title: A Mobile Health Lifestyle Program for Prevention of Weight Gain in Young Adults (TXT2BFiT): Nine-Month Outcomes of a Randomized Controlled Trial.
abstract: BACKGROUND
  The unprecedented rise in obesity among young adults, who have limited interaction with health services, has not been successfully abated.
  
  
  OBJECTIVE
  The objective of this study was to assess the maintenance outcomes of a 12-week mHealth intervention on prevention of weight gain in young adults and lifestyle behaviors at 9 months from baseline.
  
  
  METHODS
  A two-arm, parallel, randomized controlled trial (RCT) with subjects allocated to intervention or control 1:1 was conducted in a community setting in Greater Sydney, Australia. From November 2012 to July 2014, 18- to 35-year-old overweight individuals with a body mass index (BMI) of 25-31.99 kg/m2 and those with a BMI ≥ 23 kg/m2 and a self-reported weight gain of ≥ 2 kg in the past 12 months were recruited. A 12-week mHealth program "TXT2BFiT" was administered to the intervention arm. This included 5 coaching calls, 96 text messages, 12 emails, apps, and downloadable resources from the study website. Lifestyle behaviors addressed were intake of fruits, vegetables, sugar-sweetened beverages (SSBs), take-out meals, and physical activity. The control group received 1 phone call to introduce them to study procedures and 4 text messages over 12 weeks. After 12 weeks, the intervention arm received 2 further coaching calls, 6 text messages, and 6 emails with continued access to the study website during 6-month follow-up. Control arm received no further contact. The primary outcome was weight change (kg) with weight measured at baseline and at 12 weeks and self-report at baseline, 12 weeks, and 9 months. Secondary outcomes were change in physical activity (metabolic equivalent of task, MET-mins) and categories of intake for fruits, vegetables, SSBs, and take-out meals. These were assessed via Web-based surveys.
  
  
  RESULTS
  Two hundred and fifty young adults enrolled in the RCT. Intervention participants weighed less at 12 weeks compared with controls (model β=-3.7, 95% CI -6.1 to -1.3) and after 9 months (model β=- 4.3, 95% CI - 6.9 to - 1.8). No differences in physical activity were found but all diet behaviors showed that the intervention group, compared with controls at 9 months, had greater odds of meeting recommendations for fruits (OR 3.83, 95% CI 2.10-6.99); for vegetables (OR 2.42, 95% CI 1.32-4.44); for SSB (OR 3.11, 95% CI 1.47-6.59); and for take-out meals (OR 1.88, 95% CI 1.07-3.30).
  
  
  CONCLUSIONS
  Delivery of an mHealth intervention for prevention of weight gain resulted in modest weight loss at 12 weeks with further loss at 9 months in 18- to 35-year-olds. Although there was no evidence of change in physical activity, improvements in dietary behaviors occurred, and were maintained at 9 months. Owing to its scalable potential for widespread adoption, replication trials should be conducted in diverse populations of overweight young adults.
  
  
  BACKGROUND
  Australian and New Zealand Clinical Trials Registry (ANZCTR): ACTRN12612000924853; (Archived by WebCite at http://www.webcitation.org/6i6iRag55).
authors.affiliation: School of Life and Environmental Sciences, Charles Perkins Centre, University of Sydney, University of Sydney, Australia. margaret.allmanfarinelli@sydney.edu.au.
authors.forename: Margaret
authors.identifier: http://orcid.org/0000-0002-6478-1374
authors.initials: M
authors.lastname: Allman-Farinelli
authors.forename: Stephanie Ruth
authors.identifier: http://orcid.org/0000-0001-5390-3922
authors.initials: SR
authors.lastname: Partridge
authors.forename: Kevin
authors.identifier: http://orcid.org/0000-0002-9679-9827
authors.initials: K
authors.lastname: McGeechan
authors.forename: Kate
authors.identifier: http://orcid.org/0000-0002-3653-3963
authors.initials: K
authors.lastname: Balestracci
authors.forename: Lana
authors.identifier: http://orcid.org/0000-0003-1017-5827
authors.initials: L
authors.lastname: Hebden
authors.forename: Annette
authors.identifier: http://orcid.org/0000-0002-0919-330X
authors.initials: A
authors.lastname: Wong
authors.forename: Philayrath
authors.identifier: http://orcid.org/0000-0003-2460-5031
authors.initials: P
authors.lastname: Phongsavan
authors.forename: Elizabeth
authors.identifier: http://orcid.org/0000-0001-9879-4969
authors.initials: E
authors.lastname: Denney-Wilson
authors.forename: Mark F
authors.identifier: http://orcid.org/0000-0002-0705-8913
authors.initials: MF
authors.lastname: Harris
authors.forename: Adrian
authors.identifier: http://orcid.org/0000-0002-0369-4621
authors.initials: A
authors.lastname: Bauman
keywords: fruit; mHealth; physical activity; sugar-sweetened beverages; take-out foods; telehealth; vegetables; weight gain prevention; young adult