personalized, actionable, and goal-oriented; and personal contact.28,31-33
The evi-
dence is inconsistent on whether adding other technologies to the interventions enhances their effectiveness.28,32 These mHealth interventions can be integrated with other technologies,
specifically those that use text messages and connected devices as a part of the intervention.
Interventions Delivered via Text Messages
The use of text messages to deliver weight management interventions, either in full or in part, is of interest because most people with a cell phone are able to receive text messages. The other appeal of text messages is that they are pushed to the patient’s cell phone and do not require the patient to log in or initiate the activity. Text messages are often used to send reminders, support, motivation, and feedback. Text-messaging interventions for weight management have also been shown to
produce better weight outcomes than control interventions. Across the six studies included in a 2015 systematic review and meta-analysis of interventions for weight management using text messaging, the weighted mean change in body weight in intervention participants was −2.56 kg (95% CI, −3.46 to −1.65 kg), compared to −0.37 kg (95% CI, −1.22 to 0.48 kg) in control-group participants (−5.64 lb [95% CI, −7.63 to −3.64 lb] vs −0.82 lb [95% CI, −2.69 to 1.06 lb]). However, the researchers were only able to combine the reported results over periods ranging from 8 to 12 weeks, highlighting the need for longer-term data on the efficacy of interventions delivered via text messages.34 Nutrition and weight loss interventions that employ text messages (SMS) are
more efficacious when tailored to patients, with the most substantial effects perhaps occurring when messages are both tailored and targeted.23,33
Text-message interven-
tions that target weight loss have been tailored on measures such as stage of change, results of questionnaires that assessed food intake or psychosocial factors, and participant health goals; they have also been customized to meet participant prefer- ences for day of the week, time of day, and preferred number of text messages.33,35-37 Sufficient evidence is lacking to determine whether tailoring on one variable is more efficacious than tailoring on another. More research is needed to optimize tailoring and isolate its effect on outcomes in multicomponent interventions. Although some of the initial studies used static tailoring based on baseline measures, dynamic tai- loring that assesses intervention variables prior to feedback holds some promise.38
Interventions Delivered via Interactive Voice Response
Some studies have incorporated interactive voice response (IVR) as an alternative or complementary strategy to text messages for weight management. Use of IVR is less common than use of text messages, and IVR has been employed more as an adjunct technology rather than as the primary intervention modality in weight management interventions.39
health weight loss intervention delivered in a community health center system, IVR was used to support participant achievement of four tailored behavioral goals chosen for each participant.40
Specifically, the IVR system’s role was to support
self-monitoring and feedback on behavior. The system called intervention partic- ipants weekly, prompted them to respond to questions (eg, “How many days did you drink sugary drinks last week?”) via keypad, and then immediately provided automated, tailored feedback (eg, “You are doing better than last week. This week,
CHAPTER 17: The Use of Technology in the Treatment of Obesity 319
In a 12-month randomized controlled trial of a digital
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