Effectiveness of Mobile Applications in Nutritional Management of Chronic Diseases

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1 Effectiveness of Mobile Applications in Nutritional Management of Chronic Diseases Dr. Mirey Karavetian Clinical Dietitian Specialized in Renal Failure Management Assistant Professor, Zayed University, Dubai, UAE

2 What is mhealth? mhealth (mobile health) is a general term for the use of mobile phones and tablets in medical care. The most common application of mhealth is the use of mobile phones to educate consumers About preventive health care services.

3 An estimated 30,000 health apps currently exist New ones come out as quickly as old ones expire. None of these programs will ever replace the dietitian, physician, or nurse. Apps are tools, no different than measuring tapes and scales, Patients still need professional guidance regarding which apps to use and how to use them. The new technology should be embraced by the professionals for easier management of the patients. Otherwise, the apps will be used in a wrong way by patients and nonprofessionals, Lefebre, C. Integrating cell phone and mobile technologies into public health practice a social marketing perspective. Health Promot. Pract. 2009, 10,

4 Medical nutrition therapy has been found to be the most effective and economic way to prevent & manage most chronic diseases: Obesity Diabetes - Kidney failure - Most patients fail to adhere to the diet therapy due to the complexity of the dietary management chronic demanding nature. Improved self-management of disease is a factor that was seen to augment motivation and compliance to therapy; (Cueto-Manzano et al., 2010).

5 Integrating dietary education in mobile technologies is inevitable Young generations feel more comfortable using it but many aps target seniors, with bigger bolds and simpler interfaces Using mobile technologies in health care reduced health care cost by around 20% for all diseases Nutrition Apps: Opportunities to Guide Patients and Grow Your Career Journal of The Academy Of Nutrition And Dietetics. January 2014 Vol 114 (1)

6 The Academy of Nutrition and Dietetics. Provides an up to date list of the useful app that can be recommended by dietitians

7 Daily Burn The app keeps track of calories consumed and track workouts to see how much energy is burned. Diet Assistant Diet Assistant provides diet plans for those who want to gain, lose or maintain their weight. Blood Sugar Tracker Users log blood sugar levels, set target blood glucose ranges, and view history and simple graphs to quickly identify numbers that are out of range. Carb Master Free The app tracks carbohydrate intake, as well as total calories, fat, sugar, protein and fiber for the day. This app targets people with diabetes or those on a low carb diet. Gluten Free Daily The app provides education and resources on gluten free diet. Glucose Buddy & WaveSense Diabetes Manager The app helps patients track blood glucose results, carb intake, insulin doses and activities

8 Calorie counter my net diary:

9 Calorie Counter MyFitnessPal: The app tracks food, exercise, weight and all the nutrients listed on a Nutrition Facts label.

10 Meal Snap app: Camera-powered calorie counting it computes the calories on your plate as well.

11 DUBAI HAS LAUNCHED THE SMART GOVERNMENT PLAN AS DUBAI S 2021 PLAN IS TO PROVIDE ACCESSIBLE HEALTHCARE FOR ALL SEGMENTS OF THE SOCIETY, AND TO BE A LEADING SMART CITY IN ALL FIELDS; ESPECIALLY IN HEALTHCARE.

12 Some Local Examples Tifli (my baby) app provides information for pregnant women from preconception until the baby is two years Tashkhees app: This app provides articles with useful medical information and is a means to empower the community through health education Dubai RoboDoc: The DHA launched the DubaiRoboDoc which is a robot that uses telemedicine to provide distance healthcare management. This is the first time this technology is being used in Dubai and the Middle-East.

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14 The Dubai Heath Authority is pushing hospitals to become Smart Hospitals. Mobile health provides: health educational - intervention strategies - improves self-management of diseases - (Free et al, 2010). Currently, there is no mobile health Applications for management of Chronic diseases in Arabic language..

15 In UAE mobile devices use has by 74 % in past 5 years Telecommunications Regulatory Authority ). mhealth has shown to improve compliance to clinical & behavioral management in several studies (Manzoni et al, 2011; Rao et al, 2011). Cost reduction is also one of the main drives of the increase use of these technologies in health management (Ekeland et al, 2010; Manzoni et al, 2011). Obesity and Diabetes, are also on the rise in UAE And they are a major contributor to chronic diseases like renal disease (AlMaskari et al, 2010; Hassanien et al., 2012).

16 Effect on energy intake measured changes in daily caloric intake. The Turner-Mcgrievy et al. (2013) post hoc analysis of the 2009 study found that the Patients using the APP Consumed 1437 kcal/day p-value = 0.01 Patients NOT using the APP Consumed 2049 kcal/day

17 Effect on Weight Loss Positive changes in weight loss were observed across most studies in the intervention groups with mobile devices compared to baseline weight Haapala et al. [2009] :subjects receiving a mobile text message intervention lost 4.5 kg over the 12 month weight (p-value < 0.01). Patrick et al. [2009] receiving daily mobile phone SMS and MMS messages had lost 4.62 kg over in 6 months Carter et al. [2013] found that the mobile phone group using an app to self-monitor weight lost the most weight from baseline of 4.6 kg

18 Effect on Physical Activity The interventions measuring physical activity levels as a primary or secondary outcome mostly found PA & adherence to PA long term goals

19 Effect on Waist Circumference The two studies measuring changes in waist circumference found positive reductions favoring the mobile device intervention groups The Haapala et al (2009) found intervention subjects reduced their waist circumference by 0.6 cm (SD = 1.7) and the control group by 0.4 cm (SD = 6.6). WC loss

20 IN Summary mobile devices were found to induce weight loss relative to baseline weight; when compared to standard no intervention controls as well as controls receiving non-mobile weight loss interventions, Reductions in BMI, WC, % body fat, dietary intake and increase in PA levels were observed in most studies.

21 Conclusion Mobile devices appear to induce positive changes in the behavioral determinants of weight loss. Effective components of mobile apps interventions include: - Use of theory and behavior change techniques. - Individualized messages - Having a dietitian follow up (remotely and face to face) and guide the patients on a regular basis - Long term duration J Pers Med Sep; 4(3): A Systematic Review and Meta-Analysis of Mobile Devices and Weight Loss with an Intervention Content Analysis Lynnette Nathalie Lyzwinski

22 references Haapala, I.; Barengo, N.; Biggs, S.; Surakka, L.; Manninen, P. Weight loss by mobile phone: A 1-year effectiveness study. Public Health Nutr. 2009, 12, Lefebre, C. Integrating cell phone and mobile technologies into public health practice a social marketing perspective. Health Promot. Pract. 2009, 10, Hurling, R.; Catt, M.; de Boni, M.; Fairley, B.W.; Hurst, T.; Murray, P.; Richardson, A.; Sodhi, J.S. Using internet and mobile phone technology to deliver an automated physical activity program: Randomized controlled trial. J. Med. Res. 2007, 9, e7. Prestwich, A.; Perugini, M.; Hurling, R. Can implementation intentions and text messages promote brisk walking? A randomized trial. Health Psychol. 2010, 29, Napolitano, M.A.; Hayes, S.; Bennette, G.G.; Ives, A.K.; Foster, G.D. Using Facebook and text messaging to deliver a weight loss program to college students. Obesity 2013, 21,

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