in practice, dietitians can facilitate and encourage weight loss. Interactive feedback methods stimulate patient motivation and those that engage in the online learning tool will have better success rates (42. This study aims to investigate the efficiency of an interactive online program as an educational tool in bariatric practice.
Registered dietitians assume a supportive role in bariatric practice and assist in motivating the client through e-coaching. The availability of an online program to encourage weight loss post-op increases the effectiveness of weight loss interventions (3). This study will investigate the use of mobile technology to provide self-monitoring services to the client, in order to increase motivation and weight loss while receiving feedback and coaching from a nutrition professional. Mobile technology methods overcome the burden of self reporting. The easily accessible applications provide accurate photographs to be used to evaluate portion size and nutritional adequacy (4). Encouraging the use of a mobile phone application will aid clients in achieving and maintaining their weight loss goals while monitoring dietary intake.
The use of the smart phone application to document meal consumption resulted in greater weight loss when comparing bariatric post-op clients. In closing, the support and professional assistance at The Center for Bariatrics at SOMC proved to be an ideal environment to perform this study. There is still room for improvement, as more research should be done in this area. Recommendations for future implications in practice include a larger intervention group with more specific instructions for users should be encouraged.
Figure 1: Percent weight change between intervention and randomized groups
REFERENCES
1. Sullivan CS, Logan J, Kolasa KM. Medical nutrition therapy in the bariatric patient. Nutrition Today. 2006; 41(5):
S. ongtao M. Evidence on instructional technology and student engagement in an auditing course. Academy of Educational Leadership ; 15(4):
3. Gabriele JM, Carpedter BD, Fisher B. Directive and nondirective e-coach support for weight loss in overweight adults. Ann Behav Med. 2011; 41:
4. Nobuko H, Hingle MD, Merchant NC et al. Dietary assessment tools using mobile technology. Top Clin Nutr. 2011; 26(4):
Figure 2: Total weight lost between the intervention and randomized data collection groups
CONTACT INFORMATION
RESEARCH QUESTION
Intervention Group (n=12)
Untreated Random Group (n=12) Ẋ SD
BMI
38.15
11.01
35.96
4.97
Weight lost
14.16
13.76
11.83
8.01
For additional information, please contact:
Stephanie Yednak
ARAMARK Dietetic Intern
The proposed intervention hypothesizes that the use of an mobile phone application to upload photos of meals eaten that are evaluated by an e-coach will result in greater weight loss with correlating reduced body mass index (BMI) and increased percent weight change compared to the control group.