Using social and mobile tools for weight loss in overweight and obese young adults (Project SMART): a 2 year, parallel-group, randomised, controlled trial

Affiliations

¹ Center for Wireless and Population Health Systems, University of California, San Diego, La Jolla, CA, USA; Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA.
² Department of Neurology, University of Southern California, Los Angeles, CA, USA.
³ Center for Wireless and Population Health Systems, University of California, San Diego, La Jolla, CA, USA; Division of Global Public Health, University of California, San Diego, La Jolla, CA, USA; Department of Political Science, University of California, San Diego, La Jolla, CA, USA.
⁴ Center for Wireless and Population Health Systems, University of California, San Diego, La Jolla, CA, USA; Division of Pediatric Gastroenterology, University of California, San Diego, La Jolla, CA, USA.
⁵ Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA.
⁶ Center for Wireless and Population Health Systems, University of California, San Diego, La Jolla, CA, USA.
⁷ Center for Wireless and Population Health Systems, University of California, San Diego, La Jolla, CA, USA; Department of Development, Aging, and Regeneration, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, USA.
⁸ Behavior Design Laboratory, Human Sciences and Technologies Advanced Research Institute, Stanford University, Stanford, CA, USA.
⁹ Stanford Solutions Science Laboratory, Department of Pediatrics, Stanford University, Stanford, CA, USA.
¹⁰ Center for Wireless and Population Health Systems, University of California, San Diego, La Jolla, CA, USA; Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA. Electronic address: kpatrick@ucsd.edu.

PMID: 27426247
PMCID: PMC5005009
DOI: 10.1016/S2213-8587(16)30105-X

Randomized Controlled Trial

Using social and mobile tools for weight loss in overweight and obese young adults (Project SMART): a 2 year, parallel-group, randomised, controlled trial

Job G Godino et al. Lancet Diabetes Endocrinol. 2016 Sep.

. 2016 Sep;4(9):747-755.

doi: 10.1016/S2213-8587(16)30105-X. Epub 2016 Jul 14.

Authors

Affiliations

¹ Center for Wireless and Population Health Systems, University of California, San Diego, La Jolla, CA, USA; Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA.
² Department of Neurology, University of Southern California, Los Angeles, CA, USA.
³ Center for Wireless and Population Health Systems, University of California, San Diego, La Jolla, CA, USA; Division of Global Public Health, University of California, San Diego, La Jolla, CA, USA; Department of Political Science, University of California, San Diego, La Jolla, CA, USA.
⁴ Center for Wireless and Population Health Systems, University of California, San Diego, La Jolla, CA, USA; Division of Pediatric Gastroenterology, University of California, San Diego, La Jolla, CA, USA.
⁵ Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA.
⁶ Center for Wireless and Population Health Systems, University of California, San Diego, La Jolla, CA, USA.
⁷ Center for Wireless and Population Health Systems, University of California, San Diego, La Jolla, CA, USA; Department of Development, Aging, and Regeneration, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, USA.
⁸ Behavior Design Laboratory, Human Sciences and Technologies Advanced Research Institute, Stanford University, Stanford, CA, USA.
⁹ Stanford Solutions Science Laboratory, Department of Pediatrics, Stanford University, Stanford, CA, USA.
¹⁰ Center for Wireless and Population Health Systems, University of California, San Diego, La Jolla, CA, USA; Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA. Electronic address: kpatrick@ucsd.edu.

PMID: 27426247
PMCID: PMC5005009
DOI: 10.1016/S2213-8587(16)30105-X

Abstract

Background: Few weight loss interventions are evaluated for longer than a year, and even fewer employ social and mobile technologies commonly used among young adults. We assessed the efficacy of a 2 year, theory-based, weight loss intervention that was remotely and adaptively delivered via integrated user experiences with Facebook, mobile apps, text messaging, emails, a website, and technology-mediated communication with a health coach (the SMART intervention).

Methods: In this parallel-group, randomised, controlled trial, we enrolled overweight or obese college students (aged 18-35 years) from three universities in San Diego, CA, USA. Participants were randomly assigned (1:1) to receive either the intervention (SMART intervention group) or general information about health and wellness (control group). We used computer-based permuted-block randomisation with block sizes of four, stratified by sex, ethnicity, and college. Participants, study staff, and investigators were masked until the intervention was assigned. The primary outcome was objectively measured weight in kg at 24 months. Differences between groups were evaluated using linear mixed-effects regression within an intention-to-treat framework. Objectively measured weight at 6, 12, and 18 months was included as a secondary outcome. The trial is registered with ClinicalTrials.gov, number NCT01200459.

Findings: Between May 18, 2011, and May 17, 2012, 404 individuals were randomly assigned to the intervention (n=202) or control (n=202). Participants' mean (SD) age was 22·7 (3·8) years. 284 (70%) participants were female and 125 (31%) were Hispanic. Mean (SD) body-mass index at baseline was 29·0 (2·8) kg/m(2). At 24 months, weight was assessed in 341 (84%) participants, but all 404 were included in analyses. Weight, adjusted for sex, ethnicity, and college, was not significantly different between the groups at 24 months (-0·79 kg [95% CI -2·02 to 0·43], p=0·204). However, weight was significantly less in the intervention group compared with the control group at 6 months (-1·33 kg [95% CI -2·36 to -0·30], p=0·011) and 12 months (-1·33 kg [-2·30 to -0·35], p=0·008), but not 18 months (-0·67 kg [95% CI -1·69 to 0·35], p=0·200). One serious adverse event in the intervention group (gallstones) could be attributable to rapid and excessive weight loss.

Interpretation: Social and mobile technologies did not facilitate sustained reductions in weight among young adults, although these approaches might facilitate limited short-term weight loss.

Funding: The National Heart, Lung, and Blood Institute of the National Institutes of Health (U01 HL096715).

PubMed Disclaimer

Figures

**Figure 1**
Consort diagram: flow of participants through Project SMART.

**Figure 2**
Estimated marginal means, between group differences, 95% confidence intervals, and p values for the comparison of weight between the SMART intervention group and control group over 24 months from a linear mixed-effects regression model adjusted for sex, ethnicity, and college.

See this image and copyright information in PMC

Comment in

Paving the way for SMART weight loss in college students.
Monroe CM, Turner-McGrievy G. Monroe CM, et al. Lancet Diabetes Endocrinol. 2016 Sep;4(9):719-721. doi: 10.1016/S2213-8587(16)30146-2. Epub 2016 Jul 14. Lancet Diabetes Endocrinol. 2016. PMID: 27426248 No abstract available.

References

1. Institute of Medicine . Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation. National Academies Press; Washington, D.C.: 2012. - PubMed
1. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011-2012. JAMA. 2014;311(8):806–814. - PMC - PubMed
1. Sheehan TJ, DuBrava S, DeChello LM, Fang Z. Rates of weight change for black and white Americans over a twenty year period. Int J Obes. 2003;27(4):498–504. - PubMed
1. Malhotra R, Østbye T, Riley CM, Finkelstein EA. Young adult weight trajectories through midlife by body mass category. Obesity. 2013 (1930-739X (Electronic)):n/a - n/a. - PubMed
1. Lloyd-Jones DM, Liu K, Colangelo L a., et al. Consistently stable or decreased body mass index in young adulthood and longitudinal changes in metabolic syndrome components: The coronary artery risk development in young adults study. Circulation. 2007;115(8):1004–1011. - PubMed

Publication types

Actions
Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Using social and mobile tools for weight loss in overweight and obese young adults (Project SMART): a 2 year, parallel-group, randomised, controlled trial

Affiliations

Using social and mobile tools for weight loss in overweight and obese young adults (Project SMART): a 2 year, parallel-group, randomised, controlled trial

Authors

Affiliations

Abstract

Figures

Comment in

References

Publication types

MeSH terms

Associated data

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical