Preoperative Use of a Mobile Application Within the Multidisciplinary Team Approach – A Randomized Controlled Clinical Trial

BACKGROUND: Preoperative multidisciplinary team assessment (MTA) for bariatric surgery is complex and associated with high attrition rates. Digital health applications may improve patient engagement and completion rates, but evidence remains limited. METHODS: In this prospective randomized controlled trial conducted at a tertiary bariatric center, patients aged ≥ 18 years with obesity II with obesity related medical problems or obesity III were randomized 1:1 to receive either standard multidisciplinary care alone (control group) or standard care plus a smartphone application (app group). The app provided digital checklists, appointment reminders, and automated alerts to healthcare providers for missed appointments. The primary outcome was successful completion of MTA, defined as being scheduled for metabolic and bariatric surgery or achieving sufficient weight loss, assessed at 18 months. RESULTS: Among 223 enrolled participants, 178 (79.8%) completed follow-up (91 control, 87 app group). 115 participants (64.6%) successfully completed the MTA, with no significant difference between groups (62.6% control vs. 66.7% app group, p = 0.5741). However, post hoc stratification by engagement level revealed significant differences: participants with frequent app use (≥ 34% optimal app usage, n = 72) achieved 76.4% successful MTA completion versus 20.0% in low-engagement users (n = 15) and 62.6% in controls (p = 0.0002). Lower baseline BMI independently predicted successful MTA completion. Quality of life improved across all groups, while weight and body composition remained unchanged during the assessment period. CONCLUSION: A mobile health application can enhance completion rates of preoperative bariatric surgery assessment, but effectiveness is associated with user engagement. Digital health interventions should incorporate strategies to promote sustained engagement, with early identification and support for low-usage patients.