# Citation

Iyengar D, Klawans MR, Stotts AL, Northrup TF (2019) Use of Text Messaging as an Intervention to Promote Weight Loss and Reduce Waist Circumference among an Overweight and Abdominally Obese Patient Population: A Randomized-Controlled Quality Improvement Study in Primary Care. J Obes Weight-Loss Medic 5:029. doi.org/10.23937/2572-4010.1510029

# Use of Text Messaging as an Intervention to Promote Weight Loss and Reduce Waist Circumference among an Overweight and Abdominally Obese Patient Population: A Randomized-Controlled Quality Improvement Study in Primary Care

##### Deepa Iyengar, MD, MPH*, Michelle R Klawans, MPH, Angela L Stotts, PhD and Thomas F Northrup, PhD

Department of Family & Community Medicine, UTHealth, USA

# Abstract

## Purpose

Obesity is a national epidemic resulting in significant morbidity and mortality. Weight loss as modest as 5% of body weight significantly reduces the risk of hypertension, diabetes, and cardiovascular disease. The primary aim of this pilot study was to test the efficacy of a text messaging intervention in a primary care setting to motivate overweight patients to lose weight and reduce their waist circumference.

## Methods

A total of 128 adult primary care patients who were overweight and classified as abdominally obese via waist circumference measurement were randomized to enhanced care (EC, n = 62) or standard care (SC, n = 66). Patients assigned to both groups met with the physician, and the SC received a standard clinic brochure on weight loss. In addition to the brochure, the EC group met with a research assistant to discuss the risks of abdominal obesity and resources to lose weight in addition to receiving 3 motivational text messages per week for 12 weeks and 2 phone calls to check in on their progress. At baseline, three, and six months, all patients had a survey administered and weight, waist circumference and blood pressure were obtained.

## Results

In the EC group, 50% (n = 16) reported reading all of the text messages, 31% (n = 10) found the text messages helpful, and 84% (n = 26) reported using the diet and physical activity resources provided. The average weight loss at six months was 4.3 pounds in the SC group and 3 pounds in the EC group (p = 0.17). The average reduction in waist circumference at six months was 0.5 inches in the SC group and 1.2 inches in the EC group (p = 0.15). The most commonly reported diet change was reducing calories, with 28% (n = 17) and 36% (n = 18) reporting a low-calorie diet at three and six months, respectively. At six months, 26% (n = 13) reported engaging in cardiovascular exercise like jogging aerobics or swimming, while 24% (n = 12) reported engaging in some form of weightlifting as a change from baseline.

## Conclusions

This pilot study demonstrated the potential feasibility of a simple, texting-based intervention designed to motivate overweight individuals to lose weight and reduce their waist circumference in a primary care clinic. Both groups showed modest weight loss, slightly favoring the SC group, and waist circumference reductions favored the intervention group, although neither result was statistically significant. Future studies need creative ways to increase intervention exposure and harness the potential for mobile technology-based health coaching. While constraints of time and infrastructure may limit personalized counselling, mobile technology may serve as an excellent adjunct medium of communicating with patients about resources related to healthy eating and exercise. Novel methods for boosting the effectiveness of technology-based interventions are needed.

# Citation

Iyengar D, Klawans MR, Stotts AL, Northrup TF (2019) Use of Text Messaging as an Intervention to Promote Weight Loss and Reduce Waist Circumference among an Overweight and Abdominally Obese Patient Population: A Randomized-Controlled Quality Improvement Study in Primary Care. J Obes Weight-Loss Medic 5:029. doi.org/10.23937/2572-4010.1510029