{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T05:24:20Z","timestamp":1786944260047,"version":"build-2736575974"},"reference-count":47,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Form Res"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec sec-type=\"background\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Dietary counseling is an essential complement to the growing use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) to achieve sustainable weight loss. Diverse patient needs, the demand for ongoing support, and limited resources underscore the potential of using digital support tools.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"objective\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed to evaluate the usability, treatment satisfaction, and weight effects of a personalized nutrition advisor (PNA), a prototype decision-support tool designed to facilitate personalized weight management counseling.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"methods\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We assessed usability, treatment satisfaction, and weight effects of a web-based PNA prototype dashboard designed to help dietitians deliver personalized remote dietary counseling in overweight adults (BMI \u226528 kg\/m\u00b2 at pharmacotherapy initiation) who had achieved \u22655% weight loss with GLP-1 RA therapy over 12-weeks. The PNA dashboard generated tailored nutritional recommendations to help participants achieve personalized weight loss goals based on an energy balance model that estimated daily caloric intake and nutritional quality using frequent body weight measurements, dietary logs, and physical activity data from a lifestyle-tracking app. To evaluate the PNA\u2019s usability, we used a convergent parallel mixed-methods approach, combining a validated quantitative usability survey and qualitative focus-group interviews and feedback questionnaires with both dietitians and patients, alongside patient-reported satisfaction metrics for PNA-guided consultations (treatment satisfaction, general self-efficacy, and perceived health impact). Thematic analysis with a hybrid deductive-inductive methodology was applied to qualitative data, using 4 a priori themes derived from this study\u2019s conceptual framework regarding prior expectations, perceived utility and satisfaction, usability challenges, and suggestions for clinical integration. Percent weight loss during the intervention was assessed as an exploratory outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"results\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 78 participants (58\/78, 74% women), on GLP-1 RA (mean weight loss of \u221213.3%, SD 6.7%, after 10, SD 5, months of treatment), between 3 and 5 remote nutrition consultations were delivered with PNA support. After the 3-month intervention period, weight loss was sustained in all participants (\u22120.2%, SD 2.5%), with 21% (16\/78) suspending the GLP-1 RA due to drug shortages. Dietitians rated the PNA\u2019s usability as moderate (62%) on the Healthcare Systems Usability Scale. Patients evaluated the perceived health impact of the PNA-assisted consultations at 19.1 (SD 3.5) of 25 on the user version of the Mobile Application Rating Scale. No significant differences were observed in patient-reported treatment satisfaction (\n                      <jats:italic>P<\/jats:italic>\n                      =.78) or self-efficacy (\n                      <jats:italic>P<\/jats:italic>\n                      =.57) before and after PNA-assisted care. Qualitative analysis identified convergence with quantitative findings across themes of usability, treatment satisfaction, and clinical integration, with divergence observed for self-efficacy and tracking motivation. Both patients and dietitians found the PNA valuable for generating actionable nutritional insights.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"conclusions\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>While effective implementation of tools such as the PNA prototype demands dietitian training and workflow integration, they offer scalable, personalized nutrition or lifestyle guidance\u2014as a therapeutic decision-support tool within weight loss interventions, with or without adjunct GLP-1 RA pharmacotherapy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2196\/81112","type":"journal-article","created":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T05:41:11Z","timestamp":1785476471000},"page":"e81112-e81112","source":"Crossref","is-referenced-by-count":0,"title":["Clinical Decision Support for Digital Dietary Counseling Under GLP-1 Receptor Agonist Therapy: Convergent Mixed Methods Usability and Treatment Satisfaction Pilot Study of the Personalized Nutrition Advisor"],"prefix":"10.2196","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-8364-1975","authenticated-orcid":false,"given":"Freya","family":"Orban","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-4385-0266","authenticated-orcid":false,"given":"Arlette","family":"Journeaux","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-1146-1773","authenticated-orcid":false,"given":"Philipp","family":"Kanehl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9572-5703","authenticated-orcid":false,"given":"Melanie","family":"Stoll","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8817-3365","authenticated-orcid":false,"given":"Marco","family":"Lehmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0057-902X","authenticated-orcid":false,"given":"Felix","family":"Schirmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1028-9445","authenticated-orcid":false,"given":"David","family":"Herzig","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1993-7672","authenticated-orcid":false,"given":"Lia","family":"Bally","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,7,21]]},"reference":[{"issue":"6","key":"R1","doi-asserted-by":"publisher","first-page":"2256","DOI":"10.1111\/jhn.13218","article-title":"Moving towards more sustainable diets: Is there potential for a personalised approach in practice?","volume":"36","author":"Davies","journal-title":"J Hum Nutr Diet"},{"issue":"8","key":"R2","doi-asserted-by":"publisher","DOI":"10.1111\/obr.13571","article-title":"A systematic review of patient barriers and facilitators for implementing lifestyle interventions targeting weight loss in primary care","volume":"24","author":"de Jong","journal-title":"Obes Rev"},{"issue":"10","key":"R3","doi-asserted-by":"publisher","first-page":"4397","DOI":"10.1007\/s12325-022-02265-4","article-title":"The potential role of digital health in obesity care","volume":"39","author":"Hinchliffe","journal-title":"Adv Ther"},{"issue":"6","key":"R4","doi-asserted-by":"publisher","DOI":"10.1111\/obr.13734","article-title":"Role of telemedicine in the management of obesity: state-of-the-art review","volume":"25","author":"Shariq","journal-title":"Obes Rev"},{"issue":"6","key":"R5","doi-asserted-by":"publisher","first-page":"1163","DOI":"10.1002\/oby.24027","article-title":"Physiology of the weight-loss plateau in response to diet restriction, GLP-1 receptor agonism, and bariatric surgery","volume":"32","author":"Hall","journal-title":"Obesity (Silver Spring)"},{"issue":"S2","key":"R6","doi-asserted-by":"publisher","DOI":"10.1089\/dia.2023.2525.abstracts","article-title":"Inferring cause from effect: towards a personalised nutrition advisor to reach body weight targets","volume":"25","author":"Kanehl","journal-title":"Diabetes Technol Ther"},{"issue":"S2","key":"R7","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1089\/dia.2024.78502.abstracts","article-title":"Inferring dietary patterns in people with obesity participating in a remote weight management programme with or without adjunctive GLP-1RA pharmacotherapy","volume":"27","author":"Orban","journal-title":"Diabetes Technol Ther"},{"issue":"23","key":"R8","doi-asserted-by":"publisher","first-page":"2079","DOI":"10.1001\/jama.2025.19563","article-title":"An AI-powered lifestyle intervention vs human coaching in the diabetes prevention program: a randomized clinical trial","volume":"334","author":"Mathioudakis","journal-title":"JAMA"},{"issue":"1","key":"R9","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1016\/j.ajcnut.2025.04.023","article-title":"Nutritional priorities to support GLP-1 therapy for obesity: a joint advisory from the American College of Lifestyle Medicine, the American Society for Nutrition, the Obesity Medicine Association, and The Obesity Society","volume":"122","author":"Mozaffarian","journal-title":"Am J Clin Nutr"},{"issue":"14","key":"R10","doi-asserted-by":"publisher","first-page":"1414","DOI":"10.1001\/jama.2021.3224","article-title":"Effect of continued weekly subcutaneous semaglutide vs placebo on weight loss naintenance in adults with overweight or obesity","volume":"325","author":"Rubino","journal-title":"JAMA"},{"key":"R11","doi-asserted-by":"publisher","DOI":"10.1155\/2024\/8056440","article-title":"A comprehensive review on weight gain following discontinuation of glucagon-like peptide-1 receptor agonists for obesity","volume":"2024","author":"Abdullah Bin Ahmed","journal-title":"J Obes"},{"key":"R12","doi-asserted-by":"publisher","DOI":"10.3389\/fnut.2024.1363181","article-title":"Requirements for essential micronutrients during caloric restriction and fasting","volume":"11","author":"Zhang","journal-title":"Front Nutr"},{"issue":"4","key":"R13","doi-asserted-by":"publisher","DOI":"10.3390\/nu18040677","article-title":"Micronutrient deficiencies in the era of second-generation incretin-based therapies for obesity","volume":"18","author":"Koceva","journal-title":"Nutrients"},{"issue":"1","key":"R14","doi-asserted-by":"publisher","DOI":"10.1111\/cob.70070","article-title":"Micronutrient and nutritional deficiencies associated with GLP-1 receptor agonist therapy: a narrative review","volume":"16","author":"Urbina","journal-title":"Clin Obes"},{"key":"R15","doi-asserted-by":"publisher","DOI":"10.1016\/j.obpill.2025.100186","article-title":"Nutritional deficiencies and muscle loss in adults with type 2 diabetes using GLP-1 receptor agonists: a retrospective observational study","volume":"15","author":"Scott Butsch","journal-title":"Obes Pillars"},{"key":"R16","unstructured":"Creswell JW Plano Clark VL . Designing and Conducting Mixed Methods Research. 3 ed. SAGE Publications, Inc; 2017. ISBN: 9781483344379"},{"key":"R17","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6963-6-28","article-title":"Using quantitative and qualitative data in health services research - what happens when mixed method findings conflict? [ISRCTN61522618]","volume":"6","author":"Moffatt","journal-title":"BMC Health Serv Res"},{"issue":"4","key":"R18","doi-asserted-by":"publisher","DOI":"10.2196\/11656","article-title":"The iterative convergent design for mobile health usability testing: mixed methods approach","volume":"7","author":"Alwashmi","journal-title":"JMIR mHealth uHealth"},{"key":"R19","unstructured":"User manual. Oviva. URL: https:\/\/oviva.com\/ch\/en\/user-manual\/ [Accessed 24-06-2026]"},{"key":"R20","unstructured":"Swiss dietary recommendations. Federal Food Safety and Veterinary Office. URL: https:\/\/www.blv.admin.ch\/en\/swiss-dietary-recommendations [Accessed 17-07-2026]"},{"issue":"2","key":"R21","doi-asserted-by":"publisher","first-page":"466","DOI":"10.1038\/s41366-025-01967-3","article-title":"Efficacy of a digital health application for weight management in people with obesity: 6-months results from a randomized controlled trial","volume":"50","author":"Lautenbach","journal-title":"Int J Obes (Lond)"},{"issue":"1","key":"R22","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-022-21421-y","article-title":"A feasibility study to assess Mediterranean diet adherence using an AI-powered system","volume":"12","author":"Papathanail","journal-title":"Sci Rep"},{"issue":"1","key":"R23","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2022-065323","article-title":"Design and validation of a new Healthcare Systems Usability Scale (HSUS) for clinical decision support systems: a mixed-methods approach","volume":"13","author":"Ghorayeb","journal-title":"BMJ Open"},{"key":"R24","unstructured":"The Nutrition and Dietetic Patient Outcomes Questionnaires (NDPOQ). Oxford University Innovation. URL: https:\/\/innovation.ox.ac.uk\/licence-details\/nutrition-and-dietetic-patient-outcomes-questionnaire-ndpoq [Accessed 26-6-2026]"},{"issue":"2","key":"R25","doi-asserted-by":"publisher","DOI":"10.2196\/mhealth.5849","article-title":"Development and validation of the user version of the Mobile Application Rating Scale (uMARS)","volume":"4","author":"Stoyanov","journal-title":"JMIR mHealth uHealth"},{"key":"R26","unstructured":"General self-efficacy scale. Imperial. URL: https:\/\/www.imperial.ac.uk\/research-and-innovation\/education-research\/evaluation\/what-can-i-evaluate\/self-efficacy\/tools-for-assessing-self-efficacy\/general-self-efficacy-scale\/ [Accessed 24-06-2026]"},{"issue":"2","key":"R27","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"3","author":"Braun","journal-title":"Qual Res Psychol"},{"issue":"3","key":"R28","doi-asserted-by":"publisher","first-page":"308","DOI":"10.1177\/15586898221126816","article-title":"Inductive\/deductive hybrid thematic analysis in mixed methods research","volume":"17","author":"Proudfoot","journal-title":"J Mix Methods Res"},{"issue":"1","key":"R29","doi-asserted-by":"publisher","first-page":"47","DOI":"10.15265\/IY-2015-011","article-title":"Mobile mpplications for patient-centered care coordination: a review of human factors methods applied to their design, development, and evaluation","volume":"10","author":"Baysari","journal-title":"Yearb Med Inform"},{"issue":"1","key":"R30","doi-asserted-by":"publisher","DOI":"10.1038\/s41746-023-00899-4","article-title":"Barriers and facilitators to utilizing digital health technologies by healthcare professionals","volume":"6","author":"Borges do Nascimento","journal-title":"NPJ Digit Med"},{"issue":"1","key":"R31","doi-asserted-by":"publisher","DOI":"10.1038\/s41746-024-01049-0","article-title":"Understanding inherent influencing factors to digital health adoption in general practices through a mixed-methods analysis","volume":"7","author":"Weik","journal-title":"NPJ Digit Med"},{"key":"R32","unstructured":"Digital health role statement. Dietitians Australia. URL: https:\/\/dietitiansaustralia.org.au\/working-dietetics\/standards-and-scope\/role-statements\/digital-health-role-statement [Accessed 24-06-2026]"},{"issue":"3","key":"R33","doi-asserted-by":"publisher","DOI":"10.2196\/mhealth.6945","article-title":"Designing health apps to support dietetic professional practice and their patients: qualitative results from an international survey","volume":"5","author":"Chen","journal-title":"JMIR mHealth uHealth"},{"issue":"1","key":"R34","doi-asserted-by":"publisher","DOI":"10.2196\/71575","article-title":"Driving and restraining forces in the implementation of information systems in the public sector: scoping review","volume":"12","author":"Lemmettyl\u00e4","journal-title":"JMIR Hum Factors"},{"issue":"1","key":"R35","doi-asserted-by":"publisher","first-page":"66","DOI":"10.3945\/ajcn.111.014399","article-title":"Estimating changes in free-living energy intake and its confidence interval","volume":"94","author":"Hall","journal-title":"Am J Clin Nutr"},{"key":"R36","doi-asserted-by":"publisher","DOI":"10.2196\/69466","article-title":"Impact of digital engagement on weight loss outcomes in obesity management among individuals using GLP-1 and dual GLP-1\/GIP receptor agonist therapy: retrospective cohort service evaluation study","volume":"27","author":"Johnson","journal-title":"J Med Internet Res"},{"key":"R37","unstructured":"Digital technologies for delivering multidisciplinary weight-management services: early value assessment. National Institute for Healthcare and Excellence. Mar 6, 2024. URL: https:\/\/www.nice.org.uk\/guidance\/htg700 [Accessed 17-07-2026]"},{"issue":"3","key":"R38","doi-asserted-by":"publisher","DOI":"10.2196\/15294","article-title":"Volumetric food quantification using computer vision on a depth-sensing smartphone: preclinical study","volume":"8","author":"Herzig","journal-title":"JMIR mHealth uHealth"},{"issue":"9","key":"R39","doi-asserted-by":"publisher","DOI":"10.2196\/20317","article-title":"Design and usability evaluation of mobile voice-added food reporting for elderly people: randomized controlled trial","volume":"8","author":"Liu","journal-title":"JMIR mHealth uHealth"},{"key":"R40","doi-asserted-by":"publisher","DOI":"10.1016\/j.nut.2023.112291","article-title":"Can ChatGPT provide appropriate meal plans for NCD patients?","volume":"121","author":"Papastratis","journal-title":"Nutrition"},{"issue":"4","key":"R41","doi-asserted-by":"publisher","DOI":"10.1093\/ckj\/sfaf082","article-title":"From bytes to bites: application of large language models to enhance nutritional recommendations","volume":"18","author":"Bergling","journal-title":"Clin Kidney J"},{"issue":"4","key":"R42","doi-asserted-by":"publisher","DOI":"10.3390\/nu17040607","article-title":"An evaluation of ChatGPT for nutrient content estimation from meal photographs","volume":"17","author":"O\u2019Hara","journal-title":"Nutrients"},{"issue":"9","key":"R43","doi-asserted-by":"publisher","first-page":"1644","DOI":"10.1002\/eat.24483","article-title":"The prevalence of eating disorders and disordered eating in adults seeking obesity treatment: a systematic review with meta-analyses","volume":"58","author":"Melville","journal-title":"Int J Eat Disord"},{"issue":"3","key":"R44","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1001\/archgenpsychiatry.2010.2","article-title":"Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies","volume":"67","author":"Luppino","journal-title":"Arch Gen Psychiatry"},{"issue":"5","key":"R45","doi-asserted-by":"publisher","first-page":"273","DOI":"10.1111\/cob.12203","article-title":"A systematic review of reviews: exploring the relationship between obesity, weight loss and health-related quality of life","volume":"7","author":"Kolotkin","journal-title":"Clin Obes"},{"issue":"12","key":"R46","doi-asserted-by":"publisher","DOI":"10.2196\/33568","article-title":"Optimizing a just-in-time adaptive intervention to improve dietary adherence in behavioral obesity treatment: protocol for a microrandomized trial","volume":"10","author":"Goldstein","journal-title":"JMIR Res Protoc"},{"issue":"6","key":"R47","doi-asserted-by":"publisher","first-page":"989","DOI":"10.1093\/tbm\/ibz137","article-title":"Randomized controlled trial of OnTrack, a just-in-time adaptive intervention designed to enhance weight loss","volume":"9","author":"Forman","journal-title":"Transl Behav Med"}],"container-title":["JMIR Formative Research"],"original-title":[],"language":"en","deposited":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T04:29:15Z","timestamp":1786940955000},"score":1,"resource":{"primary":{"URL":"https:\/\/formative.jmir.org\/2026\/1\/e81112"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,21]]},"references-count":47,"URL":"https:\/\/doi.org\/10.2196\/81112","relation":{},"ISSN":["2561-326X"],"issn-type":[{"value":"2561-326X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,21]]},"article-number":"v10i6e81112"}}