Increasing intake of fruits and vegetables, coupled with remote health coaching and financial incentives, together help people adopt and maintain healthy behavior changes. This is the conclusion of a randomized controlled trial using mobile technology, published in the May 28, 2012, issue of Archives of Internal Medicine. Dr. Bonnie Spring of Northwestern University’s Department of Preventive Medicine led the study.

The researchers developed the trial, called Make Better Choices, to sort out which behavior changes would enable people to reduce major risk factors for cardiovascular disease, cancer and diabetes. Four combinations were assessed in the intervention among 204 people:

  • Increasing fruit and vegetable intake and physical activity
  • Reducing saturated fat intake and sedentary leisure
  • Increasing fruits and vegetables and reducing sedentary lifestyle
  • Reducing saturated fats and increasing physical activity.
The most improvement occurred in the people who increased fruits/vegetables and decreased sedentary leisure: specifically, fruit/veg intake increased from 1.2 to 5.5 servings, and sedentary leisure fell from 219 minutes to 89 minutes. The least useful tactic was traditional dieting — decreasing fat and increasing physical activities.

The mobile health technology component was a personal digital assistant that people used to record their behaviors. During treatment and follow-up, the device showed 2 decision support feedback “thermometers,” in the words of the researchers: one metric was for diet and one was for activity. Goal thermometers were updated in response to peoples’ entry of their behavior data.

The incentive was a $175 payment for meeting the goals for the two targeted behaviors during the treatment phase (food and activity).

Health Populi’s Hot Points: One of the additional benefits yielded by the most effective combination of increasing fruit/veg and decreasing sedentary lifestyle was a lowering of saturated fat intake over time. The researchers point to previous statistical associations between sedentary lifestyle and cancer, obesity, type 2 diabetes, depression, and death. Reducing screen time has been found to reduce the consumption of high-fat snacking, Spring’s team comments.

This study points to the fact that simple dieting doesn’t work as well as bringing together several behavior changes simultaneously.

The researchers are spot-on when they identify the opportunity that new forms of payment for health care present for addressing the challenge of motivating patient behavior change. Team-based, patient centered care, coupled with information/technology prescriptions and ongoing counseling via mobile platforms, can buoy patients’ results in real-time compared with a physician-led, face-to-face, three-minute counseling session twice a year about the benefits of “eating right and exercising.” Value-based benefits that many employers are adopting, to incentivize workers’ wellness through the workplace, bolster this effort.