Feasibility, acceptability, and preliminary effectiveness of an adaptive text messaging intervention for adolescent weight control in primary care.

Abstract

Behavioral interventions for adolescent weight control are often difficult to access because they are rarely provided in primary health care. This study was designed to assess the feasibility, acceptability, and preliminary effectiveness of a motivational interviewing plus adaptive text messaging intervention for adolescent weight control delivered in primary care. Methods: Forty-seven overweight adolescents (aged 13-18 years) participated in a single, hour-long, in-person motivational interviewing session in their primary care pediatrician's office with a clinical psychology doctoral student. All participants monitored diet, physical activity, and weight over 6 months and reported this information nightly via text message. Participants were selected randomly to receive computer-tailored adaptive text messages 3 times per day at mealtimes as an additional intervention component. Results: Participants found the intervention to be acceptable and beneficial for promoting weight-related behavior change. Adherence to self-monitoring was significantly higher in the adaptive text messaging group. Although body mass index z-score (zBMI) change was not significantly different across treatment groups, participants receiving the adaptive text message intervention demonstrated a reduction of .32 zBMI standard deviation units from before to after intervention, t(28) ϭ Ϫ2.84, p Ͻ .01, d ϭ .54, whereas zBMI did not change for individuals receiving the control intervention. Several domains of weight-related quality of life improved during the intervention period irrespective of treatment assignment. Conclusions: Study findings suggest that a behavioral weight control intervention delivered in a primary care is acceptable/feasible and may produce reductions in zBMI. Fully powered studies to further evaluate this intervention approach are warranted. Implications for Impact StatementThis pilot trial demonstrates that adaptive text messaging is a feasible, acceptable method for delivering weight control intervention content as an addition to inperson treatment for overweight adolescents. Furthermore, our findings suggest that interventions including adaptive text messages may improve self-monitoring adherence and produce superior weight loss outcomes.

Harnessing technological solutions for childhood obesity prevention and treatment: a systematic review and meta-analysis of current applications

“…Study interventions varied immensely in treatment modality and content. The interventions included mobile phone app interventions [ 42 , 48 , 49 ], text-based interventions [ 19 , 60 , 61 ], home-delivered interventions with technology adjunct components [ 34 , 63 ], group sessions or interactive classes with phone calls [ 53 , 58 ], group-based exergames [ 78 ], exergaming in addition to family-based behavioral treatment [ 82 ], and active video games as replacements for non-active video games [ 75 ], among others.…”

“…Two of these 27 studies (8%) reported significant improvement in measures of adiposity (e.g., percent body fat, BMIz) in both the intervention and active comparator groups at post-intervention, with one intervention delivered solely through technology [ 41 ] and the other using technology adjunctively [ 81 ]. Despite finding no differences between conditions, five studies reported significant improvements in measures of adiposity among those in the intervention groups [ 19 , 51 , 60 , 66 , 70 ], which all had active comparators. Two treatment studies that reported overall null findings did report significant effects for the intervention in subgroups.…”

“…Means and standard deviations, or effect estimates and standard errors, were extracted from all included articles (see Appendix C for tables of data that were extracted or provided by authors to calculate effect sizes). When data were not reported, authors were contacted ( n = 5), of which two provided unpublished raw means and standard deviations for the present analyses [ 18 , 19 ]. The studies of authors who did not provide data were excluded from the meta-analysis but included in the narrative review [ 20 – 22 ].…”

Effectiveness of Text Message Interventions for Weight Management in Adolescents: Systematic Review

“…A total of 215 full-text articles were assessed for edibility, and 201 were excluded with reasons outlined in Figure 1 and Multimedia Appendix 4. Eight unique studies [35][36][37][38][39][40][41][42] from 13 publications were included in this review [24,[35][36][37][38][39][40][41][43][44][45][46][47].…”

“…All studies measuring BMI (kg/m 2 ) measured height and weight in person by trained personnel using standardized procedures and calibrated equipment (Table 2). The 5 studies calculating BMI z-score specified the country of origin for the age-and sex-specific reference values [37,[39][40][41][42]. Of the 8 studies, 7 demonstrated reductions in BMI or BMI z-score in the intervention group compared with the control at the end of the final follow-up (Table 3).…”