Weight Loss Using an mHealth App Among Individuals With Obesity in Different Economic Regions of China: Cohort Study
Authors: Huang Xinru , Shi Yefei , Yao Hongyun , Li Mingjie , Lei Zhijun , Shi Jiayun , Li Bo , Zhang Weiwei , Jian Weixia 
Published: February 2024

Abstract

Background
With the increasing prevalence of obesity, weight loss has become a critical issue in China. Self-managed weight loss through a mobile health (mHealth) app may be a prospective method. However, its practicability in different economic regions of China is unknown.

Objective
This study aims to evaluate the effectiveness of self-managed weight loss through an mHealth app among individuals with obesity in different economic regions of China and to demonstrate the feasibility of online self-management for weight loss.

Methods
A total of 165,635 Chinese adults who signed up for the mHealth app were included to analyze the body composition characteristics of individuals from different economic regions by χ2 analyses. Furthermore, 2 types of participants with obesity using mHealth monitoring, including 74,611 participants with a BMI ≥24.0 kg/m2 and 22,903 participants with a normal BMI but an excessive percentage of body fat (PBF), were followed for 6 months to explore the weight loss and fat loss effects in different economic regions of China and to find independent predictors associated with weight loss success by 2-tailed Student t test and multivariable logistic regression analysis.

Results
There were 32,129 users from low-income regions and 133,506 users from high-income regions. The proportion of users with obesity in low-income regions was higher than in high-income regions, both based on BMI (15,378/32,129, 47.9% vs 59,233/133,506, 44.4%; P<.001) and PBF classification (19,146/32,129, 59.6% vs 72,033/133,506, 54%; P<.001). Follow-up analyses showed that the weight loss effect among participants with overweight or obesity in low-income regions was greater than in high-income regions (mean –4.93, SD 6.41 vs mean –4.71, SD 6.14 kg; P<.001), while there was no significant difference in fat loss (mean –2.06%, SD 3.14% vs mean –2.04%, SD 3.19%; P=.54). In the population with normal-weight obesity, the weight loss (mean –2.42, SD 4.07 vs mean –2.23, SD 4.21 kg; P=.004) and fat loss effects (mean –1.43%, SD 2.73% vs mean –1.27%, SD 2.63%; P<.001) were stronger in high-income regions than in low-income regions. In addition, multivariable logistic regression analyses showed that age, baseline PBF, skeletal muscle rate, and measurement frequency were related to weight loss, whereas gender and baseline body metabolic rate only showed a correlation with weight loss in the population in high-income regions.

Conclusions
This study found a high proportion of mHealth app users with obesity in low-income regions. Individuals with overweight and obesity in different economic regions of China experienced significant weight loss and fat loss using an mHealth app. Moreover, individuals in high-income regions paid more attention to body fat and had better fat reduction effects. Therefore, promoting self-monitoring of weight and PBF through an mHealth app could be an important intervention that could be implemented across all regions of China.