Nutritional Epidemiology Group School of Food Science and Nutrition Janet Cade & Michelle Carter “My Meal Mate” a smartphone tool for dietary assessment and weight management

Nutritional Epidemiology Group School of Food Science and Nutrition Background In UK, 89% of population has a mobile phone 27% owning a smartphone (2010) doubled in last 2 years Weight management patients want alternatives to face-to-face treatment. Smartphone – allow self-monitoring of food and exercise.

Nutritional Epidemiology Group School of Food Science and Nutrition Design of MMM app Focus groups x 3 Semi-structured design, thematic analysis Objective: to explore views and preferences of potential users to inform development of the smartphone application Interview: What do you think about this approach to weight loss? What kind of feedback would you find useful? How often would you like to receive feedback? What do you like and dislike about similar commercially available applications? (“my fitness pal”, “lose-it”, “spark-people” and “calorie- counter”)

Nutritional Epidemiology Group School of Food Science and Nutrition Results 7 women + 2 men participated: 36y (SD 11) 7 actively trying to lose weight Only 2 had used an ‘app’ before Positive response re weight loss – convenient, motivating Searchable branded food database – quick and easy to use Feedback desirable, not too frequent or negative Tailored with some human input

Nutritional Epidemiology Group School of Food Science and Nutrition MyMealMate

Nutritional Epidemiology Group School of Food Science and Nutrition Set own weight loss goal and energy target Features of “My Meal Mate”

Nutritional Epidemiology Group School of Food Science and Nutrition Features of “My Meal Mate” Self monitoring – diet and activity Electronic food diary

Nutritional Epidemiology Group School of Food Science and Nutrition Electronic food diary large searchable database Features of “My Meal Mate”

Nutritional Epidemiology Group School of Food Science and Nutrition Electronic food diary photo reminders Add favourites Recent items Features of “My Meal Mate”

Nutritional Epidemiology Group School of Food Science and Nutrition Instant nutritional feedback and progress Features of “My Meal Mate”

Nutritional Epidemiology Group School of Food Science and Nutrition Weekly feedback by SMS based on % of calorie target achieved

Nutritional Epidemiology Group School of Food Science and Nutrition Help! U-tube help videos Portion size guidance popular

Nutritional Epidemiology Group School of Food Science and Nutrition Validation Study Sample = 50 (staff and students at University) use MMM x 7 days diet reference measure – 2 x 24 hour telephone recalls Activity reference measure – accelerometery

Nutritional Epidemiology Group School of Food Science and Nutrition Results – useability (n=49) Questionnaire itemMean (95%CI) On average how long does it take you to enter a meal (min) ? 7 (6, 9) On average how long did you spend each day on the app (min) ? 22 (19, 26) How many days did it take until you felt comfortable using the phone (days) ? 1.1, (0.9, 1.4) How many days did it take until you felt comfortable using "MMM" (days) ? 1.6, (1.3, 1.9)

Nutritional Epidemiology Group School of Food Science and Nutrition Comparison of methods MMMRecallMMM-recall Correlation MMM and recall Mean (SD) Mean95% CIPr P Day 1 (n=49) Energy (kcal/d) , , 0.9<0.001 Protein (g/d) , , 0.9<0.001 CHO (g/d) , , 0.8<0.001 Fat (g/d) , , 0.8<0.001

Nutritional Epidemiology Group School of Food Science and Nutrition Mean difference between MMM and 24h recall for day 1

Nutritional Epidemiology Group School of Food Science and Nutrition Pilot trial Sample: 128 overweight from large employers in Leeds Method: RCT ÷ 3 groups MMM vs paper food diary vs online food diary Outcomes: acceptability & feasibility Process measures – drop-outs, adherence, frequency of use Characteristics of successful users?

Nutritional Epidemiology Group School of Food Science and Nutrition Sample characteristics BMI 34kg/m2 (SD 5) - self-reported 33! Age 42 years 29 men, 99 women 31% usually/always on a diet 10% current smoker 40% already owned a smartphone; 61% had used an app 58% professional & managerial occupations 6 week and 6 month follow up……..

Nutritional Epidemiology Group School of Food Science and Nutrition New project…… UK Web based 24h diet & physical activity recall Project phases: 1.Development of tool 2.Validation 3.Pilot testing in 2 cohorts – UKWCS; ICHNT Clinical Biobank