Review
1Brown School, Washington University in St. Louis, St. Louis, MO, United States
2Department of Physical Education, China University of Geosciences, Beijing, China
3Weill Cornell Medical College, Cornell University, Ithaca, NY, United States
*these authors contributed equally
Corresponding Author:
Jing Shen, PhD
Department of Physical Education, China University of Geosciences
No. 29, Xueyuan Road, Haidian District
Beijing, 100083
China
Phone: 86 010 82322397
Email: shenjing@cugb.edu.cn
Abstract
Background: Obesity is a leading cause of preventable death worldwide. Artificial intelligence (AI), characterized by machine learning (ML) and deep learning (DL), has become an indispensable tool in obesity research.
Objective: This scoping review aimed to provide researchers and practitioners with an overview of the AI applications to obesity research, familiarize them with popular ML and DL models, and facilitate the adoption of AI applications.
Methods: We conducted a scoping review in PubMed and Web of Science on the applications of AI to measure, predict, and treat obesity. We summarized and categorized the AI methodologies used in the hope of identifying synergies, patterns, and trends to inform future investigations. We also provided a high-level, beginner-friendly introduction to the core methodologies to facilitate the dissemination and adoption of various AI techniques.
Results: We identified 46 studies that used diverse ML and DL models to assess obesity-related outcomes. The studies found AI models helpful in detecting clinically meaningful patterns of obesity or relationships between specific covariates and weight outcomes. The majority (18/22, 82%) of the studies comparing AI models with conventional statistical approaches found that the AI models achieved higher prediction accuracy on test data. Some (5/46, 11%) of the studies comparing the performances of different AI models revealed mixed results, indicating the high contingency of model performance on the data set and task it was applied to. An accelerating trend of adopting state-of-the-art DL models over standard ML models was observed to address challenging computer vision and natural language processing tasks. We concisely introduced the popular ML and DL models and summarized their specific applications in the studies included in the review.
Conclusions: This study reviewed AI-related methodologies adopted in the obesity literature, particularly ML and DL models applied to tabular, image, and text data. The review also discussed emerging trends such as multimodal or multitask AI models, synthetic data generation, and human-in-the-loop that may witness increasing applications in obesity research.
doi:10.2196/40589
Keywords
Introduction
Background
The double burden of malnutrition, characterized by the coexistence of overnutrition (eg, overweight and obesity) and undernutrition (eg, stunting and wasting), is present at all levels of the population: country, city, community, household, and individual [The double burden of malnutrition. The Lancet. 2019 Dec 16. URL: https://www.thelancet.com/series/double-burden- malnutrition [accessed 2022-06-18] 1]. Obesity is a leading cause of preventable death and consumes substantial social resources in many high-income and some low- and middle-income economies [An R, Ji M, Zhang S. Global warming and obesity: a systematic review. Obes Rev 2018 Mar;19(2):150-163. [CrossRef] [Medline]2]. Worldwide, the obesity rate has nearly tripled since 1975 [Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014 Aug 30;384(9945):766-781 [FREE Full text] [CrossRef] [Medline]3]. In 2016, 13% of the global population, or 650 million adults, were obese [Obesity and overweight. World Health Organization. URL: https://www.who.int/news- room /fact-sheets/detail/ obesity-and -overweight [accessed 2022-06-18] 4]. More than 340 million children and adolescents aged 5 to 19 years and 39 million children aged <5 years were overweight or obese [Obesity and overweight. World Health Organization. URL: https://www.who.int/news- room /fact-sheets/detail/ obesity-and -overweight [accessed 2022-06-18] 4]. By 2025, the global obesity prevalence is projected to reach 18% among men and 21% among women [NCD Risk Factor Collaboration (NCD-RisC). Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19·2 million participants. Lancet 2016 Apr 02;387(10026):1377-1396 [FREE Full text] [CrossRef] [Medline]5].
Health data are now available to researchers and practitioners in ways and quantities that have never existed before, presenting unprecedented opportunities for advancing health sciences through state-of-the-art data analytics [Sivarajah U, Kamal M, Irani Z, Weerakkody V. Critical analysis of Big Data challenges and analytical methods. J Business Res 2017 Jan;70:263-286 [FREE Full text] [CrossRef]6]. By contrast, dealing with large-scale, complex, unconventional data (eg, text, image, video, and audio) requires innovative analytic tools and computing power only available in recent years [Dash S, Shakyawar S, Sharma M, Kaushik S. Big data in healthcare: management, analysis and future prospects. J Big Data 2019 Jun 19;6(1):54 [FREE Full text] [CrossRef]7,Agrawal R, Prabakaran S. Big data in digital healthcare: lessons learnt and recommendations for general practice. Heredity (Edinb) 2020 Apr;124(4):525-534 [FREE Full text] [CrossRef] [Medline]8]. Artificial intelligence (AI), characterized by machine learning (ML) and deep learning (DL), has become increasingly recognized as an indispensable tool in health sciences, with relevant applications expanding from disease outbreak prediction to medical imaging and patient communication to behavioral modification [Xu Y, Liu X, Cao X, Huang C, Liu E, Qian S, et al. Artificial intelligence: a powerful paradigm for scientific research. Innovation (Camb) 2021 Nov 28;2(4):100179 [FREE Full text] [CrossRef] [Medline]9-Goh YS, Ow Yong JQ, Chee BQ, Kuek JH, Ho CS. Machine learning in health promotion and behavioral change: scoping review. J Med Internet Res 2022 Jun 02;24(6):e35831 [FREE Full text] [CrossRef] [Medline]14]. Over the past decade, an upsurge of the scientific literature adopting AI in health research has been witnessed [Bohr A, Memarzadeh K. The rise of artificial intelligence in healthcare applications. In: Artificial Intelligence in Healthcare. Cambridge, Massachusetts, United States: Academic Press; 2020.15,Rajpurkar P, Chen E, Banerjee O, Topol EJ. AI in health and medicine. Nat Med 2022 Jan;28(1):31-38. [CrossRef] [Medline]16]. These investigations applied a wide range of AI models: from shallow ML algorithms (eg, decision trees (DTs) and k-means clustering) and deep neural networks [Miotto R, Wang F, Wang S, Jiang X, Dudley JT. Deep learning for healthcare: review, opportunities and challenges. Brief Bioinform 2018 Nov 27;19(6):1236-1246 [FREE Full text] [CrossRef] [Medline]17] to various data sources (eg, clinical and observational) and types (eg, tabular, text, and image) [Davenport T, Kalakota R. The potential for artificial intelligence in healthcare. Future Healthc J 2019 Jun;6(2):94-98 [FREE Full text] [CrossRef] [Medline]18]. This boom in AI applications raises many questions [Aung YY, Wong DC, Ting DS. The promise of artificial intelligence: a review of the opportunities and challenges of artificial intelligence in healthcare. Br Med Bull 2021 Sep 10;139(1):4-15. [CrossRef] [Medline]19-Kelly CJ, Karthikesalingam A, Suleyman M, Corrado G, King D. Key challenges for delivering clinical impact with artificial intelligence. BMC Med 2019 Oct 29;17(1):195 [FREE Full text] [CrossRef] [Medline]21]: How do AI-based approaches differ from conventional statistical analyses? Do AI techniques provide additional benefits or advantages over traditional methods? What are the typical AI applications and algorithms applied in obesity research? Is AI a buzzword that will eventually fall out of fashion, or will the upward trend of AI adoption to study obesity continue in the future?
Synthesizing and Disseminating AI Methodologies Adopted in Obesity Research
Three previous studies reviewed the applications of AI in weight loss interventions through diet and exercise [Chew HS, Achananuparp P. Perceptions and needs of artificial intelligence in health care to increase adoption: scoping review. J Med Internet Res 2022 Jan 14;24(1):e32939 [FREE Full text] [CrossRef] [Medline]22-Triantafyllidis AK, Tsanas A. Applications of machine learning in real-life digital health interventions: review of the literature. J Med Internet Res 2019 Apr 05;21(4):e12286 [FREE Full text] [CrossRef] [Medline]24]. They found preliminary but promising evidence regarding the effectiveness of AI-powered tools in decision support and digital health interventions [Chew HS, Achananuparp P. Perceptions and needs of artificial intelligence in health care to increase adoption: scoping review. J Med Internet Res 2022 Jan 14;24(1):e32939 [FREE Full text] [CrossRef] [Medline]22-Triantafyllidis AK, Tsanas A. Applications of machine learning in real-life digital health interventions: review of the literature. J Med Internet Res 2019 Apr 05;21(4):e12286 [FREE Full text] [CrossRef] [Medline]24]. However, to our knowledge, no study has been conducted to summarize AI algorithms, models, and methods applied to obesity research. This study remains the first methodological review on the applications of AI to measure, predict, and treat childhood and adult obesity. It serves 2 purposes: synthesizing and disseminating AI methodologies adopted in obesity research. First, we focused on summarizing and categorizing AI methodologies used in the obesity literature in the hope of identifying synergies, patterns, and trends to inform future scientific investigations. Second, we provided a high-level, beginner-friendly introduction to the core methodologies for interested readers, aiming to facilitate the dissemination and adoption of various AI techniques.
Methods
The scoping review was conducted in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines [Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med 2018 Oct 02;169(7):467-473 [FREE Full text] [CrossRef] [Medline]25].
Study Selection Criteria
Studies that met all of the following criteria were included in the review: (1) study design: experimental or observational studies; (2) analytic approach: use of AI, including ML and DL (ie, deep neural networks), in measuring, predicting, or intervening obesity-related outcomes; (3) study participants: humans of all ages; (4) outcomes: obesity or body weight status (eg, BMI, body fat percentage [BFP], waist circumference [WC], and waist-to-hip ratio [WHR]); (5) article type: original, empirical, and peer-reviewed journal publications; (6) time window of search: from the inception of an electronic bibliographic database to January 1, 2022; and (7) language: articles written in English.
Studies that met any of the following criteria were excluded from the review: (1) studies focusing on outcomes other than obesity (eg, diet, physical activity, energy expenditure, and diabetes); (2) studies that used a rule-based (hard-coded) approach rather than example-based ML or DL; (3) articles not written in English; and (4) letters, editorials, study or review protocols, case reports, and review articles.
Search Strategy
A keyword search was performed in 2 electronic bibliographic databases: PubMed and Web of Science. The search algorithm included all possible combinations of keywords from the following two groups: (1) “artificial intelligence,” “computational intelligence,” “machine intelligence,” “computer reasoning,” “machine learning,” “deep learning,” “neural network,” “neural networks,” or “reinforcement learning” and (2) “obesity,” “obese,” “overweight,” “body mass index,” “BMI,” “adiposity,” “body fat,” “waist circumference,” “waist to hip,” or “waist‐to‐hip.” The Medical Subject Headings terms “artificial intelligence” and “obesity” were included in the PubMed search. Search algorithm used in PubMed.Multimedia Appendix 1
Data Extraction and Synthesis
A standardized data extraction form was used to collect the following methodological and outcome variables from each included study: authors; year of publication; country; data collection period; study design; sample size; training, validation, and test set size; sample characteristics; the proportion of female participants; age range; AI models used; input data source; input data format; input features; outcome data type; outcome measures; unit of analysis; main study findings; and implications for the effectiveness and usefulness of AI in measuring, predicting, or intervening obesity-related outcomes.
Methodological Review
We classified AI methodologies adopted by the included studies into 2 primary categories: ML and DL models. Among the ML models, methods were organized into 2 subcategories: unsupervised and supervised learning. Among the DL models, methods were classified into 3 subcategories: tabular data modeling, computer vision (CV), and natural language processing (NLP). Rather than enumerating every single model performed by the included studies, which is unnecessary and unilluminating, we focused on the popular models used by multiple studies.
Results
Identification of Studies
Figure 1 shows the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram. We identified a total of 3090 articles through the keyword search, and after removing 499 (16.15%) duplicates, 2591 (83.85%) unique articles underwent title and abstract screening. Of these 2591 articles, 2532 (97.72%) were excluded, and the full texts of the remaining 59 (2.28%) were reviewed against the study selection criteria. Of these 59 articles, 13 (22%) were excluded. The reasons for exclusion were as follows: no adoption of AI technologies (1/13, 8%), no obesity-related outcomes (11/13, 85%), and commentary rather than original empirical research (1/13, 8%). Therefore, of the 3090 articles identified initially through the keyword search, 46 (1.49%) were included in the review [Abdel-Aal RE, Mangoud AM. Modeling obesity using abductive networks. Comput Biomed Res 1997 Dec;30(6):451-471. [CrossRef] [Medline]26-Positano V, Cusi K, Santarelli MF, Sironi A, Petz R, Defronzo R, et al. Automatic correction of intensity inhomogeneities improves unsupervised assessment of abdominal fat by MRI. J Magn Reson Imaging 2008 Aug;28(2):403-410. [CrossRef] [Medline]71].

Study Characteristics
Table 1 summarizes the key characteristics of the 46 included studies. An increasing trend in relevant publications was observed. The earliest study included in the review was published in 1997; others were published in, or after, 2008; for example, 2% (1/46) each in 2008, 2012, and 2017; 4% (2/46) each in 2014 and 2016; 7% (3/46) each in 2009 and 2015; 9% (4/46) in 2018; 15% (7/46) in 2019; 20% (9/46) in 2020; and 26% (12/46) in 2021. Of the 46 studies, 16 (35%) were conducted in the United States [Zare S, Thomsen MR, Nayga RM, Goudie A. Use of machine learning to determine the information value of a BMI screening program. Am J Prev Med 2021 Mar;60(3):425-433 [FREE Full text] [CrossRef] [Medline]28,Park HJ, Francisco SC, Pang MR, Peng L, Chi G. Exposure to anti-black lives matter movement and obesity of the black population. Soc Sci Med 2021 Jul 28:114265. [CrossRef] [Medline]32,Pang X, Forrest CB, Lê-Scherban F, Masino AJ. Prediction of early childhood obesity with machine learning and electronic health record data. Int J Med Inform 2021 Jun;150:104454 [FREE Full text] [CrossRef] [Medline]33,Cheng X, Lin S, Liu J, Liu S, Zhang J, Nie P, et al. Does physical activity predict obesity-a machine learning and statistical method-based analysis. Int J Environ Res Public Health 2021 Apr 09;18(8):3966 [FREE Full text] [CrossRef] [Medline]37,Phan L, Yu W, Keralis JM, Mukhija K, Dwivedi P, Brunisholz KD, et al. Google street view derived built environment indicators and associations with state-level obesity, physical activity, and chronic disease mortality in the united states. Int J Environ Res Public Health 2020 May 22;17(10):3659 [FREE Full text] [CrossRef] [Medline]42,Dunstan J, Aguirre M, Bastías M, Nau C, Glass TA, Tobar F. Predicting nationwide obesity from food sales using machine learning. Health Informatics J 2020 Mar;26(1):652-663 [FREE Full text] [CrossRef] [Medline]46,Stephens TN, Joerin A, Rauws M, Werk LN. Feasibility of pediatric obesity and prediabetes treatment support through Tess, the AI behavioral coaching chatbot. Transl Behav Med 2019 May 16;9(3):440-447. [CrossRef] [Medline]48, Scheinker D, Valencia A, Rodriguez F. Identification of factors associated with variation in US county-level obesity prevalence rates using epidemiologic vs machine learning models. JAMA Netw Open 2019 Apr 05;2(4):e192884 [FREE Full text] [CrossRef] [Medline]50-Hammond R, Athanasiadou R, Curado S, Aphinyanaphongs Y, Abrams C, Messito MJ, et al. Predicting childhood obesity using electronic health records and publicly available data. PLoS ONE 2019 Apr 22;14(4):e0215571 [FREE Full text] [CrossRef] [Medline]53,Maharana A, Nsoesie EO. Use of deep learning to examine the association of the built environment with prevalence of neighborhood adult obesity. JAMA Netw Open 2018 Aug 03;1(4):e181535 [FREE Full text] [CrossRef] [Medline]57,Ortega Hinojosa AM, MacLeod KE, Balmes J, Jerrett M. Influence of school environments on childhood obesity in California. Environ Res 2018 Oct;166:100-107. [CrossRef] [Medline]58,Lingren T, Thaker V, Brady C, Namjou B, Kennebeck S, Bickel J, et al. Developing an algorithm to detect early childhood obesity in two tertiary pediatric medical centers. Appl Clin Inform 2016 Jul 20;7(3):693-706 [FREE Full text] [CrossRef] [Medline]60,Nau C, Ellis H, Huang H, Schwartz BS, Hirsch A, Bailey-Davis L, et al. Exploring the forest instead of the trees: an innovative method for defining obesogenic and obesoprotective environments. Health Place 2015 Sep;35:136-146 [FREE Full text] [CrossRef] [Medline]62,Dugan T, Mukhopadhyay S, Carroll A, Downs S. Machine learning techniques for prediction of early childhood obesity. Appl Clin Inform 2017 Dec 19;06(03):506-520 [FREE Full text] [CrossRef]63]; 6 (13%) in China [Yao Y, Song L, Ye J. Motion-to-BMI: using motion sensors to predict the body mass index of smartphone users. Sensors (Basel) 2020 Feb 19;20(4):1134 [FREE Full text] [CrossRef] [Medline]39,Xiao Y, Zhang Y, Sun Y, Tao P, Kuang X. Does green space really matter for residents' obesity? A new perspective from Baidu street view. Front Public Health 2020;8:332 [FREE Full text] [CrossRef] [Medline]40,Fu Y, Gou W, Hu W, Mao Y, Tian Y, Liang X, et al. Integration of an interpretable machine learning algorithm to identify early life risk factors of childhood obesity among preterm infants: a prospective birth cohort. BMC Med 2020 Jul 10;18(1):184 [FREE Full text] [CrossRef] [Medline]45,Wang H, Chang S, Lin W, Chen C, Chiang S, Huang K, et al. Machine learning-based method for obesity risk evaluation using single-nucleotide polymorphisms derived from next-generation sequencing. J Comput Biol 2018 Dec;25(12):1347-1360. [CrossRef] [Medline]56,Chen H, Yang B, Liu D, Liu W, Liu Y, Zhang X, et al. Using blood indexes to predict overweight statuses: an extreme learning machine-based approach. PLoS One 2015;10(11):e0143003 [FREE Full text] [CrossRef] [Medline]64,Shao YE. Body fat percentage prediction using intelligent hybrid approaches. ScientificWorldJournal 2014;2014:383910 [FREE Full text] [CrossRef] [Medline]65]; 3 (7%) each in the United Kingdom [Alkutbe RB, Alruban A, Alturki H, Sattar A, Al-Hazzaa H, Rees G. Fat mass prediction equations and reference ranges for Saudi Arabian Children aged 8-12 years using machine technique method. PeerJ 2021;9:e10734 [FREE Full text] [CrossRef] [Medline]27,Zhang S, Tjortjis C, Zeng X, Qiao H, Buchan I, Keane J. Comparing data mining methods with logistic regression in childhood obesity prediction. Inf Syst Front 2009 Feb 24;11(4):449-460 [FREE Full text] [CrossRef]68,Yang H, Spasic I, Keane JA, Nenadic G. A text mining approach to the prediction of disease status from clinical discharge summaries. J Am Med Inform Assoc 2009;16(4):596-600 [FREE Full text] [CrossRef] [Medline]69] and Korea [Lee K, Kim HY, Lee SJ, Kwon SO, Na S, Hwang HS, Korean Society of Ultrasound in ObstetricsGynecology Research Group. Prediction of newborn's body mass index using nationwide multicenter ultrasound data: a machine-learning study. BMC Pregnancy Childbirth 2021 Mar 02;21(1):172 [FREE Full text] [CrossRef] [Medline]35,Park B, Chung C, Lee MJ, Park H. Accurate neuroimaging biomarkers to predict body mass index in adolescents: a longitudinal study. Brain Imaging Behav 2020 Oct;14(5):1682-1695. [CrossRef] [Medline]43,Shin S, Lee J, Choe S, Yang HI, Min J, Ahn K, et al. Dry electrode-based body fat estimation system with anthropometric data for use in a wearable device. Sensors (Basel) 2019 May 10;19(9):2177 [FREE Full text] [CrossRef] [Medline]49]; 2 (4%) each in Italy [Delnevo G, Mancini G, Roccetti M, Salomoni P, Trombini E, Andrei F. The prediction of body mass index from negative affectivity through machine learning: a confirmatory study. Sensors (Basel) 2021 Mar 29;21(7):2361 [FREE Full text] [CrossRef] [Medline]36,Positano V, Cusi K, Santarelli MF, Sironi A, Petz R, Defronzo R, et al. Automatic correction of intensity inhomogeneities improves unsupervised assessment of abdominal fat by MRI. J Magn Reson Imaging 2008 Aug;28(2):403-410. [CrossRef] [Medline]71], Turkey [Taghiyev A, Altun A, Caglar S. A hybrid approach based on machine learning to identify the causes of obesity. J Control Eng Applied Informatic 2020;22(2):56-66.41,Ergün U. The classification of obesity disease in logistic regression and neural network methods. J Med Syst 2009 Feb;33(1):67-72. [CrossRef] [Medline]70], Finland [Kibble M, Khan SA, Ammad-Ud-Din M, Bollepalli S, Palviainen T, Kaprio J, et al. An integrative machine learning approach to discovering multi-level molecular mechanisms of obesity using data from monozygotic twin pairs. R Soc Open Sci 2020 Oct;7(10):200872 [FREE Full text] [CrossRef] [Medline]44,Seyednasrollah F, Mäkelä J, Pitkänen N, Juonala M, Hutri-Kähönen N, Lehtimäki T, et al. Prediction of adulthood obesity using genetic and childhood clinical risk factors in the cardiovascular risk in young finns study. Circ Cardiovasc Genet 2017 Jun;10(3):e001554 [FREE Full text] [CrossRef] [Medline]59], Germany [Gerl MJ, Klose C, Surma MA, Fernandez C, Melander O, Männistö S, et al. Machine learning of human plasma lipidomes for obesity estimation in a large population cohort. PLoS Biol 2019 Oct;17(10):e3000443 [FREE Full text] [CrossRef] [Medline]54,Duran I, Martakis K, Rehberg M, Semler O, Schoenau E. Diagnostic performance of an artificial neural network to predict excess body fat in children. Pediatr Obes 2019 Feb;14(2):e12494. [CrossRef] [Medline]55], and India [Delnevo G, Mancini G, Roccetti M, Salomoni P, Trombini E, Andrei F. The prediction of body mass index from negative affectivity through machine learning: a confirmatory study. Sensors (Basel) 2021 Mar 29;21(7):2361 [FREE Full text] [CrossRef] [Medline]36,Positano V, Cusi K, Santarelli MF, Sironi A, Petz R, Defronzo R, et al. Automatic correction of intensity inhomogeneities improves unsupervised assessment of abdominal fat by MRI. J Magn Reson Imaging 2008 Aug;28(2):403-410. [CrossRef] [Medline]71]; and 1 (2%) each in Saudi Arabia [Abdel-Aal RE, Mangoud AM. Modeling obesity using abductive networks. Comput Biomed Res 1997 Dec;30(6):451-471. [CrossRef] [Medline]26], Iran [Heydari ST, Ayatollahi SM, Zare N. Comparison of artificial neural networks with logistic regression for detection of obesity. J Med Syst 2012 Aug;36(4):2449-2454. [CrossRef] [Medline]67], Serbia [Kupusinac A, Stokić E, Doroslovački R. Predicting body fat percentage based on gender, age and BMI by using artificial neural networks. Comput Methods Programs Biomed 2014 Feb;113(2):610-619. [CrossRef] [Medline]66], Portugal [Almeida SM, Furtado JM, Mascarenhas P, Ferraz ME, Silva LR, Ferreira JC, et al. Anthropometric predictors of body fat in a large population of 9-year-old school-aged children. Obes Sci Pract 2016 Sep;2(3):272-281 [FREE Full text] [CrossRef] [Medline]61], Spain [Blanes-Selva V, Tortajada S, Vilar R, Valdivieso B, García-Gómez JM. Machine learning-based identification of obesity from positive and unlabelled electronic health records. Stud Health Technol Inform 2020 Jun 16;270:864-868. [CrossRef] [Medline]47], Singapore [Bhanu PK, Arvind CS, Yeow LY, Chen WX, Lim WS, Tan CH. CAFT: a deep learning-based comprehensive abdominal fat analysis tool for large cohort studies. MAGMA 2022 Apr;35(2):205-220. [CrossRef] [Medline]38], Australia [Lin Z, Feng W, Liu Y, Ma C, Arefan D, Zhou D, et al. Machine learning to identify metabolic subtypes of obesity: a multi-center study. Front Endocrinol (Lausanne) 2021;12:713592 [FREE Full text] [CrossRef] [Medline]34], and Indonesia [Thamrin SA, Arsyad DS, Kuswanto H, Lawi A, Nasir S. Predicting obesity in adults using machine learning techniques: an analysis of Indonesian basic health research 2018. Front Nutr 2021;8:669155 [FREE Full text] [CrossRef] [Medline]29]. Of the 46 studies, 32 (70%) adopted a cross-sectional study design [Abdel-Aal RE, Mangoud AM. Modeling obesity using abductive networks. Comput Biomed Res 1997 Dec;30(6):451-471. [CrossRef] [Medline]26,Alkutbe RB, Alruban A, Alturki H, Sattar A, Al-Hazzaa H, Rees G. Fat mass prediction equations and reference ranges for Saudi Arabian Children aged 8-12 years using machine technique method. PeerJ 2021;9:e10734 [FREE Full text] [CrossRef] [Medline]27,Thamrin SA, Arsyad DS, Kuswanto H, Lawi A, Nasir S. Predicting obesity in adults using machine learning techniques: an analysis of Indonesian basic health research 2018. Front Nutr 2021;8:669155 [FREE Full text] [CrossRef] [Medline]29-Park HJ, Francisco SC, Pang MR, Peng L, Chi G. Exposure to anti-black lives matter movement and obesity of the black population. Soc Sci Med 2021 Jul 28:114265. [CrossRef] [Medline]32,Cheng X, Lin S, Liu J, Liu S, Zhang J, Nie P, et al. Does physical activity predict obesity-a machine learning and statistical method-based analysis. Int J Environ Res Public Health 2021 Apr 09;18(8):3966 [FREE Full text] [CrossRef] [Medline]37,Yao Y, Song L, Ye J. Motion-to-BMI: using motion sensors to predict the body mass index of smartphone users. Sensors (Basel) 2020 Feb 19;20(4):1134 [FREE Full text] [CrossRef] [Medline]39-Phan L, Yu W, Keralis JM, Mukhija K, Dwivedi P, Brunisholz KD, et al. Google street view derived built environment indicators and associations with state-level obesity, physical activity, and chronic disease mortality in the united states. Int J Environ Res Public Health 2020 May 22;17(10):3659 [FREE Full text] [CrossRef] [Medline]42,Dunstan J, Aguirre M, Bastías M, Nau C, Glass TA, Tobar F. Predicting nationwide obesity from food sales using machine learning. Health Informatics J 2020 Mar;26(1):652-663 [FREE Full text] [CrossRef] [Medline]46-Scheinker D, Valencia A, Rodriguez F. Identification of factors associated with variation in US county-level obesity prevalence rates using epidemiologic vs machine learning models. JAMA Netw Open 2019 Apr 05;2(4):e192884 [FREE Full text] [CrossRef] [Medline]50,Hong N, Wen A, Stone DJ, Tsuji S, Kingsbury PR, Rasmussen LV, et al. Developing a FHIR-based EHR phenotyping framework: a case study for identification of patients with obesity and multiple comorbidities from discharge summaries. J Biomed Inform 2019 Nov;99:103310 [FREE Full text] [CrossRef] [Medline]52,Duran I, Martakis K, Rehberg M, Semler O, Schoenau E. Diagnostic performance of an artificial neural network to predict excess body fat in children. Pediatr Obes 2019 Feb;14(2):e12494. [CrossRef] [Medline]55-Ortega Hinojosa AM, MacLeod KE, Balmes J, Jerrett M. Influence of school environments on childhood obesity in California. Environ Res 2018 Oct;166:100-107. [CrossRef] [Medline]58,Lingren T, Thaker V, Brady C, Namjou B, Kennebeck S, Bickel J, et al. Developing an algorithm to detect early childhood obesity in two tertiary pediatric medical centers. Appl Clin Inform 2016 Jul 20;7(3):693-706 [FREE Full text] [CrossRef] [Medline]60-Dugan T, Mukhopadhyay S, Carroll A, Downs S. Machine learning techniques for prediction of early childhood obesity. Appl Clin Inform 2017 Dec 19;06(03):506-520 [FREE Full text] [CrossRef]63,Shao YE. Body fat percentage prediction using intelligent hybrid approaches. ScientificWorldJournal 2014;2014:383910 [FREE Full text] [CrossRef] [Medline]65-Positano V, Cusi K, Santarelli MF, Sironi A, Petz R, Defronzo R, et al. Automatic correction of intensity inhomogeneities improves unsupervised assessment of abdominal fat by MRI. J Magn Reson Imaging 2008 Aug;28(2):403-410. [CrossRef] [Medline]71], 7 (15%) a prospective study design [Zare S, Thomsen MR, Nayga RM, Goudie A. Use of machine learning to determine the information value of a BMI screening program. Am J Prev Med 2021 Mar;60(3):425-433 [FREE Full text] [CrossRef] [Medline]28,Pang X, Forrest CB, Lê-Scherban F, Masino AJ. Prediction of early childhood obesity with machine learning and electronic health record data. Int J Med Inform 2021 Jun;150:104454 [FREE Full text] [CrossRef] [Medline]33,Bhanu PK, Arvind CS, Yeow LY, Chen WX, Lim WS, Tan CH. CAFT: a deep learning-based comprehensive abdominal fat analysis tool for large cohort studies. MAGMA 2022 Apr;35(2):205-220. [CrossRef] [Medline]38,Park B, Chung C, Lee MJ, Park H. Accurate neuroimaging biomarkers to predict body mass index in adolescents: a longitudinal study. Brain Imaging Behav 2020 Oct;14(5):1682-1695. [CrossRef] [Medline]43,Fu Y, Gou W, Hu W, Mao Y, Tian Y, Liang X, et al. Integration of an interpretable machine learning algorithm to identify early life risk factors of childhood obesity among preterm infants: a prospective birth cohort. BMC Med 2020 Jul 10;18(1):184 [FREE Full text] [CrossRef] [Medline]45,Gerl MJ, Klose C, Surma MA, Fernandez C, Melander O, Männistö S, et al. Machine learning of human plasma lipidomes for obesity estimation in a large population cohort. PLoS Biol 2019 Oct;17(10):e3000443 [FREE Full text] [CrossRef] [Medline]54,Seyednasrollah F, Mäkelä J, Pitkänen N, Juonala M, Hutri-Kähönen N, Lehtimäki T, et al. Prediction of adulthood obesity using genetic and childhood clinical risk factors in the cardiovascular risk in young finns study. Circ Cardiovasc Genet 2017 Jun;10(3):e001554 [FREE Full text] [CrossRef] [Medline]59], 6 (13%) a retrospective study design [Lin Z, Feng W, Liu Y, Ma C, Arefan D, Zhou D, et al. Machine learning to identify metabolic subtypes of obesity: a multi-center study. Front Endocrinol (Lausanne) 2021;12:713592 [FREE Full text] [CrossRef] [Medline]34-Delnevo G, Mancini G, Roccetti M, Salomoni P, Trombini E, Andrei F. The prediction of body mass index from negative affectivity through machine learning: a confirmatory study. Sensors (Basel) 2021 Mar 29;21(7):2361 [FREE Full text] [CrossRef] [Medline]36,Ramyaa R, Hosseini O, Krishnan GP, Krishnan S. Phenotyping women based on dietary macronutrients, physical activity, and body weight using machine learning tools. Nutrients 2019 Jul 22;11(7):1681 [FREE Full text] [CrossRef] [Medline]51,Hammond R, Athanasiadou R, Curado S, Aphinyanaphongs Y, Abrams C, Messito MJ, et al. Predicting childhood obesity using electronic health records and publicly available data. PLoS ONE 2019 Apr 22;14(4):e0215571 [FREE Full text] [CrossRef] [Medline]53,Chen H, Yang B, Liu D, Liu W, Liu Y, Zhang X, et al. Using blood indexes to predict overweight statuses: an extreme learning machine-based approach. PLoS One 2015;10(11):e0143003 [FREE Full text] [CrossRef] [Medline]64], and 1 (2%) a cotwin control design [Kibble M, Khan SA, Ammad-Ud-Din M, Bollepalli S, Palviainen T, Kaprio J, et al. An integrative machine learning approach to discovering multi-level molecular mechanisms of obesity using data from monozygotic twin pairs. R Soc Open Sci 2020 Oct;7(10):200872 [FREE Full text] [CrossRef] [Medline]44]. Sample sizes varied substantially across the included studies, ranging from 20 to 5,265,265. Of the 46 studies, 7 (15%) had a sample size of between 20 and 82; 11 (24%) between 130 and 600; 19 (41%) between 1061 and 9524; 6 (13%) between 16,553 and 49,805; 2 (4%) between 244,053 and 618,898; and 1 (2%) study had a sample size of 5,265,265. Of the 46 studies, 23 (50%) focused on adults, 14 (30%) on children and adolescents, 1 (2%) on people of all ages, and the remaining 8 (17%) did not report the age range of participants.
Authors, year | Country | Data collection period | Study design | Sample size | Training set size | Validation set size; test set size | Sample characteristics | Female participants (%) | Age (years) | AIa model |
Abdel-Aal and Mangoud [Abdel-Aal RE, Mangoud AM. Modeling obesity using abductive networks. Comput Biomed Res 1997 Dec;30(6):451-471. [CrossRef] [Medline]26], 1997 | Saudi Arabia | 1995 | Cross-sectional | 1100 | 800 | N/A; 300 | Patients | N/Ab | ≥20 | NNc (AIMd abductive) |
Positano et al [Positano V, Cusi K, Santarelli MF, Sironi A, Petz R, Defronzo R, et al. Automatic correction of intensity inhomogeneities improves unsupervised assessment of abdominal fat by MRI. J Magn Reson Imaging 2008 Aug;28(2):403-410. [CrossRef] [Medline]71], 2008 | Italy | N/A | Cross-sectional | 20 | N/A | N/A | Participants with varying levels of obesity | N/A | Mean 52 (SD 16) | Fuzzy c-means |
Ergün [Ergün U. The classification of obesity disease in logistic regression and neural network methods. J Med Syst 2009 Feb;33(1):67-72. [CrossRef] [Medline]70], 2009 | Turkey | N/A | Cross-sectional | 82 | 41 | N/A; 41 | Participants with different ranges of obesity | N/A | N/A | LRe, MLPf |
Yang et al [Yang H, Spasic I, Keane JA, Nenadic G. A text mining approach to the prediction of disease status from clinical discharge summaries. J Am Med Inform Assoc 2009;16(4):596-600 [FREE Full text] [CrossRef] [Medline]69], 2009 | United Kingdom | N/A | Cross-sectional | 507 | N/A | N/A | Patients | N/A | N/A | SVMg |
Zhang et al [Zhang S, Tjortjis C, Zeng X, Qiao H, Buchan I, Keane J. Comparing data mining methods with logistic regression in childhood obesity prediction. Inf Syst Front 2009 Feb 24;11(4):449-460 [FREE Full text] [CrossRef]68], 2009 | United Kingdom | 1988 to 2003 | Cross-sectional | 16,553 | 11,091 | N/A; 5462 | Children | N/A | Birth to 3 | NBh, SVM, DTi, NN |
Heydari et al [Heydari ST, Ayatollahi SM, Zare N. Comparison of artificial neural networks with logistic regression for detection of obesity. J Med Syst 2012 Aug;36(4):2449-2454. [CrossRef] [Medline]67], 2012 | Iran | 2010 | Cross-sectional | 414 | 248 | N/A; 104 | Healthy military personnel | N/A | Mean 34.4 (SD 7.5) | NN, LR |
Kupusinac et al [Kupusinac A, Stokić E, Doroslovački R. Predicting body fat percentage based on gender, age and BMI by using artificial neural networks. Comput Methods Programs Biomed 2014 Feb;113(2):610-619. [CrossRef] [Medline]66], 2014 | Serbia | N/A | Cross-sectional | 2755 | 1929 | 413; 413 | Adults | 48.3 | 18 to 88 | NN |
Shao [Shao YE. Body fat percentage prediction using intelligent hybrid approaches. ScientificWorldJournal 2014;2014:383910 [FREE Full text] [CrossRef] [Medline]65], 2014 | China | N/A | Cross-sectional | 248 | 174 | N/A; 74 | N/A | N/A | N/A | MRj, MARSk, SVM, NN |
Chen et al [Chen H, Yang B, Liu D, Liu W, Liu Y, Zhang X, et al. Using blood indexes to predict overweight statuses: an extreme learning machine-based approach. PLoS One 2015;10(11):e0143003 [FREE Full text] [CrossRef] [Medline]64], 2015 | China | N/A | Retrospective | 476 | N/A | N/A | Participants with different ranges of obesity | 62.4 | 22 to 82 | NN (ELMl) |
Dugan et al [Dugan T, Mukhopadhyay S, Carroll A, Downs S. Machine learning techniques for prediction of early childhood obesity. Appl Clin Inform 2017 Dec 19;06(03):506-520 [FREE Full text] [CrossRef]63], 2015 | United States | N/A | Cross-sectional | 7519 | 6767 | N/A; 752 | Children | 49 | 2 to 10 | DT, RFm, NB, NN (BNn) |
Nau et al [Nau C, Ellis H, Huang H, Schwartz BS, Hirsch A, Bailey-Davis L, et al. Exploring the forest instead of the trees: an innovative method for defining obesogenic and obesoprotective environments. Health Place 2015 Sep;35:136-146 [FREE Full text] [CrossRef] [Medline]62], 2015 | United States | 2010 | Cross-sectional | 22,497 | 15,073 | N/A; 7424 | Children | N/A | 10 to 18 | RF |
Almeida et al [Almeida SM, Furtado JM, Mascarenhas P, Ferraz ME, Silva LR, Ferreira JC, et al. Anthropometric predictors of body fat in a large population of 9-year-old school-aged children. Obes Sci Pract 2016 Sep;2(3):272-281 [FREE Full text] [CrossRef] [Medline]61], 2016 | Portugal | 2009 to 2013 | Cross-sectional | 3084 | 1537 | N/A; 664 | School-age children | 49.7 | 9 | LR, NN |
Lingren et al [Lingren T, Thaker V, Brady C, Namjou B, Kennebeck S, Bickel J, et al. Developing an algorithm to detect early childhood obesity in two tertiary pediatric medical centers. Appl Clin Inform 2016 Jul 20;7(3):693-706 [FREE Full text] [CrossRef] [Medline]60], 2016 | United States | N/A | Cross-sectional | 428 | 257 | N/A; 86 | Children | N/A | 1 to 6 | SVM, NB |
Seyednasrollah et al et al [Seyednasrollah F, Mäkelä J, Pitkänen N, Juonala M, Hutri-Kähönen N, Lehtimäki T, et al. Prediction of adulthood obesity using genetic and childhood clinical risk factors in the cardiovascular risk in young finns study. Circ Cardiovasc Genet 2017 Jun;10(3):e001554 [FREE Full text] [CrossRef] [Medline]59], 2017 | Finland | 1980 to 2012 | Prospective | 2262 | 1625 | N/A; 637 | Adults | N/A | ≥18 | GBo |
Hinojosa et al [Ortega Hinojosa AM, MacLeod KE, Balmes J, Jerrett M. Influence of school environments on childhood obesity in California. Environ Res 2018 Oct;166:100-107. [CrossRef] [Medline]58], 2018 | United States | 2003 to 2007 | Cross-sectional | 5,265,265 | N/A | N/A | School-age children: grades 5, 7, and 9 | N/A | N/A | RF |
Maharana and Nsoesie [Maharana A, Nsoesie EO. Use of deep learning to examine the association of the built environment with prevalence of neighborhood adult obesity. JAMA Netw Open 2018 Aug 03;1(4):e181535 [FREE Full text] [CrossRef] [Medline]57], 2018 | United States | 2017 | Cross-sectional | 1695 | 508 | N/A; 339 | Adults | N/A | ≥18 | NN (CNNp) |
Wang et al [Wang H, Chang S, Lin W, Chen C, Chiang S, Huang K, et al. Machine learning-based method for obesity risk evaluation using single-nucleotide polymorphisms derived from next-generation sequencing. J Comput Biol 2018 Dec;25(12):1347-1360. [CrossRef] [Medline]56], 2018 | China | 2014 to 2015 | Cross-sectional | 139 | 111 | N/A; 28 | Participants with different ranges of obesity | 36.7 | 27 to 53 | SVM, KNNq, DT, LR |
Duran et al [Duran I, Martakis K, Rehberg M, Semler O, Schoenau E. Diagnostic performance of an artificial neural network to predict excess body fat in children. Pediatr Obes 2019 Feb;14(2):e12494. [CrossRef] [Medline]55], 2018 | Germany | 1999 to 2004 | Cross-sectional | 1999 | 1333 | N/A; 666 | Children | 42.8 | 8 to 19 | NN |
Gerl et al [Gerl MJ, Klose C, Surma MA, Fernandez C, Melander O, Männistö S, et al. Machine learning of human plasma lipidomes for obesity estimation in a large population cohort. PLoS Biol 2019 Oct;17(10):e3000443 [FREE Full text] [CrossRef] [Medline]54], 2019 | Germany | 2012; 1991 to 1994 | Prospective | 1061 | 796 | 206; 250 | N/A | 53.8 | N/A | Cubist, LASSOr, PLSs, GB, RF, LMt |
Hammond et al [Hammond R, Athanasiadou R, Curado S, Aphinyanaphongs Y, Abrams C, Messito MJ, et al. Predicting childhood obesity using electronic health records and publicly available data. PLoS ONE 2019 Apr 22;14(4):e0215571 [FREE Full text] [CrossRef] [Medline]53], 2019 | United States | 2008 to 2016 | Retrospective | 3449 | 482 | N/A; 207 | Children | 49.2 | 4.5 to 5.5 | LASSO, RF, GB |
Hong et al [Hong N, Wen A, Stone DJ, Tsuji S, Kingsbury PR, Rasmussen LV, et al. Developing a FHIR-based EHR phenotyping framework: a case study for identification of patients with obesity and multiple comorbidities from discharge summaries. J Biomed Inform 2019 Nov;99:103310 [FREE Full text] [CrossRef] [Medline]52], 2019 | United States | 2008 | Cross-sectional | 1237 | 1400 | N/A; 600 | Patients | N/A | ≥18 | LR, SVM, DT, RF |
Ramyaa et al [Ramyaa R, Hosseini O, Krishnan GP, Krishnan S. Phenotyping women based on dietary macronutrients, physical activity, and body weight using machine learning tools. Nutrients 2019 Jul 22;11(7):1681 [FREE Full text] [CrossRef] [Medline]51], 2019 | United States | 1993 to 1994 | Retrospective | 48,508 | 33,956 | N/A; 14,552 | Postmenopausal women | 100 | 50 to 79 | SVM, KNN, DT, PCAu, RF, NN |
Scheinker et al [Scheinker D, Valencia A, Rodriguez F. Identification of factors associated with variation in US county-level obesity prevalence rates using epidemiologic vs machine learning models. JAMA Netw Open 2019 Apr 05;2(4):e192884 [FREE Full text] [CrossRef] [Medline]50], 2019 | United States | 2018 | Cross-sectional | 3138 | N/A | N/A | Census population | 49.9 | All ages | LM, GB |
Shin et al [Shin S, Lee J, Choe S, Yang HI, Min J, Ahn K, et al. Dry electrode-based body fat estimation system with anthropometric data for use in a wearable device. Sensors (Basel) 2019 May 10;19(9):2177 [FREE Full text] [CrossRef] [Medline]49], 2019 | Korea | N/A | Cross-sectional | 163 | 143 | N/A; 20 | Amateur athletes | 37.4 | 17 to 25 | NN |
Stephens et al [Stephens TN, Joerin A, Rauws M, Werk LN. Feasibility of pediatric obesity and prediabetes treatment support through Tess, the AI behavioral coaching chatbot. Transl Behav Med 2019 May 16;9(3):440-447. [CrossRef] [Medline]48], 2019 | United States | N/A | Cross-sectional | 23 | N/A | N/A | Youth with obesity symptoms | 57 | Range 9.78-18.54 | NN |
Blanes-Selva et al [Blanes-Selva V, Tortajada S, Vilar R, Valdivieso B, García-Gómez JM. Machine learning-based identification of obesity from positive and unlabelled electronic health records. Stud Health Technol Inform 2020 Jun 16;270:864-868. [CrossRef] [Medline]47], 2020 | Spain | N/A | Cross-sectional | 49,805 | 39,844 | N/A; 9961 | Patients | N/A | N/A | PUv learning |
Dunstan et al [Dunstan J, Aguirre M, Bastías M, Nau C, Glass TA, Tobar F. Predicting nationwide obesity from food sales using machine learning. Health Informatics J 2020 Mar;26(1):652-663 [FREE Full text] [CrossRef] [Medline]46], 2020 | United States | 2008 | Cross-sectional | 79 | N/A | N/A | Adults | N/A | ≥20 | SVM, RF, GB |
Fu et al [Fu Y, Gou W, Hu W, Mao Y, Tian Y, Liang X, et al. Integration of an interpretable machine learning algorithm to identify early life risk factors of childhood obesity among preterm infants: a prospective birth cohort. BMC Med 2020 Jul 10;18(1):184 [FREE Full text] [CrossRef] [Medline]45], 2020 | China | 1999 to 2003 | Prospective | 2125 | 1143 | 381; 382 | Children | 40.6 | 4 to 7 | GB |
Kibble et al [Kibble M, Khan SA, Ammad-Ud-Din M, Bollepalli S, Palviainen T, Kaprio J, et al. An integrative machine learning approach to discovering multi-level molecular mechanisms of obesity using data from monozygotic twin pairs. R Soc Open Sci 2020 Oct;7(10):200872 [FREE Full text] [CrossRef] [Medline]44], 2020 | Finland | N/A | Cotwin control | 43 | N/A | N/A | Young adult monozygotic twin pairs | 53 | 22 to 36 | GFAw |
Park et al [Park B, Chung C, Lee MJ, Park H. Accurate neuroimaging biomarkers to predict body mass index in adolescents: a longitudinal study. Brain Imaging Behav 2020 Oct;14(5):1682-1695. [CrossRef] [Medline]43], 2020 | Korea | N/A | Prospective | 76 | 75 | N/A; 1 | Adolescents | 6.8; N/A | Mean 11.94 (SD 3.13); mean 13.42 (SD 3.25) | LASSO |
Phan et al [Phan L, Yu W, Keralis JM, Mukhija K, Dwivedi P, Brunisholz KD, et al. Google street view derived built environment indicators and associations with state-level obesity, physical activity, and chronic disease mortality in the united states. Int J Environ Res Public Health 2020 May 22;17(10):3659 [FREE Full text] [CrossRef] [Medline]42], 2020 | United States | 2017 to 2018 | Cross-sectional | 18,700 images | 14,960 | N/A; 3740 | Adolescents and adults | N/A | N/A | LM, NN (CNN) |
Taghiyev et al [Taghiyev A, Altun A, Caglar S. A hybrid approach based on machine learning to identify the causes of obesity. J Control Eng Applied Informatic 2020;22(2):56-66.41], 2020 | Turkey | 2019 | Cross-sectional | 500 | 325 | N/A; 175 | Female patients | 100 | ≥18 | DT, LR |
Xiao et al [Xiao Y, Zhang Y, Sun Y, Tao P, Kuang X. Does green space really matter for residents' obesity? A new perspective from Baidu street view. Front Public Health 2020;8:332 [FREE Full text] [CrossRef] [Medline]40], 2020 | China | 2007 to 2010 | Cross-sectional | 9524 | N/A | N/A | Residents | 54 | ≥18 | LR, NN (CNN) |
Yao et al [Yao Y, Song L, Ye J. Motion-to-BMI: using motion sensors to predict the body mass index of smartphone users. Sensors (Basel) 2020 Feb 19;20(4):1134 [FREE Full text] [CrossRef] [Medline]39], 2020 | China | N/A | Cross-sectional | 67; 24 | N/A | N/A | Smartphone users | N/A; 41.7 | Mean 25.19; range 18-46 | NN |
Alkutbe et al [Alkutbe RB, Alruban A, Alturki H, Sattar A, Al-Hazzaa H, Rees G. Fat mass prediction equations and reference ranges for Saudi Arabian Children aged 8-12 years using machine technique method. PeerJ 2021;9:e10734 [FREE Full text] [CrossRef] [Medline]27], 2021 | United Kingdom | 2014; 2015 to 2016 | Cross-sectional | 1223 | 977 | N/A; 246 | Children | 61.8 | 8 to 12 | GB |
Bhanu et al [Bhanu PK, Arvind CS, Yeow LY, Chen WX, Lim WS, Tan CH. CAFT: a deep learning-based comprehensive abdominal fat analysis tool for large cohort studies. MAGMA 2022 Apr;35(2):205-220. [CrossRef] [Medline]38], 2021 | Singapore | 2003 to 2006 | Prospective | 130 | 104 | N/A; 26 | Older adults | 69.5 | Mean 67.85 (SD 7.90) | NN (U-Net) |
Cheng et al [Cheng X, Lin S, Liu J, Liu S, Zhang J, Nie P, et al. Does physical activity predict obesity-a machine learning and statistical method-based analysis. Int J Environ Res Public Health 2021 Apr 09;18(8):3966 [FREE Full text] [CrossRef] [Medline]37], 2021 | United States | 2003 to 2004; 2005 to 2006 | Cross-sectional | 7162 | N/A | N/A | Adults | 48.6 | 20 to 85 | NB, KNN, MEFCx, DT, NN (MLP) |
Delnevo et al [Delnevo G, Mancini G, Roccetti M, Salomoni P, Trombini E, Andrei F. The prediction of body mass index from negative affectivity through machine learning: a confirmatory study. Sensors (Basel) 2021 Mar 29;21(7):2361 [FREE Full text] [CrossRef] [Medline]36], 2021 | Italy | N/A | Retrospective | 221 | 176 | N/A; 45 | Participants with different ranges of obesity | N/A | N/A | GB, RF |
Lee et al [Lee K, Kim HY, Lee SJ, Kwon SO, Na S, Hwang HS, Korean Society of Ultrasound in ObstetricsGynecology Research Group. Prediction of newborn's body mass index using nationwide multicenter ultrasound data: a machine-learning study. BMC Pregnancy Childbirth 2021 Mar 02;21(1):172 [FREE Full text] [CrossRef] [Medline]35], 2021 | Korea | 2015 to 2020 | Retrospective | 3159 | 2370 | N/A; 789 | Obstetric patients and their newborns | 100 | 20 to 44 | LM, RF, NN |
Lin et al [Lin Z, Feng W, Liu Y, Ma C, Arefan D, Zhou D, et al. Machine learning to identify metabolic subtypes of obesity: a multi-center study. Front Endocrinol (Lausanne) 2021;12:713592 [FREE Full text] [CrossRef] [Medline]34], 2021 | Australia | 2010 to 2019 | Retrospective | 2495 | 882 | N/A; 1613 | Participants with different ranges of obesity | 67.4 | 21 to 36 | Two-step cluster analysis, k-means |
Pang et al [Pang X, Forrest CB, Lê-Scherban F, Masino AJ. Prediction of early childhood obesity with machine learning and electronic health record data. Int J Med Inform 2021 Jun;150:104454 [FREE Full text] [CrossRef] [Medline]33], 2021 | United States | 2009 to 2017 | Prospective | 27,203 | 21,762 | N/A; 5441 | Children | 49.2 | <2 | DT, NB, LR, SVM, GB, NN |
Park et al [Park HJ, Francisco SC, Pang MR, Peng L, Chi G. Exposure to anti-black lives matter movement and obesity of the black population. Soc Sci Med 2021 Jul 28:114265. [CrossRef] [Medline]32], 2021 | United States | 2014 to 2016 | Cross-sectional | 5000 tweets | 4500 | N/A; 500 | Twitter users | 60.7 | Mean 51.91 (SD 17.20) | NB, SVM, NN (CNN, LSTMy) |
Rashmi et al [Rashmi R, Umapathy S, Krishnan P. Thermal imaging method to evaluate childhood obesity based on machine learning techniques. Int J Imaging Syst Technol 2021 Mar 20;31(3):1752-1768 [FREE Full text] [CrossRef]31], 2021 | India | 2020 | Cross-sectional | 600 images | 420 | 120; 60 | Children | 50 | 8 to 11 | SVM, NB, RF |
Snekhalatha and Sangamithirai [U S, K. PT, K S. Computer aided diagnosis of obesity based on thermal imaging using various convolutional neural networks. Biomed Signal Process Control 2021 Jan;63:102233 [FREE Full text] [CrossRef]30], 2021 | India | N/A | Cross-sectional | 2700 images | 2000 | 500; 200 | Adults | N/A | Mean 45 (SD 2.5) | NN (VGG, ResNet, DenseNet) |
Thamrin et al [Thamrin SA, Arsyad DS, Kuswanto H, Lawi A, Nasir S. Predicting obesity in adults using machine learning techniques: an analysis of Indonesian basic health research 2018. Front Nutr 2021;8:669155 [FREE Full text] [CrossRef] [Medline]29], 2021 | Indonesia | 2018 | Cross-sectional | 618,898 | 557,008 | N/A; 61,890 | Adults | N/A | ≥18 | DT, NB, LR |
Zare et al [Zare S, Thomsen MR, Nayga RM, Goudie A. Use of machine learning to determine the information value of a BMI screening program. Am J Prev Med 2021 Mar;60(3):425-433 [FREE Full text] [CrossRef] [Medline]28], 2021 | United States | 2003 to 2019 | Prospective | 244,053 | 162,702 | N/A; 81,351 | Children | 49 | 5 to 6 | DT, LR, RF, NN |
aAI: artificial intelligence.
bN/A: not applicable.
cNN: neural network.
dAIM: abductory induction mechanism.
eLR: logistic regression.
fMLP: multilayer perceptron.
gSVM: support vector machine.
hNB: naïve Bayes.
iDT: decision tree.
jMR: multiple regression.
kMARS: multivariate adaptive regression splines.
lELM: extreme learning machine.
mRF: random forest.
nBN: BayesNet.
oGB: gradient boosting.
pCNN: convolutional neural network.
qKNN: k-nearest neighbor.
rLASSO: least absolute shrinkage and selection operator.
sPLS: partial least squares.
tLM: linear model.
uPCA: principal component analysis.
vPU: positive and unlabeled.
wGFA: group factor analysis.
xMEFC: multiobjective evolutionary fuzzy classifier.
yLSTM: long short-term memory.
Data Sources and Outcome Measures
Table 2 summarizes the data sources and outcome measures of the studies included in the review. Input data were obtained from a variety of sources, including health surveys (eg, National Health and Nutrition Examination Survey), electronic health records, magnetic resonance imaging (MRI) scans, social media data (eg, tweets), and geographically aggregated data sets (eg, InfoUSA and Dun & Bradstreet). Of the 46 studies, 34 (74%) analyzed tabular data (eg, spreadsheet data) [Abdel-Aal RE, Mangoud AM. Modeling obesity using abductive networks. Comput Biomed Res 1997 Dec;30(6):451-471. [CrossRef] [Medline]26-Thamrin SA, Arsyad DS, Kuswanto H, Lawi A, Nasir S. Predicting obesity in adults using machine learning techniques: an analysis of Indonesian basic health research 2018. Front Nutr 2021;8:669155 [FREE Full text] [CrossRef] [Medline]29,Pang X, Forrest CB, Lê-Scherban F, Masino AJ. Prediction of early childhood obesity with machine learning and electronic health record data. Int J Med Inform 2021 Jun;150:104454 [FREE Full text] [CrossRef] [Medline]33-Cheng X, Lin S, Liu J, Liu S, Zhang J, Nie P, et al. Does physical activity predict obesity-a machine learning and statistical method-based analysis. Int J Environ Res Public Health 2021 Apr 09;18(8):3966 [FREE Full text] [CrossRef] [Medline]37,Yao Y, Song L, Ye J. Motion-to-BMI: using motion sensors to predict the body mass index of smartphone users. Sensors (Basel) 2020 Feb 19;20(4):1134 [FREE Full text] [CrossRef] [Medline]39,Taghiyev A, Altun A, Caglar S. A hybrid approach based on machine learning to identify the causes of obesity. J Control Eng Applied Informatic 2020;22(2):56-66.41,Kibble M, Khan SA, Ammad-Ud-Din M, Bollepalli S, Palviainen T, Kaprio J, et al. An integrative machine learning approach to discovering multi-level molecular mechanisms of obesity using data from monozygotic twin pairs. R Soc Open Sci 2020 Oct;7(10):200872 [FREE Full text] [CrossRef] [Medline]44-Blanes-Selva V, Tortajada S, Vilar R, Valdivieso B, García-Gómez JM. Machine learning-based identification of obesity from positive and unlabelled electronic health records. Stud Health Technol Inform 2020 Jun 16;270:864-868. [CrossRef] [Medline]47,Shin S, Lee J, Choe S, Yang HI, Min J, Ahn K, et al. Dry electrode-based body fat estimation system with anthropometric data for use in a wearable device. Sensors (Basel) 2019 May 10;19(9):2177 [FREE Full text] [CrossRef] [Medline]49-Ramyaa R, Hosseini O, Krishnan GP, Krishnan S. Phenotyping women based on dietary macronutrients, physical activity, and body weight using machine learning tools. Nutrients 2019 Jul 22;11(7):1681 [FREE Full text] [CrossRef] [Medline]51,Hammond R, Athanasiadou R, Curado S, Aphinyanaphongs Y, Abrams C, Messito MJ, et al. Predicting childhood obesity using electronic health records and publicly available data. PLoS ONE 2019 Apr 22;14(4):e0215571 [FREE Full text] [CrossRef] [Medline]53-Wang H, Chang S, Lin W, Chen C, Chiang S, Huang K, et al. Machine learning-based method for obesity risk evaluation using single-nucleotide polymorphisms derived from next-generation sequencing. J Comput Biol 2018 Dec;25(12):1347-1360. [CrossRef] [Medline]56,Ortega Hinojosa AM, MacLeod KE, Balmes J, Jerrett M. Influence of school environments on childhood obesity in California. Environ Res 2018 Oct;166:100-107. [CrossRef] [Medline]58-Zhang S, Tjortjis C, Zeng X, Qiao H, Buchan I, Keane J. Comparing data mining methods with logistic regression in childhood obesity prediction. Inf Syst Front 2009 Feb 24;11(4):449-460 [FREE Full text] [CrossRef]68,Ergün U. The classification of obesity disease in logistic regression and neural network methods. J Med Syst 2009 Feb;33(1):67-72. [CrossRef] [Medline]70], 8 (17%) analyzed digital image data [U S, K. PT, K S. Computer aided diagnosis of obesity based on thermal imaging using various convolutional neural networks. Biomed Signal Process Control 2021 Jan;63:102233 [FREE Full text] [CrossRef]30,Rashmi R, Umapathy S, Krishnan P. Thermal imaging method to evaluate childhood obesity based on machine learning techniques. Int J Imaging Syst Technol 2021 Mar 20;31(3):1752-1768 [FREE Full text] [CrossRef]31,Bhanu PK, Arvind CS, Yeow LY, Chen WX, Lim WS, Tan CH. CAFT: a deep learning-based comprehensive abdominal fat analysis tool for large cohort studies. MAGMA 2022 Apr;35(2):205-220. [CrossRef] [Medline]38,Xiao Y, Zhang Y, Sun Y, Tao P, Kuang X. Does green space really matter for residents' obesity? A new perspective from Baidu street view. Front Public Health 2020;8:332 [FREE Full text] [CrossRef] [Medline]40,Phan L, Yu W, Keralis JM, Mukhija K, Dwivedi P, Brunisholz KD, et al. Google street view derived built environment indicators and associations with state-level obesity, physical activity, and chronic disease mortality in the united states. Int J Environ Res Public Health 2020 May 22;17(10):3659 [FREE Full text] [CrossRef] [Medline]42,Park B, Chung C, Lee MJ, Park H. Accurate neuroimaging biomarkers to predict body mass index in adolescents: a longitudinal study. Brain Imaging Behav 2020 Oct;14(5):1682-1695. [CrossRef] [Medline]43,Maharana A, Nsoesie EO. Use of deep learning to examine the association of the built environment with prevalence of neighborhood adult obesity. JAMA Netw Open 2018 Aug 03;1(4):e181535 [FREE Full text] [CrossRef] [Medline]57,Positano V, Cusi K, Santarelli MF, Sironi A, Petz R, Defronzo R, et al. Automatic correction of intensity inhomogeneities improves unsupervised assessment of abdominal fat by MRI. J Magn Reson Imaging 2008 Aug;28(2):403-410. [CrossRef] [Medline]71], and 4 (9%) analyzed text data [Park HJ, Francisco SC, Pang MR, Peng L, Chi G. Exposure to anti-black lives matter movement and obesity of the black population. Soc Sci Med 2021 Jul 28:114265. [CrossRef] [Medline]32,Stephens TN, Joerin A, Rauws M, Werk LN. Feasibility of pediatric obesity and prediabetes treatment support through Tess, the AI behavioral coaching chatbot. Transl Behav Med 2019 May 16;9(3):440-447. [CrossRef] [Medline]48,Hong N, Wen A, Stone DJ, Tsuji S, Kingsbury PR, Rasmussen LV, et al. Developing a FHIR-based EHR phenotyping framework: a case study for identification of patients with obesity and multiple comorbidities from discharge summaries. J Biomed Inform 2019 Nov;99:103310 [FREE Full text] [CrossRef] [Medline]52,Yang H, Spasic I, Keane JA, Nenadic G. A text mining approach to the prediction of disease status from clinical discharge summaries. J Am Med Inform Assoc 2009;16(4):596-600 [FREE Full text] [CrossRef] [Medline]69]. Obesity-related measures used across the studies included anthropometrics (eg, body weight, BMI, BFP, WC, and WHR) and biomarkers.
Authors, year | Input data source | Input data format | Input features (independent variables) | Outcome data type | Outcome measures | Unit of analysis |
Abdel-Aal and Mangoud [Abdel-Aal RE, Mangoud AM. Modeling obesity using abductive networks. Comput Biomed Res 1997 Dec;30(6):451-471. [CrossRef] [Medline]26], 1997 | Medical survey data | Tabular | 13 health parameters | Continuous | WHRa | Individual |
Positano et al [Positano V, Cusi K, Santarelli MF, Sironi A, Petz R, Defronzo R, et al. Automatic correction of intensity inhomogeneities improves unsupervised assessment of abdominal fat by MRI. J Magn Reson Imaging 2008 Aug;28(2):403-410. [CrossRef] [Medline]71], 2008 | MRIb | Image | Subcutaneous adipose tissue and visceral adipose tissue | Binary | Abdominal adipose tissue distribution | Individual |
Ergün [Ergün U. The classification of obesity disease in logistic regression and neural network methods. J Med Syst 2009 Feb;33(1):67-72. [CrossRef] [Medline]70], 2009 | Obtained from participants | Tabular | 24 obesity parameters | Binary | Classification of obesity | Individual |
Yang et al [Yang H, Spasic I, Keane JA, Nenadic G. A text mining approach to the prediction of disease status from clinical discharge summaries. J Am Med Inform Assoc 2009;16(4):596-600 [FREE Full text] [CrossRef] [Medline]69], 2009 | Clinical data | Text | Clinical discharge summaries | Binary | Obesity status | Individual |
Zhang et al [Zhang S, Tjortjis C, Zeng X, Qiao H, Buchan I, Keane J. Comparing data mining methods with logistic regression in childhood obesity prediction. Inf Syst Front 2009 Feb 24;11(4):449-460 [FREE Full text] [CrossRef]68], 2009 | Objective measure | Tabular | Data recorded regarding the weight of the child during the first 2 years of the child’s life | Binary | Obesity | Individual |
Heydari et al [Heydari ST, Ayatollahi SM, Zare N. Comparison of artificial neural networks with logistic regression for detection of obesity. J Med Syst 2012 Aug;36(4):2449-2454. [CrossRef] [Medline]67], 2012 | Questionnaire and objective measure | Tabular | Age, systole, diastole, weight, height, BMI, WCc, HCd, and triceps skinfold and abdominal thicknesses | Binary | Obesity | Individual |
Kupusinac et al [Kupusinac A, Stokić E, Doroslovački R. Predicting body fat percentage based on gender, age and BMI by using artificial neural networks. Comput Methods Programs Biomed 2014 Feb;113(2):610-619. [CrossRef] [Medline]66], 2014 | Objective measure | Tabular | Gender, age, and BMI | Continuous | BFPe | Individual |
Shao [Shao YE. Body fat percentage prediction using intelligent hybrid approaches. ScientificWorldJournal 2014;2014:383910 [FREE Full text] [CrossRef] [Medline]65], 2014 | Objective measure | Tabular | 13 body circumference measurements | Continuous | BFP | Individual |
Chen et al [Chen H, Yang B, Liu D, Liu W, Liu Y, Zhang X, et al. Using blood indexes to predict overweight statuses: an extreme learning machine-based approach. PLoS One 2015;10(11):e0143003 [FREE Full text] [CrossRef] [Medline]64], 2015 | Objective measure | Tabular | 18 blood indexes and 16 biochemical indexes | Continuous | Overweight | Individual |
Dugan et al [Dugan T, Mukhopadhyay S, Carroll A, Downs S. Machine learning techniques for prediction of early childhood obesity. Appl Clin Inform 2017 Dec 19;06(03):506-520 [FREE Full text] [CrossRef]63], 2015 | Questionnaire and objective measure | Tabular | 167 clinical data attributes | Continuous | Obesity | Individual |
Nau et al [Nau C, Ellis H, Huang H, Schwartz BS, Hirsch A, Bailey-Davis L, et al. Exploring the forest instead of the trees: an innovative method for defining obesogenic and obesoprotective environments. Health Place 2015 Sep;35:136-146 [FREE Full text] [CrossRef] [Medline]62], 2015 | Two secondary data sources (InfoUSA and Dun & Bradstreet) | Tabular | 44 community characteristics | Binary | Obesogenic and obesoprotective environments | Community |
Almeida et al [Almeida SM, Furtado JM, Mascarenhas P, Ferraz ME, Silva LR, Ferreira JC, et al. Anthropometric predictors of body fat in a large population of 9-year-old school-aged children. Obes Sci Pract 2016 Sep;2(3):272-281 [FREE Full text] [CrossRef] [Medline]61], 2016 | Objective measure | Tabular | Age, sex, BMI z score, and calf circumference | Continuous | BFP | Individual |
Lingren et al [Lingren T, Thaker V, Brady C, Namjou B, Kennebeck S, Bickel J, et al. Developing an algorithm to detect early childhood obesity in two tertiary pediatric medical centers. Appl Clin Inform 2016 Jul 20;7(3):693-706 [FREE Full text] [CrossRef] [Medline]60], 2016 | EHRf | Tabular | EHR data | Binary | Obesity | Individual |
Seyednasrollah et al [Seyednasrollah F, Mäkelä J, Pitkänen N, Juonala M, Hutri-Kähönen N, Lehtimäki T, et al. Prediction of adulthood obesity using genetic and childhood clinical risk factors in the cardiovascular risk in young finns study. Circ Cardiovasc Genet 2017 Jun;10(3):e001554 [FREE Full text] [CrossRef] [Medline]59], 2017 | Objective measure | Tabular | Clinical factors and genetic risk factors | Binary | Obesity | Individual |
Hinojosa et al [Ortega Hinojosa AM, MacLeod KE, Balmes J, Jerrett M. Influence of school environments on childhood obesity in California. Environ Res 2018 Oct;166:100-107. [CrossRef] [Medline]58], 2018 | Objective measure | Tabular | School environment | Binary | Obesity | School |
Maharana and Nsoesie [Maharana A, Nsoesie EO. Use of deep learning to examine the association of the built environment with prevalence of neighborhood adult obesity. JAMA Netw Open 2018 Aug 03;1(4):e181535 [FREE Full text] [CrossRef] [Medline]57], 2018 | Objective measure | Image | Built environment | Continuous | Prevalence of obesity | Census tract |
Wang et al [Wang H, Chang S, Lin W, Chen C, Chiang S, Huang K, et al. Machine learning-based method for obesity risk evaluation using single-nucleotide polymorphisms derived from next-generation sequencing. J Comput Biol 2018 Dec;25(12):1347-1360. [CrossRef] [Medline]56], 2018 | Objective measure | Tabular | Single-nucleotide polymorphisms | Binary | Obesity risk | Individual |
Duran et al [Duran I, Martakis K, Rehberg M, Semler O, Schoenau E. Diagnostic performance of an artificial neural network to predict excess body fat in children. Pediatr Obes 2019 Feb;14(2):e12494. [CrossRef] [Medline]55], 2018 | NHANESg | Tabular | Age, height, weight, and WC | Binary | Excess body fat | Individual |
Gerl et al [Gerl MJ, Klose C, Surma MA, Fernandez C, Melander O, Männistö S, et al. Machine learning of human plasma lipidomes for obesity estimation in a large population cohort. PLoS Biol 2019 Oct;17(10):e3000443 [FREE Full text] [CrossRef] [Medline]54], 2019 | Objective measure | Tabular | Human plasma lipidomes | Binary and continuous | Obesity: BMI, WC, WHR, and BFP | Individual |
Hammond et al [Hammond R, Athanasiadou R, Curado S, Aphinyanaphongs Y, Abrams C, Messito MJ, et al. Predicting childhood obesity using electronic health records and publicly available data. PLoS ONE 2019 Apr 22;14(4):e0215571 [FREE Full text] [CrossRef] [Medline]53], 2019 | EHR and publicly available data | Tabular | EHR data | Binary and continuous | Obesity status | Individual |
Hong et al [Hong N, Wen A, Stone DJ, Tsuji S, Kingsbury PR, Rasmussen LV, et al. Developing a FHIR-based EHR phenotyping framework: a case study for identification of patients with obesity and multiple comorbidities from discharge summaries. J Biomed Inform 2019 Nov;99:103310 [FREE Full text] [CrossRef] [Medline]52], 2019 | EHR | Text | Discharge summaries | Binary | Identification of obesity | Individual |
Ramyaa et al [Ramyaa R, Hosseini O, Krishnan GP, Krishnan S. Phenotyping women based on dietary macronutrients, physical activity, and body weight using machine learning tools. Nutrients 2019 Jul 22;11(7):1681 [FREE Full text] [CrossRef] [Medline]51], 2019 | Questionnaire | Tabular | Energy balance components | Binary and continuous | Energy stores: body weight | Individual |
Scheinker et al [Scheinker D, Valencia A, Rodriguez F. Identification of factors associated with variation in US county-level obesity prevalence rates using epidemiologic vs machine learning models. JAMA Netw Open 2019 Apr 05;2(4):e192884 [FREE Full text] [CrossRef] [Medline]50], 2019 | 2018 Robert Wood Johnson Foundation County Health Rankings | Tabular | Demographic factors, socioeconomic factors, health care factors, and environmental factors | Continuous | Obesity prevalence | County |
Shin et al [Shin S, Lee J, Choe S, Yang HI, Min J, Ahn K, et al. Dry electrode-based body fat estimation system with anthropometric data for use in a wearable device. Sensors (Basel) 2019 May 10;19(9):2177 [FREE Full text] [CrossRef] [Medline]49], 2019 | Objective measure | Tabular | Upper body impedance and lower body anthropometric data | Continuous | BFP | Individual |
Stephens et al [Stephens TN, Joerin A, Rauws M, Werk LN. Feasibility of pediatric obesity and prediabetes treatment support through Tess, the AI behavioral coaching chatbot. Transl Behav Med 2019 May 16;9(3):440-447. [CrossRef] [Medline]48], 2019 | From recorded dialogue | Text | Dialogue | Binary | Weight management program | Individual |
Blanes-Selva et al [Blanes-Selva V, Tortajada S, Vilar R, Valdivieso B, García-Gómez JM. Machine learning-based identification of obesity from positive and unlabelled electronic health records. Stud Health Technol Inform 2020 Jun 16;270:864-868. [CrossRef] [Medline]47], 2020 | EHR of HULAFEh | Tabular | 32 variables | Binary | Identification of obesity | Individual |
Dunstan et al [Dunstan J, Aguirre M, Bastías M, Nau C, Glass TA, Tobar F. Predicting nationwide obesity from food sales using machine learning. Health Informatics J 2020 Mar;26(1):652-663 [FREE Full text] [CrossRef] [Medline]46], 2020 | Euromonitor data set | Tabular | National sales of a small subset of food and beverage categories | Continuous | Nationwide obesity prevalence | Country |
Fu et al [Fu Y, Gou W, Hu W, Mao Y, Tian Y, Liang X, et al. Integration of an interpretable machine learning algorithm to identify early life risk factors of childhood obesity among preterm infants: a prospective birth cohort. BMC Med 2020 Jul 10;18(1):184 [FREE Full text] [CrossRef] [Medline]45], 2020 | Clinical data | Tabular | Demographic characteristics, maternal anthropometrics, perinatal clinical history, laboratory tests, and postnatal feeding practices | Binary | Obesity | Individual |
Kibble et al [Kibble M, Khan SA, Ammad-Ud-Din M, Bollepalli S, Palviainen T, Kaprio J, et al. An integrative machine learning approach to discovering multi-level molecular mechanisms of obesity using data from monozygotic twin pairs. R Soc Open Sci 2020 Oct;7(10):200872 [FREE Full text] [CrossRef] [Medline]44], 2020 | Clinical data | Tabular | 42 clinical variables | Binary | Mechanisms of obesity | Individual |
Park et al [Park B, Chung C, Lee MJ, Park H. Accurate neuroimaging biomarkers to predict body mass index in adolescents: a longitudinal study. Brain Imaging Behav 2020 Oct;14(5):1682-1695. [CrossRef] [Medline]43], 2020 | Openly accessible database | Image | Neuroimaging biomarkers | Continuous | BMI | Individual |
Phan et al [Phan L, Yu W, Keralis JM, Mukhija K, Dwivedi P, Brunisholz KD, et al. Google street view derived built environment indicators and associations with state-level obesity, physical activity, and chronic disease mortality in the united states. Int J Environ Res Public Health 2020 May 22;17(10):3659 [FREE Full text] [CrossRef] [Medline]42], 2020 | Objective measure | Image | Neighborhood built environment characteristics | Binary, continuous | Obesity | State |
Taghiyev et al [Taghiyev A, Altun A, Caglar S. A hybrid approach based on machine learning to identify the causes of obesity. J Control Eng Applied Informatic 2020;22(2):56-66.41], 2020 | EHR | Tabular | Results of blood tests | Binary | Obesity | Individual |
Xiao et al [Xiao Y, Zhang Y, Sun Y, Tao P, Kuang X. Does green space really matter for residents' obesity? A new perspective from Baidu street view. Front Public Health 2020;8:332 [FREE Full text] [CrossRef] [Medline]40], 2020 | Objective measure | Image | Vertical greenness level | Binary | Obesity | Individual |
Yao et al [Yao Y, Song L, Ye J. Motion-to-BMI: using motion sensors to predict the body mass index of smartphone users. Sensors (Basel) 2020 Feb 19;20(4):1134 [FREE Full text] [CrossRef] [Medline]39], 2020 | Objective measure | Tabular | Characteristics of body movement captured by smartphone’s built-in motion sensors | Continuous | BMI | Individual |
Alkutbe et al [Alkutbe RB, Alruban A, Alturki H, Sattar A, Al-Hazzaa H, Rees G. Fat mass prediction equations and reference ranges for Saudi Arabian Children aged 8-12 years using machine technique method. PeerJ 2021;9:e10734 [FREE Full text] [CrossRef] [Medline]27], 2021 | Self-reported and objective measures | Tabular | Weight, height, age, and gender | Binary and continuous | BFP | Individual |
Bhanu et al [Bhanu PK, Arvind CS, Yeow LY, Chen WX, Lim WS, Tan CH. CAFT: a deep learning-based comprehensive abdominal fat analysis tool for large cohort studies. MAGMA 2022 Apr;35(2):205-220. [CrossRef] [Medline]38], 2021 | MRI | Image | SATi and VATj | Binary | Abdominal fat | Individual |
Cheng et al [Cheng X, Lin S, Liu J, Liu S, Zhang J, Nie P, et al. Does physical activity predict obesity-a machine learning and statistical method-based analysis. Int J Environ Res Public Health 2021 Apr 09;18(8):3966 [FREE Full text] [CrossRef] [Medline]37], 2021 | Objective measure | Tabular | Physical activity | Binary | Obesity | Individual |
Delnevo et al [Delnevo G, Mancini G, Roccetti M, Salomoni P, Trombini E, Andrei F. The prediction of body mass index from negative affectivity through machine learning: a confirmatory study. Sensors (Basel) 2021 Mar 29;21(7):2361 [FREE Full text] [CrossRef] [Medline]36], 2021 | Questionnaire | Tabular | Positive and negative psychological variables | Binary and continuous | BMI values and BMI status | Individual |
Lee et al [Lee K, Kim HY, Lee SJ, Kwon SO, Na S, Hwang HS, Korean Society of Ultrasound in ObstetricsGynecology Research Group. Prediction of newborn's body mass index using nationwide multicenter ultrasound data: a machine-learning study. BMC Pregnancy Childbirth 2021 Mar 02;21(1):172 [FREE Full text] [CrossRef] [Medline]35], 2021 | Objective measure | Tabular | 64 independent variables: nationwide multicenter ultrasound data and maternal and delivery information | Continuous | BMI | Individual |
Lin et al [Lin Z, Feng W, Liu Y, Ma C, Arefan D, Zhou D, et al. Machine learning to identify metabolic subtypes of obesity: a multi-center study. Front Endocrinol (Lausanne) 2021;12:713592 [FREE Full text] [CrossRef] [Medline]34], 2021 | Objective measure | Tabular | Key clinical variables | Binary | Obesity classification criterion | Individual |
Pang et al [Pang X, Forrest CB, Lê-Scherban F, Masino AJ. Prediction of early childhood obesity with machine learning and electronic health record data. Int J Med Inform 2021 Jun;150:104454 [FREE Full text] [CrossRef] [Medline]33], 2021 | EHR data from pediatric big data repository | Tabular | Demographic variables and 54 clinical variables | Binary | Obesity | Individual |
Park et al [Park HJ, Francisco SC, Pang MR, Peng L, Chi G. Exposure to anti-black lives matter movement and obesity of the black population. Soc Sci Med 2021 Jul 28:114265. [CrossRef] [Medline]32], 2021 | Corpus of geotagged tweets | Text | Tweets | Binary and continuous | BMI and obesity | Individual |
Rashmi et al [Rashmi R, Umapathy S, Krishnan P. Thermal imaging method to evaluate childhood obesity based on machine learning techniques. Int J Imaging Syst Technol 2021 Mar 20;31(3):1752-1768 [FREE Full text] [CrossRef]31], 2021 | Objective measure | Image | 600 thermograms | Binary | Obesity | Individual |
Snekhalatha and Sangamithirai [U S, K. PT, K S. Computer aided diagnosis of obesity based on thermal imaging using various convolutional neural networks. Biomed Signal Process Control 2021 Jan;63:102233 [FREE Full text] [CrossRef]30], 2021 | Objective measure | Image | Thermal imaging | Binary | Diagnosis of obesity | Individual |
Thamrin et al [Thamrin SA, Arsyad DS, Kuswanto H, Lawi A, Nasir S. Predicting obesity in adults using machine learning techniques: an analysis of Indonesian basic health research 2018. Front Nutr 2021;8:669155 [FREE Full text] [CrossRef] [Medline]29], 2021 | Publicly available health data | Tabular | Risk factors for obesity | Binary | Obesity | Individual |
Zare et al [Zare S, Thomsen MR, Nayga RM, Goudie A. Use of machine learning to determine the information value of a BMI screening program. Am J Prev Med 2021 Mar;60(3):425-433 [FREE Full text] [CrossRef] [Medline]28], 2021 | BMI panel data set | Tabular | Kindergarten BMI z score | Binary | Obesity by grade 4 | Individual |
aWHR: waist-hip ratio.
bMRI: magnetic resonance imaging.
cWC: waist circumference.
dHC: hip circumference.
eBFP: body fat percentage.
fEHR: electronic health record.
gNHANES: National Health and Nutrition Examination Survey.
hHULAFE: Hospital Universitari i Politècnic La Fe.
iSAT: subcutaneous adipose tissue.
jVAT: visceral adipose tissue.
Main Findings
Table 3 summarizes the estimated effects and main findings of the studies included in the review. Four key findings have emerged.
First, the studies found that ML or DL models were generally effective in detecting clinically meaningful patterns of obesity or relationships between covariates and weight outcomes; for example, ML and DL models were found useful in classifying obesity severity [U S, K. PT, K S. Computer aided diagnosis of obesity based on thermal imaging using various convolutional neural networks. Biomed Signal Process Control 2021 Jan;63:102233 [FREE Full text] [CrossRef]30,Blanes-Selva V, Tortajada S, Vilar R, Valdivieso B, García-Gómez JM. Machine learning-based identification of obesity from positive and unlabelled electronic health records. Stud Health Technol Inform 2020 Jun 16;270:864-868. [CrossRef] [Medline]47,Hong N, Wen A, Stone DJ, Tsuji S, Kingsbury PR, Rasmussen LV, et al. Developing a FHIR-based EHR phenotyping framework: a case study for identification of patients with obesity and multiple comorbidities from discharge summaries. J Biomed Inform 2019 Nov;99:103310 [FREE Full text] [CrossRef] [Medline]52], identifying anthropometric [Lin Z, Feng W, Liu Y, Ma C, Arefan D, Zhou D, et al. Machine learning to identify metabolic subtypes of obesity: a multi-center study. Front Endocrinol (Lausanne) 2021;12:713592 [FREE Full text] [CrossRef] [Medline]34] and genetic characteristics of obesity [Wang H, Chang S, Lin W, Chen C, Chiang S, Huang K, et al. Machine learning-based method for obesity risk evaluation using single-nucleotide polymorphisms derived from next-generation sequencing. J Comput Biol 2018 Dec;25(12):1347-1360. [CrossRef] [Medline]56], and predicting obesity onset in children [Zare S, Thomsen MR, Nayga RM, Goudie A. Use of machine learning to determine the information value of a BMI screening program. Am J Prev Med 2021 Mar;60(3):425-433 [FREE Full text] [CrossRef] [Medline]28,Hammond R, Athanasiadou R, Curado S, Aphinyanaphongs Y, Abrams C, Messito MJ, et al. Predicting childhood obesity using electronic health records and publicly available data. PLoS ONE 2019 Apr 22;14(4):e0215571 [FREE Full text] [CrossRef] [Medline]53,Dugan T, Mukhopadhyay S, Carroll A, Downs S. Machine learning techniques for prediction of early childhood obesity. Appl Clin Inform 2017 Dec 19;06(03):506-520 [FREE Full text] [CrossRef]63]. ML algorithms (eg, random forest [RF] and conditional RF) revealed meaningful relationships between school and neighborhood environments and overweight and obesity [Fu Y, Gou W, Hu W, Mao Y, Tian Y, Liang X, et al. Integration of an interpretable machine learning algorithm to identify early life risk factors of childhood obesity among preterm infants: a prospective birth cohort. BMC Med 2020 Jul 10;18(1):184 [FREE Full text] [CrossRef] [Medline]45,Ortega Hinojosa AM, MacLeod KE, Balmes J, Jerrett M. Influence of school environments on childhood obesity in California. Environ Res 2018 Oct;166:100-107. [CrossRef] [Medline]58,Nau C, Ellis H, Huang H, Schwartz BS, Hirsch A, Bailey-Davis L, et al. Exploring the forest instead of the trees: an innovative method for defining obesogenic and obesoprotective environments. Health Place 2015 Sep;35:136-146 [FREE Full text] [CrossRef] [Medline]62]. DL algorithms (eg, convolutional neural network [CNN]) effectively extracted built environment features from satellite images to assess their associations with the local obesity rate [Maharana A, Nsoesie EO. Use of deep learning to examine the association of the built environment with prevalence of neighborhood adult obesity. JAMA Netw Open 2018 Aug 03;1(4):e181535 [FREE Full text] [CrossRef] [Medline]57].
Second, most (18/22, 82%) of the studies comparing AI models with conventional statistical methods reported that the AI models achieved higher prediction accuracy on test data, whereas others (4/22, 18%) found similar model performances; for example, ML and DL models were found to explain a larger proportion of variations in county-level obesity prevalence than conventional statistical approaches [Scheinker D, Valencia A, Rodriguez F. Identification of factors associated with variation in US county-level obesity prevalence rates using epidemiologic vs machine learning models. JAMA Netw Open 2019 Apr 05;2(4):e192884 [FREE Full text] [CrossRef] [Medline]50]. ML models showed flexibility in handling various variable types [Delnevo G, Mancini G, Roccetti M, Salomoni P, Trombini E, Andrei F. The prediction of body mass index from negative affectivity through machine learning: a confirmatory study. Sensors (Basel) 2021 Mar 29;21(7):2361 [FREE Full text] [CrossRef] [Medline]36,Taghiyev A, Altun A, Caglar S. A hybrid approach based on machine learning to identify the causes of obesity. J Control Eng Applied Informatic 2020;22(2):56-66.41] and large-scale data sets [Park HJ, Francisco SC, Pang MR, Peng L, Chi G. Exposure to anti-black lives matter movement and obesity of the black population. Soc Sci Med 2021 Jul 28:114265. [CrossRef] [Medline]32] and producing robust, generalizable inferences [Taghiyev A, Altun A, Caglar S. A hybrid approach based on machine learning to identify the causes of obesity. J Control Eng Applied Informatic 2020;22(2):56-66.41,Gerl MJ, Klose C, Surma MA, Fernandez C, Melander O, Männistö S, et al. Machine learning of human plasma lipidomes for obesity estimation in a large population cohort. PLoS Biol 2019 Oct;17(10):e3000443 [FREE Full text] [CrossRef] [Medline]54,Chen H, Yang B, Liu D, Liu W, Liu Y, Zhang X, et al. Using blood indexes to predict overweight statuses: an extreme learning machine-based approach. PLoS One 2015;10(11):e0143003 [FREE Full text] [CrossRef] [Medline]64,Shao YE. Body fat percentage prediction using intelligent hybrid approaches. ScientificWorldJournal 2014;2014:383910 [FREE Full text] [CrossRef] [Medline]65] with higher prediction accuracy [Almeida SM, Furtado JM, Mascarenhas P, Ferraz ME, Silva LR, Ferreira JC, et al. Anthropometric predictors of body fat in a large population of 9-year-old school-aged children. Obes Sci Pract 2016 Sep;2(3):272-281 [FREE Full text] [CrossRef] [Medline]61,Kupusinac A, Stokić E, Doroslovački R. Predicting body fat percentage based on gender, age and BMI by using artificial neural networks. Comput Methods Programs Biomed 2014 Feb;113(2):610-619. [CrossRef] [Medline]66]. By contrast, Cheng et al [Cheng X, Lin S, Liu J, Liu S, Zhang J, Nie P, et al. Does physical activity predict obesity-a machine learning and statistical method-based analysis. Int J Environ Res Public Health 2021 Apr 09;18(8):3966 [FREE Full text] [CrossRef] [Medline]37] reported that ML algorithms and conventional statistical approaches had similar performance.
Third, some (5/46, 11%) of the studies comparing the performances of different AI models yielded mixed results, reflecting the interdependence between model and data or task; for example, logistic regressions were reported to achieve higher prediction accuracy than DTs, naïve Bayes (NB) [Thamrin SA, Arsyad DS, Kuswanto H, Lawi A, Nasir S. Predicting obesity in adults using machine learning techniques: an analysis of Indonesian basic health research 2018. Front Nutr 2021;8:669155 [FREE Full text] [CrossRef] [Medline]29], and DL [Lee K, Kim HY, Lee SJ, Kwon SO, Na S, Hwang HS, Korean Society of Ultrasound in ObstetricsGynecology Research Group. Prediction of newborn's body mass index using nationwide multicenter ultrasound data: a machine-learning study. BMC Pregnancy Childbirth 2021 Mar 02;21(1):172 [FREE Full text] [CrossRef] [Medline]35]. By contrast, Heydari et al [Heydari ST, Ayatollahi SM, Zare N. Comparison of artificial neural networks with logistic regression for detection of obesity. J Med Syst 2012 Aug;36(4):2449-2454. [CrossRef] [Medline]67] found that logistic regressions and DL models performed equally well in solving classification problems. Zhang et al [Zhang S, Tjortjis C, Zeng X, Qiao H, Buchan I, Keane J. Comparing data mining methods with logistic regression in childhood obesity prediction. Inf Syst Front 2009 Feb 24;11(4):449-460 [FREE Full text] [CrossRef]68] and Ergün [Ergün U. The classification of obesity disease in logistic regression and neural network methods. J Med Syst 2009 Feb;33(1):67-72. [CrossRef] [Medline]70] reported that data mining and DL techniques outperformed logistic regressions in classification accuracy.
Fourth, newer studies increasingly adopted state-of-the-art DL models to address CV and NLP tasks; for example, chatbots built on NLP models were used to support pediatric obesity treatment [Stephens TN, Joerin A, Rauws M, Werk LN. Feasibility of pediatric obesity and prediabetes treatment support through Tess, the AI behavioral coaching chatbot. Transl Behav Med 2019 May 16;9(3):440-447. [CrossRef] [Medline]48]. CNN-based CV models were used to construct indicators for the built environment using images from Google Street View [Phan L, Yu W, Keralis JM, Mukhija K, Dwivedi P, Brunisholz KD, et al. Google street view derived built environment indicators and associations with state-level obesity, physical activity, and chronic disease mortality in the united states. Int J Environ Res Public Health 2020 May 22;17(10):3659 [FREE Full text] [CrossRef] [Medline]42]. DL-based tools were used to efficiently visualize and analyze abdominal visceral adipose tissue and subcutaneous adipose tissue [Bhanu PK, Arvind CS, Yeow LY, Chen WX, Lim WS, Tan CH. CAFT: a deep learning-based comprehensive abdominal fat analysis tool for large cohort studies. MAGMA 2022 Apr;35(2):205-220. [CrossRef] [Medline]38].
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Shao [Shao YE. Body fat percentage prediction using intelligent hybrid approaches. ScientificWorldJournal 2014;2014:383910 [FREE Full text] [CrossRef] [Medline]65], 2014 |
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Chen et al [Chen H, Yang B, Liu D, Liu W, Liu Y, Zhang X, et al. Using blood indexes to predict overweight statuses: an extreme learning machine-based approach. PLoS One 2015;10(11):e0143003 [FREE Full text] [CrossRef] [Medline]64], 2015 |
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Dugan et al [Dugan T, Mukhopadhyay S, Carroll A, Downs S. Machine learning techniques for prediction of early childhood obesity. Appl Clin Inform 2017 Dec 19;06(03):506-520 [FREE Full text] [CrossRef]63], 2015 |
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Almeida et al [Almeida SM, Furtado JM, Mascarenhas P, Ferraz ME, Silva LR, Ferreira JC, et al. Anthropometric predictors of body fat in a large population of 9-year-old school-aged children. Obes Sci Pract 2016 Sep;2(3):272-281 [FREE Full text] [CrossRef] [Medline]61], 2016 |
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Maharana and Nsoesie [Maharana A, Nsoesie EO. Use of deep learning to examine the association of the built environment with prevalence of neighborhood adult obesity. JAMA Netw Open 2018 Aug 03;1(4):e181535 [FREE Full text] [CrossRef] [Medline]57], 2018 |
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Hammond et al [Hammond R, Athanasiadou R, Curado S, Aphinyanaphongs Y, Abrams C, Messito MJ, et al. Predicting childhood obesity using electronic health records and publicly available data. PLoS ONE 2019 Apr 22;14(4):e0215571 [FREE Full text] [CrossRef] [Medline]53], 2019 |
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Hong et al [Hong N, Wen A, Stone DJ, Tsuji S, Kingsbury PR, Rasmussen LV, et al. Developing a FHIR-based EHR phenotyping framework: a case study for identification of patients with obesity and multiple comorbidities from discharge summaries. J Biomed Inform 2019 Nov;99:103310 [FREE Full text] [CrossRef] [Medline]52], 2019 |
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Zare et al [Zare S, Thomsen MR, Nayga RM, Goudie A. Use of machine learning to determine the information value of a BMI screening program. Am J Prev Med 2021 Mar;60(3):425-433 [FREE Full text] [CrossRef] [Medline]28], 2021 |
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aAI: artificial intelligence.
bWHR: waist-to-hip ratio.
cAIM: abductory induction mechanism.
dCV: coefficient of variation.
eVAT: visceral adipose tissue.
fSAT: subcutaneous adipose tissue.
gSVM: support vector machine.
hHC: hip circumference.
iANN: artificial neural network.
jBFP: body fat percentage.
kELM: extreme learning machine.
lBPNN: back propagation neural network.
mID3: iterative dichotomizer 3.
nCHICA: Child Health Improvement Through Computer Automation.
oML: machine learning.
pCRF: conditional random forest.
qWHtR: waist-to-height ratio.
rCC: calf circumference.
sHC: hip circumference.
tRMSE: root mean square error.
uCCHMC: Cincinnati Children’s Hospital and Medical Center.
vBCH: Boston Children’s Hospital.
wBHS: Bogalusa Heart Study.
xWGRS: weighted genetic risk score.
yRF: random forest.
zCNN: convolutional neural network.
aaSNP: single-nucleotide polymorphism.
bbWC: waist circumference.
ccLASSO: least absolute shrinkage and selection operator.
ddEHR: electronic health record.
eeMIMIC: Multiparameter Intelligent Monitoring in Intensive Care.
ffNLP: natural language processing.
ggFHIR: Fast Healthcare Interoperability Resources.
hhKNN: k-nearest neighbor.
iiDL: deep learning.
jjPU: positive and unlabeled.
kkXGB: extreme gradient boosting.
llDNN: deep neural network.
mmDT: decision tree.
nnVGI: Visible Green Index.
ooNB: naïve Bayes.
ppPCA: principal component analysis.
Methodological Review
AI Overview
AI symbolizes the effort to automate intellectual tasks usually performed by humans [Haenlein M, Kaplan A. A brief history of artificial intelligence: on the past, present, and future of artificial intelligence. California Manag Rev 2019 Jul 17;61(4):5-14. [CrossRef]72]. In general, AI consists of 2 domains or developmental periods: symbolic AI and modern AI [Artificial Intelligence. Stanford Encyclopedia of Philosophy. URL: https://plato.stanford.edu/ [accessed 2022-06-18] 73]. Symbolic AI prevailed from the 1950s to the 1980s, characterized by the endeavors to achieve human-level intelligence by having programmers handcraft a sufficiently large set of explicit rules for manipulating knowledge [Chollet F. Deep Learning with Python, Second Edition. Shelter Island, New York, United States: Manning; 2021.74]. Although symbolic AI proved suitable for solving well-defined, logical problems, such as a rule-based question-answer system, it became intractable when creating rules to solve more complex, fuzzy issues such as image classification, speech recognition, and language translation [Chollet F. Deep Learning with Python, Second Edition. Shelter Island, New York, United States: Manning; 2021.74]. The definition of ML is “the field of study that gives computers the ability to learn without being explicitly programmed” [Samuel A. Some studies in machine learning using the game of checkers. IBM J Res Dev 1959 Jul;3(3):210-229 [FREE Full text] [CrossRef]75]. Instead of hard coding all the rules in the symbolic AI, researchers provide examples (eg, images with labels that identify the objects in them) to train modern ML models to output rules [Chollet F. Deep Learning with Python, Second Edition. Shelter Island, New York, United States: Manning; 2021.74]. As a subdomain of ML, DL is based on artificial neural networks in which multiple (deep) layers of artificial neurons are used to progressively extract higher-level features from data [Alzubaidi L, Zhang J, Humaidi AJ, Al-Dujaili A, Duan Y, Al-Shamma O, et al. Review of deep learning: concepts, CNN architectures, challenges, applications, future directions. J Big Data 2021;8(1):53 [FREE Full text] [CrossRef] [Medline]76]. This layered representation enables the modeling of more complex, dynamic patterns compared with traditional ML (which sometimes is called shallow learning in contrast to DL), which finds its utility in analyzing big data: data massive in scale and messy to work with (eg, unstructured texts and images) [Chauhan N, Singh K. A review on conventional machine learning vs deep learning. In: Proceedings of the International Conference on Computing, Power and Communication Technologies (GUCON). 2018 Presented at: International Conference on Computing, Power and Communication Technologies (GUCON); Sep 28-29, 2018; Greater Noida, India. [CrossRef]77]. The first ML and DL algorithms were developed in the 1950s, attracting initial excitement but then lying dormant for several decades [Haenlein M, Kaplan A. A brief history of artificial intelligence: on the past, present, and future of artificial intelligence. California Manag Rev 2019 Jul 17;61(4):5-14. [CrossRef]72]. Since the late 1980s, partly because of the rediscovery of backpropagation algorithms, the invention of CNNs, and the strong growth in computational capacity, ML and DL have regained their popularity vis-à-vis symbolic AI [Haenlein M, Kaplan A. A brief history of artificial intelligence: on the past, present, and future of artificial intelligence. California Manag Rev 2019 Jul 17;61(4):5-14. [CrossRef]72].
AI Versus Conventional Statistical Methods
Admittedly, the concept of conventional statistical methods is dubious at best because the development of statistical theories and algorithms is continual in time and intertwines at all levels [Rajula HS, Verlato G, Manchia M, Antonucci N, Fanos V. Comparison of conventional statistical methods with machine learning in medicine: diagnosis, drug development, and treatment. Medicina (Kaunas) 2020 Sep 08;56(9):455 [FREE Full text] [CrossRef] [Medline]78]. Indeed, many conventional models fall into the ML domain, such as linear and logistic regressions. Despite the poorly defined domain and overlapping algorithms, at least 2 distinctions could be made between modern AI (ie, ML and DL) and other statistical methods. In terms of aims, the objective of AI models and their evaluation metrics predominantly concern prediction precision (often at the cost of compromising interpretability as models become complex) [Rajula HS, Verlato G, Manchia M, Antonucci N, Fanos V. Comparison of conventional statistical methods with machine learning in medicine: diagnosis, drug development, and treatment. Medicina (Kaunas) 2020 Sep 08;56(9):455 [FREE Full text] [CrossRef] [Medline]78,Bennett M, Hayes K, Kleczyk E, Mehta R. Similarities and differences between machine learning and traditional advanced statistical modeling in healthcare analytics. arXiv 2022 [FREE Full text] [CrossRef]79]. By contrast, conventional statistical approaches usually attempt to reveal relationships among variables (statistical inference) and focus on model interpretability [Ley C, Martin RK, Pareek A, Groll A, Seil R, Tischer T. Machine learning and conventional statistics: making sense of the differences. Knee Surg Sports Traumatol Arthrosc 2022 Mar;30(3):753-757. [CrossRef] [Medline]80]. In terms of procedures, it is standard practice to split data into training, validation, and test sets so that an AI model can be trained using the training set with the aim of achieving the optimal performance on some predefined evaluation metrics (eg, accuracy and mean squared error) when testing on the validation set [KhosrowHassibi. Machine learning vs. traditional statistics: different philosophies, different approaches. Data Science Central. 2016 Oct 28. URL: https://www.datasciencecentral.com/machine-learning-vs-traditional-statistics-different- [accessed 2022-06-18] 81,Raschka S. Model evaluation, model selection, and algorithm selection in machine learning. arXiv. 2018 Nov. URL: https://arxiv.org/pdf/1811.12808.pdf [accessed 2022-06-18] 82]. The fine-tuned AI model is subsequently tested on the test set. The utility of the validation set is to prevent model overfitting (ie, too tailored to the training set while losing generalizability to new, unseen data) and fine-tune hyperparameters (ie, parameters external to the model, whose values cannot be automatically learned from data). The test set is preserved to test the final model’s performance on unseen data. By contrast, conventional statistical methods do not usually fit and evaluate models using training, validation, and test sets but use other model selection criteria (eg, adjusted R-squared and Akaike and Bayesian information criteria) to evaluate model performance [Ding J, Tarokh V, Yang Y. Model selection techniques: an overview. arXiv. URL: https://arxiv.org/pdf/ [accessed 2022-06-18] 83].
ML Subcategories
Overview
ML is classified into 2 subcategories: unsupervised ML and supervised ML [Alloghani M, Al-Jumeily D, Mustafina J, Hussain A, Aljaaf A. A Systematic Review on Supervised and Unsupervised Machine Learning Algorithms for Data Science. Cham: Springer; 2019.84]. Unsupervised ML analyzes and clusters unlabeled data sets, discovering hidden patterns or data groupings without the need for human intervention [Wittek P. Quantum Machine Learning What Quantum Computing Means to Data Mining. Boston: Academic Press; 2014.85]. Its capability to reveal similarities and differences in information makes it ideal for exploratory data analysis. Unsupervised ML models are used for 3 main tasks: clustering, association, and dimensionality reduction [Géron A. Hands-On Machine Learning with Scikit-Learn and TensorFlow Concepts, Tools, and Techniques to Build Intelligent Systems. Sebastopol, California, United States: O'Reilly Media; 2017.86]. Clustering algorithms (eg, k-means clustering, hierarchical clustering, and Gaussian mixture) group unlabeled data based on similarities [Géron A. Hands-On Machine Learning with Scikit-Learn and TensorFlow Concepts, Tools, and Techniques to Build Intelligent Systems. Sebastopol, California, United States: O'Reilly Media; 2017.86]. Association algorithms (eg, Apriori, Eclat, and FP-Growth) identify rules and relations among variables in large databases [Addi A, Tarik A, Fatima G. Comparative survey of association rule mining algorithms based on multiple-criteria decision analysis approach. In: Proceedings of the 3rd International Conference on Control, Engineering & Information Technology (CEIT). 2015 Presented at: 3rd International Conference on Control, Engineering & Information Technology (CEIT); May 25-27, 2015; Tlemcen, Algeria. [CrossRef]87]. Dimensionality reduction algorithms (eg, principal component analysis [PCA], singular value decomposition, and multidimensional scaling) deal with an excessive number of features during data preprocessing, reducing them to a manageable size while preserving the integrity of the data set as much as possible [Velliangiri S, Alagumuthukrishnan S, Thankumar joseph SI. A review of dimensionality reduction techniques for efficient computation. Procedia Comput Sci 2019;165:104-111. [CrossRef]88]. Supervised ML uses a training set consisting of input-output pairs to enable the algorithm to learn a function that maps input to output over time [Singh A, Thakur N, Sharma A. A review of supervised machine learning algorithms. In: Proceedings of the 2016 3rd International Conference on Computing for Sustainable Global Development (INDIACom). 2016 Presented at: 2016 3rd International Conference on Computing for Sustainable Global Development (INDIACom); Mar 16-18, 2016; New Delhi, India.89]. The algorithm measures its accuracy through the loss function, adjusting until the error is minimized sufficiently. The critical difference between supervised ML and unsupervised ML is that the former requires labeled data (ie, input-output pairs), whereas the latter only requires inputs (ie, unlabeled data) [Alloghani M, Al-Jumeily D, Mustafina J, Hussain A, Aljaaf A. A Systematic Review on Supervised and Unsupervised Machine Learning Algorithms for Data Science. Cham: Springer; 2019.84]. Supervised ML models are used for 2 main tasks: classification and regression [Alloghani M, Al-Jumeily D, Mustafina J, Hussain A, Aljaaf A. A Systematic Review on Supervised and Unsupervised Machine Learning Algorithms for Data Science. Cham: Springer; 2019.84]. Classification algorithms assign data to specific categories (eg, obese or nonobese). Regression algorithms learn the relationship between input features and continuously distributed outcomes and are commonly used for projections (eg, BMI in 5 years).
Unsupervised ML
K-means Clustering
K-means clustering is an iterative algorithm that tries to partition the data set into a total of k nonoverlapping groups (ie, clusters) [Géron A. Hands-On Machine Learning with Scikit-Learn and TensorFlow Concepts, Tools, and Techniques to Build Intelligent Systems. Sebastopol, California, United States: O'Reilly Media; 2017.86,Ashabi A, Sahibuddin S, Haghighi MS. The systematic review of K-means clustering algorithm. In: Proceedings of the 2020 The 9th International Conference on Networks, Communication and Computing. 2020 Presented at: ICNCC 2020: 2020 The 9th International Conference on Networks, Communication and Computing; Dec 18 - 20, 2020; Tokyo Japan. [CrossRef]90]. Each data point belongs to only 1 group. The algorithm attempts to make the intracluster data points as similar as possible while keeping the clusters apart. In particular, it assigns data points to a cluster such that the sum of the squared distance between the data points and the cluster’s centroid (ie, arithmetic mean of all the data points belonging to that cluster) is minimized. As the number of clusters k needs to be determined before implementing the algorithm, silhouette coefficients are commonly used to identify the optimal k value. Lin et al [Lin Z, Feng W, Liu Y, Ma C, Arefan D, Zhou D, et al. Machine learning to identify metabolic subtypes of obesity: a multi-center study. Front Endocrinol (Lausanne) 2021;12:713592 [FREE Full text] [CrossRef] [Medline]34] used k-means clustering to classify patients with obesity into 4 groups based on 3 biomarkers concerning glucose, insulin, and uric acid.
Fuzzy C-means Clustering
In nonfuzzy clustering (also known as hard clustering; for example, k-means clustering), data are divided into distinct clusters, where each data point can only belong to 1 cluster [Géron A. Hands-On Machine Learning with Scikit-Learn and TensorFlow Concepts, Tools, and Techniques to Build Intelligent Systems. Sebastopol, California, United States: O'Reilly Media; 2017.86]. In fuzzy clustering, data points can potentially belong to multiple clusters [Gosain A, Dahiya S. Performance analysis of various fuzzy clustering algorithms: a review. Procedia Comput Sci 2016;79:100-111. [CrossRef]91]. Fuzzy c-means clustering assigns each data point membership from 0% to 100% in each cluster center [Arora J, Khatter K, Tushir M. Fuzzy c-Means Clustering Strategies: A Review of Distance Measures. Singapore: Springer; 2018.92]. The fuzzy partition coefficient is often used to determine the optimal number of clusters with a value ranging from 0 (worst) to 1 (best) [Zhang M, Zhang W, Sicotte H, Yang P. A new validity measure for a correlation-based fuzzy c-means clustering algorithm. In: Proceedings of the 2009 Annual International Conference of the IEEE Engineering in Medicine and Biology Society. 2009 Presented at: 2009 Annual International Conference of the IEEE Engineering in Medicine and Biology Society; Sep 03-06, 2009; Minneapolis, MN, USA. [CrossRef]93]. Positano et al [Positano V, Cusi K, Santarelli MF, Sironi A, Petz R, Defronzo R, et al. Automatic correction of intensity inhomogeneities improves unsupervised assessment of abdominal fat by MRI. J Magn Reson Imaging 2008 Aug;28(2):403-410. [CrossRef] [Medline]71] used the fuzzy c-means algorithm to classify MRI pixels into clusters to assess abdominal fat.
Group Factor Analysis
Factor analysis describes relationships among the individual variables of a data set [Tavakol M, Wetzel A. Factor analysis: a means for theory and instrument development in support of construct validity. Int J Med Educ 2020 Nov 06;11:245-247 [FREE Full text] [CrossRef] [Medline]94]. Group factor analysis (GFA) extends this classical formulation into describing relationships among groups of variables, where each group represents either a set of related variables or a data set [Klami A, Virtanen S, Leppäaho E, Kaski S. Group factor analysis. IEEE Trans Neural Netw Learn Syst 2015 Sep;26(9):2136-2147. [CrossRef] [Medline]95]. GFA is commonly formulated as a latent variable model consisting of 2 hierarchical levels: the higher level models the relationships among the groups, and the lower-level models the observed variables given the higher level [Klami A, Virtanen S, Leppäaho E, Kaski S. Group factor analysis. IEEE Trans Neural Netw Learn Syst 2015 Sep;26(9):2136-2147. [CrossRef] [Medline]95]. Kibble et al [Kibble M, Khan SA, Ammad-Ud-Din M, Bollepalli S, Palviainen T, Kaprio J, et al. An integrative machine learning approach to discovering multi-level molecular mechanisms of obesity using data from monozygotic twin pairs. R Soc Open Sci 2020 Oct;7(10):200872 [FREE Full text] [CrossRef] [Medline]44] used GFA to jointly analyze 5 large multivariate data sets to understand the multimolecular-level interactions associated with obesity development.
PCA for Large Data Sets
Large data sets are increasingly common nowadays. PCA is a classic, widely adopted method to reduce the dimensionality of a large data set while preserving as much statistical information (ie, variability) as possible [Géron A. Hands-On Machine Learning with Scikit-Learn and TensorFlow Concepts, Tools, and Techniques to Build Intelligent Systems. Sebastopol, California, United States: O'Reilly Media; 2017.86]. In particular, PCA attempts to find new variables, called principal components, that are linear functions of those in the original data set. The new variables are uncorrelated with each other (ie, orthogonal) and maximize the projected data variance. Rashmi et al [Rashmi R, Umapathy S, Krishnan P. Thermal imaging method to evaluate childhood obesity based on machine learning techniques. Int J Imaging Syst Technol 2021 Mar 20;31(3):1752-1768 [FREE Full text] [CrossRef]31] used PCA to reduce the feature dimensions of a thermal imaging data set to classify children by their obesity severity level.
Supervised ML
Linear Regression
Linear regression is considered a conventional statistical model and a classical architecture to develop a predictive model [Steyerberg E. Clinical Prediction Models A Practical Approach to Development, Validation, and Updating. New York: Springer; 2009.96], but it fulfills all criteria from an ML point of view and is widely used as an ML algorithm to predict continuous outcomes such as BMI or BFP [Dasgupta A, Sun YV, König IR, Bailey-Wilson JE, Malley JD. Brief review of regression-based and machine learning methods in genetic epidemiology: the Genetic Analysis Workshop 17 experience. Genet Epidemiol 2011;35 Suppl 1:S5-11 [FREE Full text] [CrossRef] [Medline]97]. Trainable weights (ie, coefficients) of linear regression are commonly estimated using ordinary least squares or gradient descent. Compared with many other ML models, linear regression has the advantages of simplicity and interpretability [Gosiewska A, Kozak A, Biecek P. Simpler is better: lifting interpretability-performance trade-off via automated feature engineering. Decision Support Syst 2021 Nov;150:113556. [CrossRef]98]. It is easy to understand how the model reaches its predictions. Wang et al [Wang H, Chang S, Lin W, Chen C, Chiang S, Huang K, et al. Machine learning-based method for obesity risk evaluation using single-nucleotide polymorphisms derived from next-generation sequencing. J Comput Biol 2018 Dec;25(12):1347-1360. [CrossRef] [Medline]56] used linear regressions to identify features of single-nucleotide polymorphisms that predict obesity risk. Phan et al [Phan L, Yu W, Keralis JM, Mukhija K, Dwivedi P, Brunisholz KD, et al. Google street view derived built environment indicators and associations with state-level obesity, physical activity, and chronic disease mortality in the united states. Int J Environ Res Public Health 2020 May 22;17(10):3659 [FREE Full text] [CrossRef] [Medline]42] used linear regressions to estimate the associations between built environment indicators and state-level obesity prevalence.
Regularized Linear Regression
The bias-variance tradeoff is a fundamental issue faced by all ML models [Géron A. Hands-On Machine Learning with Scikit-Learn and TensorFlow Concepts, Tools, and Techniques to Build Intelligent Systems. Sebastopol, California, United States: O'Reilly Media; 2017.86,Belkin M, Hsu D, Ma S, Mandal S. Reconciling modern machine-learning practice and the classical bias-variance trade-off. Proc Natl Acad Sci U S A 2019 Aug 06;116(32):15849-15854 [FREE Full text] [CrossRef] [Medline]99]. Bias is an error from erroneous assumptions in a learning algorithm. High bias may cause the algorithm to miss the relevant relations between features and outputs (called underfitting). Variance is an error from a learning algorithm’s sensitivity to small fluctuations in the training set. A high variance may result from the algorithm modeling the random noise in the training data, often leading to the algorithm’s poor generalizability to new, unseen data (called overfitting). In general, decreasing variance increases bias and vice versa, and ML algorithms need to be fine-tuned to balance these 2 properties. Regularization is an essential technique to prevent model overfitting and improve generalizability (at the cost of increasing bias) by adding a penalty term of trainable weights to the loss function [Géron A. Hands-On Machine Learning with Scikit-Learn and TensorFlow Concepts, Tools, and Techniques to Build Intelligent Systems. Sebastopol, California, United States: O'Reilly Media; 2017.86]. Optimization algorithms that minimize the loss function will learn to avoid extreme weight values and thus reduce variance. The penalty term with the sum of squared trainable weights is called L2 regularization, used in Ridge regression. The penalty term with the sum of the absolute values of trainable weights is called L1 regularization, used in the least absolute shrinkage and selection operator (LASSO) regression. Unlike Ridge regression, LASSO regression often shrinks some feature weights to absolute zero, making it useful for feature selection. Finally, ElasticNet regression uses a weighted sum of L1 and L2 regularizations. Gerl et al [Gerl MJ, Klose C, Surma MA, Fernandez C, Melander O, Männistö S, et al. Machine learning of human plasma lipidomes for obesity estimation in a large population cohort. PLoS Biol 2019 Oct;17(10):e3000443 [FREE Full text] [CrossRef] [Medline]54] used LASSO regression to estimate the relationship between human plasma lipidomes and body weight outcomes, including BMI, WC, WHR, and BFP.
Logistic Regression
In its simplest form, logistic regression uses a logistic function, called the sigmoid function, to model a binary outcome [Bewick V, Cheek L, Ball J. Statistics review 14: logistic regression. Crit Care 2005 Feb;9(1):112-118 [FREE Full text] [CrossRef] [Medline]100]. A sigmoid function is a continuous, smooth, differentiable S-shaped mathematical function that maps a real number to a value in the range of 0 and 1, making it ideal for modeling probabilities. The estimated probabilities are converted to predictions (0 or 1, denoting exclusive group membership) based on some predefined threshold (eg, >0.5). In ML, logistic regression often incorporates regularizations (L1, L2, or both) to prevent overfitting. Another common extension of logistic regression in ML is to solve multiclass classification problems when classification tasks involve >2 (exclusive) classes. A typical strategy uses the one-vs-rest method (also called one-vs-all) that fits 1 classifier (eg, a logistic regression) per class against all the other classes [Rifkin R, Klautau A. In defense of one-vs-all classification. J Mach Learn Res 2004;5:101-141.101]. A data point is assigned to the class with the highest confidence score among all classifiers. Thamrin et al [Thamrin SA, Arsyad DS, Kuswanto H, Lawi A, Nasir S. Predicting obesity in adults using machine learning techniques: an analysis of Indonesian basic health research 2018. Front Nutr 2021;8:669155 [FREE Full text] [CrossRef] [Medline]29] used logistic regressions to assess the predictability of various obesity risk factors. Cheng et al [Cheng X, Lin S, Liu J, Liu S, Zhang J, Nie P, et al. Does physical activity predict obesity-a machine learning and statistical method-based analysis. Int J Environ Res Public Health 2021 Apr 09;18(8):3966 [FREE Full text] [CrossRef] [Medline]37] used logistic regressions to classify obesity status based on participants’ physical activity levels.
NB Classifier
NB algorithms apply the Bayes theorem with the naïve assumption of conditional independence among each pair of features given the value of the class [Wickramasinghe I, Kalutarage H. Naive Bayes: applications, variations and vulnerabilities: a review of literature with code snippets for implementation. Soft Comput 2020 Sep 09;25(3):2277-2293. [CrossRef]102]. Despite this oversimplified assumption, NB classifiers have been widely used and have worked well in solving many real-world problems. The decoupling of conditional feature distributions allows each distribution to be independently estimated as 1D, making the training of NB classifiers much faster than more sophisticated ML models [Géron A. Hands-On Machine Learning with Scikit-Learn and TensorFlow Concepts, Tools, and Techniques to Build Intelligent Systems. Sebastopol, California, United States: O'Reilly Media; 2017.86]. By contrast, the predicted probabilities of NB classifiers are less trustworthy owing to the algorithm’s naïve assumption. Rashmi et al [Rashmi R, Umapathy S, Krishnan P. Thermal imaging method to evaluate childhood obesity based on machine learning techniques. Int J Imaging Syst Technol 2021 Mar 20;31(3):1752-1768 [FREE Full text] [CrossRef]31] used NB to classify childhood obesity based on thermogram images. Thamrin et al [Thamrin SA, Arsyad DS, Kuswanto H, Lawi A, Nasir S. Predicting obesity in adults using machine learning techniques: an analysis of Indonesian basic health research 2018. Front Nutr 2021;8:669155 [FREE Full text] [CrossRef] [Medline]29] adopted NB to predict adult obesity using Indonesian health survey data [Thamrin SA, Arsyad DS, Kuswanto H, Lawi A, Nasir S. Predicting obesity in adults using machine learning techniques: an analysis of Indonesian basic health research 2018. Front Nutr 2021;8:669155 [FREE Full text] [CrossRef] [Medline]29].
K-nearest Neighbor
K-nearest neighbor (KNN) is a nonparametric, supervised learning algorithm suitable for classification and regression tasks [Taunk K, De S, Verma S, Swetapadma A. A brief review of nearest neighbor algorithm for learning and classification. In: Proceedings of the 2019 International Conference on Intelligent Computing and Control Systems (ICCS). 2019 Presented at: 2019 International Conference on Intelligent Computing and Control Systems (ICCS); May 15-17, 2019; Madurai, India URL: https://doi.org/10.1109/ICCS45141.2019.9065747 [CrossRef]103]. The input consists of the k closest training data points based on a prespecified distance measure (eg, Euclidean, Manhattan, or Minkowski distance). For classification tasks, the output is a class membership. A test data point is assigned to the class most common among its k-nearest neighbors (if k=1, the test data point is assigned to the class of the single nearest neighbor). For regression tasks, the output is the average value of its k-nearest neighbors. KNN should not be confused with k-means. The former is a supervised ML algorithm to determine the class or value of a data point based on its k-nearest neighbors, whereas the latter is an unsupervised ML algorithm to classify data points into k clusters that minimize the distances within clusters while maximizing those between clusters [Ashabi A, Sahibuddin S, Haghighi MS. The systematic review of K-means clustering algorithm. In: Proceedings of the 2020 The 9th International Conference on Networks, Communication and Computing. 2020 Presented at: ICNCC 2020: 2020 The 9th International Conference on Networks, Communication and Computing; Dec 18 - 20, 2020; Tokyo Japan. [CrossRef]90]. KNN is a memory-based learning algorithm that requires no training (called a lazy learner) but can become significantly slower when the sample size increases. Wang et al [Wang H, Chang S, Lin W, Chen C, Chiang S, Huang K, et al. Machine learning-based method for obesity risk evaluation using single-nucleotide polymorphisms derived from next-generation sequencing. J Comput Biol 2018 Dec;25(12):1347-1360. [CrossRef] [Medline]56] used KNN to predict obesity risk based on features of single-nucleotide polymorphisms. Ramyaa et al [Ramyaa R, Hosseini O, Krishnan GP, Krishnan S. Phenotyping women based on dietary macronutrients, physical activity, and body weight using machine learning tools. Nutrients 2019 Jul 22;11(7):1681 [FREE Full text] [CrossRef] [Medline]51] performed KNN to predict body weight using physical activity and dietary data.
Support Vector Machines
Support vector machines (SVMs), which are supervised learning models that construct a hyperplane in a high-dimensional space, can be used for classification and regression tasks [Cervantes J, Garcia-Lamont F, Rodríguez-Mazahua L, Lopez A. A comprehensive survey on support vector machine classification: applications, challenges and trends. Neurocomputing 2020 Sep;408:189-215. [CrossRef]104]. SVMs attempt to identify the hyperplane separating different classes while maximizing the distance to any class’s nearest training data point (ie, margin). Intuitively, the larger the margin, the more likely the model’s generalizability to new, unseen data. The choice of margin type can be critical for SVMs [Géron A. Hands-On Machine Learning with Scikit-Learn and TensorFlow Concepts, Tools, and Techniques to Build Intelligent Systems. Sebastopol, California, United States: O'Reilly Media; 2017.86]. Hard-margin SVMs maximize the margin by minimizing the distance from the decision boundary to the training points. However, hard-margin SVMs may lead to overfitting and have no solution if the training data are linearly inseparable. Soft-margin SVMs modify the constraints of the hard-margin SVMs by allowing some data points to violate the margin (ie, misclassified). In practice, data are seldom linearly separable in the original feature space, and kernel methods are applied to map the input space of the data to a higher-dimensional feature space where linear models can be trained [Ponte P, Melko RG. Kernel methods for interpretable machine learning of order parameters. Phys Rev B 2017 Nov 27;96(20). [CrossRef]105]. Many kernel functions, such as the Gaussian radial basis, sigmoid, and polynomial kernel, can be chosen. Wang et al [Wang H, Chang S, Lin W, Chen C, Chiang S, Huang K, et al. Machine learning-based method for obesity risk evaluation using single-nucleotide polymorphisms derived from next-generation sequencing. J Comput Biol 2018 Dec;25(12):1347-1360. [CrossRef] [Medline]56] used SVM to predict obesity risk based on the features of single-nucleotide polymorphisms. Ramyaa et al [Ramyaa R, Hosseini O, Krishnan GP, Krishnan S. Phenotyping women based on dietary macronutrients, physical activity, and body weight using machine learning tools. Nutrients 2019 Jul 22;11(7):1681 [FREE Full text] [CrossRef] [Medline]51] applied SVM to predict body weight using physical activity and diet data.
DT Algorithms
DTs are nonparametric supervised learning methods for classification and regression tasks [Kotsiantis SB. Decision trees: a recent overview. Artif Intell Rev 2011 Jun 29;39(4):261-283. [CrossRef]106]. In DT algorithms, a tree is built by splitting the source set that constitutes the tree’s root node into subsets, which comprise the successor children [Podgorelec V, Zorman M. Decision tree learning. In: Encyclopedia of Complexity and Systems Science. Berlin, Heidelberg: Springer; 2015.107]. The splitting is based on a set of rules applied to input features. Different splitting rules exist, such as variance reduction for regression tasks and Gini impurity or information gain for classification tasks. The splitting process is repeated on each derived subset recursively (ie, recursive partitioning). The recursion is completed when all subsets at a node share the same target value or when splitting no longer adds value to the predictions. DTs have several advantages over other ML algorithms, such as high transparency and interpretability and few requirements for data preprocessing [Somvanshi M, Chavan P, Tambade S, Shinde S. A review of machine learning techniques using decision tree and support vector machine. In: Proceedings of the 2016 International Conference on Computing Communication Control and automation (ICCUBEA). 2016 Presented at: 2016 International Conference on Computing Communication Control and automation (ICCUBEA); Aug 12-13, 2016; Pune, India. [CrossRef]108]. However, DTs can be prone to overfitting (ie, too confident about the rules learned from the training set, which does not generalize well to the test set) and instability (minor variations in the data resulting in a very different tree). Using features extracted from electronic medical records, Hong et al [Hong N, Wen A, Stone DJ, Tsuji S, Kingsbury PR, Rasmussen LV, et al. Developing a FHIR-based EHR phenotyping framework: a case study for identification of patients with obesity and multiple comorbidities from discharge summaries. J Biomed Inform 2019 Nov;99:103310 [FREE Full text] [CrossRef] [Medline]52] used DTs to predict obesity and 15 other comorbidities. Taghiyev et al [Taghiyev A, Altun A, Caglar S. A hybrid approach based on machine learning to identify the causes of obesity. J Control Eng Applied Informatic 2020;22(2):56-66.41] performed DTs to identify risk factors associated with obesity onset.
RF Models
Ensemble methods are approaches that aggregate the predictions of a group of models aiming for improved performance in classification or regression tasks [Re M, Valentini G. Ensemble methods: a review. In: Advances in Machine Learning and Data Mining for Astronomy. London, United Kingdom: Chapman & Hall; 2012.109]. Various ensemble methods exist, such as bagging, pasting, boosting, and stacking [Géron A. Hands-On Machine Learning with Scikit-Learn and TensorFlow Concepts, Tools, and Techniques to Build Intelligent Systems. Sebastopol, California, United States: O'Reilly Media; 2017.86]. Bagging and pasting use the same training algorithm for every predictor included in the ensemble and train it on different random subsets of the training set. When sampling is performed with replacement, the method is called bagging; when sampling is performed without replacement, it is called pasting. RF is an ensemble of DTs commonly trained via the bagging or pasting method [Parmar A, Katariya R, Patel V. A review on random forest: an ensemble classifier. In: International Conference on Intelligent Data Communication Technologies and Internet of Things. Cham: Springer; 2018.110]. Specifically, RF fits many DTs on various subsets of the data and uses averaging to improve the predictive accuracy and prevent overfitting. For classification tasks, the RF output is the class selected by most trees; for regression tasks, the mean prediction of the individual trees is used. Some common hyperparameters of RF for fine-tuning include the number of trees in the forest, the maximum number of features considered for splitting a node, the maximum number of branches in each tree, the minimum number of data points placed in a node before the node is split, the minimum number of data points allowed in a leaf node, and the method for sampling data points (ie, with or without replacement) [Géron A. Hands-On Machine Learning with Scikit-Learn and TensorFlow Concepts, Tools, and Techniques to Build Intelligent Systems. Sebastopol, California, United States: O'Reilly Media; 2017.86]. RF typically produces more accurate and robust predictions than DTs and is one of the most popular supervised ML algorithms [Talekar B. A detailed review on decision tree and random forest. Biosci Biotech Res Comm 2020 Dec 28;13(14):245-248. [CrossRef]111]. Using RF models, Hinojosa et al [Ortega Hinojosa AM, MacLeod KE, Balmes J, Jerrett M. Influence of school environments on childhood obesity in California. Environ Res 2018 Oct;166:100-107. [CrossRef] [Medline]58] examined the relationship between social and physical school environments and childhood obesity in California, United States. Dunstan et al [Dunstan J, Aguirre M, Bastías M, Nau C, Glass TA, Tobar F. Predicting nationwide obesity from food sales using machine learning. Health Informatics J 2020 Mar;26(1):652-663 [FREE Full text] [CrossRef] [Medline]46] performed RF to predict national obesity prevalence using food sales data from 79 countries.
Extreme Gradient Boosting
Boosting refers to any ensemble method that combines several weak models into a strong one [Ferreira A, Figueiredo M. Boosting algorithms: a review of methods, theory, and applications. In: Ensemble Machine Learning. Boston, MA: Springer; 2012.112]. The difference between boosting and bagging and pasting is that in boosting, different models are applied to the entire training set sequentially, the new model attempting to address the weaknesses (eg, misclassified targets and residual errors) of the previous model. By contrast, in bagging and pasting, the same models are trained on different random subsets of the training set. A popular boosting algorithm is gradient boosting, in which the new model is trained on the residual errors made by the previous model [Bentéjac C, Csörgő A, Martínez-Muñoz G. A comparative analysis of gradient boosting algorithms. Artif Intell Rev 2020 Aug 24;54(3):1937-1967. [CrossRef]113]. Extreme gradient boosting (XGBoost) implements an optimized, parallel-tree gradient boosting algorithm, aiming to be highly efficient, flexible, and portable [Chen T, Guestrin C. XGBoost: a scalable tree boosting system. In: Proceedings of the 22nd ACM SIGKDD International Conference on Knowledge Discovery and Data Mining. 2016 Presented at: KDD '16: The 22nd ACM SIGKDD International Conference on Knowledge Discovery and Data Mining; Aug 13 - 17, 2016; San Francisco California USA. [CrossRef]114]. XGBoost is considered one of the most powerful ML algorithms, often serving as an essential component of winning entries in ML competitions [Géron A. Hands-On Machine Learning with Scikit-Learn and TensorFlow Concepts, Tools, and Techniques to Build Intelligent Systems. Sebastopol, California, United States: O'Reilly Media; 2017.86]. A few drawbacks of XGBoost include lacking interpretability and being prone to overfitting. Pang et al [Pang X, Forrest CB, Lê-Scherban F, Masino AJ. Prediction of early childhood obesity with machine learning and electronic health record data. Int J Med Inform 2021 Jun;150:104454 [FREE Full text] [CrossRef] [Medline]33] used XGBoost to predict early childhood obesity based on electronic health records. Alkutbe et al [Alkutbe RB, Alruban A, Alturki H, Sattar A, Al-Hazzaa H, Rees G. Fat mass prediction equations and reference ranges for Saudi Arabian Children aged 8-12 years using machine technique method. PeerJ 2021;9:e10734 [FREE Full text] [CrossRef] [Medline]27] applied gradient boosting to predict BFP based on cross-sectional health survey data collected in Saudi Arabia.
Multivariate Adaptive Regression Splines
Multivariate adaptive regression splines (MARS) is a nonparametric regression technique that automatically models nonlinearities and interactions among variables by combining ≥2 linear regressions using hinge functions [Prihastuti Yasmirullah SD, Otok BW, Trijoyo Purnomo JD, Prastyo DD. Modification of Multivariate Adaptive Regression Spline (MARS). J Phys Conf Ser 2021 Mar 01;1863(1):012078. [CrossRef]115,Friedman J. Multivariate adaptive regression splines. Ann Statist 1991 Mar 1;19(1):1-67 [FREE Full text] [CrossRef]116]. A hinge function is a function equal to its argument where that argument is >0 and 0 everywhere else. MARS builds a model using a 2-phase procedure [Zhang W, Goh A. Multivariate adaptive regression splines for analysis of geotechnical engineering systems. Comput Geotechnics 2013 Mar;48:82-95. [CrossRef]117]. The forward phase starts with a model consisting of only the intercept term (ie, mean of the target) and repeatedly adds basis functions (ie, constant or hinge function) in pairs to the model that minimizes the squared error loss of the training set. The backward (or pruning) phase usually starts with an overfitted model and removes its least effective term at each step until the best submodel is found. MARS requires little or no data preparation, is easy to understand and interpret, and can address classification and regression tasks. However, it often underperforms boosting ensemble methods. Shao [Shao YE. Body fat percentage prediction using intelligent hybrid approaches. ScientificWorldJournal 2014;2014:383910 [FREE Full text] [CrossRef] [Medline]65] applied MARS to predict BFP using a small-scale health record data set.
DL Models
In the obesity literature reviewed, DL models were applied to 3 distinct data types: tabular data (eg, spreadsheet data), images, and texts. The model architectures differ systematically across these data types.
DL on Tabular Data
Although shallow ML models perform well on tabular data sets in most cases, some complex relationships between the features and the target could be more effectively learned by a deep neural network model [Zhong G, Ling X, Wang L. From shallow feature learning to deep learning: benefits from the width and depth of deep architectures. WIREs Data Min Knowl 2018 Mar 28;9(1):e1255 [FREE Full text] [CrossRef]118]. A fully connected neural network consists of a series of fully connected layers, with each artificial neuron (ie, node) of a layer linking with all neurons in the following layer [Alzubaidi L, Zhang J, Humaidi AJ, Al-Dujaili A, Duan Y, Al-Shamma O, et al. Review of deep learning: concepts, CNN architectures, challenges, applications, future directions. J Big Data 2021;8(1):53 [FREE Full text] [CrossRef] [Medline]76]. A multilayer perceptron (MLP) is a classic fully connected neural network consisting of at least 3 layers of neurons: an input layer, a hidden layer, and an output layer [Gardner M, Dorling S. Artificial neural networks (the multilayer perceptron)—a review of applications in the atmospheric sciences. Atmospheric Environ 1998 Aug;32(14-15):2627-2636. [CrossRef]119]. One advantage of fully connected neural networks is that they are structure agnostic, requiring no specific assumptions about the input. However, neural networks trained on tabular data can sometimes be prone to overfitting [Rynkiewicz J. On overfitting of multilayer perceptrons for classification. In: ESANN 2019 proceedings, European Symposium on Artificial Neural Networks, Computational Intelligence and Machine Learning. 2019 Presented at: ESANN 2019 proceedings, European Symposium on Artificial Neural Networks, Computational Intelligence and Machine Learnin; Apr 24-26, 2019; Bruges, Belgium URL: https://www.esann.org/sites/default/files/proceedings/legacy/es2019-80.pdf [CrossRef]120]. Park and Edington [Park J, Edington DW. Application of a prediction model for identification of individuals at diabetic risk. Methods Inf Med 2004;43(3):273-281. [Medline]121] used MLP to identify individuals at elevated diabetic risk. Heydari et al [Heydari ST, Ayatollahi SM, Zare N. Comparison of artificial neural networks with logistic regression for detection of obesity. J Med Syst 2012 Aug;36(4):2449-2454. [CrossRef] [Medline]67] performed MLP to predict obesity status using data from a cross-sectional study of military personnel in Iran.
DL on Images
CV is a field of AI that enables computers to learn from digital images, videos, or other visual inputs and derive meaningful information for decision-making and recommendations [Voulodimos A, Doulamis N, Bebis G, Stathaki T. Recent developments in deep learning for engineering applications. Comput Intell Neurosci 2018;2018:8141259-8142018 [FREE Full text] [CrossRef] [Medline]122,Chai J, Zeng H, Li A, Ngai EW. Deep learning in computer vision: a critical review of emerging techniques and application scenarios. Mach Learn Application 2021 Dec;6:100134. [CrossRef]123]. Nowadays, most CV applications use DL models, which prove more capable than their shallow-learning (ie, ML models) counterparts in representing and revealing high-dimensional, complex nonlinear patterns inherent in image data. Specifically, CNNs consistently outperform the traditional densely connected neural networks (eg, MLP) and achieve human-like or superhuman accuracy in many challenging CV tasks ranging from image classification to object detection and segmentation [Dhillon A, Verma GK. Convolutional neural network: a review of models, methodologies and applications to object detection. Prog Artif Intell 2019 Dec 20;9(2):85-112. [CrossRef]124,Khan A, Sohail A, Zahoora U, Qureshi AS. A survey of the recent architectures of deep convolutional neural networks. Artif Intell Rev 2020 Apr 21;53(8):5455-5516. [CrossRef]125]. The main advantages of CNNs over densely connected neural networks are locality, translation invariance, and computational efficiency [Stevens E, Antiga L, Viehmann T. Deep Learning with PyTorch Build, Train, and Tune Neural Networks Using Python Tools. Shelter Island, New York, United States: Manning; 2020.126]. Locality refers to the repeated use of small-sized kernels (or filters) in CNNs to identify local patterns at an increasing level of complexity (eg, from basic shapes such as lines and edges to complex objects such as adipose tissue or brain tumor). Translation invariance refers to CNNs’ capacity to detect an entity independent of its position in the image. The computational efficiency of CNNs is achieved by using kernels, global pooling, and other techniques, which typically make the models much smaller (ie, fewer learnable parameters) than their densely connected counterparts. Over the past decade, numerous CNN-based DL models were built and adopted to tackle domain-specific CV problems [Alzubaidi L, Zhang J, Humaidi AJ, Al-Dujaili A, Duan Y, Al-Shamma O, et al. Review of deep learning: concepts, CNN architectures, challenges, applications, future directions. J Big Data 2021;8(1):53 [FREE Full text] [CrossRef] [Medline]76,Aloysius N, Geetha M. A review on deep convolutional neural networks. In: Proceedings of the 2017 International Conference on Communication and Signal Processing (ICCSP). 2017 Presented at: 2017 International Conference on Communication and Signal Processing (ICCSP); Apr 06-08, 2017; Chennai, India. [CrossRef]127]. Some landmark models include, but are not limited to, LeNet, AlexNet, VGG, Inception, ResNet, Xception, ResNeXt, and U-Net.
Transfer learning plays a crucial role in modern AI, where a model developed for a task is reused as the starting point for a model on a different but related task [Zhuang F, Qi Z, Duan K, Xi D, Zhu Y, Zhu H, et al. A comprehensive survey on transfer learning. Proc IEEE 2021 Jan;109(1):43-76. [CrossRef]128]; for instance, the ResNet model trained on ImageNet data with >14 million images in approximately 1000 categories (eg, tables and horses) has stored many useful visual patterns in its weights, which can help solve other CV tasks (eg, identifying fat tissues in MRI scans) [He K, Zhang X, Ren S, Sun J. Deep residual learning for image recognition. In: Proceedings of the IEEE Conference on Computer Vision and Pattern Recognition (CVPR). 2016 Presented at: IEEE Conference on Computer Vision and Pattern Recognition (CVPR); Jun 27-30, 2016; Las Vegas, NV, USA. [CrossRef]129]. Transfer learning can substantially reduce the number of images required to train a model for a particular task and boost model performance compared with models trained from scratch [Weiss K, Khoshgoftaar T, Wang D. A survey of transfer learning. J Big Data 2016 May 28;3(1):1-40 [FREE Full text] [CrossRef]130].
Maharana and Nsoesie [Maharana A, Nsoesie EO. Use of deep learning to examine the association of the built environment with prevalence of neighborhood adult obesity. JAMA Netw Open 2018 Aug 03;1(4):e181535 [FREE Full text] [CrossRef] [Medline]57] adopted the VGG model architecture to examine the relationship between obesity prevalence and the built environment measured by Google Maps images (eg, parks, highways, green streets, crosswalks, and diverse housing types). Similarly, Phan et al [Phan L, Yu W, Keralis JM, Mukhija K, Dwivedi P, Brunisholz KD, et al. Google street view derived built environment indicators and associations with state-level obesity, physical activity, and chronic disease mortality in the united states. Int J Environ Res Public Health 2020 May 22;17(10):3659 [FREE Full text] [CrossRef] [Medline]42] used the VGG model to assess the link between the statewide prevalence of obesity, physical activity, and chronic disease mortality and the built environment using images from Google Street View. Bhanu et al [Bhanu PK, Arvind CS, Yeow LY, Chen WX, Lim WS, Tan CH. CAFT: a deep learning-based comprehensive abdominal fat analysis tool for large cohort studies. MAGMA 2022 Apr;35(2):205-220. [CrossRef] [Medline]38] applied the U-Net model to identify adipose tissues from MRI data. Snekhalatha and Sangamithirai [U S, K. PT, K S. Computer aided diagnosis of obesity based on thermal imaging using various convolutional neural networks. Biomed Signal Process Control 2021 Jan;63:102233 [FREE Full text] [CrossRef]30] applied transfer learning on a pretrained CNN model to detect obesity based on thermal imaging data.
DL on Text
Besides CV, NLP is another field where DL dominates [Li H. Deep learning for natural language processing: advantages and challenges. National Sci Rev 2017;5(1):24-26 [FREE Full text]131]. Early NLP models primarily adopted recurrent neural network (RNN) architecture, demonstrating broad applicability to various NLP tasks such as sentiment analysis, text summarization, language translation, and speech recognition [Chollet F. Deep Learning with Python, Second Edition. Shelter Island, New York, United States: Manning; 2021.74,Le Glaz A, Haralambous Y, Kim-Dufor D, Lenca P, Billot R, Ryan TC, et al. Machine learning and natural language processing in mental health: systematic review. J Med Internet Res 2021 May 04;23(5):e15708 [FREE Full text] [CrossRef] [Medline]132]. RNN differs from feed-forward MLP in that it takes information from prior inputs (stored as memories) to influence the current input and output, which capitalizes on the structure of sequential data where order matters (eg, time series or natural languages) [Lipton ZC, Berkowitz J, Elkan C. A critical review of recurrent neural networks for sequence learning. arXiv 2015 Jun 5 [FREE Full text]133]. Some popular RNN models used in NLP tasks include gated recurrent unit and long short-term memory unit [Chollet F. Deep Learning with Python, Second Edition. Shelter Island, New York, United States: Manning; 2021.74]. However, in today’s NLP landscape, transformers, invented by a team at Google in 2017, have surpassed RNN models such as gated recurrent unit and long short-term memory unit [Chernyavskiy A, Ilvovsky D, Nakov P. Transformers: “the end of history” for natural language processing? In: Machine Learning and Knowledge Discovery in Databases. Cham: Springer; 2021.134-Vaswani A, Shazeer N, Parmar N, Uszkoreit J, Jones L, Gomez AN. Attention is all you need. In: Proceedings of the 31st Conference on Neural Information Processing Systems (NIPS 2017). 2017 Presented at: 31st Conference on Neural Information Processing Systems (NIPS 2017); Dec 4 - 9, 2017; Long Beach, CA, USA URL: https://proceedings.neurips.cc/paper/2017/file/3f5ee243547dee91fbd053c1c4a845aa-Paper.pdf136]. Transformers are encoder-decoder models that use self-attention to process language sequences [Tunstall L, von WL, Wolf T. Natural Language Processing with Transformers, Revised Edition. Sebastopol, California, United States: O'Reilly Media; 2022.137]. An encoder maps an input sequence into state representation vectors. A decoder decodes the state representation vector to generate the target output sequence. The self-attention mechanism is used repeatedly within the encoder and the decoder to help them contextualize the input data. Specifically, the mechanism compares every word in the sentence to every other word, including itself, and reweighs each word’s embeddings to incorporate contextual relevance. Popular transformer models such as GPT-3, BERT, XLNet, RoBERTa, and T5 have been widely applied to various NLP tasks and achieved state-of-the-art results [Tunstall L, von WL, Wolf T. Natural Language Processing with Transformers, Revised Edition. Sebastopol, California, United States: O'Reilly Media; 2022.137]. Stephens et al [Stephens TN, Joerin A, Rauws M, Werk LN. Feasibility of pediatric obesity and prediabetes treatment support through Tess, the AI behavioral coaching chatbot. Transl Behav Med 2019 May 16;9(3):440-447. [CrossRef] [Medline]48] tested the efficacy of pediatric obesity treatment support through Tess, a behavioral coaching chatbot built on NLP models. The study concluded that Tess demonstrated therapeutic values to pediatric patients with obesity and prediabetes, especially outside of office hours, and could be scaled up to serve a larger patient population.
Discussion
Overview
This study conducted a scoping review of the applications of AI to obesity research. A keyword search in digital bibliographic databases identified 46 studies that used diverse ML and DL models to study obesity-related outcomes. In general, the studies found AI models helpful in detecting clinically meaningful patterns of obesity or relationships between specific covariates and weight outcomes. The majority (18/22, 82%) of the studies comparing AI models with conventional statistical approaches found that the AI models achieved higher prediction accuracy on test data. Some (5/46, 11%) of the studies comparing the performances of different AI models revealed mixed results, likely indicating the high contingency of model performance on the data set and task it was applied to. An accelerating trend of adopting state-of-the-art DL models over standard ML models was observed to address challenging CV and NLP tasks. We concisely introduced the popular ML and DL models and summarized their specific applications in the studies included in the review.
Despite the variety of ML and DL models used in obesity research, it could well be the beginning of the trend for using AI applications in the big data era. Future adoptions of AI in obesity research could be influenced by a broad spectrum of factors, with 3 prominent ones discussed in the following sections.
Artificial General Intelligence
The ML and DL models reviewed in this study were primarily unimodal and task specific: they were built on a single data type (eg, tabular, text, or image) to solve a specific problem such as obesity classification or BMI prediction. Recent advances in AI showcase the feasibility and possibly superior performance of multimodal, multitask ML and DL models that are trained on diverse data types (eg, tabular plus text, image, video, or audio) and can handle many domains of downstream tasks (eg, text generation, object detection, time series prediction, and speech recognition) simultaneously [Summaira J, Li X, Shoib AM, Bourahla O, Songyuan L, Abdul J. Recent advances and trends in multimodal deep learning: a review. arXiv 2021 May [FREE Full text]138-Zhang Y, Yang Q. An overview of multi-task learning. National Sci Rev 2018;5(1):30-43. [CrossRef]140]. However, it should be noted that the predictive accuracy of AI models may vary across gender and age groups [Alkutbe RB, Alruban A, Alturki H, Sattar A, Al-Hazzaa H, Rees G. Fat mass prediction equations and reference ranges for Saudi Arabian Children aged 8-12 years using machine technique method. PeerJ 2021;9:e10734 [FREE Full text] [CrossRef] [Medline]27] and sex and age groups [Seyednasrollah F, Mäkelä J, Pitkänen N, Juonala M, Hutri-Kähönen N, Lehtimäki T, et al. Prediction of adulthood obesity using genetic and childhood clinical risk factors in the cardiovascular risk in young finns study. Circ Cardiovasc Genet 2017 Jun;10(3):e001554 [FREE Full text] [CrossRef] [Medline]59]. Different from BMI, BMI z scores adjust for sex and age differences [Fagerberg P, Charmandari E, Diou C, Heimeier R, Karavidopoulou Y, Kassari P, et al. Fast eating is associated with increased BMI among high-school students. Nutrients 2021 Mar 09;13(3):880 [FREE Full text] [CrossRef] [Medline]141]. Future research may evaluate the potential disparities in AI model performances in their applications to BMI versus BMI z scores as outcome measures. Artificial general intelligence (AGI) refers to the ability of an intelligent agent to understand or learn any intellectual task performed by a human being [Nyalapelli V, Gandhi M, Bhargava S, Dhanare R, Bothe S. Review of progress in artificial general intelligence and human brain inspired cognitive architecture. In: Proceedings of the 2021 International Conference on Computer Communication and Informatics (ICCCI). 2021 Presented at: 2021 International Conference on Computer Communication and Informatics (ICCCI); Jan 27-29, 2021; Coimbatore, India. [CrossRef]142,Long L, Cotner C. A review and proposed framework for artificial general intelligence. In: Proceedings of the 2019 IEEE Aerospace Conference. 2019 Presented at: 2019 IEEE Aerospace Conference; Mar 02-09, 2019; Big Sky, MT, USA. [CrossRef]143]. It is too early to tell whether these multimodal, multitask ML and DL models may lead to AGI (or whether we could ever achieve AGI through technological innovations) [Fjelland R. Why general artificial intelligence will not be realized. Humanit Soc Sci Commun 2020 Jun 17;7(1). [CrossRef]144]. Nevertheless, we may soon witness increasing applications of these models in obesity-related research.
Synthetic Data Generation
Data access is fundamental to any AI model training. Two primary barriers with regard to data are limited sample size and confidentiality concerns [Bae H, Jang J, Jung D, Jang H, Ha H, Lee H, et al. Security and privacy issues in deep learning. arXiv 2021 Mar [FREE Full text]145-Liu B, Wei Y, Zhang Y, Yang Q. Deep neural networks for high dimension, low sample size data. In: Proceedings of the Twenty-Sixth International Joint Conference on Artificial Intelligence (IJCAI-17). 2017 Presented at: Proceedings of the Twenty-Sixth International Joint Conference on Artificial Intelligence (IJCAI-17); Aug 19-25, 2017; Melbourne, Australia URL: https://www.ijcai.org/Proceedings/2017/0318.pdf [CrossRef]148]. ML and DL models are increasingly used to generate synthetic data as an alternative to data collected from the real world [Goncalves A, Ray P, Soper B, Stevens J, Coyle L, Sales AP. Generation and evaluation of synthetic patient data. BMC Med Res Methodol 2020 May 07;20(1):108 [FREE Full text] [CrossRef] [Medline]149,Chen RJ, Lu MY, Chen TY, Williamson DF, Mahmood F. Synthetic data in machine learning for medicine and healthcare. Nat Biomed Eng 2021 Jun;5(6):493-497 [FREE Full text] [CrossRef] [Medline]150]. Synthetic data do not contain private information requiring human subject review and, therefore, can be shared with other parties or the public without confidentiality concerns [Rankin D, Black M, Bond R, Wallace J, Mulvenna M, Epelde G. Reliability of supervised machine learning using synthetic data in health care: model to preserve privacy for data sharing. JMIR Med Inform 2020 Jul 20;8(7):e18910 [FREE Full text] [CrossRef] [Medline]151]. By contrast, synthetic data preserve the original data’s mathematical and statistical properties, ensuring that the AI model trained on them can be generalized to real-world data [El Emam K, Mosquera L, Hoptroff R. Practical Synthetic Data Generation Balancing Privacy and the Broad Availability of Data. Sebastopol, California, United States: O'Reilly Media; 2020.152]. In addition, given the unrestrained availability of synthetic data (only limited by the computational power of data generation), AI models trained on synthetic data can be robust with regard to data variations [Sergey I N. Synthetic Data for Deep Learning. Cham: Springer International Publishing; 2021.153]. Synthetic data of various types, such as tabular, text, and image, have been generated in massive quantities to train ML and DL models cost-effectively. Obesity-related data or, more generally, health-related data can be expensive to collect (eg, MRI scans) and contain confidential information (eg, patients’ names or residential addresses), which could be addressed by synthetic data generation [Moya-Sáez E, Peña-Nogales Ó, Luis-García R, Alberola-López C. A deep learning approach for synthetic MRI based on two routine sequences and training with synthetic data. Comput Methods Programs Biomed 2021 Oct;210:106371 [FREE Full text] [CrossRef] [Medline]154].
Human-in-the-Loop
There have been increasing concerns over AI-related data bias and ethical issues [Mehrabi N, Morstatter F, Saxena N, Lerman K, Galstyan A. A survey on bias and fairness in machine learning. ACM Comput Surv 2021 Jul;54(6):1-35. [CrossRef]155,Zhou N, Zhang Z, Nair V, Singhal H, Chen J. Bias, fairness and accountability with artificial intelligence and machine learning algorithms. Int Statistical Rev 2022 Apr 10;90(3):468-480 [FREE Full text] [CrossRef]156]. Fundamentally, AI models should facilitate but not replace human judgment and decision-making [Zerilli J, Knott A, Maclaurin J, Gavaghan C. Algorithmic decision-making and the control problem. Minds Mach 2019 Dec 11;29(4):555-578. [CrossRef]157,Lepri B, Oliver N, Pentland A. Ethical machines: the human-centric use of artificial intelligence. iScience 2021 Mar 19;24(3):102249 [FREE Full text] [CrossRef] [Medline]158]. Human-in-the-loop (HITL) is an AI model that requires human interaction [Monarch R. Human-in-the-Loop Machine Learning Active Learning and Annotation for Human-centered AI. Shelter Island, New York, United States: Manning Publications; 2021.159,Wu X, Xiao L, Sun Y, Zhang J, Ma T, He L. A survey of human-in-the-loop for machine learning. Future Gen Comput Syst 2022 Oct;135:364-381 [FREE Full text] [CrossRef]160]. HITL ensures that algorithm biases and potentially destructive model outputs can be identified in a timely manner and corrected to prevent adverse consequences. However, such interactions between humans and machines require thoughtful designs in the data-processing pipeline, model architecture, and personnel management [Monarch R. Human-in-the-Loop Machine Learning Active Learning and Annotation for Human-centered AI. Shelter Island, New York, United States: Manning Publications; 2021.159]. Data- and model-driven decision-making related to obesity, such as behavioral modifications (eg, diet or physical activity interventions) or medical treatment, can be complex [Timmins KA, Green MA, Radley D, Morris MA, Pearce J. How has big data contributed to obesity research? A review of the literature. Int J Obes (Lond) 2018 Dec;42(12):1951-1962 [FREE Full text] [CrossRef] [Medline]161]. AI-powered wearables and other digital health platforms can detect change in an individual’s physical activity and provide actionable information to improve health outcomes [Sapci AH, Sapci HA. Innovative assisted living tools, remote monitoring technologies, artificial intelligence-driven solutions, and robotic systems for aging societies: systematic review. JMIR Aging 2019 Nov 29;2(2):e15429 [FREE Full text] [CrossRef] [Medline]162-Wilmink G, Dupey K, Alkire S, Grote J, Zobel G, Fillit HM, et al. Artificial intelligence-powered digital health platform and wearable devices improve outcomes for older adults in assisted living communities: pilot intervention study. JMIR Aging 2020 Sep 10;3(2):e19554 [FREE Full text] [CrossRef] [Medline]164]. Mobile chemical sensors could offer timely dietary information by monitoring real-time chemical variations upon food consumption, collecting dynamic data based on an individual’s metabolic profile and environmental exposure, thus supporting dietary behavior decision-making to improve precise nutrition [Sempionatto J, Montiel V, Vargas E, Teymourian H, Wang J. Wearable and mobile sensors for personalized nutrition. ACS Sens 2021 May 28;6(5):1745-1760 [FREE Full text] [CrossRef] [Medline]165]. HITL may integrate AI model outputs with expert inputs to make informed decisions that capitalize on the strengths of both and maximize patients’ chances of health restoration and improvement [Patel BN, Rosenberg L, Willcox G, Baltaxe D, Lyons M, Irvin J, et al. Human–machine partnership with artificial intelligence for chest radiograph diagnosis. NPJ Digit Med 2019 Nov 18;2(1):111 [FREE Full text] [CrossRef] [Medline]166].
Limitations of the Scoping Review and Included Studies
To our knowledge, this study is the first to systematically review AI-related methodologies adopted in the obesity literature and project trends for future technological development and applications. However, several limitations should be noted concerning this review and the included studies. As our review focused on ML and DL methods, study-specific findings (eg, the effectiveness of an intervention and estimated associations between covariates and an outcome) were not synthesized in detail. The included studies were heterogeneous in terms of hypothesis and research question, study design, population sampled, data collection method, sample size, and data quality. The analytic approach chosen was endogenous to these study-specific parameters; therefore, across-study comparisons of model performances may not be reliable. Even within the same study, conclusions about relative model performances (eg, the prediction accuracy of logistic regression vs SVM) may lack generalizability because of the interdependency between data and ML and DL algorithms. AI technologies are rapidly advancing, with innovations and breakthroughs almost daily. A review such as this one will have a short shelf life and warrant periodic updates.
Conclusions
This study reviewed the AI-related methodologies adopted in the obesity literature, particularly ML and DL models applied to tabular, image, and text data for obesity measurement, prediction, and treatment. It aimed to provide researchers and practitioners with an overview of the AI applications to obesity research, familiarize them with popular ML and DL models, and facilitate their adoption of AI applications. The review also discussed emerging trends such as multimodal and multitask AI models, synthetic data generation, and HITL, which may witness increasing applications in obesity research.
Acknowledgments
This research was partially funded by the Fundamental Research Funds for the Central Universities, China University of Geosciences, Beijing (grant 2-9-2020-036).
Authors' Contributions
RA designed the study and wrote the manuscript. RA and JS jointly designed the search algorithm and screened articles. JS performed data extraction and constructed the summary tables. YX drafted part of the Discussion section. JS and YX revised the manuscript. The co–first authors RA and JS contributed equally.
Conflicts of Interest
None declared.
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Abbreviations
AGI: artificial general intelligence |
AI: artificial intelligence |
BFP: body fat percentage |
CNN: convolutional neural network |
CV: computer vision |
DL: deep learning |
DT: decision tree |
GFA: group factor analysis |
HITL: human-in-the-loop |
KNN: k-nearest neighbor |
LASSO: least absolute shrinkage and selection operator |
MARS: multivariate adaptive regression splines |
ML: machine learning |
MLP: multilayer perceptron |
MRI: magnetic resonance imaging |
NB: naïve Bayes |
NLP: natural language processing |
PCA: principal component analysis |
PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses |
PRISMA-ScR: Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews |
RF: random forest |
RNN: recurrent neural network |
SVM: support vector machine |
WC: waist circumference |
WHR: waist-to-hip ratio |
XGBoost: extreme gradient boosting |
Edited by R Kukafka; submitted 28.06.22; peer-reviewed by N Maglaveras, B Puladi; comments to author 30.08.22; revised version received 05.10.22; accepted 01.11.22; published 07.12.22
Copyright©Ruopeng An, Jing Shen, Yunyu Xiao. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 07.12.2022.
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