RELAX: A Mobile Application Suite Targeting Obesity and Stress

Obesity and stress are highly comorbid and both increase risk for cardiovascular disease
(CVD). Stress is associated with disinhibited eating, junk food consumption and low
consumption of produce and whole grains. Both stress and stress-induced eating are not only
associated with obesity but also predict worst outcomes in lifestyle interventions. Stress
and stress-induced eating should be targeted in interventions to maximize weight loss;
however, this makes for a very intensive intervention. Technology could be leveraged to
reduce intervention burden. The purpose of this proposal is to develop and test the
feasibility and proof-of-concept of RELAX Application Suite (AS), a mobile-, cloud- and
web-based companion to a lifestyle intervention that addresses stress. RELAX-AS will be
designed to reduce clinical visit time by identifying for the clinician the patient's
behavior and stress patterns that account for the greatest deviations in energy balance.
Investigators have created an app for diet and exercise self-monitoring. The RELAX-AS will
build upon previous work to create a comprehensive weight loss and stress reduction
application suite.

RELAX-AS will include RELAX-app and RELAX-web. RELAX-app is a patient-facing mobile
application that will be linked to the Microsoft Health Vault, a cloud-based platform that
allows for secure access of health data online. RELAX-app will include self-monitoring (diet,
exercise, stress, stress-induced eating); automated feedback via easy-to-interpret visual
displays and feedback reports on the amount, timing, context, and relationship between target
behaviors; and self-guided stress management features that are prompted when stress ratings
are elevated. To minimize burden, investigators will incorporate barcode scanners for diet
recording, GPS for exercise tracking, visual analogue scales for stress ratings, and provide
brief stress reduction strategies. RELAX-web is a web-based application for clinicians to
access the patient's information in the form of easily digestible visual displays and
feedback reports to increase the efficiency of their counseling. In traditional counseling
much time is spent reviewing paper self-monitoring records and soliciting information from
the patient about factors impacting their adherence (e.g., stress and stress eating). The
purpose of RELAX-web is to reduce the clinic time needed to deliver care. The goal is to use
RELAX-AS to create an intervention delivery model that reduces both weight and stress. The
investigators propose a 3-year study to develop and test usability, feasibility, and
acceptability. This work is in preparation for a 2-arm efficacy trial comparing RELAX-AS with
a brief lifestyle intervention to a brief lifestyle intervention alone on weight, stress, and
stress eating.

Inclusion Criteria:

- Phone connectivity at home and work

- Have written clearance from their PCP

- Willing to use the Nexus (Google) smartphone that runs on the Android operating
system.

Exclusion Criteria:

1. Under the age of 18 or over the age of 65;

2. BMI under 30 or over 45;

3. Does not currently own a smartphone;

4. Not phone connectivity at home and work;

5. Unable to collect medical clearance;

6. Unable to walk unaided for 1/4 mile without stopping;

7. Taking medications known to affect appetite and/or weight;

8. Has a condition which precludes dietary changes (i.e. ulcerative colitis, Crohn's
disease, active diverticulitis, renal disease);

9. Type 1 or 2 diabetes;

10. Had gastric bypass surgery;

11. Plans to have gastric bypass surgery during the study period;

12. Pregnant/lactating;

13. Bipolar disorder, substance abuse, psychosis, bulimia, or severe depression;

14. Had bariatric surgery or recently lost significant weight;

15. On medication affecting weight;

16. Unwillingness of the patient's PCP to participate (phase 4 RELAX-AS condition only)

17. Prisoner; or

18. Unable to provide consent