A framework for examining the function of digital health technologies for weight management

Research is rapidly extending its focus to develop and evaluate weight management interventions that incorporate eHealth technologies. Comparative effectiveness of eHealth interventions is partly limited by the extensive heterogeneity in intervention design, variation in use of eHealth tools, and expanding development of novel tools to promote weight management. We closely examined, characterized, and categorized the use and function of eHealth tools across a wide range of eHealth interventions for weight management in order to first create a novel schematic framework for eHealth interventions and, second, to evaluate eHealth interventions using this framework. We examined 49 randomized controlled trials from two systematic reviews evaluating the effectiveness of eHealth interventions for weight loss. Further characterization of each intervention identified common use and function of eHealth tools represented within interventions and thus important to include in the proposed framework. This resulted in six descriptive domains. We then categorized each eHealth intervention within the context of the newly developed framework. Last, we examined efficacious interventions in the context of the framework. Twenty-five randomized controlled trials reported significantly more weight loss between the intervention group utilizing eHealth, compared to a non-eHealth control intervention and/or within an eHealth intervention group. Of these 25 interventions, 15 (60%) used automated feedback (Domain 1), 13 (52%) used non-eHealth tailored feedback by a health care provider (Domain 5), and 8 (32%) used tailored feedback from a health care professional through an electronic channel (Domain 2). The proposed schematic framework offers an alternative and novel approach for comparing across interventions and informing the development and evaluation of eHealth interventions.