Text Message Support for Weight Loss in Patients With Prediabetes: A Randomized Clinical Trial.

OBJECTIVE: Although the benefits of in-person Diabetes Prevention Program (DPP) classes for diabetes prevention have been demonstrated in trials, effectiveness in clinical practice is limited by low participation rates. This study explores whether text message support enhances weight loss in patients offered DPP classes. RESEARCH DESIGN AND METHODS: English- and Spanish-speaking patients with prediabetes (n = 163) were randomized to the control group, which only received an invitation to DPP classes as defined by the Centers for Disease Control and Prevention, or to the text message-augmented intervention group, which also received text messages adapted from the DPP curriculum for 12 months. RESULTS: Mean weight decreased 0.6 pounds (95% CI -2.7 to 1.6) in the control group and 2.6 pounds (95% CI -5.5 to 0.2) in the intervention group (P value 0.05). Three percent weight loss was achieved by 21.5% of participants in the control group (95% CI 12.5-30.6), compared with 38.5% in the intervention group (95% CI 27.7-49.3) (absolute difference 17.0%; P value 0.02). Mean glycated hemoglobin (HbA1c) increased by 0.19% or 2.1 mmol/mol (95% CI -0.1 to 0.5%) and decreased by 0.09% or 1.0 mmol/mol (95% CI -0.2 to 0.0%) in the control group and intervention participants, respectively (absolute difference 0.28%; P value 0.07). Stratification by language demonstrated a significant treatment effect in Spanish speakers but not in English speakers. CONCLUSIONS: Text message support can lead to clinically significant weight loss in patients with prediabetes. Further study assessing effect by primary language and in an operational setting is warranted.

A pilot randomized trial comparing a commercial weight loss program with a clinic-based intervention for weight loss.

OBJECTIVE: To compare the efficacy of a popular commercial program with that of a clinic-based intervention for weight loss. METHODS: Randomized clinical trial conducted at an internal medicine clinic affiliated with a city hospital in Denver, Colorado. Participant (n = 46) had a body mass index ≥ 30 kg/m(2) and no life-threatening medical conditions. They either were provided a voucher to attend Weight Watchers for 17 weeks (n = 23), or they were assigned to the clinic group (n = 23), which provided 12 visits over 17 weeks and the option to augment weight loss using either meal replacements or weight loss medication. The primary study outcome was weight change. RESULTS: Participants assigned to the clinic arm lost 4.0 ± 1.2 kg, compared to 0.4 ± 1.1 for those assigned to the commercial program (P = .04 for difference). Weight losses in the clinic arm were 3.2 kg for meal replacements (n = 10) and 5.0 kg for phentermine (n = 13). CONCLUSIONS: In this single-site trial, a clinic-based intervention was more effective than a popular commercial program for weight loss. Primary care providers in the United States are under increasing pressure to combat the epidemic of obesity. This trial, although small, begins to address how the primary care setting might play that role.