Researchers and others can benefit from using mobile health apps to improve healthy lifestyle choices. m-Health initiatives that focus on a single dietary behavior, such as the recommendation of Sugar-Sweetened Beverages (SSBs), may enhance overall dietary health and provide encouragement for people to adopt more beneficial dietary choices. To improve the healthy lifestyle behavior associated with SSBs consumption using m-Health app among college students. It investigates the effectiveness of tailored feedback (tracking SSBs consumption, labeling caloric intake, and the serving size) as a method to decrease the consumption of SSBs and increase the consumption of water. A 12-week randomized controlled trial. Texas A&M University-College Station. College students (n=130) were randomized to intervention (n=55) and control (n=58) conditions. Intervention (n=55) and control (n=58) groups received SSBs education via smartphone. Intervention-group also received via smartphone their goals for SSBs reduction (<=240mL SSBs/d (<=8 floz SSB/d)), and smartphone-based progress tracking/feedback. Sugar sweetened beverages consumption, water consumption, and SSB-s consumption self-efficacy scores. During the intervention periods, there was a statistically significant difference in SSB consumption among intervention participants (X2(3)=13.571, P=0.004). Furthermore, from week 1 to week 12, there was a substantial increase in water consumption among intervention participants (Mean differences=-1.652; P=0.00). However, neither the control group (mean=-0.06207, t57=-0.620, p=0.54) nor the intervention group (mean=-0.17321, t55=-1.594, p=0.12) showed any significant changes in post-SSB consumption self-efficacy scores. An m-Health app intervention may provide the participants encouragement and support to adopt healthy behaviors related to decrease their consumption of SSBs, and consume water instead of SSBs.

Obesity has become a worldwide problem that affects both developing and developed countries. Physical inactivity and unhealthy dietary habits are the main risk factors for obesity and overweight. The "energy gap" between weight maintenance and weight gain has been estimated to be around 100 kcal/day. Sugar Sweetened Beverages (SSBs) could be adjusted to improve weight stability and obesity prevention by providing a clearly visible source of calories that contribute to this energy imbalance. Half of the US population consumes SSBs on a daily basis, according to the National Health and Nutrition Examination Survey (NHANES), with 5% consuming at least 567 calories (equal to four cans of soda). The study used a theory-based m-Health app intervention to promote healthy living behavior linked with sugar sweetened beverage consumption among college students in a 12-week RCT involving 130 students from Texas A&M university/college station campus. The research team used university networks to issue email invites to students throughout campus after the university of Texas A and M Institutional Review Board (IRB) approved the study protocol (#2018-0022D). Participants who were interested in participating in the study were screened to ensure that they met the study's inclusion and exclusion criteria. The informed consent forms were signed and returned by those who agreed. Healthy college students aged 18 years-30 years old, engaged in a healthy lifestyle, with a BMI of 18.5 kg/m2, and access to a smartphone were eligible for the study (i-phone or android). Participants who are pregnant, lactating, have undergone bariatric or recent surgery, or have any of the diagnosed chronic conditions such as musculoskeletal problems, heart failure, diabetes mellitus, hypertension, dyslipidemia, or cancer were excluded from this study. Following the screening visit, eligible participants were randomly assigned to one of two groups: Intervention (m-Health intervention app) or control (control group). All of the participants had the Smartphone app installed on their phones.

The use of m-Health applications to replace SSBs with water and other healthy drinking options is part of a campaign to minimize SSB consumption among college students. The amount of SSB consumed before (week 1) and after (week 12) the current m-Health intervention was not significantly different (z=-1.12, p=0.265). Our findings were explained by the fact that after 12 weeks of intervention, the intervention participants' SSBs self-efficacy to limit their use of SSBs had not changed significantly. Multiple studies, on the other hand, indicated that the intervention group using the m-Health app consumed much fewer SSBs than the control group. Furthermore, the intervention group had a 145 kcal/day reduction in SSBs/juice, which is clinically significant and reduces the risk of becoming overweight or obese . Using an m-health app to reduce SSB consumption through suggested portions, feedback, and positive rewards was related with a significant reduction in SBBs (-0.33, p=0.09), according to data from a study of low-income girls (9-14) years old. Although previous studies indicated a significant reduction in SSB consumption, they were conducted over a longer period of time (6 months) and were entirely focused on this outcome. Reduced kcal/day intake as a result of reduced SSB intake may have a long-term impact on health. When compared to the baseline (week 1), however, the current data showed significant increases in water consumption during the intervention period of weeks 4, 8, and 12 (p=0.00). The findings show that an m-Health app intervention could motivate and help users to adopt healthy habits such as restricting SSB consumption and substituting water for SSBs. This positive experience can be just what college students need to keep and develop healthy lifestyle habits. As a result, m-Health applications are more likely to appeal to college students for future health promotion interventions focusing on good eating behaviors than other types of apps.

With Regards,
Joseph Kent
Journal Manager
Journal of Clinical Nutrition & Dietetics