Triggering Australian adults' to modify their diet and exercise habits by deploying digital health tools.

This prospective cohort study reports the result of assessing participants knowledge of the calorific value of food. Then completing an electronic food diary and subsequently being triggered with personalised avatars of their future-self based on their choice of calorie restriction and exercise regimen using the FutureMe app. The team had access to 3951 people. The project aimed to recruit 100 participants, 87 were recruited to the study and of these 42 completed the study (48%). Pregnant females and those with body dysmorphia were specifically excluded. The majority of participants were female and almost all were above 25 years of age. The average BMI was 34.1 + 4.8. For weight loss the intervention required participants to restrict their calorie intake and taking regular exercise. At interview 1, only one in three (33.3%) accurately estimated the calories required by people to maintain normal weight. A similar percentage (32.2%) overestimated the requirement the rest underestimated or did not know. Most participants tended to overestimate the calorie content of low-calorie foods compared to high calorie foods. Fewer participants were in the preparation stage at interviews 5, 4 3 and 2 compared to interview 1. The difference was significant for interview 5 (p<0.05), and almost reached significance for interview 4 (p=0.059). Participants aged between 26- 40 years had higher emotional re-evaluation scores than those above 40 years of age in the contemplation stage and participants aged 60 years and older in the action stage. In the contemplation stage, females had a higher mean emotional re-evaluation score than males. There were no significant differences observed for the other processes of change. Of those participants who completed the study (42/ 87, 48%), a significant proportion of participants (54.8%) reported restricting their calorie intake and exercising more at least 4 times a week. Many participants (45%) reported that it was somewhat difficult to eat less and exercise more. This is the second study to report that personalised avatar can trigger people to make attempts at weight management. One in eight of those who commented after they completed the study reported that they had made significant progress with weight management. This study has demonstrated that a digital app including personalised avatars of people who are motivated to manage their weight can be triggered to action. The proportion of people beyond the contemplation stage of change suggests that most participants were already considering how to manage their weight and that the proportion in the preparation and action phase increased through the study. The potentially limiting factors of this intervention is poor food literacy (w.r.t. calorific value) and the challenge of performing daily regular exercise.