Onnikka Health offers a lifestyle intervention application designed to support weight management. Onnikka® is intended for persons aged 18 to 65 with a body mass index (BMI) of 27 to 40 kg/m2. Contraindications for using the app include a previously diagnosed eating disorder, alcohol or medication dependence, or severe psychiatric illness. [1] The application is based on the weight management method developed at the University of Oulu, which makes use of a cognitive behavioural therapy framework (Health Behaviour Change Support Systems, HBCSS) and persuasive programming (Persuasive Systems Design, PSD) [2,3,4,5].
Onnikka® includes various functionalities for users, including self-monitoring, virtual exercise, positive feedback, reminders, and tips. The Onnikka® lifestyle intervention application helps users to independently observe and possibly change their thoughts, feelings, and behavioural models related to their lifestyles. The application aims to support health-promoting changes in diet while improving health literacy. [1]
Evidence of the methodology on which the product under assessment is based
PrevMetSyn study
The Onnikka® application is based on a web-based weight management method, which has been studied as part of the PrevMetSyn study from 2012 to 2019 [6,7]. The study examined how well group counselling based on cognitive behavioural therapy in conjunction with the web-based weight management method promoted weight loss, as well as the web-based weight management method alone.
The study had 532 participants with the following enrolment criteria: their body mass index (BMI) had to be 27-35 kg/m2 and age between 20 and 60 years; people with health barriers such as pregnancy were not enrolled; no other obesity treatment methods were allowed at the same time; the participants needed to have access to the Internet.
The subjects were randomly divided into three main groups. The main groups were divided into two further subgroups, one using the web-based weight management method and the other not. The main groups were as follows:
- The subjects participated in eight face-to-face nutritional counselling sessions based on cognitive behavioural therapy.
- The subjects participated in two face-to-face nutritional counselling sessions based on face-to-face cognitive behavioural therapy.
- The subjects did not receive face-to-face nutritional counselling.
PrevMetSyn was a two-year follow-up study. The web-based weight management method was used for 52 weeks from the beginning of the study. Of the subjects started the study, 80% attended the one-year intervention follow-up and 70% the two-year follow-up. The results of the study have been published in two peer-reviewed articles. [6,7]
Studies based on the PrevMetSyn data
An article by Teeriniemi et al. studied the impact of the web-based weight management method on the body weight of the subjects based on the PrevMetSyn data. The main outcome of the study was a change in body weight compared to baseline at the 1-year and 2-year follow-ups. The largest weight loss was achieved in the group that participated in eight face-to-face nutritional guidance sessions along with using the web-based weight management method. The subjects achieved a 4.1% (95% CI [-5.4 ─ -2.8], P < 0.001) weight loss at 12 months and a 3.4% (95% CI [-4.8 ─ -2.0], P < 0.001) loss at 24 months. The web-based weight management method, even without nutritional guidance, reduced the average weight by 1.6% in 24 months (95% CI [-2.9 ─ -0.3], P = 0.015).
In all groups using web-based weight management, the highest weight loss was achieved by individuals with a BMI of 30-35 kg/m2. Similarly, all of those using the web-based weight management method had still had a reduced waist circumference even at 24 months. [6] According to the Current Care Guidelines, a weight loss of at least 5% appears to result in beneficial metabolic changes [8].
The goal of the peer-reviewed study, Seon et al., published in 2020, was to investigate the impact of the web-based weight management method on the incidence of metabolic syndrome based on the PrevMetSyn data. The study compared the incidence of metabolic syndrome among the users of a web-based weight management method and other subjects. After two years of follow-up, results showed that the proportion of metabolic syndrome in the group using web-based weight management was significantly lower than in the group not using web-based weight management (33.7% vs. 45,3%, p = .022). The group using web-based weight management had a lower incidence of metabolic syndrome after intervention than the non-using group by 0.50 (OR [0.27–0.90]). In addition, the study suggested that more active use of web-based weight management is associated with a larger reduction in the incidence of metabolic syndrome. [7]
Other studies
A peer-reviewed study published in 2023 evaluated the impact of a weight management method used on a mobile device in the treatment of obesity as a standalone treatment. 200 subjects with an average BMI of 34.3 kg/m2 and aged between 18 and 65 years participated in the study. The study measured the anthropometric (body composition measurement) and metabolic characteristics of the participants. The subjects were randomized to two groups. At the beginning of the study, one group immediately adopted the weight management method used on a mobile device, while the other group waited six months before the introduction of the weight management method used a mobile device. Retention rates were 98.5% at the six-month (6) follow-up and 89.0% at the twelve-month (12) follow-up. At the six-month follow-up it was observed that those receiving immediate access to the application achieved a significantly higher weight loss of -2.3% (95% CI [-3.4 ─ 1.6], p < 0.001) than those who had to wait for the application to be introduced by 0.2%, (95% CI [-0.4 ─ 0.9], p = 0.466; inter-group p < 0.001). Weight loss remained at -2.1% (95% CI [-3.3 ─ 0.9], p = 0.001) in the application user group at 12 months. [9]
Literature reviews
The National Institute for Health and Care Excellence (NICE) has issued recommendations on the use of digital weight management technologies in the UK health care sector. The recommendations evaluate the clinical effectiveness of weight management technologies. [10]
Digital weight management technologies are an integral part of the recommendations, offering an alternative to traditional face-to-face weight management services. Preliminary evidence suggests that the weight loss achieved through the technologies is comparable to traditional services over a two-year period. [10]
The recommendations also noted that diverse weight management programmes covering dietary habits, physical activity and behavioural change techniques can help adults lose weight and maintain weight management for at least 12-18 months. This will increase understanding of how diverse technologies can complement the health care weight management strategy effectively. [11]
Recommendations and previous assessments
The Finnish Food Authority refers to Onnikka as an example of low-threshold lifestyle intervention in conjunction with service chains and operating models. The web-based weight management software has proven to be an effective method in primary health care and has impacts on both weight and cardiovascular health. In particular, the use of Onnikka has been shown to reduce the incidence of metabolic syndrome by up to 71% in the one-third who made most use of the software. [12]
In 2020, the Council for Choices in Health Care in Finland (COHERE Finland) certified Onnikka as an effective lifestyle guidance method. The practices observed in the design of the weight management software, such as information exchange, setting objectives, planning, monitoring and feedback, have proven to be effective. [13] The Current Care Guidelines for the treatment of obesity refer to Onnikka as a potential internet-based treatment of obesity that supports weight loss and weight management in a cost-effective manner [14].
