Proof of Concept for a Twitter-Based Weight Loss Intervention

Background. Lifestyle interventions have been proven efficacious in multiple large clinical trials but have not been widely adopted in clinical and community settings because by requiring multiple visits over 1-2 years they are expensive and have high patient and provider burden. An online social network may be a less expensive, lower burden intervention modality for weight loss intervention. Online social networks can potentially reduce visit frequency, provider time, patient burden, and cost. However, this may come at the expense of efficacy, given that briefer contacts via an online social network may detract from the counseling experience. We know very little about whether counseling patients online is effective or acceptable to patients. The purpose of this proof-of-concept pilot study series was to determine the feasibility of delivering a behavioral weight loss intervention both partially and entirely via an online social network. Methods. In this series of pilot studies, 35 obese participants (mean age= 48; 82% female) were assigned to 3 conditions all of which involved 12 weeks of behavioral counseling for weight loss. In the Traditional condition (TR), 12 participants received a traditional in-person group-delivered weight loss intervention with no social network. In the Traditional Plus Social Network condition (TSN), 11 participants received a traditional in-person group-delivered weight loss intervention along with a private social network on Twitter where they could interact with each other and their coaches. In the Social Network condition (SN), (n=12) the weight loss intervention was delivered entirely via the private social network on Twitter with the exception of a single “check-in” visit. Coaching was delivered via tweets by 3 coaches who each logged in on average twice a day. Coaches tweeted assignments, advice, blog posts describing behavioral weight loss strategies, weight loss success stories, recipes, positive reinforcement, encouragement, and check-ins. Results. At 12 weeks, participants in the TR, TSN, and SN conditions lost 3.1% (4.1), 3.1% (3.3), and 3.8% (3.0) of baseline weight, respectively. The study was not powered to detect statistical differences in weight loss and no differences were found. Retention was 83%, 82%, and 100%, respectively. In conditions with social networks, total tweets predicted greater weight loss, r =-.69, p=.001, suggesting that engagement in the social network was associated with success. About 42% of participants were still posting tweets regularly 1 month after the end of the intervention even though coaches were no longer active, suggesting that this modality has potential to generate longer term peer-to-peer support. Conclusions. Findings provide initial support for the feasibility of a social network-delivered weight loss intervention. We found no evidence that offloading coaching to the online social network was detrimental to outcomes. While previous studies have used online social networks as an adjunct to in-person weight loss interventions, our findings suggest that an online social network may be effective as the main intervention delivery modality. Further research should evaluate whether social network based interventions could be a cost-effective alternative to traditional group-based lifestyle interventions. []