User experiences of a smartphone-based attentive eating app and their association with diet and weight loss outcomes: Thematic and exploratory analyses from a randomized controlled trial

Background: Short-term laboratory studies suggest that eating attentively can reduce food intake. However, in a recent randomized controlled trial we found no evidence that using an attentive eating smartphone app outside of the laboratory had an effect on energy intake or weight loss over 8 weeks. Objective: This research examined trial participants’ experiences of using an attentive eating smartphone app and whether app usage was associated with energy intake and weight loss outcomes over 8 weeks. Methods: We conducted thematic analysis of semistructured interviews (N=38) among participants in the attentive eating smartphone app group of the trial who completed the 8-week assessment. Linear regression models examined the associations between energy intake and weight loss outcomes at 8 weeks and app usage. Results: Participants reported several barriers and facilitators to using the smartphone app, including repetition of app content, social setting, motivation, and habitual use of the app. Participants believed that using the app had some beneficial effects on their eating behavior and diet. Exploratory analyses indicated that more frequent recording of eating episodes in the app was associated with lower body weight (B=–0.02, P=.004) and greater self-reported energy intake (B=5.98, P=.01) at 8 weeks, but not body fat percentage or taste-test energy intake. Total audio clip plays, gallery views, and percentage of food entries recorded using an image were not significantly associated with energy intake or weight. Conclusions: Frequent recording of eating episodes in a smartphone app was associated with greater weight loss. There are barriers and facilitators to frequent use of an attentive eating smartphone app that may be useful to address when designing dietary behavior change smartphone apps. Trial Registration: ClinicalTrials.gov NCT03602001; https://clinicaltrials.gov/ct2/show/NCT03602001; Open Science Framework DOI 10.17605/osf.io/btzhw; https://osf.io/btzhw