Clinical research study
Mobile Health Messages Help Sustain Recent Weight Loss

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Abstract

Background

Using regulatory focus theory, an intervention of daily weight loss-sustaining messages was developed and tested for acceptability, feasibility, and efficacy on helping people sustain weight loss.

Methods

Participants (n = 120) were randomized to a promotion, prevention, or an attention-control text message group after completion of a weight loss program. Participants completed baseline assessments, and reported their weight at 1 and 3 months postbaseline.

Results

Participants found the message content and intervention acceptable and valuable. A minimum of one message per day delivered at approximately 8:00 am was deemed the optimal delivery time and frequency. The sustained weight loss rate at month 3 for the control, promotion, and prevention groups was 90%, 95%, and 100%, respectively. Medium-to-large effects were observed for the promotion and prevention groups at month 1 and for prevention at month 3 relative to controls. The mean weight loss for promotion and prevention was 15 pounds, compared with 10 in the controls at month 3.

Conclusion

A clinically significant decrease in mean weight, higher rate of sustained weight loss, and medium-to-large effects on sustained weight loss occurred in the promotion and prevention interventions. Tools such as this text message-based intervention that are constructed and guided by evidence-based content and theoretical constructs show promise in helping people sustain healthy behaviors that can lead to improved health outcomes.

Section snippets

Study Design

We conducted an exploratory randomized controlled trial using mixed methods, with data collected at baseline, and 1 month and 3 months post baseline. Permuted block randomization with a block size of 3 was used by the research coordinator to assign 120 participants to 1 of the 3 following message intervention groups: promotion-framed (n = 41), prevention-framed (n = 40), or general health message control group (n = 39; see Figure). Effect sizes specific to text message-based interventions and

Baseline Characteristics

We recruited 120 participants from May 2011 to February 2012 (Figure). Most participants were white (94%), college educated (81%), and financially stable (80%). A majority was female (59%), currently working (58%), and almost half were married (48%). The mean weight was 247.5 (SD = 61.8) pounds and mean body mass index was 38.1 (SD 7.8). Significant group differences in baseline characteristics were not observed (P >.05; Table 1). The sample was comparable with the DFC population with regard to

Discussion

Findings for sustained weight loss indicated that the overall rate of sustained weight loss was 98% after 1 month and 95% after 3 months. A higher proportion of participants sustained their weight loss in the 2 active intervention groups when compared with the control condition. Clinically meaningful effects on sustained weight loss were observed for the promotion and prevention arms relative to controls after month 1. Interestingly, the effect of the prevention intervention further increased

Conclusion

Communication technologies such as mobile phones may serve as an effective medium to deliver affordable health promotion and disease prevention care to an array of people due to their ubiquity and penetration into people's everyday lives. However, emerging and promising technologies must be matched with content that successfully resonates and motivates people to change and sustain behaviors. Our findings demonstrate that it is not only feasible and acceptable to use text messaging as a health

Acknowledgments

We thank William Tatum, Jeffrey Hess, and Lucie Knapp for their support.

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    Funding: This research was supported by a Duke University Health System Information Technology Fellowship, a National Research Service Award (1F31 NR012599) from the National Institutes of Health (NIH), National Institute of Nursing Research, and a Department of Veterans Affairs Health Services Research and Development Office of Academic Affiliations nursing postdoctoral research award (TPP-21-021), to the first author. HBB was supported by a Research Career Scientist award from the Department of Veterans Affairs Office of Health Services Research and Development RCS-08-027. The content is solely the responsibility of the authors and does not necessarily represent the official views of Duke University, the NIH, or the US Department of Veterans Affairs.

    Conflict of interest: None.

    Authorship: All work herein is original. All authors meet the criteria for authorship, including acceptance of responsibility for the scientific content of the manuscript.

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