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

Abstract

Background The incidence of obesity among adolescents is increasing. Text messages are a primary communication form for adolescents and potentially a scalable strategy for delivering population health interventions. Objective This study aimed to determine the effectiveness of text message interventions in reducing BMI in adolescents and describe characteristics that are common to effective interventions. Methods This systematic review included randomized controlled trials of text message lifestyle interventions involving adolescents aged 10 to 19 years with outcomes focused on obesity prevention or management. Primary outcome was objective or self-report change in BMI. Results In total, 4362 records were identified, and 215 full-text articles were assessed for eligibility. A total of 8 unique studies were identified, including 767 participants, mean age 14.3 (SD 0.9) years, BMI 29.7 (SD 1.6) kg/m2 and 53.1% (407/767) female (31/101, 30.7%-172/172, 100.0%). All interventions were multicomponent. The median active intervention period was 4.5 months. During the active and extended intervention phases, text messages accounted for >50% (8 studies) and >85% (3 studies) of contact points, respectively. Text messages were heterogeneous, with a median of 1.5 text messages sent per week (range: 1-21). A total of 4 studies utilized two-way text message communication with health professionals 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. The effect was only statistically significant in 1 study at 6 months. Over 6 months, reductions in BMI (kg/m2) ranged from 1.3% to 4.5% and BMI z-score ranged from 4.2% to 28.1%. Overall quality of the studies was low. Conclusions Further research is required to elucidate the effectiveness and potential impact of text message interventions on weight and weight-related behaviors in adolescents.

Process evaluations of early childhood obesity prevention interventions delivered via telephone or text messages: a systematic review

“…These reviews observed a small number of studies that delivered interventions to adolescents and young adults via telephone, text messages or mobile apps. Very limited or post hoc process evaluation studies were noted [ 76 ] and research in this area was considered to be in its infancy with further research required to elucidate effectiveness [ 75 , 76 ].…”

“…Previous reviews have not reported on process evaluation literature but noted its potential value [ 26 , 71 , 76 ]. Process evaluation findings in this review demonstrate that participants valued and trusted interventions delivered from credible sources, hence intervention deliverers are crucial to the acceptability of interventions.…”

“…Systematic reviews of obesity prevention interventions delivered to older children and adolescents (12-24 years of age) using mobile technologies have noted heterogeneity in research design and in the interventions delivered [75][76][77]. These reviews observed a small number of studies that delivered interventions to adolescents and young adults via telephone, text messages or mobile apps.…”

Mothers’ Nutrition Knowledge Is Unlikely to Be Related to Adolescents’ Habitual Nutrient Intake Inadequacy in Japan: A Cross-Sectional Study of Japanese Junior High School Students

“…Obesity is a serious clinical and public health problems worldwide [1]. The proportion of obesity has been reported to increase during adolescence for young adults in developed countries, including Japan [2][3][4]. Dietary habits have been reported to have a great influence on the development of lifestyle-related diseases, such as obesity and diabetes [5].…”

Mobile Health and Telehealth Interventions to Increase Physical Activity in Adolescents with Obesity: a Promising Approach to Engaging a Hard-to-Reach Population

“…Assessment of participants' "behavioral phenotype" may allow text messages to be most appropriately tailored for ongoing engagement, minimizing the risk that individuals who tend to avoid bad news do not become avoidant and disengaged, while still supporting and providing feedback to those who are less discouraged by poor results or lack of progress. In all text messaging-based interventions, messages should be carefully constructed [37] and ideally co-designed with the target audience in order to avoid negative perceptions or disengagement [38,39].…”