Autonomous digital lifestyle intervention for obesity: a comparative study of software-generated vs. provider-delivered body composition outcomes
- 1Department of Surgery, Holyoke Medical Center, Holyoke, MA, United States
- 2Department of Surgery, Boundless Apps LLC, Los Angeles, CA, United States
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.
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BibTeX
@article{pagani2026autonomous,
title = {{Autonomous digital lifestyle intervention for obesity: a comparative study of software-generated vs. provider-delivered body composition outcomes}},
author = {Ioanna Pagani and Maria Syed and Cynthia Ages and Michael Bell and Yannis Raftopoulos},
journal = {Frontiers in Digital Health},
year = {2026},
month = oct,
doi = {10.3389/fdgth.2026.1874279},
url = {https://doi.org/10.3389/fdgth.2026.1874279},
note = {CC BY},
}
RIS
TY - JOUR
TI - Autonomous digital lifestyle intervention for obesity: a comparative study of software-generated vs. provider-delivered body composition outcomes
AU - Ioanna Pagani
AU - Maria Syed
AU - Cynthia Ages
AU - Michael Bell
AU - Yannis Raftopoulos
PY - 2026
DA - 2026/10/23
JO - Frontiers in Digital Health
DO - 10.3389/fdgth.2026.1874279
UR - https://doi.org/10.3389/fdgth.2026.1874279
AB - 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.
SN - 2673-253X
ER -