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      Text messaging and brief phone calls for weight loss in overweight and obese English- and Spanish-speaking adults: A 1-year, parallel-group, randomized controlled trial

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          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Background

          Weight loss interventions based solely on text messaging (short message service [SMS]) have been shown to be modestly effective for short periods of time and in some populations, but limited evidence is available for positive longer-term outcomes and for efficacy in Hispanic populations. Also, little is known about the comparative efficacy of weight loss interventions that use SMS coupled with brief, technology-mediated contact with health coaches, an important issue when considering the scalability and cost of interventions. We examined the efficacy of a 1-year intervention designed to reduce weight among overweight and obese English- and Spanish-speaking adults via SMS alone (ConTxt) or in combination with brief, monthly health-coaching calls. ConTxt offered 2–4 SMS/day that were personalized, tailored, and interactive. Content was theory- and evidence-based and focused on reducing energy intake and increasing energy expenditure. Monthly health-coaching calls (5–10 minutes’ duration) focused on goal-setting, identifying barriers to achieving goals, and self-monitoring.

          Methods and findings

          English- and Spanish-speaking adults were recruited from October 2011 to March 2013. A total of 298 overweight (body mass index [BMI] 27.0 to 39.9 kg/m 2) adults (aged 21–60 years; 77% female; 41% Hispanic; 21% primarily Spanish speaking; 44% college graduates or higher; 22% unemployed) were randomly assigned (1:1) to receive either ConTxt only ( n = 101), ConTxt plus health-coaching calls ( n = 96), or standard print materials on weight reduction (control group, n = 101). We used computer-based permuted-block randomization with block sizes of three or six, stratified by sex and Spanish-speaking status. Participants, study staff, and investigators were masked until the intervention was assigned. The primary outcome was objectively measured percent of weight loss from baseline at 12 months. Differences between groups were evaluated using linear mixed-effects regression within an intention-to-treat framework. A total of 261 (87.2%) and 253 (84.9%) participants completed 6- and 12-month visits, respectively. Loss to follow-up did not differ by study group. Mean (95% confidence intervals [CIs]) percent weight loss at 12 months was −0.61 (−1.99 to 0.77) in the control group, −1.68 (−3.08 to −0.27) in ConTxt only, and −3.63 (−5.05 to −2.81) in ConTxt plus health-coaching calls. At 12 months, mean (95% CI) percent weight loss, adjusted for baseline BMI, was significantly different between ConTxt plus health-coaching calls and the control group (−3.0 [−4.99 to −1.04], p = 0.003) but not between the ConTxt-only and the control group (−1.07 [−3.05 to 0.92], p = 0.291). Differences between ConTxt plus health-coaching calls and ConTxt only were not significant (−1.95 [−3.96 to 0.06], p = 0.057). These findings were consistent across other weight-related secondary outcomes, including changes in absolute weight, BMI, and percent body fat at 12 months. Exploratory subgroup analyses suggested that Spanish speakers responded more favorably to ConTxt plus health-coaching calls than English speakers (Spanish contrast: −7.90 [−11.94 to −3.86], p < 0.001; English contrast: −1.82 [−4.03 to 0.39], p = 0.107). Limitations include the unblinded delivery of the intervention and recruitment of a predominantly female sample from a single site.

          Conclusions

          A 1-year intervention that delivered theory- and evidence-based weight loss content via daily personalized, tailored, and interactive SMS was most effective when combined with brief, monthly phone calls.

          Trial registration

          ClinicalTrials.gov NCT01171586

          Author summary

          Why was this study done?
          • Overweight and obese adults have increased risk for several chronic diseases, including type 2 diabetes, hypertension, cardiovascular disease, and many types of cancer.

          • Most effective weight loss interventions are costly, require in-person behavioral counseling, and lack evidence of long-term effectiveness.

          • We sought to determine whether weight loss content delivered by text message alone or in combination with brief, technology-mediated contact with health coaches that is scalable can improve weight loss among English- and Spanish-speaking adults.

          What did the researchers do and find?
          • We examined the efficacy of a 1-year randomized controlled trial designed to reduce weight among overweight and obese English- and Spanish-speaking adults via theory- and evidence-based, personalized, tailored, and interactive text messaging alone (ConTxt) or in combination with brief, monthly health-coaching calls.

          • At 12 months, mean percent weight loss, adjusted for baseline body mass index, was significantly different between ConTxt plus health-coaching calls and the control group but not between ConTxt only and the control group. The combined intervention resulted in a weight loss equal to 3.6%, contrasted against those in the control who lost 0.6%, at 1 year among a diverse sample of English- and Spanish-speaking adults who were overweight or obese.

          What do these findings mean?
          • A 1-year intervention that delivered theory- and evidence-based weight loss content via daily personalized, tailored, and interactive text messaging was most effective when combined with brief, monthly phone calls.

          • Given the high scalability of our intervention, these results represent an intriguing weight loss approach, particularly among hard-to-reach populations who are disproportionately affected by the negative consequences of overweight and obesity.

          Related collections

          Most cited references 14

          • Record: found
          • Abstract: found
          • Article: not found

          Revision of the Physical Activity Readiness Questionnaire (PAR-Q).

          The original Physical Activity Readiness Questionnaire (PAR-Q) offers a safe preliminary screening of candidates for exercise testing and prescription, but it screens out what seems an excessive proportion of apparently healthy older adults. To reduce unnecessary exclusions, an expert committee established by Fitness Canada has now revised the questionnaire wording. The present study compares responses to the original and the revised PAR-Q questionnaire in 399 men and women attending 40 accredited fitness testing centres across Canada. The number of subjects screened out by the revised test decreased significantly (p < .05), from 68 to 48 of the 399 subjects. The change reflects in part the inclusion of individuals who had made an erroneous positive response to the original question regarding high blood pressure. There is no simple gold standard to provide an objective evaluation of the sensitivity and specificity of either questionnaire format, but the revised wording has apparently had the intended effect of reducing positive responses, particularly to the question regarding an elevation of blood pressure.
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            • Abstract: found
            • Article: not found

            Efficacy of text messaging-based interventions for health promotion: a meta-analysis.

            This meta-analysis investigated the efficacy of text messaging-based health promotion interventions. Nineteen randomized controlled trials conducted in 13 countries met inclusion criteria and were coded on a variety of participant, intervention, and methodological moderators. Meta-analytic procedures were used to compute and aggregate effect sizes. The overall weighted mean effect size representing the impact of these interventions on health outcomes was d = .329 (95% CI = .274, .385; p < .001). This effect size was statistically heterogeneous (Q18 = 55.60, p < .001, I(2) = 67.62), and several variables significantly moderated the effects of interventions. Smoking cessation and physical activity interventions were more successful than interventions targeting other health outcomes. Message tailoring and personalization were significantly associated with greater intervention efficacy. No significant differences were found between text-only interventions and interventions that included texting plus other components. Interventions that used an individualized or decreasing frequency of messages over the course of the intervention were more successful than interventions that used a fixed message frequency. We discuss implications of these results for health promotion interventions that use text messaging. Copyright © 2013 Elsevier Ltd. All rights reserved.
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              • Article: not found

              Mobile phone interventions to increase physical activity and reduce weight: a systematic review.

              This systematic review was conducted to determine user satisfaction and effectiveness of smartphone applications and text messaging interventions to promote weight reduction and physical activity.
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                Author and article information

                Contributors
                Role: Data curationRole: Formal analysisRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: InvestigationRole: MethodologyRole: Writing – review & editing
                Role: ConceptualizationRole: InvestigationRole: MethodologyRole: Writing – review & editing
                Role: ConceptualizationRole: InvestigationRole: MethodologyRole: Writing – review & editing
                Role: ConceptualizationRole: InvestigationRole: MethodologyRole: Writing – review & editing
                Role: ConceptualizationRole: InvestigationRole: MethodologyRole: Writing – review & editing
                Role: Data curationRole: InvestigationRole: MethodologyRole: Writing – review & editing
                Role: Data curationRole: InvestigationRole: Project administrationRole: Writing – review & editing
                Role: Data curationRole: InvestigationRole: MethodologyRole: Writing – review & editing
                Role: Data curationRole: Formal analysisRole: VisualizationRole: Writing – review & editing
                Role: Data curationRole: Writing – review & editing
                Role: Data curationRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: ResourcesRole: SupervisionRole: Writing – original draftRole: Writing – review & editing
                Role: Academic Editor
                Journal
                PLoS Med
                PLoS Med
                plos
                plosmed
                PLoS Medicine
                Public Library of Science (San Francisco, CA USA )
                1549-1277
                1549-1676
                25 September 2019
                September 2019
                : 16
                : 9
                Affiliations
                [1 ] Center for Wireless and Population Health Systems, University of California, San Diego, La Jolla, California, United States of America
                [2 ] Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California, United States of America
                [3 ] Exercise and Physical Activity Resource Center, University of California, San Diego, La Jolla, California, United States of America
                [4 ] Department of Computer Science and Engineering, University of California, San Diego, La Jolla, California, United States of America
                [5 ] Graduate School of Public Health, San Diego State University, San Diego, California, United States of America
                Harvard Medical School, UNITED STATES
                Author notes

                The authors have declared that no competing interests exist.

                Article
                PMEDICINE-D-19-00236
                10.1371/journal.pmed.1002917
                6760774
                31553725
                © 2019 Godino et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                Page count
                Figures: 3, Tables: 4, Pages: 17
                Product
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/100000002, National Institutes of Health;
                Award ID: R01 CA138730
                Award Recipient :
                This project was supported by NIH Grant R01 CA138730. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Biology and Life Sciences
                Physiology
                Physiological Parameters
                Body Weight
                Weight Loss
                Medicine and Health Sciences
                Physiology
                Physiological Parameters
                Body Weight
                Weight Loss
                Biology and Life Sciences
                Physiology
                Physiological Parameters
                Body Weight
                Obesity
                Medicine and Health Sciences
                Physiology
                Physiological Parameters
                Body Weight
                Obesity
                People and Places
                Population Groupings
                Ethnicities
                Hispanic People
                Biology and Life Sciences
                Anatomy
                Biological Tissue
                Adipose Tissue
                Medicine and Health Sciences
                Anatomy
                Biological Tissue
                Adipose Tissue
                Medicine and Health Sciences
                Public and Occupational Health
                Physical Activity
                Biology and Life Sciences
                Physiology
                Physiological Parameters
                Body Weight
                Body Mass Index
                Medicine and Health Sciences
                Physiology
                Physiological Parameters
                Body Weight
                Body Mass Index
                Medicine and Health Sciences
                Public and Occupational Health
                Behavioral and Social Aspects of Health
                Biology and Life Sciences
                Biochemistry
                Bioenergetics
                Custom metadata
                Data from the ConTxt Study cannot be deposited publicly because of ethics and informed-consent issues. However, requests for anonymized data for nonprofit, research purposes can be made to the UC San Diego Library’s Research Data Curation team: research-data-curation@ 123456ucsd.edu .

                Medicine

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