There are so many weight loss apps on the market that even Weight Watchers is feeling the pressure, and yet a recent study published in the American Journal of Preventive Medicine found these apps do not employ long-established strategies to bring about behavior change.

Only two apps had 13 out of 20 of the behavioral strategies commonly included in evidence-based behavioral weight-loss interventions from the Diabetes Prevention Program (DPP) Lifestyle Intervention Protocol. The DPP Lifestyle Intervention Protocol is based on a study done between 1994 and 1995, which, of course, predates the smartphone and the widespread adoption of mobile devices in general.

The recent study also mentioned that it was not the only analysis of whether weight loss mobile apps followed longheld guidelines. One of the first, conducted in 2009, was covered by MobiHealthNews. At the time, we pointed out that this kind of study, which only examines whether apps follow existing protocols to determine how effective their weight loss strategies are, is not actually testing efficacy.

The research team also acknowledged this isn't a true efficacy study -- and that more research must be done to "determine the efficacy of weight-loss mobile apps when they are used in combination with physician advice and monitoring."

The published paper includes results from the study of 30 (free and paid) mobile apps found in January 2012 in the Apple App store and Google Play store. The data for the apps was analyzed in June 2012. Some of the apps analyzed included MyNetDiary, Livestrong, Fitbit, LoseIt!, and MyFitnessPal, according to the researchers.

Established behavioral strategies that the research team looked for included weight-loss goals, dietary goals, stimulus control, a food pyramid, and portion control. There were seven behavioral strategies that none of the apps used -- stress reduction, relapse prevention, negative thinking, social cues, developing a regular eating pattern, time management, and nutrition label reading.

MyNetDiary, pro and free versions, included the greatest number of established behavioral strategies (13 out of 20), while Noom Weight Loss and All-in Fitness had the second highest percentage (5 out of 20). MyFitnessPal, Fitbit's app, LoseIt!, Livestrong, and 14 more included 3 out of 20 of the behavioral strategies. The study notes other mobile apps linked to websites that included additional information about behavioral strategies but these were not included because they were not in the apps themselves.

The most common technological feature incorporated in the apps was a food barcode scanner, appearing in about 57 percent of the apps. A little under half the apps, or about 47 percent, had social media capabilities, and 20 percent sent email reminders if tracking lapsed. When comparing paid and free apps, the study found paid apps were no more likely to include any more of the established behavioral strategies than free apps.

Because the study's goal was to "focus exclusively on features accessible via the app, not on an entire multimedia enterprise," some apps that had features at an additional cost were not evaluated. Features could include contact with a coach, companion websites, DVDs, products, magazines, and books. The study also didn't include apps that were targeted to anything other than weight loss, such as diabetes apps -- instead only apps the targeted weight, diet, and physical activity self-monitoring were included in the study.