A self-directed mobile intervention (WaznApp) to promote weight control among employees at a Lebanese university: protocol for a feasibility pilot randomized controlled trial

Background: Overweight and obesity have become major health problems globally with more than 1.9 billion overweight adults. In Lebanon, the prevalence of obesity and overweight is 65.4% combined. Risk factors of obesity and overweight are preventable and can be addressed by modifications in the environment and in an individual's lifestyle. Mobile technologies are increasingly used in behavioral, self-directed weight management interventions, providing users with additional opportunities to attain weight control (weightloss, weight gain prevention, etc). Mobile apps may allow for the delivery of Just-in-Time Adaptive Interventions (JITAIs), which provide support through skill building, emotional support, and instrumental support, following the participants' progress. A few commercially available apps offer JITAI features,but no studies have tested their efficacy.

Objective: The primary objective of this study is to examinethe feasibility of a self-directed weight loss intervention, targeting employees of an academic institution, using a virtual coaching app with JITAIfeatures (Lark) and a self-help calorie-counting app (MyFitnessPal). The secondary objective is to estimate the effects of the intervention on mainstudy outcomes.

Methods: This study is a single-center, parallel, randomized controlled trial with 2 study arms (intervention and control). Participants willbe randomly allocated in equal proportions to the intervention (Lark) and control groups (MyFitnessPal). To be eligible for this study, participants must be employed full- or part-time at the university or its medical center, able to read English, have a smartphone, and be interested in controlling their weight. Recruitment strategies entail email invitations, printed posters, and social media postings. We will assess quantitative rates of recruitment, adherence and retention, self-reported app quality using the user version of the MobileApp Rating Scale. We will also assess changes in weight-related outcomes (absolute weight and waist circumference), behavioral outcomes (physicalactivity and diet), and cognitive factors (motivation to participate in the trial and to manage weight).

Results: WaznApp was funded in June 2017, and recruitmentstarted in March 2018.

Conclusions: This study will provide information as towhether the selected mobile apps offer a feasible solution for promoting weightmanagement in an academic workplace. The results will inform a larger trialwhose results might be replicated in similar workplaces in Lebanon and theMiddle East and North Africa region and will be used as a benchmark forfurther investigations in other settings and similar target groups.