Using text-messaging to battle obesity

Kids have already replaced pencil and paper with text-messaging to pass notes in class, and doing the same to track a weight-loss program could help them battle obesity, according to a new study.

Children used text-messaging to track their daily activity level and calorie intake in a study conducted at the University of North Carolina (UNC). Over a two-month period, the children and their parents proved more than twice as likely as those tracking the same behaviours with a paper and pencil diary.

The results show text messaging could be used to reduce the risk that overweight children will become obese adults, according to principal investigator Jennifer Shapiro.

“We know self-monitoring energy intake and expenditure is the best way to lose weight, but people don’t do it – especially children,” the assistant professor of psychiatry at the university says. He says if the activity seemed like fun the kids would be more likely to do it.

Families in the study had to record three numbers every day. The number of steps taken as shown on a pedometer, the number of sugary beverages consumed, and minutes spent in front of a screen. Of the families using text, or SMS, to track the behaviour, 43 per cent did so for the entire two months. Only one in five families who used a paper diary kept up their entries.

Children sending text messages also got an instant automated response based on their behaviour. For example, if the child had met their goals for number of steps taken but drank too many pops in a day, they might get a message like this: “Wow, you met your step and screen time goals – congratulations! What happened to beverages?”

Hundreds of messages were created by researchers for study participants. The aim was to keep things fresh and stave off boredom, Shapiro says.

“They were really excited about the feedback,” she says. “Self-monitoring is time consuming and tedious. That’s why we need to improve it.”
Cell phones are a good fit with any activity that requires accurate self-monitoring, says Marc Choma, director of communications for the Canadian Wireless Telecommunications Association. If people plan to write things down at the end of the day, it is too easy to forget about it or not bother.

“If they have cell phone in the palm of their hand on the bus, then that will get done,” he says. “It’s the instant nature of it and the interactive component.”

Jennifer Shapiro, assistant professor of psychiatry at the University of North Carolina.

Canadians are big on text messaging, exchanging an astounding 10 billion text messages through the first half of 2008.   So it’s no big leap to say would  use text-messaging in a weight-loss effort, experts say.

Many of those text messages, they say, could be to the 430 interactive programs available to Canadians via short codes. Since 2003, text-messaging services have been able to use five- or six-digit numbers instead of full 10-digit phone numbers.  Services range from checking whether your flight is on time at the airport, getting sports scores, or requesting information about electoral campaigns.

The UNC study shows kids are willing to maintain behaviours if it means using a new technology they like, says Arya Sharma, chair of obesity research at the University of Alberta. But he is skeptical that many would continue with the practice over the long term.

“Kids like to adopt new technologies, but on the other hand they also bore easily,” he says. Some kids will love this stuff and keep doing it, others will tire of it.

The key to creating a successful SMS service is to focus on the basic information people are trying to get at with their phones, says Ted Burns, vice-president of product development at 4INFO. The company provides many text-based services in the U.S.

“Our focus was getting out the user the very immediate need that they have,” he says. “If you search ‘Titans’ during the NFL season, then we’ll send you the last score for the Tennessee Titans.”

The 31 families and 58 children that participated in the study were divided into three groups – the text-messaging group, the paper diary group and a control group that did not monitor their behaviour.

The families were given three education sessions aimed at encouraging increase in physical activity, less time in front of the TV, and the consumption of fewer sugary beverages. The text-messaging group participants were given cell phones for the purposes of the study.

While none of the children in the study group achieved a significant weight loss, the point was to establish a better practice for self-monitoring. When it comes to changing behaviour for a medical benefit, having individuals track their behaviour is critical, Shapiro says.

“People often forget how much they’re eating on a daily basis,” she says. “When you’re trying to lose weight, you have to stay in a certain range.”

It’s plausible that young people will latch on to SMS as a way to manage their diets, Burns agrees.

“Text is a really key way to reach that generation,” he says. “A lot of daily personal transactions are conducted over SMS. It is a really good way to reach somebody and interact with them.”

Shapiro also thinks there are other applications for text-messaging in health care. Her next study will attempt those suffering from bulimia to monitor the number of binges and purges they perform.

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