Use of information and communication technology to improve dietary assessment and tackle obesity

BACKGROUND: In 2010, 30 million British adults used the internet daily or nearly every day. 27% of UK adults and 47% of teenagers owned a smartphone in 2011. Information and communication technology (ICT) is a promising new route to deliver public health interventions. It allows a wide target population to be reached and offers cost-effectiveness, convenience, and familiarity of use. There is potential for ICT to be used in dietary assessment to monitor the effectiveness of interventions and assess exposures in aetiological investigations in epidemiology. Paper-based approaches to dietary data are time-consuming, need trained interviewers, and are costly to collect and code. Our hypothesis is that specifically tailored ICT methods can be successfully implemented to assess dietary exposures and aid weight loss and maintenance. METHODS: We have developed a smartphone application “My meal mate” (MMM) that allows participants to self-monitor their calorie intake and physical activity. It has been validated against a 24-h recall (based on the US Department of Agriculture multiple pass telephone recall procedure) in a sample of 50 adults (University of Leeds, UK, staff and students) and has been piloted in 128 overweight adults versus an online or a paper diary in a randomised controlled trial for 6 months to assess adherence and acceptability. Trial participants were recruited from large employers in Leeds, including Leeds City Council, Leeds Metropolitan University, University of Leeds, West Yorkshire Police, Asda, and Morrisons. As an extension of this work, we are also developing a UK online 24-h dietary recall. This recall will be developed on the basis of the automated multiple pass method, with focus groups' input after trying online tools developed in the USA and France. It will be validated against repeated interviewer-administered dietary recalls, and both will be compared with independent nutrient biomarkers. It will be piloted in subgroups of two epidemiological cohorts: the UK Women's Cohort Study, their children, and their grandchildren; and the UK Clinical Biobank. FINDINGS: In the validation study (72% female, 82% white ethnic origin, mean age 35 years [SD 9], mean body-mass index [BMI] 24 kg/m² [SD 4]), energy recorded on MMM correlated well with the 24-h dietary recalls (day 1 recall: r=0·77, 95% CI 0·62–0·86; day 2 recall: 0·85, 0·75–0·91), and had a small mean difference (MMM recall, day 1: −16 kcals per day, 95% CI −132 to 100; day 2: −105 kcals per day, −204 to −7). It took an average 7 (95% CI 6–9) min to enter a meal and an average 22 (95% CI 19–26) min to input a day's intake. In the MMM pilot trial (71% female, 89% white ethnic origin, mean age 42 years [SD 9], mean BMI 34 kg/m² [5]), retention rate was 93% (95% CI 81–99) in the smartphone group, 45% (30–61) in the website group, and 47% (31–62) in the paper diary group at 6 months. Adherence was measured as number of days recorded with 500–5000 kcals (either on app, diary, or online) by all participants. Adherence to dietary self-monitoring was higher in the smartphone group than in the other two groups (p<0·0001). MMM was also rated higher in terms of convenience and comfort of use in social settings. However, the pilot was not powered to detect difference in weight change between the groups. INTERPRETATION: ICT provides a step-change for improvement of dietary assessment and monitoring in population health research. MMM has shown potential as a feasible and acceptable dietary assessment and weight management aid. We now plan to undertake a full randomised trial of this approach to assess weight loss and maintenance. The UK online 24-h dietary recall should be ready for dissemination and use by 2015, free of charge to other UK researchers. FUNDING: National Prevention Research Initiative (grant G0802108) and UK Medical Research Council (G1100235).