Text4Diet: A Text Message-based Intervention for Weight Loss

Text4Diet™is a mobile phone-based intervention tool that addresses dietary, physical activity and sedentary behaviors with the goal of promoting and sustaining weight loss. The percentage of overweight and obese adults in the United States has been increasing steadily as have chronic diseases that result from excess body weight. Even a modest weight reduction—between 5 and 10% of body weight—in an overweight adult can reduce the risk of hypertension and diabetes. Text4Diet is a lifestyle intervention aimed to promote modest levels of sustained weight loss.

Users receive between 2 and 5 text messages per day depending on the frequency and schedule they choose. The messages contain tips, suggestions, and positive reinforcement or encouragement for improved behaviors; half of the text messages request the user to reply. The topics of the messages change weekly and contain behavioral and dietary strategies known to prompt weight loss and weight control. Topics include: goal setting, portion control, foods that are healthy and make one feel “full,” strategies for eating out and maintaining a physical activity regime. An example of a question sent to Text4Diet users is: “Did you buy fresh fruits and vegetables today?” If the user responds no, he or she will receive a follow-up message suggesting types of fruits and vegetables that can be added to a healthy and varied shopping list. Users have a baseline dietary and lifestyle assessment conducted by a nutritionist or counselor and the results of this inform the type and content of the text messages that will be sent to the user. The users also receive a weekly text that tracks their weight and activity levels.

To facilitate behavior change among overweight adults that leads to sustained weight loss.

Those who use Text4Diet are exposed to customized advice regarding healthy behavior changes. Participants on average saw an average 6-pound weight loss during a four-month use period. This is a statistically significant difference from weight loss in the usual care comparison group.

A randomized controlled trial was conducted to determine if users of the Text4Diet text message-based weight loss intervention produced higher levels of weight loss compared to a program where participants were mailed monthly printed materials containing the same tips, suggestions and messages about weight loss and physical activity. At the end of 4 months, the intervention group (n = 33) lost more weight than the comparison group (−1.97 kg difference, 95% CI −0.34 to −3.60 kg, P = .02) after adjusting for sex and age. Intervention participants’ adjusted average weight loss was 2.88 kg or about 6 pounds (3.16%).