title: Tailored, interactive text messages for enhancing weight loss among African American adults: the TRIMM randomized controlled trial.
abstract: BACKGROUND
  Helping patients control obesity remains a clinical challenge for internists, and African Americans experience obesity rates higher than other racial/ethnic groups.
  
  
  OBJECTIVE
  To investigate whether a behavioral theory-based mobile health intervention would enhance weight loss when added to standard care among overweight/obese African American adults.
  
  
  METHODS
  A randomized controlled trial of 124 adults recruited from Baltimore-area African American churches. Participant follow-up ended March 2013. Participants were randomized to standard care (included one-on-one counseling sessions with a dietitian and a physician) or standard care plus daily tailored text messages for 6 months. Text messages were delivered in phases: preparation, reinforcement of participant-selected diet and exercise goals, reflection, goal integration, weight loss methods, and maintenance. There were follow-up visits at 3, 6, and 12 months. Primary outcome was weight change from baseline to end-intervention at 6 months. Secondary outcomes included weight change at 3 months, engagement, and satisfaction with the intervention.
  
  
  RESULTS
  Sixty-three participants were randomized to the mobile health intervention and 61 to standard-care control. Weights were collected in-window for 45 (36.3%) at 3 months and 51 (41.1%) at 6 months. Mean weight loss at 3 months was 2.5 kg greater in the intervention group compared with standard care (95% confidence interval [CI], -4.3 to -0.6; P < .001), and 3.4 kg greater (95% CI, -5.2 to -1.7; P = .001) at 6 months. Degree of engagement with messages was correlated with weight loss.
  
  
  CONCLUSIONS
  While attrition was high, this study supports a tailored, interactive text-message intervention to enhance weight loss among obese African-American adults.
authors.affiliation: Johns Hopkins School of Medicine, Baltimore, Md.
authors.forename: Michael
authors.initials: M
authors.lastname: Lin
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.
authors.forename: Zayan
authors.initials: Z
authors.lastname: Mahmooth
authors.affiliation: Johns Hopkins University, Baltimore, Md.
authors.forename: Nicket
authors.initials: N
authors.lastname: Dedhia
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.
authors.forename: Robin
authors.initials: R
authors.lastname: Frutchey
authors.affiliation: Georgetown University School of Medicine, Washington, DC.
authors.forename: Catherine E
authors.initials: CE
authors.lastname: Mercado
authors.affiliation: Clinical Pharmacology and Therapeutics Research Branch of the National Institute on Drug Abuse Intramural Research Program, Baltimore, Md.
authors.forename: David H
authors.initials: DH
authors.lastname: Epstein
authors.affiliation: Clinical Pharmacology and Therapeutics Research Branch of the National Institute on Drug Abuse Intramural Research Program, Baltimore, Md.
authors.forename: Kenzie L
authors.initials: KL
authors.lastname: Preston
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Gibbons
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.
authors.forename: Janice V
authors.initials: JV
authors.lastname: Bowie
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.
authors.forename: Alain B
authors.initials: AB
authors.lastname: Labrique
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, Md. Electronic address: cheskin@jhu.edu.
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: Cheskin
mesh_terms: D000328:Adult; D001741:Black or African American / Q000523:psychology*; D015142:Baltimore; D001521:Behavior Therapy / Q000379:methods*; D003376:Counseling; D004038:Diet, Reducing; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000208:ethnology* / Q000628:therapy*; D050177:Overweight / Q000208:ethnology* / Q000628:therapy*; D010352:Patient Dropouts; D010353:Patient Education as Topic; D060145:Text Messaging; D015431:Weight Loss; D055815:Young Adult
keywords: African-American; Obesity; Text messaging; Weight loss