title: Technology-assisted weight loss interventions in primary care: a systematic review.
abstract: BACKGROUND
  The US Preventive Services Task Force recommends screening for and treating obesity. However, there are many barriers to successfully treating obesity in primary care (PC). Technology-assisted weight loss interventions offer novel ways of improving treatment, but trials are overwhelmingly conducted outside of PC and may not translate well into this setting. We conducted a systematic review of technology-assisted weight loss interventions specifically tested in PC settings.
  
  
  METHODS
  We searched the literature from January 2000 to March 2014.
  
  
  METHODS
  (1) Randomized controlled trial; (2) trials that utilized the Internet, personal computer, and/or mobile device; and (3) occurred in an ambulatory PC setting. We applied the Cochrane Effective Practice and Organization of Care (EPOC) and Delphi criteria to assess bias and the Pragmatic-Explanatory Continuum Indicator Summary (PRECIS) criteria to assess pragmatism (whether trials occurred in the real world versus under ideal circumstances). Given heterogeneity, results were not pooled quantitatively.
  
  
  RESULTS
  Sixteen trials met inclusion criteria. Twelve (75 %) interventions achieved weight loss (range: 0.08 kg - 5.4 kg) compared to controls, while 5-45 % of patients lost at least 5 % of baseline weight. Trial duration and attrition ranged from 3-36 months and 6-80 %, respectively. Ten (63 %) studies reported results after at least 1 year of follow-up. Interventions used various forms of personnel, technology modalities, and behavior change elements; trials most frequently utilized medical doctors (MDs) (44 %), web-based applications (63 %), and self-monitoring (81 %), respectively. Interventions that included clinician-guiding software or feedback from personnel appeared to promote more weight loss than fully automated interventions. Only two (13 %) studies used publically available technologies. Many studies had fair pragmatism scores (mean: 2.8/4), despite occurring in primary care.
  
  
  CONCLUSIONS
  Compared to usual care, technology-assisted interventions in the PC setting help patients achieve weight loss, offering evidence-based options to PC providers. However, best practices remain undetermined. Despite occurring in PC, studies often fall short in utilizing pragmatic methodology and rarely provide publically available technology. Longitudinal, pragmatic, interdisciplinary, and open-source interventions are needed.
authors.affiliation: Department of Medicine, New York University School of Medicine, 423 E 23rd St Rm 15161, New York, NY, 10010, USA, David.levine2@med.nyu.edu.
authors.forename: David M
authors.initials: DM
authors.lastname: Levine
authors.forename: Stella
authors.initials: S
authors.lastname: Savarimuthu
authors.forename: Allison
authors.initials: A
authors.lastname: Squires
authors.forename: Joseph
authors.initials: J
authors.lastname: Nicholson
authors.forename: Melanie
authors.initials: M
authors.lastname: Jay
mesh_terms: D020811:Biomedical Technology / Q000379:methods*; D003695:Delivery of Health Care / Q000379:methods; D006801:Humans; D020407:Internet; D063731:Mobile Applications; D009765:Obesity / Q000503:physiopathology / Q000628:therapy*; D011320:Primary Health Care / Q000379:methods*; D015431:Weight Loss