In Germany, it is now possible for apps to be prescribed for therapeutic purposes, including for obesity therapy. Two obesity apps have been included provisionally in the directory of Digital Health Apps (DiGA) at the country’s Federal Institute for Drugs and Medical Devices (BfArM). Studies of both apps are ongoing.
The way in which obesity treatment apps should be scientifically evaluated was recently summarized by nutritionist Christina Holzapfel, PhD, from the Ludwig Maximilian University, in Munich, Germany, at the conference of the German Nutrition Society (DGE).
In previous studies, weight loss apps tended to have moderate success. Compared to standard therapies, use of them is not necessarily associated with greater weight loss. A recent meta-analysis has shown, however, that they do affect eating habits and nutrition-dependent endpoints, such as body mass index.
Most studies to date have only observed short-term effects of the apps. In general, conclusions about the long-term progression of weight or eating habits cannot be drawn from these findings.
Apps Have Advantages
“It is unlikely that apps will be able to replace the human touch,” said Holzapfel.
Digital helpers have advantages, however. Apps can help a lot, particularly with self-observation and questions such as, “How much am I actually eating and how often am I moving?” In this way, they can support weight loss. In addition, the data collected in the apps can be useful for enabling nutritional experts to give targeted feedback or to conduct long-term care, said Holzapfel.
Nevertheless, the studies in this field become outdated very quickly, she said. “We need more investigations with the new generation of these apps.” Since advances in design are being made continuously, today’s apps are probably being used much more intensively than the version from the first study in 2015.
Britta Renner, PhD, a psychologist from Konstanz, Germany, who uses and investigates apps in the field of nutrition for research, is of the same opinion. “Give it 3 years, and the apps will look completely different,” she said.
A range of online programs are available in Germany, and there are no randomized controlled studies on them, said Holzapfel. A British study on the online programs available there did not detect any convincing weight loss effect, however. “The subjects in the online programs performed only marginally better than the control group in this study,” said Holzapfel.
The Overweight Elderly
When it comes to obesity, an age group for whom apps and online programs are often out of the question is becoming more and more important. “Obesity rates have increased enormously recently, even in more elderly age groups,” said Eva Kiesswetter, PhD, from the Institute for Geriatric Biomedicine at the University of Nuremberg, Germany, at the DGE conference.
In addition to the other well-known consequences, excess weight in the elderly can affect fall risk, pain, cognitive performance, and above all, one’s independence. Nevertheless, there are concerns about weight loss, even in the elderly. This is because a decrease in muscle mass or bone density can be particularly risky for elderly people.
In a network meta-analysis, Kiesswetter and her colleagues investigated which weight-loss interventions had a positive effect on elderly people’s physical functionality. The team incorporated 49 studies into their evaluations.
They found that multimodal therapies (the combination of a nutritional and movement-related intervention and a behavioral therapy) produced the best results. Multimodal therapies can improve functional status and moderately reduce body weight without causing a loss in muscle mass, according to the findings.
“However, it was the younger elderly who were more represented in these studies,” said Kiesswetter. “It is not clear whether the results can be generalized to the oldest old.”