Twitter-Delivered Behavioral Weight-Loss Interventions: A Pilot Series.
BACKGROUND
Lifestyle interventions are efficacious at reducing risk for diabetes and cardiovascular disease but have not had a significant public health impact given high cost and patient and provider burden.


OBJECTIVE
Online social networks may reduce the burden of lifestyle interventions to the extent that they displace in-person visits and may enhance opportunities for social support for weight loss.


METHODS
We conducted an iterative series of pilot studies to evaluate the feasibility and acceptability of using online social networks to deliver a lifestyle intervention.


RESULTS
In Study 1 (n=10), obese participants with depression received lifestyle counseling via 12 weekly group visits and a private group formed using the online social network, Twitter. Mean weight loss was 2.3 pounds (SD 7.7; range -19.2 to 8.2) or 1.2% (SD 3.6) of baseline weight. A total of 67% (6/9) of participants completing exit interviews found the support of the Twitter group at least somewhat useful. In Study 2 (n=11), participants were not depressed and were required to be regular users of social media. Participants lost, on average, 5.6 pounds (SD 6.3; range -15 to 0) or 3.0% (SD 3.4) of baseline weight, and 100% (9/9) completing exit interviews found the support of the Twitter group at least somewhat useful. To explore the feasibility of eliminating in-person visits, in Study 3 (n=12), we delivered a 12-week lifestyle intervention almost entirely via Twitter by limiting the number of group visits to one, while using the same inclusion criteria as that used in Study 2. Participants lost, on average, 5.4 pounds (SD 6.4; range -14.2 to 3.9) or 3.0% (SD 3.1) of baseline weight, and 90% (9/10) completing exit interviews found the support of the Twitter group at least somewhat useful. Findings revealed that a private Twitter weight-loss group was both feasible and acceptable for many patients, particularly among regular users of social media.


CONCLUSIONS
Future research should evaluate the efficacy and cost-effectiveness of online social network-delivered lifestyle interventions relative to traditional modalities.
Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States. Sherry.Pagoto@umassmed.edu.
Sherry L
http://orcid.org/0000-0002-2462-8797
SL
Pagoto
Molly E
http://orcid.org/0000-0002-9884-9824
ME
Waring
Kristin L
http://orcid.org/0000-0002-7445-5118
KL
Schneider
Jessica L
http://orcid.org/0000-0001-8270-2302
JL
Oleski
Effie
http://orcid.org/0000-0001-5472-8054
E
Olendzki
Rashelle B
http://orcid.org/0000-0002-2590-3404
RB
Hayes
Bradley M
http://orcid.org/0000-0002-5195-802X
BM
Appelhans
Matthew C
http://orcid.org/0000-0002-4972-4267
MC
Whited
Andrew M
http://orcid.org/0000-0002-3577-5960
AM
Busch
Stephenie C
http://orcid.org/0000-0003-3321-6070
SC
Lemon
Twitter; digital health; obesity; online social networking; peer-to-peer health care; social networks; weight loss