{
  "abstract": "BackgroundMany lifestyle intervention apps for weight management rely on human coaching, which increases cost and variability, or use calorie-counting approaches that lack structured, individualized guidance. Fully autonomous digital platforms that deliver personalized nutrition and exercise plans with body composition tracking remain limited.ObjectiveTo compare an autonomous, protein-focused digital lifestyle intervention (RightBMI App) with provider-delivered lifestyle intervention for weight loss and body composition outcomes in metabolic and bariatric surgery (MBS) candidates.Materials and methodsThis prospective quasi-experimental study enrolled 160 patients at a single center (April 2024–April 2025). Patients were sequentially allocated to the RightBMI App (n = 80) or provider-delivered care (n = 80). Outcomes (% total body weight loss [%TBWL], % fat mass loss [%FML], % visceral fat loss [%VFL], and % muscle mass loss [%MML]) were assessed over 24 weeks using Generalized Estimating Equations (GEE) with multiple imputation and inverse probability weighting, adjusting for age, Body Mass Index (BMI), and sex. A time-to-event analysis (Kaplan–Meier and Cox proportional hazards) was performed as the primary sensitivity analysis to address informative censoring due to MBS clearance at ≥10% TBWL.ResultsIn GEE models, the App group showed significantly greater %TBWL at weeks 12 (+2.64%, p < 0.001) and 16 (+2.47%, p = 0.027), and greater %FML at weeks 12 (+2.94%, p = 0.028) and 16 (+4.20%, p = 0.003) compared with provider-delivered care. By week 24, outcomes were comparable (%TBWL: 20.01% vs. 19.97%; %FML: 36.81% vs. 35.74%). Both groups achieved substantial fat mass loss while preserving muscle mass. Time-to-event analysis showed no significant difference in time to ≥10% TBWL (log-rank p = 0.23; adjusted HR 0.83, p = 0.43). The App group had a higher MBS clearance rate by week 24 (90% vs. 71.25%, p = 0.0023) with low attrition. User satisfaction was high (mean 8.76/10).ConclusionThe autonomous RightBMI App demonstrated greater mid-study weight and fat loss compared with provider-delivered care after statistical adjustment, with comparable 24-week outcomes and effective muscle preservation. Time-to-event analysis showed no significant difference in time to achieve ≥10% TBWL. These findings support the potential of fully autonomous digital platforms as scalable alternatives to traditional provider-led interventions in MBS candidates. Limitations include the non-randomized design and use of consumer-grade bioimpedance scales.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Surgery, Holyoke Medical Center, Holyoke, MA, United States",
    "Department of Surgery, Boundless Apps LLC, Los Angeles, CA, United States"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 5,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Ioanna Pagani"
    },
    {
      "affs": [
        0
      ],
      "name": "Maria Syed"
    },
    {
      "affs": [
        1
      ],
      "name": "Cynthia Ages"
    },
    {
      "affs": [
        0
      ],
      "name": "Michael Bell"
    },
    {
      "affs": [
        0
      ],
      "name": "Yannis Raftopoulos"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/cb32ttswtybj5.bib",
  "cited_by": 0,
  "doi": "10.3389/fdgth.2026.1874279",
  "fulltext_url": "https://www.frontiersin.org/articles/10.3389/fdgth.2026.1874279/full",
  "id": "cb32ttswtybj5",
  "issns": [
    "2673-253X"
  ],
  "landing_url": "https://doi.org/10.3389/fdgth.2026.1874279",
  "language": "en",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "lcc",
      "QA75.5-76.95"
    ],
    [
      "lcc",
      "R"
    ],
    [
      "lcc",
      "RA1-1270"
    ],
    [
      "openalex",
      "3600|Mobile Health and mHealth Applications"
    ]
  ],
  "openalex": "W7223282017",
  "pdf_url": "https://www.frontiersin.org/journals/digital-health/articles/10.3389/fdgth.2026.1874279/pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-23",
  "publisher": "Frontiers Media S.A.",
  "ris": "https://research.draconitic.com/paper/cb32ttswtybj5.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T13:44:14Z",
      "native_id": "33566fffd6874fe281a79901709f66c2",
      "source": "doaj",
      "url": "https://doi.org/10.3389/fdgth.2026.1874279"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "lcc:RA1-1270",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Autonomous digital lifestyle intervention for obesity: a comparative study of software-generated vs. provider-delivered body composition outcomes",
  "title_text": "Autonomous digital lifestyle intervention for obesity: a comparative study of software-generated vs. provider-delivered body composition outcomes",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T13:44:14Z",
  "url": "https://research.draconitic.com/paper/cb32ttswtybj5",
  "venue": "Frontiers in Digital Health",
  "versions": []
}