An Image-Recognition Dietary Assessment App for Adolescents with Obesity: Usability and Feasibility Testing (Pilot Randomized Controlled Trial) (Preprint)

BACKGROUND Adolescence is a period of increased susceptibility for developing obesity-related health issues due to poor eating patterns and increased sedentary behaviours. Recommendations for pediatric obesity management include dietary assessments. However, adolescents often avoid food logging through traditional methods. Use of image-recognition dietary assessment applications (apps) in adolescents with obesity is not well studied. Eating for Wellness (E4W) is a mobile app that determines the nutritional content of meals from photos and incorporates nutritional goal-setting. Nutritional data can be displayed for healthcare providers (HCPs) via the Clinician Portal while the data is presented to the user in a manner that minimizes the focus on calorie counting. OBJECTIVE To evaluate the usability, feasibility, and preliminary effectiveness of E4W, a mobile health (mHealth) app designed to improve dietary intake in adolescents with obesity attending an obesity clinic, using a phased approach. METHODS The overall study was conducted in two phases to refine and evaluate E4W. Phase 1: Usability was tested through three iterative cycles of patient interviews. A total of 14 patient participants, aged 12-18 years with a BMI ≥ 97th percentile, were included. Participants performed standardized scenario-based tasks in E4W and provided feedback on the app. Two iterative cycles were conducted for healthcare providers (n=4). Refinements were made during each cycle based on issues encountered and feedback provided. Phase 2: A pilot randomized controlled trial of 32 adolescents (16 enrolled in the experimental group for 1 month, 16 controls enrolled for 1 month) was completed. Both groups met with their dietitian at baseline, mid-study and one month following their baseline visit to discuss goals and eating patterns. Control group was instructed to take photos of all intake using their default phone camera, without access to E4W, while those in the experimental group received full access to E4W. Primary outcome was the feasibility of implementation. Secondary outcomes examined overall change in dietary intake and achievement of nutritional goals. RESULTS Usability testing demonstrated that E4W and the Clinician Portal were easy to use, efficient and well-liked by patients and HCPs. Feasibility testing was hindered by technical challenges, patient engagement and adherence to traditional methods of food logging, and there was no improvement in dietary intake. However, patient acceptability scores were high. CONCLUSIONS E4W and the Clinician Portal were well-received by patients and HCPs. Further research is warranted to determine if E4W can improve dietary intake and achievement of nutritional goals in adolescents with obesity. CLINICALTRIAL Phase 2 Feasibility Testing was registered with ClinicalTrials.gov (NCT05548868).