Waiting for Mom to tell you to eat your veggies? New study shows that remote coaching via smart phone app is just as effective in getting you to eat your fruits and veggies as was your Mom making you sit at the table until you did so.

Eat More Veggies? There's an App for That

By Kristina Fiore, Staff Writer, MedPage TodayPublished: May 30, 2012

Reviewed by Zalman S. Agus, MD; Emeritus Professor, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse Planner

A mobile device that connects patients to a coach can help the patients eat more fruits and vegetables and spend less time sitting around, researchers found.

Patients who focused on these two behaviors and uploaded their daily dietary intake and exercise habits to a remote coach saw their daily fruit and vegetable intake rise from an average of 1.2 servings at baseline to 5.5 servings at the end of the trial phase, while their sedentary leisure time fell from 219.2 minutes to 89.3 minutes. In addition, their percentage of calories from saturated fat fell from 12% to 9.5%, noted Bonnie Spring, PhD, of Northwestern University, and colleagues.

The study "demonstrates the feasibility of changing multiple unhealthy diet and activity behaviors simultaneously, efficiently, and with minimal face-to-face contact by using mobile technology, remote coaching, and incentives," they wrote in the May 28 issue of Archives of Internal Medicine.

To test which combinations of diet and activity advice would be most helpful in the context of remote coaching, the researchers randomized 204 adults with elevated saturated fat and low fruit and vegetable intake, lots of sedentary leisure time, and little physical activity to one of four sets of objectives:

• Increase fruit and vegetable intake and physical activity
• Increase fruit and vegetable intake and decrease sedentary leisure time
• Decrease fat and sedentary leisure time
• Decrease fat and increase physical activity

All of the treatments involved three weeks of remote coaching. Patients used a handheld mobile device to send their coaches information on dietary intake, activity, and sedentary time. They were advised to carry the device around and record their behaviors immediately, earning money for those updates during the treatment phase and a follow-up period.

They also communicated as needed with their coaches via phone or email.

Among the 200 patients who completed 20 weeks of follow-up, the investigators found that those who increased their fruits and vegetables and decreased their sedentary time had significantly better improvements in healthy behaviors as measured by the Composite Diet Activity Improvement Score than any of the other three groups (P<0.001).

The superiority of that regimen was evident after just one week and was maintained through the end of the 3-week treatment phase and through the end of follow-up, the researchers reported. At the end of follow-up, the healthy eating and activity patterns were maintained, with means of 2.9 servings of fruits and vegetables, 125.7 minutes of sedentary time, and 9.9% of calories from saturated fat, they wrote.

They said the saturated fat intake was not targeted, but was likely a product of reduced unhealthy snacking during sedentary time.

In fact, the degree to which patients decreased their sedentary time positively correlated with the degree to which they also reduced their fat intake (P=0.04), they found. There were no other significant correlations between behaviors.

"Reduced screen time may be an important behavioral target, not only to reverse direct adverse effects of prolonged sitting, but also to disrupt pairing of screen time with high-fat snacking," they wrote.

Traditional dieting -- decreasing fat intake and increasing physical activity -- was the worst intervention, improving significantly less than the three other strategies (P<0.001).

The study may be limited to those with entrenched unhealthy dietary and activity behaviors, and by the fact that it relied on self-reported data. Also, only a quarter of the sample was male, the researchers cautioned.

Still, they concluded that the study shows remote coaching via a mobile device that focuses on improving fruit and vegetable intake and lowering sedentary time can help patients achieve healthy behaviors that last.

In an accompanying commentary, William Riley, PhD, of the National Heart, Lung, and Blood Institute, said the study contributes to "the empirical evidence of the value of these technologies."

But, Riley cautioned, "many more research contributions such as this are needed to establish that technologically delivered multiple risk factor interventions improve outcomes."

The study was supported by the National Institutes of Health and the Robert H. Lurie Comprehensive Cancer Center.
Neither the researchers nor the editorialist reported any conflicts of interest.

Primary source: Archives of Internal Medicine
Source reference:
Spring B, et al "Multiple behavior changes in diet and activity: A randomized controlled trial using mobile technology" Arch Intern Med 2012; 172(10): 789-796.
Additional source: Archives of Internal Medicine
Source reference:
Riley WT "Leveraging technology for multiple risk factor interventions" Arch Intern Med 2012; 172(10): 796-798.