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

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 group 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.