Adherence to a caloric budget and body weight change vary by season, gender, and BMI: An observational study of daily users of a mobile health app

Objective: Self-monitoring, one of the most important behaviors for successful weight loss, can be facilitated through mobile health applications (mHealth apps). Therefore, it is of interest to determine whether consistent users of these apps succeed in achieving their weight goals. This study used data from an mHealth app that enabled tracking of caloric intake, body weight, and physical activity and provided a caloric budget depending on weight goal. The primary objective was to evaluate adherence to caloric budget and body weight change among the most consistent (Le., daily) trackers of caloric intake over a calendar year (n = 9372, 50% male). Methods: Gender-stratified linear mixed models were conducted to examine the effects of quarter of year (Q1-Q4 as season proxies) and body mass index (BMI) group (normal weight, overweight, obesity) on adherence to a caloric budget (kcal/day). Change in body weight was analyzed using a subset of users (n = 5808) who entered their weight in the app at least once per week, once per month, or once in Q1 and Q4. Physical activity entries were evaluated in exploratory analyses. Results: Only users with obesity met their caloric budget in Q1. Deviation from budget increased for all groups from Q1 to Q2 (mean change[-standard error of the mean]: +23.7[+/- 1.8] and +39.7[+/- 2.2] kcal/day for female and male users, p < 0.001), was stable between Q2 and Q3, and fluctuated thereafter depending on gender and BMI, with greater deviation among males with overweight. Users with obesity with weight entries at least once per month lost the most weight (-6.1[+/- 0.3] and -4.5 [+/- 0.3] kg for females and males, p < 0.001). Physical activity was highest in the summer months. Conclusions: Among consistent calorie trackers, adherence to a caloric budget and body weight vary by season, gender, and BMI. Self-monitoring of body weight in addition to calorie tracking may lead to improved weight loss outcomes.