REVIEW

A Systematic Review of Application and

Effectiveness of mHealth Interventions for Obesity
and Diabetes Treatment and Self-Management1–3

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Youfa Wang,4,5* Hong Xue,4,5 Yaqi Huang,4 Lili Huang,6 and Dongsong Zhang7,8*
4
Systems-Oriented Global Childhood Obesity Intervention Program, Fisher Institute of Health and Well-being, College of Health, Ball State
University, Muncie, IN; 5Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; 6School of Public Health, Jilin University,
Jilin, China; 7Software School, North University of China, Shanxi, China; and 8Department of Information Systems, University of Maryland,
Baltimore County, Baltimore, MD

ABSTRACT

The use of mobile and wireless technologies and wearable devices for improving health care processes and outcomes (mHealth) is promising
for health promotion among patients with chronic diseases such as obesity and diabetes. This study comprehensively examined published
mHealth intervention studies for obesity and diabetes treatment and management to assess their effectiveness and provide recommendations
for future research. We systematically searched PubMed for mHealth-related studies on diabetes and obesity treatment and management
published during 2000–2016. Relevant information was extracted and analyzed. Twenty-four studies met inclusion criteria and varied in terms of
sample size, ethnicity, gender, and age of the participating patients and length of follow-up. The mHealth interventions were categorized into
3 types: mobile phone text messaging, wearable or portable monitoring devices, and applications running on smartphones. Primary outcomes
included weight loss (an average loss ranging from 21.97 kg in 16 wk to 27.1 kg in 5 wk) or maintenance and blood glucose reduction (an average
decrease of glycated hemoglobin ranging from 20.4% in 10 mo to 21.9% in 12 mo); main secondary outcomes included behavior changes and
patient perceptions such as self-efficacy and acceptability of the intervention programs. More than 50% of studies reported positive effects of
interventions based on primary outcomes. The duration or length of intervention ranged from 1 wk to 24 mo. However, most studies included small
samples and short intervention periods and did not use rigorous data collection or analytic approaches. Although some studies suggest that
mHealth interventions are effective and promising, most are pilot studies or have limitations in their study designs. There is an essential need for
future studies that use larger study samples, longer intervention ($ 6 mo) and follow-up periods ($ 6 mo), and integrative and personalized innovative
mobile technologies to provide comprehensive and sustainable support for patients and health service providers. Adv Nutr 2017;8:449–62.

Keywords: mHealth, intervention, obesity, overweight, diabetes

Introduction as hypertension, hyperlipidemia, and some cancers (2). The

Overweight and obesity are global public health problems
because ;40% of adults are overweight or obese worldwide.
In the United States, the largest developed country, two-
thirds of the population are overweight or obese (1). Obesity
and diabetes increase the risk for many other diseases, such
1
Supported by research grants from the NIH (1R01HD064685-01A1, R01DK81335-01A1, U54
HD070725, and 2R42CA168107-02). The U54 project (U54 HD070725) is funded by the
Eunice Kennedy Shriver National Institute of Child Health and Human Development and the
Office of the Director, NIH.
2
Author disclosures: H Xue, Y Huang, L Huang, and D Zhang, no conflicts of interest. Y Wang is
the principal investigator of the first 3 projects listed above in the grant support from the NIH.
3
The content of the article is solely the responsibility of the authors and does not necessarily
represent the official views of the funders.
*To whom correspondence should be addressed. E-mail: ywang26@bsu.edu (Y Wang),
zhangd@umbc.edu (D Zhang).
number of patients with type 2 diabetes (T2D)9 in the United
States increased from 26 million in 2010 to 29 million in 2015
(3), and 14% of all health care cost was spent on diabetes
treatment. Poor diabetes control is associated with low socio-
economic status. The prevalence of T2D has been increasing
worldwide in the past 2 decades, especially at a particularly
fast pace in some developing countries such as China and In-
dia (4–8). For example, the rate of diabetes has reached ~10%
among adults in China, which is similar to that of US adults
9
Abbreviations used: APP, application run on a smartphone; HbA1c, glycated hemoglobin;
mHealth, use of mobile and wireless technologies and wearable devices for improving the
health care processes and outcomes; MPTM, mobile phone text messaging; PA, physical
activity; RCT, randomized control trial; T2D, type 2 diabetes; WPMD, wearable or portable
monitoring device.

ã2017 American Society for Nutrition. Adv Nutr 2017;8:449–62; doi:10.3945/an.116.014100. 449
(7). It is projected that India will have 101 million patients
with T2D, the largest number in the world, by 2030 (8).
Providing good health care services and preventing related
health complications are critical for diabetic and obese pa-
tients, their families, and the society at large. Without effective
prevention and management of diabetes and obesity, patients
and their families will suffer. The society will also suffer from
huge financial and other costs incurred during the care of
those patients. However, there are many challenges in provid-
ing good health care to obese and diabetic patients and help-
ing them control their weight and blood glucose (7, 9, 10),
especially in developing countries with limited health care fa-
cilities and professionals. Treatment of obesity and diabetes is
costly; requires long-term efforts from patients, their health
providers, and other stakeholders; and is often ineffective be-
cause of complex factors, including many challenges that pa-
tients may face in their daily work and life.
Development of lower-cost, more effective methods for
treatment and self-management of obesity and diabetes is
greatly needed to reduce health care costs associated with
obesity and diabetes while at the same time improving the
quality of care and the life of patients (11, 12).
New advances in the use of mobile and wireless technologies
and wearable devices for improving health care processes and
outcomes (mHealth) provide promising options for low-cost,
effective care (13) and health promotion for patients with
chronic diseases such as obesity and diabetes. It can be an effec-
tive tool for patients by helping facilitate their interactions with
health care providers, other patients, and family members.
mHealth has no standard definition yet. For the purpose of
this study, we defined mHealth as health practice or services
supported by mobile technologies and devices, including cell
phones, wearable devices, and sensors as well as mobile applica-
tions running on smartphones (APPs). mHealth has been widely
adopted to help manage diseases in various domains, such as
HIV and AIDS, malaria, tuberculosis, diabetes, asthma, obesity,
and smoking (13–17). However, despite the growing number of
applications of mHealth, the effectiveness of mHealth APPs in
improving health remains inconclusive, and the evidence is scat-
tered. A systematic examination of related mHealth studies is
needed to guide future mHealth research and practice.
The existing literature reviews of mHealth APPs mainly fo-
cus on the availability of commercial applications and use for
patients (18). However, there are very few systematic reviews
regarding the current APPs and their effectiveness as mHealth
tools for obesity and diabetes treatment and management. To
fill this gap and advance our understanding of existing research
on mHealth in support of obesity and diabetes treatment and
management, we conducted a systematic review of the related
research and assessed the effectiveness of the mHealth inter-
ventions for obesity and diabetes treatment and management,
identified gaps in the literature, and provided recommenda-
tions for future research.
Methods
This systematic literature review was conducted following the Preferred Re-
porting Items for Systematic Reviews and Meta-Analyses framework (19) in
450 Wang et al.
terms of study selection, data collection, data analysis, and result reporting.
Because of the high heterogeneity in study characteristics of the selected
studies and limited number of comparable studies and quantitative results,
quantitative meta-analysis could not be conducted in the present study.
Study selection
Database and search strategy. To identify studies that have investigated the
effectiveness of mHealth intervention programs for obesity and/or diabetes
treatment and management, we searched PubMed for relevant articles
published between 1 January 2000 and 31 August 2016. We limited the
search for studies published since 2000 because, although smartphones
originated in ;2007, some mobile devices were available and tested in
health promotion–related research before then. In the end, we found 24
studies that met our inclusion criteria, all published after 2008 (see
Figure 1).
The terms we used in the PubMed search included “cell phone and over-
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weight,” “cell phone and obesity,” “cell phone and diabetes,” “smartphone
and overweight,” “smartphone and obesity,” “smartphone and diabetes,”
“mobile phone and overweight,” “mobile phone and obesity,” “mobile
phone and diabetes,” “mHealth and overweight,” “mHealth and obesity,”
“mHealth and diabetes,” “eHealth and overweight,” “eHealth and obesity,”
“eHealth,” and “diabetes.” The search was limited to studies involving ran-
domized trials (i.e., experimental but not observational studies), human
studies, and publication in English. Search results were further screened
manually by study title, abstract, and full text based on our study inclusion
and exclusion criteria.
Study inclusion and exclusion criteria. Inclusion criteria that we used were
1) participants in studies were diabetic or obese patients; 2) mobile devices,
such as mobile phones and/or wearable monitoring devices, were used in
the health intervention or care delivery; 3) diabetes- and obesity-related
behaviors and outcomes were evaluated, for example, whether weight
changes of obese patients or glycated hemoglobin (HbA1c) changes of
diabetic patients were reported; 4) the study design was a randomized
clinical trial (RCT) or quasi-experiment; and 5) the study was published
in English.
Exclusion criteria included 1) review or commentary articles or studies
not published in English; 2) proposed interventions that only used emails,
web-based programs, or log books without interacting with patients and de-
livering an intervention to a mobile device; and 3) studies that involved pa-
tients with other chronic diseases, such as cardiac disease or cancer.
Data collection and analysis
Two coauthors and a research assistant extracted information from identi-
fied studies that met inclusion criteria, including study design, subjects, na-
ture of the intervention, inclusion of control groups, and key research
results. Extracted information was reviewed by other coauthors to verify ac-
curacy. The methodological quality of the selected studies was assessed by
using the Jadad scale (20), which has been recognized as a useful tool for
evaluation of RCT quality (21). Jadad scores range from 0 (very poor) to
5 (rigorous) and consist of points for randomization (randomized = 1 point;
table of random numbers or computer-generated randomization = addi-
tional 1 point), double blindness (double blind = 1 point; use masking
such as identical placebo = additional 1 point), and follow-up (stating num-
bers of subjects withdrawn and the reasons for them in each group of a
study = 1 point) (22).
The research designs used in previous RCT studies were highly het-
erogeneous with respect to intervention durations, outcome variables,
and target populations, which prohibited quantitative analysis (i.e.,
meta-analysis). Thus, we present a narrative synthesis of the results of
mHealth interventions for diabetes and obesity management reported
by those studies.
Results
Main characteristics of the selected studies
Table 1 shows the main characteristics of the 24 selected
studies. Among them, 15 studies (63%) were conducted in

FIGURE 1 Flow chart of the literature search and study selection procedures. RCT, randomized controlled trial.
the United States, and the rest were conducted in 7 other
countries, including Iran, Germany, South Korea, Italy,
Finland, Spain, and Australia. Regarding study design, 16
studies (67%) were randomized controlled trials, and
8 (33%) were quasi-experiments.
Most studies included small samples. Sample sizes of the
selected studies ranged from 15 to 124 subjects/intervention
or control group, with 8 studies (33%) with no groups
of >30 subjects/group, 11 studies (46%) with 30–60
subjects/group, and 5 studies (21%) with >60 subjects/
group. Two studies (8%) recruited only female subjects,
whereas 22 (92%) recruited both male and female subjects
(Table 2).
Types of mHealth interventions
As reported in Tables 1 and 2, based on the nature of specific
mHealth technologies investigated by the selected studies,
we categorized the mHealth interventions into 3 types: 1)
mobile phone text messaging (MPTM), which uses text
messages as the primary mode of communication between
patients and health care providers; 2) an APP, which uses
smartphones to deliver patient education or help patients
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self-manage their conditions; and 3) wearable or portable
monitoring devices (WPMDs), which offer patient data
collection over a wireless connection and can monitor
patients’ physiological status. This classification is made
based on several considerations including simplicity, un-
derstandability to a nontechnical audience, and technolog-
ical complexity involved in interventions, but there could
be other ways to classify. For example, from a system per-
spective, text messaging is an APP running on a mobile
phone. Wearable devices are hardware and are associated
with software.
Regarding tested mHealth intervention approaches,
about half (13 studies, 54%) used MPTM, 6 (25%) used
WPMDs, and 5 (21%) used APPs. Intervention durations
ranged widely from only 1 wk to 2 y, although most had a
short duration. Specifically, more than half (13 studies,
54%) had an intervention <3 mo (i.e., 12 wk), 7 (29%)
had an intervention between 3 and 6 mo, and only 4 studies
(17%) had an intervention >6 mo.
This study found that MPTM and APP were largely used
to facilitate behavior changes in patients with obesity or di-
abetes by providing patients with knowledge and tips for
mHealth for obesity and diabetes management 451
 TABLE 1 Main study characteristics and findings from 24 studies that examined mHealth interventions for obesity and diabetes treatment and management1
Study Study mHealth Intervention
ID2 Reference, year design Country SS G Age,3 y type period Intervention Control treatment Key outcome(s) Conclusions Effective
1 Patrick et al. (16), RCT United States 65 2 25–55 MPTM 16 wk Personalized message Printed materials on More weight loss than controls Promote behavior changes Yes
2009 2–5 times/d, printed weight control (21.97 kg difference, 95% CI: that support weight loss in
materials, and phone 1 time/mo 20.34, 23.60 kg), after overweight adults.

452 Wang et al.

2 Turner-McGrievy
and Tate (23),
2011
3 Shaw (24), 2012
4 Park and Kim
(25), 2012
5 Burke et al. (26),
2012
6 Schiel et al. (27),
2012
7 Sharifi et al. (28),
2013
calls from a counselor adjusting for sex and age
1 time/mo (P = 0.02).
RCT United States 96 3 42.9 6 11.2 APP 6 mo A diet and PA-monitoring 2 podcasts/wk and 2 1) Weight loss did not differ by Mobile communication via No
APP, and interaction minipodcasts/wk group at 6 mo (P = 0.28). 2) Twitter and a monitoring
with study counselors Social support did not differ APP without feedback did
and other participants between groups (P = 0.08). not enhance weight loss.
on Twitter
RCT United States 120 3 52 6 15.5 MPTM 1 mo General health message General health message 1) The sustained weight loss rate Text messaging shows No
plus 1) messages between cases and controls promise in helping people
about promoting was nearly the same at sustain healthy behaviors.
success and rewarding month 3 (P = 0.08). 2) The
oneself and 2) mean weight loss between
messages about controls was not different at
preventing failure and month 3 (P . 0.05).
avoiding temptations
Q-E South Korea 67 1 56.7 6 5.6 MPTM 12 wk Record WC, BW, BP, Only informed about the 1) WC (P , 0.001), BW (P , 0.001), Tailored SMS improved health Yes
dietary patterns, and study and TC (P , 0.001) significantly outcomes in
exercise weekly decreased in the intervention postmenopausal women
through cellular group and significantly with abdominal obesity.
phone increased in the control group.
Recommendations for 2) BP and LDL-C significantly
diet and exercise were decreased in the intervention
sent to each patient by group
cellular phone ((P = 0.001, P = 0.025) but not
significantly in the control
group (P = 0.476, P = 0.104).
RCT United States 210 3 46.84 APP 24 mo Feedback on their PDA or Recorded diet by paper The mean percentage weight Mobile technology that offers No
PDA only to help diary loss at 24 mo was not feedback can play a role in
self-monitoring of diet different among groups improving weight loss.
and weight loss (P = 0.33).
Q-E Germany 124 1 13.5 6 2.8 WPMD 5 wk A mobile phone to assess Pre-intervention 1) Significant weight Mobile phones are highly Yes
PA and eating habits reduction of 7.1 6 3.0 kg accepted by children and
(P , 0.01) and 2) significant adolescents and augment
PA and time spent in existing weight reduction
activities were associated and weight loss
with weight reduction stabilization.
(P = 0.04).
Q-E United States 31 1 6–12 MPTM 3 wk Three weeks of text Pre-intervention 1) Parents were generally Text messaging is a promising Yes
messages of enthusiastic about text medium in pediatric
obesity-related messages to support healthy obesity-related behavior
behaviors behaviors for their children. intervention. Parent
2) Parents anticipated high perspectives could assist in
responsiveness to messaging the design of text-based
endorsed by their child’s interventions.
doctor.

(Continued)

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 TABLE 1 (Continued )

Study Study mHealth Intervention

ID2 Reference, year design Country SS G Age,3 y type period Intervention Control treatment Key outcome(s) Conclusions Effective
8 Allen et al. (29), RCT United States 68 4 45 6 11 APP 6 mo 1) Intensive counseling Intensive counseling Smartphone group tended to Smartphone application for No
2013 plus smartphone, 2) intervention lose more weight (P = 0.89). self-monitoring is an
less intensive adjunct to behavioral
counseling plus counseling.
smartphone, and 3)
smartphone only to
help self-monitoring
9 Oliver et al. (30), Q-E Spain 30 2 9–15 APP 1 wk Record dietary and PA by Record dietary and PA 1) PDAs produced more records A PDA is a reliable system for Yes
2013 PDA with paper and pencil than paper and pencil data collection.
(P , 0.001). 2) Participants
preferred a PDA over paper
and pencil (P . 0.01).
10 Bond et al. (31), Q-E United States 30 1 47.5 6 13.5 APP 3 wk Smartphone-based PA Pre-intervention Significant decreases in The smartphone APP is useful Yes
2014 “breaks” were utilized sedentary time and increases in PA promotion.
to get participants in light and moderate-to-
active vigorous PA (P , 0.05).
11 Nollen et al. (32), RCT United States 51 2 9–14 APP 12 wk Used a mobile APP to set Same content in a written Increased fruit/vegetable intake Mobile APPs may help change No
2014 real-time goals and manual (P = 0.08) and decreased diet behaviors, but
self-monitor, provided sugar-sweetened beverage larger-scale testing of
tips, feedback, and (P = 0.09) consumption. similar programs is needed.
positive reinforcement
12 Partridge et al. RCT Australia 214 2 18–35 MPTM 12 wk 8 text messages/wk, Printed dietary and PA 2.2 kg (95% CI: 0.8, 3.6 kg) lighter Text messaging was Yes
(33), 2015 1 email/wk, guidelines (P , 0.05); consumed more successful in preventing
5 personalized vegetables (P = 0.009), fewer weight gain and improving
coaching calls, a diet sugary soft drinks (P = 0.002), lifestyle behaviors among
booklet, and access to and fewer energy-dense overweight young adults.
resources and mobile takeout meals (P = 0.001);
phone APP on a increased PA time (P = 0.003)
website compared with controls.
13 Martin et al. (34), RCT United States 40 2 44.4 6 11.8 APP 12 wk Prescribed personalized Health tips via smartphone Weight loss was significantly A smartphone APP may Yes
2015 diet via a smartphone greater than controls at week efficaciously promote
based on wireless 12 (P , 0.001). clinically meaningful
body weight and step weight loss.
data
14 Pretlow et al. Q-E Unites States 43 1 10–21 APP 20 wk Smartphone APP with Pre-intervention 1) Significantly decreased The food withdrawal Yes
(35), 2015 health professionals’ %overBMI from baseline approach, which can be
support to lose weight (P , 0.05). 2) Significant delivered through a
improvements of self-esteem, smartphone, was feasible
control over food, and a to implement and was
reduction in turning to food useful in helping reduce
when stressed (P , 0.01). 3) weight, particularly among
Males, younger participants, boys.
and participants with higher
levels of compliance
achieved better weight loss
(P = 0.02).

mHealth for obesity and diabetes management

(Continued)

453
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 TABLE 1 (Continued )

Study Study mHealth Intervention

ID2 Reference, year design Country SS G Age,3 y type period Intervention Control treatment Key outcome(s) Conclusions Effective
15 Faridi et al. (36), RCT United States 30 2 55.3 6 8.7 MPTM 3 mo Daily tailored text Standard diabetes 1) HbA1c levels changed but not Text messages may have a No

454 Wang et al.

2008 messages to enhance self-management significantly (P = 0.1534). 2) positive impact on some
diabetic self-care Self-efficacy scores improved clinical outcomes and
behavior significantly (P = 0.008). self-efficacy in patients
with type 2 diabetes.
16 Hanauer et al. RCT United States 40 2 12–25 MPTM 3 mo SMS reminders via cell Electronic reminders via Usage of SMS waned by month 3. Maintaining interest about No
(37), 2009 phone e-mail text messages for
prolonged intervals
remains a challenge.
17 Rossi et al. (38), Q-E Italy 41 1 31.6 6 11.9 APP 9 mo Diary APP on mobile Pre-intervention Reduction in fasting blood Mobile APPs represent a No
2009 phones record blood glucose (P = 0.09), useful, safe, and
glucose and quantify postprandial glucose easy-to-use tool to
the total cholesterol (P = 0.13), and HbA1c levels promote dietary freedom.
intake, communicate (P = 0.27).
with physician by SMS
18 Quinn et al. (14), RCT United States 163 4 18–64 MPTM 12 mo Personalized messaging Usual care 1) HbA1c decreased over 12 mo Mobile coaching-based Yes
2011 in response to blood (P , 0.001). 2) Appreciable personal data analyzed and
glucose values, differences in depression, presented with
diabetes medications, diabetes symptoms, BP, and evidence-based guidelines
and lifestyle behaviors lipid concentrations were not reduce HbA1c.
by mobile phone observed between groups
(P . 0.05).
19 Luley et al. (39), RCT Germany 70 2 57.8 6 8 WPMD 6 mo Telephone monitoring of Conventional low-fat diet Weight loss, glucose, HbA1c, Telephone monitoring can Yes
2011 PA and a low-calorie, and standard care and antidiabetic drug intake effectively lower body
low–glycemic index diet were reduced (P , 0.001). weight, HbA1c, and
antidiabetic drug use in
patients with type 2 diabetes.
20 Goodarzi et al. RCT Iran 81 2 53.8 6 10.32 MPTM 12 wk 4 messages/wk about Usual care and did not Improved significantly in HbA1C This SMS improved the Yes
(40), 2012 exercise, diet, receive any (P , 0.024), LDL (P = 0.019), management of type 2
medication, and educational message cholesterol (P = 0.002), BUN diabetes by social and
importance of self- (P # 0.001), microalbumin, behavioral constructs, such
monitoring blood knowledge (P # 0.001), as self-efficacy and
glucose practice (P # 0.001), and knowledge.
self-efficacy (P # 0.001).
21 Bell et al. (41), RCT United States 65 2 58 6 11 MPTM 6 mo Self-care video messages Standard diabetes care Decline in HbA1C over 12 mo One-way, mobile phone–based Yes
2012 by cell phone (P , 0.002). video messages about
diabetes self-care can
improve HbA1C.
22 Zolfaghari et al. Q-E Iran 77 2 18–65 MPTM 3 mo A short message every Counseling appointments Between control and SMSs of cellular phones may No
(42), 2012 week on diet, exercise, via telephone intervention groups, there improve adherence to
taking diabetic was no significant difference diabetes therapeutic
medication, in HbA1C (P = 0.489), diet regimen in patients with
self-monitoring of adherence (P = 0.438), or type 2 diabetes.
blood glucose, and physical exercise (P = 0.327),
stress management but medication adherence
improved in the control
group (P = 0.034).

(Continued)

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 weight or blood sugar control, providing reminders about

for improving the health care processes and outcomes; LDL-C, LDL cholesterol; MPTM, mobile phone text messaging; PA, physical activity; PDA, personal digital assistant; Q-E, quasi-experiment; RCT, randomized controlled trial; SMS, short-
APP, application run on a smartphone; BP, blood pressure; BW, body weight; BUN, blood urea nitrogen; G, number of groups; HbA1c, glycated hemoglobin; ID, identifier; mHealth, use of mobile and wireless technologies and wearable devices
some activities to control them, providing social support,
Effective
Yes

No
and collecting patient physiological data, such as body
weight and amount of physical activity (PA), for self-

The use of a telemetric device

outcomes in patients with

for care management was

monitoring and disease management (23, 26). MPTM

associated with improved

to download information

message service; SS, sample size; TC, total cholesterol; WC, waist circumference; WPMD, wearable or portable monitoring device; %overBMI, BMI 2 BMI at 50th percentile for age and sex/BMI at 50th percentile 3 100.
was mainly used for providing knowledge and tips on
Conclusions
Automated feedback

diet, PA, and drugs, whereas APPs played versatile roles

improves patient

control of LDL-C.
type 2 diabetes.
in disease control, such as providing feedback to help
with positive behavior changes and serving as data collec-
tion platforms.
In contrast, our review suggested that WPMD were used
exclusively for data collection (patient monitoring). The in-
fructosamine (P = 0.881), and

significant changes between

(P , 0.03) and body weight
Significant reduction in HbA1c

terventions transmitted to mobile devices based on the

HbA1c (P = 0.310) had no

groups. 2) LDL tended to

1) Self-efficacy (P = 0.319),

awareness of patient status through patient monitoring in-

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Key outcome(s)

decrease more in the

intervention group

cluded 1) information related to controlling one’s weight

and diabetes; 2) reminders about diet, PA, or medication;
(P = 0.045).
(P , 0.03).

3) feedback on food consumption, PA, anthropometry, or

laboratory test results; and 4) supportive remarks to encour-
age and motivate patients to continue making positive be-
havior changes.
Interestingly, the use of MPTM was more common in
Control treatment

short-term studies and obesity interventions, whereas

Remote patient reporting Standard of care

APPs and WPMD were more popular in long-term studies

Telemetry device at home Standard care

and for obesity and diabetes interventions, respectively

(Table 3).
Table 4 shows that among 24 studies, 17 (71%) were pi-
levels, BP readings, and
weight measurements

lot studies, indicating that those studies were at the early

to the diabetes care
telephone feedback

to transmit glucose
and an automated

stage of their research. Among 11 studies (46%) that pro-

Intervention

manager weekly

vided incentives to participants, such as money or mobile

devices, 8 (73%) had intervention periods >3 mo. The aver-
system

age dropout rate across all studies that reported this infor-
mation was 17.4%. Obesity intervention studies had a
higher average drop-out rate (19.6%) than those on diabetes
mHealth Intervention

interventions (13.9%).
period
10 mo

6 mo

Applications of mHealth interventions by disease

(obesity and/or diabetes)
WPMD

WPMD
type

Out of the 24 studies reviewed, 14 mHealth interventions

(58%) were for overweight or obesity treatment and man-
agement, whereas 10 (42%) were for diabetes. APPs were
61.9 6 7.8
Age,3 y

18–75

used mostly in obesity control (8 for obesity compared

with 2 for diabetes). MPTM interventions were equally
Unless otherwise indicated, values are ranges or means 6 SDs.
G

used with 5 MPTM interventions for both obesity and dia-

2

2
48

United States 225

betes treatment and management, respectively. As a new

SS

source for data collection, WPMD were less prevalent than

Country

the other 2 types of mHealth interventions (1 for obesity,

Finland

3 for diabetes).
Study IDs indicate the 1st to 24th study.
design

Findings of the effects of mHealth interventions

Study

RCT

RCT

Qualitative findings. For the 14 studies on mHealth inter-

ventions for overweight or obesity management, 9 (64%)
TABLE 1 (Continued )

Reference, year

Pressman et al.

reported positive results (16, 25, 27, 28, 30, 31, 33–35), 6
Orsama et al.
(43), 2013

(44), 2014

studies (43%) reported weight loss or waist circumference

decrease (16, 25, 27, 34, 35), 5 studies (36%) reported
behavior changes (16, 28, 31, 33, 35), and 2 studies (14%)
Study

Mean.

reported secondary outcomes, such as acceptability, biochem-

ID2

ical tests, or blood pressure with statistically significant

23

24

2
3
4

mHealth for obesity and diabetes management 455

 TABLE 2 Summary of characteristics of 24 studies that examined mHealth interventions for
obesity and diabetes treatment and management1
Category Number of studies (%) Study ID2
Country/setting
United States 15 (63) 1–3, 5, 7, 8, 10, 11, 13, 14–16, 18, 21, 24
Iran 2 (8) 20, 22
Germany 2 (8) 6, 19
Spain 1 (4) 9
Australia 1 (4) 12
Finland 1 (4) 23
Italy 1 (4) 17
South Korea 1 (4) 4
Targeted disease outcome
Overweight/obesity 14 (58) 1–14
Diabetes 10 (42) 15–24

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Study type
RCT 16 (67) 1–3, 5, 8, 11–13, 15, 16, 18–24
Q-E 8 (33) 4, 6, 7, 9, 10, 14, 17, 22
mHealth type
MPTM 11 (46) 1, 3–4, 7, 12, 15, 16, 18, 20–22
APP 9 (33) 2, 5, 8–11, 13, 14, 17
WPMD 4 (31) 6, 19, 23–24
Intervention time/duration
,3 mo 13 (54) 1, 3, 6, 7, 9–13, 15, 16, 20, 22
3–6 mo 7 (29) 2, 4, 8, 14, 19, 21, 24
.6 mo 4 (17) 5, 17, 18, 23
Sample size per group
#30 8 (33) 8–13, 15, 16, 23
.30–60 11 (46) 1–3, 7, 14, 17–22
.60 5 (21) 4–6, 12, 24
Age group
Child 6 (25) 6, 7, 9, 11, 14, 16
Adult 18 (75) 1–5, 8, 10, 12, 13, 15, 17–24
Subject sex
Female 2 (8) 4, 10
Male and female 22 (92) 1–3, 5–9, 11–24
1
APP, application run on a smartphone; ID, identifier; mHealth, use of mobile and wireless technologies and wearable
devices for improving the health care processes and outcomes; MPTM, mobile phone text messaging; Q-E, quasi-
experiment; RCT, randomized controlled trial; WPMD, wearable or portable monitoring device.
2
See Table 1 for the related references for each study.

improvement (25, 31). Shorter-term interventions tended
to get more positive results in weight-control studies than
did the longer-term interventions (Table 5).
For the 10 studies on mHealth interventions for dia-
betes treatment and management, 5 (50%) reported sta-
tistically significantly improved results in primary
outcomes or clinical biochemical analysis, such as blood
glucose, HbA1c, and blood lipids (14, 39, 40, 41, 43).
Two WPMD intervention studies reported positive re-
sults, but the only APP intervention appeared to have
no effect on controlling diabetes. It is notable that behav-
ior changes after receiving interventions did not reach
statistical significance in any diabetes control studies
(Table 5).
Quantitative findings. As shown in Table 6, 6 studies on
mHealth interventions for obesity management reveal sig-
nificant body weight loss (16, 25, 27, 34, 35); the highest
average body weight loss was 7.1 kg (pre- and postinterven-
tion comparison) (27); the highest proportion of weight
loss after receiving mobile interventions was 9.4% higher
than that at baseline (34). Some research reported that
a mobile intervention reduced waist circumference by
3.0 cm (25), reduced sedentary time by 47.2 min/d (31),
increased completion rate of self-registrations of diet
and PAs by nearly 20% (30), and increased light PA time
by 31 min/d and moderate-to-vigorous PA time by
16.3 min/d (31).
Among studies on diabetes, the mHealth interven-
tions used in 5 studies resulted in decreased HbA1c
(14, 39, 40, 41, 43). The greatest percentage reduction
of HbA1c was ;1% (40), and blood glucose reduction
was ;1 mmol/L (39).
Discussion
The growing global obesity and diabetes epidemic affects
both developed and developing counties, many of which
have limited resources to help patients fight the related
consequences (45, 46). At present a large number of peo-
ple worldwide suffer from the epidemic, with >40% of
adults being overweight or obese globally. The number
of obese and diabetic patients will continue to increase

456 Wang et al.

TABLE 3 The types and specific functions of mHealth interventions for obesity and diabetes treatment and management1
Study ID2
Type and specific
function provided Overweight/obesity Diabetes
by interventions 13 24 33 44 55 63 73 84 93 103 113 123 133 144 153 163 175 185 194 203 214 223 233 244
MPTM
Knowledge/tips
Diet X X X X X X X X
PA X X X X X X X
Drug X X X
Reminder
Glucose test X X X
PA X
Social support6 X X X X
Surveillance
Diet X X

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PA X X X
BW/WC X
BP X
Blood sugar X
Feedback
Diet X
PA X
APP
Knowledge/tips
Diet X X X
Drug X X
Reminder
Weighed self X X
PA X X X
Glucose test X
Social support X X X
Data collection
Diet X X X X X X X
PA X X X X
BW X
Blood sugar X X
Feedback
Diet X X X X
PA X X X X
Blood sugar X
WPMD
Surveillance
Diet X
PA X X X
BW X X X
Blood sugar X X
BP X
1
APP, application run on a smartphone; BP, blood pressure; BW, body weight; ID, identifier; mHealth, use of mobile and wireless technologies and wearable devices for improving
the health care processes and outcomes; MPTM, mobile phone text messaging; PA, physical activity; WC, waist circumference; WPMD, wearable or portable monitoring device.
2
See Table 1 for the related references for each study.
3
Length of intervention period: ,3 mo.
4
Length of intervention period: 3–6 mo.
5
Length of intervention period: .6 mo.
6
Patient-patient and patient–health care giver communication.

at least in the near future. Effective and sustainable inter-
vention programs are needed to improve patients’ health
and reduce care cost. The use of mobile and wireless tech-
nologies (i.e., mHealth interventions), attributable to the
pervasiveness and ubiquity of mobile, handheld devices,
to support obesity and diabetes treatment and manage-
ment, including long-term care and self-management by
patients, may transform health service delivery across the
globe (13).
Some earlier literature reviews documented the dramatic
increase of mHealth use (18, 47–49). For example, there
were >1000 commercial APPs for diabetes care in the
Google Play Store (for Android) and 605 in the Apple App
store (for iOS) in 2013 (18). Previous reviews evaluated the
usability, feasibility, and acceptability or patient preferences
of mHealth interventions (49, 50). However, few existing re-
views have assessed the impact of mHealth on disease-specific
clinical outcomes (50, 51). In addition, previous reviews

mHealth for obesity and diabetes management 457

TABLE 4 The implementation of mHealth interventions for obesity and diabetes treatment and management1
Implementation
of mHealth Overweight/obesity
intervention 13 24 33 44 55 63 73 84 93 103 113 123 133 144 153 163 175 185 194 203 214 223 233 244
Was a pilot study Y Y Y N N Y Y Y Y Y
Provided incentive N Y N N Y N N N Y N
to subjects6
Subject drop-out rate, % 17 10 15 23 14 NA NA 35 NA 14
1
ID, identifier; mHealth, use of mobile and wireless technologies and wearable devices for improving the health care processes and outcomes; N, no; NA, not available; Y, yes.
2
See Table 1 for the related references for each study.
3
Length of intervention period: ,3 mo.
4
Length of intervention period: 3–6 mo.
5
Length of intervention period: .6 mo.
6
In this row, N indicates no or not available.
focused on certain types of mHealth tools only (e.g., mobile
phone messaging applications) (47, 48, 50, 51) or focused
only on specific populations, mHealth intervention methods
(e.g., only on phone text messages), or outcomes (e.g., only
on obesity or BMI) (52–54).
To fill the research gaps and help guide future research,
our systematic review evaluated the whole spectrum of ef-
fects of mHealth interventions for obesity and diabetes
treatment and management. We categorized mHealth in-
tervention methods into 3 types, namely MPTM, APPs,
and WPMDs, based on the type of information and com-
munication technologies used. MPTM plays an important
role in providing knowledge outreach, activity reminders,
tools for social support, feedback for behavior changes
and maintenance, and sometimes serves as an indirect
channel for data collection and monitoring. MPTM has
been more easily and widely used than the 2 other types
of mHealth interventions because it is easy to implement,
but it is largely limited to patient education. APPs have
been playing versatile roles in interventions, whereas
WPMDs mainly support health-related data collection.
The subject dropout rate was higher in studies related to
controlling overweight and obesity than those related to
controlling diabetes (25, 29, 32, 35–37, 39, 41, 44), suggest-
ing that interventions may be more difficult to adopt and
less well perceived by patients with overweight and obesity
than by diabetic patients because diabetes is likely viewed
by patients as a more severe condition than obesity. For
both types of studies, incentives were important to maintain
participants’ adherence to interventions, which highlights
the importance of investigating the self-sustainability of
such mHealth interventions in future studies.
According to behavior change theories, such as the
Knowledge-Attitude-Practice Model (55), the Health Be-
lief Model (56), Social Cognitive Theory (57), and the
Stages of Change Model (57), mHealth interventions
can serve multiple functions in the self-management of
obesity or diabetes (58). Our review suggests that the ma-
jority of the mHealth interventions targeted improving
nutrition-related behaviors, including diet and PA, and
this was particularly true for obesity management. More-
over, existing mHealth applications for diabetes treatment
and management have been expanded to nonnutrition
458 Wang et al.
Study ID2
Diabetes
Y N Y Y Y Y Y N N N N Y Y Y
N Y N Y N Y N Y Y N Y N Y Y
27 14 10 37 0 11 18 23 6 19 8 NA NA 12
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aspects, for example, WPTM is used to provide personal-
ized guidelines for medication and lifestyle behaviors
(14), and WPMDs are used to transmit glucose, blood
pressure, and weight information to care providers to im-
prove care management (44).
Our review results show that the effects of mHealth inter-
ventions are heterogeneous across studies, which may be
partially because of the different outcomes targeted and
assessed. The selected studies assessed a wide range of health
outcomes, although most studies focused only on 1 or 2
outcomes. The primary and direct outcomes were weight
loss, weight maintenance, and waist circumference reduc-
tion for obesity studies, and blood glucose and HbA1c con-
trol and reduction for diabetes studies. The most important
secondary outcomes of both types of studies were health be-
haviors, such as PA and diet. Some studies also assessed
other clinical measurements and management actions,
such as blood pressure, medicine dose, self-efficacy, social
support, and acceptability of mHealth (25, 28, 38, 40–42).
We found the mHealth interventions were more effective
if they targeted PA-related outcomes than other outcomes,
with 11 of 18 studies that targeted PA reporting positive
effects on increased PA and decreased body weight and waist
circumference. Second to PA interventions were the in-
terventions targeting diet-related outcomes, with 9 of 16
studies that targeted diet outcomes reporting improved
diet. Our results suggest that mHealth intervention effective-
ness is outcome-, context-, and intervention-dependent. Find-
ings may vary even when similar mHealth tools are used
(e.g., MPTM or an APP) in different intervention designs
and settings.
Despite the limitations of the 24 studies, such as short
intervention durations, >50% of the studies reported
some desirable, positive effects on obesity and diabetes
control based on the primary outcomes (14, 16, 25, 27,
28, 30, 31, 33–35, 39–41, 43). This is encouraging for
future related research and interventions. Theoretically, be-
havior changes should precede changes in anthropometry
and laboratory examination outcomes because obesity
and diabetes are lifestyle-related diseases. However, the
studies included in this review reported that mobile inter-
ventions were less effective in changing behavior than they
were in changing anthropometry or laboratory results
TABLE 5 The effects of mHealth interventions on various outcomes related to obesity and diabetes, by type of mHealth intervention1
Study ID2
Overweight/obesity Diabetes
Outcomes examined 13 24 33 44 55 63 73 84 93 103 113 123 133 144 153 163 175 185 194 203 214 223 233 244
MPTM
Weight loss X X X X
Weight maintenance
Waist circumference X X
Biochemical test X X X X
Self-efficacy
Acceptability X
Behavior X
Blood pressure X
Symptoms
APP

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Weight loss X
Self-efficacy X
Acceptability
Behavior X X X
Biochemical test
WPMD
Weight loss X X X
Biochemical test X X X
Behaviors X
Medicine dose X
Blood pressure
1
All outcomes (see Table 1 for details) denoted with an X were statistically significant (P # 0.05). APP, application run on a smartphone; ID, identifier; mHealth, use of mobile and
wireless technologies and wearable devices for improving the health care processes and outcomes; MPTM, mobile phone text messaging; WPMD, wearable or portable
monitoring device.
2
See Table 1 for the related references for each study.
3
Length of intervention period: ,3 mo.
4
Length of intervention period: 3–6 mo.
5
Length of intervention period: .6 mo.

(14, 16, 25, 34, 40, 41). This finding may be attributable to the
limitations of the published studies and the challenges of eval-
uating health behaviors and changes in those behaviors. For ex-
ample, evaluations of PA and eating behaviors in previous
studies were typically based on self-reported questionnaires
that included only subjective questions. There is a need for
more objective and precise measurements of behavior changes
in future research.
Although more than half of the 24 studies demonstrated
some positive effects of mHealth interventions on obesity or
diabetes control, our findings related to the effectiveness of
mHealth should be interpreted with caution. This is also be-
cause of the limitations of the published related studies in
study design and implementation. First, sample sizes of
most available studies were small. Only 5 of 24 studies had
>60 subjects in the intervention and control groups (25–
27, 33, 44). Second, the intervention period in more
than half of the studies was <3 mo. Such short-term inter-
ventions showed more positive effects than long-term inter-
ventions (>6 mo). Some studies revealed that long-term
effects of mHealth technologies were difficult to maintain
in obesity and diabetes interventions for a number of rea-
sons. For example, if an intervention is long enough to cover
holiday seasons, changes in diet and PA patterns during the
holidays may affect the intervention (26, 35, 54), the burden
of long-time adherence to self-monitoring may also poten-
tially affect long-term effects (26, 35, 54), and personal
contact and coaching in addition to self-monitoring may
be needed to achieve the desired long-term effects (54).
Third, most of the studies were carried out in developed
countries such as the United States; therefore, the findings
may not be generalizable to developing countries. There
are some limitations of our study. Because of the highly
heterogeneous characteristics of the selected studies,
a quantitative meta-analysis was not possible. Despite
these limitations, this study provides a broad overview of
mHealth applications for the treatment and management
of obesity and diabetes and sheds some light on future
research.
In conclusion, a growing body of research has investi-
gated some mHealth interventions for the management
and treatment of obesity and diabetes across countries,
with most conducted in the United States. Although the
preliminary evidence collected from existing research is
mixed, mHealth interventions are likely a promising
means to promote behavior changes among patients
with chronic diseases by providing them with health in-
formation and timely suggestions for improving health
behaviors, providing them with feedback and social sup-
port, helping them collect health data, and showing
data to patients and their care providers. In the future,
more research with rigorous and innovative study de-
signs and intervention strategies should be conducted. In
addition, studies with large sample sizes and long-term

mHealth for obesity and diabetes management 459

 TABLE 6 Key quantitative outcomes with statistical significance of 24 studies that examined
mHealth interventions for obesity and diabetes treatment and management1
mHealth methods, targeted
outcomes, and study ID2 Outcome Key results P
Patient education
PA
1 BW, kg DI 2 C = 21.97 0.02
4 WC, cm DI, A 2 B = 23.0, DC, A 2 B = 20.9 ,0.001
BW, kg DI, A 2 B = 22.0, DC, A 2 B = 20.7 ,0.001
12 BW, kg DI 2 C = 22.2 ,0.05
20 HbA1c, % DI, A 2 B = 20.89, DC, A 2 B = 0.35 ,0.024
21 HbA1c, % DI 2 C = 20.2 ,0.002
Diet
4, 12, 20, 21 [ [
13 BW, % DI, A 2 B = 29.4, DC, A 2 B = 0.6 ,0.001
18 HbA1c, % DI, A 2 B = 21.9, DC, A 2 B = 20.7 ,0.001

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Diabetes medicine
18, 20, 21 [ [
Surveillance
PA
4 [ [
6 BW, kg DI 2 C = 27.1 ,0.01
9 %CSD DI 2 C = 19.4 0.009
%CSPA DI 2 C = 24.11 0.001
19 BG, mmol/L DI, A 2 B = 21.0 ,0.001
HbA1c, % DI, A 2 B = 20.8 ,0.001
23 HbA1c, % DI, A 2 B = 20.4, DC, A 2 B = 0.036 ,0.03
Diet
4, 9, 18, 23 [ [
6 BW, kg DI 2 C = 27.1 ,0.01
BG
18, 23 [ [
BW
19 [ [
Feedback to subjects
PA
4, 18 [ [
Diet
4, 13, 18 [ [
BW
13 [ [
BG
18 [ [
Behavioral reminder
PA
10 ST, min DI, A 2 B = 247.2 ,0.05
LPA, min DI, A 2 B = +31.0 ,0.05
MVPA, min DI, A 2 B = +16.3 ,0.05
14 %overBMI DI, A 2 B = 7.1 ,0.05
BG test
21 [ [
Social support3
18, 20, 21 [ [
1
BG, blood glucose; BW, body weight; DC, A 2 B, difference between before and after intervention in the control group; DI, A 2 B,
difference between after and before intervention in the intervention group; DI 2 C, difference between the intervention group
and the control group; HbA1c, glycated hemoglobin; ID, identifier; LPA, light physical activity; mHealth, use of mobile and
wireless technologies and wearable devices for improving the health care processes and outcomes; MVPA, moderate-to-
vigorous physical activity; PA, physical activity; ST, sedentary time; WC, waist circumference; %CSD, percentage of completed
self-register of diet; %CSPA, percentage of completed self-register of PA; %overBMI, BMI 2 BMI at 50th percentile for age and
sex/BMI at 50th percentile 3 100; [, see the result with the same study number above.
2
See Table 1 for the related references for each study.
3
Patient-patient and patient–health care giver communication.

interventions and follow-ups are needed to help assess the Acknowledgments

effectiveness of mHealth intervention programs and their We thank Yong Zhang for helping conduct some literature
impact on multiple health-related outcomes more thor- search and some analysis, Paula Vincent for helping improve
oughly and objectively. the manuscript, and Xi Cheng for helping manage references.

460 Wang et al.

All authors contributed to the study and read and approved
the final manuscript.
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