Running head: UTILIZING TECHNOLOGY TO PROMOTE WEIGHT LOSS

Utilizing Technology to Promote Weight Loss

Jorge Guzman
University of South Florida

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Abstract
Clinical Problem: Overweight middle-aged adults have struggled with finding an effective
weight loss tool. Being overweight increases the risk for cardiovascular complications such as
myocardial infarction, congestive heart failure and also increases the chance of cerebral vascular
accident.
Objective: To determine if utilizing technology such as text messages and emails will increase
the amount of weight loss in overweight middle-aged adults over a twelve month period as
opposed to not receiving any form of intervention. The search engines used to retrieve data and
guidelines include the following: The New England Journal of Medicine, Cambridge Journals
Online, National Center for Biotechnology Information (NCBI), and the National Guideline
Clearinghouse.
Results: All three randomized controlled trials showed a further reduction in weight when
utilizing technology to promote weight loss and contact the patient.
Conclusion: Based on three randomized controlled trials, evidence shows that utilizing
technology can promote significant weight loss in overweight middle-aged adults as opposed to
not receiving any reminders via mobile phone and internet. Utilizing text messages and emails as
daily reminders to exercise may increase weight reduction in this particular population.

Keywords: Mobile phone; Internet; Technology; Weight reduction

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Utilizing Technology to Promote Weight Loss
One of the biggest problems the world is currently facing is the increasing overweight
middle-aged adult population. With technology advancing at an alarming rate, more people are
choosing to stay in to watch Netflix, play video games, and spend time on social media instead
of engaging in physically activity. A daily text message to a clients mobile device may be the
treatment tool and support overweight patients are lacking from their health care providers
(Appel et al., 2011). A friendly reminder via text message may help implement a daily exercise
regimen within the overweight population and weight loss may be obtained as a result. Expected
outcome measures include seeing a quarterly trend in weight reduction over this twelve month
period. The group receiving the text message intervention is expected to lose more weight in
comparison to the group that is not receiving the text message intervention. In overweight
middle-aged adults will a daily reminder to engage in physical activity via text message, as
opposed to not receiving a text message, affect the total amount of weight loss over a twelve
month period?
Literature Search
The New England Journal of Medicine, Cambridge Journals Online, National Center for
Biotechnology Information (NCBI), and the National Guideline Clearinghouse were utilized to
gather data from randomized controlled trials and guidelines. The key search terms used were
weight loss promotion, weight reduction, weight management, mobile phones, text messages,
technology intervention, obesity, health management, exercise, body mass index and internet.
Literature Review
This intervention is based upon promoting weight reduction in middle-aged overweight
adults when given a daily reminder to engage in physical activity via text message. Participants

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that are receiving the intervention are required to check their text message inbox at least three
times daily. One of the most efficient and effective routes of communication, used more and
more in todays day in age may be utilized to improve health and promote an active lifestyle
(Stephens & Allen, 2013). The outcome expected is to identify a noticeable difference in the
amount of weight loss of those participants that received the intervention when compared to the
participants that did not receive the intervention.
The population of interest of overweight middle-aged adults ranges from ages eighteen
to sixty-five years, consisting of both men and women. None of the participants in the studies
were under the age of eighteen or over the age of sixty-five years. Those participants that were
receiving the intervention had to have access to a smartphone daily in order to receive the daily
text messages.
The study conducted by Appel et al. (2011) used obese adult patients with at least one
cardiovascular risk factor as their target population. There were a total of three groups in this
particular trial. Two that received the intervention of text messages and emails as the main
component of intervention and one control group that did not receive any form of intervention.
The difference between the two intervention groups was that one received in-person support
groups and the other did not. The sample size consisted of a total of 415 participants, control
group (N= 138), in-person support (N= 138), and remote support only (N= 139) (Appel et al.,
2011). The results were as expected, both groups receiving the primary intervention achieved a
greater reduction in weight than the control group. However, the intervention group receiving the
in-person support group as a secondary intervention achieved a greater amount in weight
reduction than the other intervention group that only received the electronic intervention. When
comparing the two intervention groups to the control after twenty-four months, the change in

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weight was -3.8 kg for the group receiving only the primary intervention and -4.3 kg for the
group receiving both the primary and secondary interventions (Appel et al., 2011). The
percentage of weight reduction between the control group and both intervention groups over the
twenty-four month study was -1.1% for the control group, -5.0% for the group receiving the
primary intervention, and -5.2% for the intervention group receiving the primary and secondary;
P<0.001 for both intervention groups (Appel et al., 2011). On average over this twenty four
month period the group receiving the primary and secondary prevention obtained a -0.5 kg
difference in weight loss, P=0.63, when compared to the group receiving the only the primary
intervention, which are not significant findings. This goes to show that the true difference maker
is the electronic intervention of text messages and emails on a daily basis.
The study conducted by Haapala, Barengo, Biggs, Surakka, and Manninen (2009)
consisted of a total of one hundred and twenty-five overweight, 25-44 year-old participants in
which 62 of the participants were randomized into an experimental group that was utilizing a
mobile phone operated weight-loss program. The duration of this study varied between three and
twelve months. This experiment showed that the most weight loss was obtained within the first
three months of the trial. From baseline to three months, the experimental group had achieved a
mean percentage of weight loss of 5.3, P <0.0001 (Haapala, Barengo, Biggs, Surakka, and
Manninen, 2009). From baseline to twelve months, the experimental group achieved a mean
percentage of weight loss of 5.4, P< 0.0001. The control group achieved a mean percentage of
weight loss of 1.3, (P = 0.247) over the twelve month duration. The experimental group had a
total of 19 participants that maintained a minimum of five percent weight loss compared to the
control groups total of 8 participants (Haapala et al., 2009).

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The study conducted by Patrick et al. (2009) used a smaller sample size with a total of 65
overweight adult participants which were divided into an intervention group of 33 and a control
group of 32 (Patrick et al., 2009). This trial had a shorter duration than the other two randomized
controlled trials lasting only four months. At the end of the four month trial, the group receiving
the intervention lost 1.99 kg more than the control group, (P= .04) (Patrick et al., 2009). Ninetytwo percent of the participants were satisfied with the program and stated they would
recommend it to their colleagues and family members.
Synthesis
One guideline and three randomized controlled trials were utilized to determine if using a
text message or email as a daily reminder would promote more weight loss than not receiving
daily reminders via mobile phones. According to the guideline, a clinically significant amount of
weight loss is considered to be greater than or equal to five percent and may have an impact on
reduction of high blood pressure, elevated blood glucose levels, and body mass index (Brauer et
al., 2015). Accoding to Brauer et al. (2015), a body mass index greater than or equal to twentyfive is considered overweight and a body mass index of greater than or equal to thirty is
considered obese. The guideline was not applied to any individuals with a body mass index of
greater than or equal to forty.
All case studies measured changes in weight, body mass index, and waist circumference.
All three randomized controlled trials results showed a greater reduction in weight loss when
incorporating a daily reminder via mobile phone through text messages or emails. More weight
loss may be obtained when incorporating in-person support groups and more frequent doctor
visits. However, the daily reminders to exercise via text messages and emails have shown to be
more effective in the result of obtaining more overall weight loss. User satisfaction in all three

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randomized controlled trials were significantly high, with participants highly likely to
recommend the program to friends and family. One thing I observed was that the total number of
contacts per week had a significant impact on the amount of weight loss. The more often
participants were contacted throughout the week, the more weight they lost on average. The
useful features of this intervention are the use of mobile phones, the fact that the participants do
not have to pay, reporting for weight measurements regularly, and the immediate feedback
participants receive via mobile phones. The primary use of text messages as a daily reminder has
shown to be effective in all of the experiments. Thus, one can infer that daily reminders via text
messages and emails are reliable tools to promote weight loss.
Clinical Recommendations
Structured behavioral interventions such as daily text messages, are highly recommended
for adults who are overweight or obese with a BMI less than 40 (Brauer et al., 2015). With a
growing population of mobile users and more people choosing to text, this intervention was
effective in promoting weight loss among the overweight population (Patrick et al., 2009).
Taking into account the convenience factor for the participants receiving the intervention has
made it a desirable method for weight loss promotion (Stephens & Allen, 2013). The majority of
the population worldwide now utilizes mobile phones as the primary mode of communication
(Stephens & Allen, 2013). Text messages and emails may be an effective and efficient way to
promote weight loss behaviors in overweight middle-aged adults.

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References
Appel, J. L., Clark, M. J., Yeh, C. H., Wang, Y. N., Coughlin, W. J., Daumit, G., . . . Brancati, L.
F. (2011). Comparative effectiveness of weight-loss interventions in clinical practice. The
New England Journal of Medicine, 365, 1959-1968. doi: 10.1056/NEJMoa1108660
Brauer, P., Connor Gorber, S., Shaw, E., Singh, H., Bell, N., Shane, A.R., Canadian Task
Force on Preventive Health Care (2015). Recommendations for prevention of weight gain
and use of behavioural and pharmacologic interventions to manage overweight and
obesity in adults in primary care. Canadian Medical Association Journal. 187(3), 184
195. doi: 10.1503/cmaj.140887
Haapala, I., Barengo N. C., Biggs, S., Surakka, L., Manninen, P. (2009). Weight loss by mobile
phone: A 1-year effectiveness study. National Center for Biotechnology Information, 12
(12), 2382-2391. doi: 10.1017/S1368980009005230.
Patrick, K., Raab, F., Adams, M. A., Dillon, L., Zabinski, M., Rock, C. L., . . . Norman, G. J.
(2009). A text messagebased intervention for weight loss: Randomized controlled trial.
Journal of Medical Internet Research, 11(1). doi: 10.2196/jmir.1100
Stephens, J. & Allen, J. (2013). Mobile phone interventions to increase physical activity and
reduce weight: A systematic review. The Journal of Cardiovascular Nursing, 28(4), 320329. doi: 10.1097/JCN.0b013e318250a3e7