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Life sciences · Journal article
Frontiers in Digital Health · October 23, 2026
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Background Many lifestyle intervention apps for weight management rely on human coaching, which increases cost and variability, or use calorie-counting approaches that lack structured, individualized guidance. Fully autonomous digital platforms that deliver personalized nutrition and exercise plans with body composition tracking remain limited. Objective To compare an autonomous, protein-focused digital lifestyle intervention (RightBMI App) with provider-delivered lifestyle intervention for weight loss and body composition outcomes in metabolic and bariatric surgery (MBS) candidates. Materials and methods This prospective quasi-experimental study enrolled 160 patients at a single center (April 2024–April 2025). Patients were sequentially allocated to the RightBMI App ( n = 80) or provider-delivered care ( n = 80). Outcomes (% total body weight loss [%TBWL], % fat mass loss [%FML], % visceral fat loss [%VFL], and % muscle mass loss [%MML]) were assessed over 24 weeks using Generalized Estimating Equations (GEE) with multiple imputation and inverse probability weighting, adjusting for age, Body Mass Index (BMI), and sex. A time-to-event analysis (Kaplan–Meier and Cox proportional hazards) was performed as the primary sensitivity analysis to address informative censoring due to MBS clearance at ≥10% TBWL. Results In GEE models, the App group showed significantly greater %TBWL at weeks 12 (+2.64%, p < 0.001) and 16 (+2.47%, p = 0.027), and greater %FML at weeks 12 (+2.94%, p = 0.028) and 16 (+4.20%, p = 0.003) compared with provider-delivered care. By week 24, outcomes were comparable (%TBWL: 20.01% vs. 19.97%; %FML: 36.81% vs. 35.74%). Both groups achieved substantial fat mass loss while preserving muscle mass. Time-to-event analysis showed no significant difference in time to ≥10% TBWL (log-rank p = 0.23; adjusted HR 0.83, p = 0.43). The App group had a higher MBS clearance rate by week 24 (90% vs. 71.25%, p = 0.0023) with low attrition. User satisfaction was high (mean 8.76/10). Conclusion The autonomous RightBMI App demonstrated greater mid-study weight and fat loss compared with provider-delivered care after statistical adjustment, with comparable 24-week outcomes and effective muscle preservation. Time-to-event analysis showed no significant difference in time to achieve ≥10% TBWL. These findings support the potential of fully autonomous digital platforms as scalable alternatives to traditional provider-led interventions in MBS candidates. Limitations include the non-randomized design and use of consumer-grade bioimpedance scales.