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Social media/mobile intervention yields short-term weight loss in young adults
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Young adults with overweight and obesity randomly assigned to a technology-based weight-loss intervention saw short-term reductions in body weight, but did not lose more weight at 2 years than those assigned to a control program, according to recent findings.
In a parallel-group, randomized controlled trial, Job G. Godino, PhD, of the Center for Wireless and Population Health Systems at the University of California, San Diego, and colleagues analyzed data from 404 college students (aged 18-35 years) with overweight or obesity (BMI, 25-34.9 kg/m²) from three universities in San Diego between May 2011 and May 2012 (mean age, 23 years; 70% women; 31% Hispanic; mean BMI, 29 kg/m²). All participants owned a smartphone and personal computer and were willing to use Facebook. After a baseline measurement visit, researchers assigned participants to the Social Mobile Approaches to Reduce Weight (SMART) intervention (n = 202) or to general information about health and wellness (control group; n = 202).
SMART intervention was delivered via Facebook, three study-designed mobile apps, text messaging, emails, a blog and technology-mediated communication with a health coach (up to 10 brief interactions). Participants in the intervention group were instructed to use at least one of the modalities a minimum of five times weekly throughout the 24-month study period. Participants could privately or publicly set individually tailored physical activity and diet goals, receive feedback and participate in goal review; the health coach initiated themed challenges centered on diet and fitness goals. Researchers recorded interactions on the study Facebook page, mobile apps, text messages sent and replied to, and communication with the health coach between follow-up visits.
Primary outcome was objectively measured weight at 24 months. Researchers used linear mixed-effects regression within an intention-to-treat framework to measure differences between groups. Secondary outcome was objectively measured weight at 6, 12 and 18 months. Participants received $40 at baseline and $50 at 6 months.
At 24 months, weight was assessed in 341 (84%; 16% were lost to follow-up) participants, but all 404 were included in analyses. Weight, adjusted for sex, ethnicity and college, was not significantly different between the groups at 24 months (–0.79 kg; 95% CI, 2.02-0.43). However, weight was less in the intervention group compared with the control group at 6 months (–1.33 kg; 95% CI, –2.36 to –0.3) and at 12 months (–1.33 kg; 95% CI, –2.3 to –0.35), but not 18 months (–0.67 kg; 95% CI, –1.69 to 0.35).
Among those in the intervention group, the level of engagement with the program decreased during follow-up; from a mean of 98 interactions at 6 months to a mean of 12 interactions at 24 months. Those with higher levels of engagement with the program did not achieve greater weight loss vs. those with low engagement, according to researchers.
One participant in the intervention group reported experiencing a serious adverse event (gallstones), which researchers noted could be attributable to rapid and excessive weight loss.
“The SMART intervention is the first to incorporate several theory-based behavior change
techniques previously demonstrated to be effective in improving weight-related behaviors and deliver them in an individually tailored and dynamic manner via Facebook and mobile technologies commonly used among young adults,” the researchers wrote. “If future social and mobile interventions are able to stimulate reductions in weight similar to those observed in the first 12 months of this trial, but maintained for a longer period of time, a
meaningful population-level effect on the weight status and health of young adults could be seen.” – by Regina Schaffer
Disclosure: The study was supported by a cooperative agreement with the National Heart, Lung, and Blood Institute through the NIH. The researchers report no relevant financial disclosures.
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Henry H. Fischer, MD
Congratulations to Godino and his team on a well-designed study of mobile health support for weight loss in young overweight adults with follow-up out to 2 years. The intervention was well conceived with multiple mobile health modalities, as well as social networking and supplemental coaching, which could be individualized and adjusted for the participant throughout the intervention. The content and design were grounded in behavioral change and social cognitive theory. While the participants had clinically relevant weight loss through year 1, the effect disappeared in year 2.
What does this say about our ability to help patients lose weight through mobile health interventions? As the authors note, challenges to achieving an intervention effect included fairly healthy, motivated participants (average exercise at baseline was 118 minutes per week in the control group) and contamination both across the groups and from outside weight-loss modalities. We anticipate ongoing study of how we can engage patients for extended periods of time; of which types of mobile health modalities are most effective for different subgroups of patients; and of how we can deliver scalable mobile health interventions at low cost, which can have a major public health impact even with modest 3% weight loss.
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