Tailored, Interactive Text Messages for Enhancing Weight Loss Among African American Adults: The TRIMM Randomized Controlled Trial



      Helping patients control obesity remains a clinical challenge for internists, and African Americans experience obesity rates higher than other racial/ethnic groups.


      To investigate whether a behavioral theory-based mobile health intervention would enhance weight loss when added to standard care among overweight/obese African American adults.


      A randomized controlled trial of 124 adults recruited from Baltimore-area African American churches. Participant follow-up ended March 2013. Participants were randomized to standard care (included one-on-one counseling sessions with a dietitian and a physician) or standard care plus daily tailored text messages for 6 months. Text messages were delivered in phases: preparation, reinforcement of participant-selected diet and exercise goals, reflection, goal integration, weight loss methods, and maintenance. There were follow-up visits at 3, 6, and 12 months. Primary outcome was weight change from baseline to end-intervention at 6 months. Secondary outcomes included weight change at 3 months, engagement, and satisfaction with the intervention.


      Sixty-three participants were randomized to the mobile health intervention and 61 to standard-care control. Weights were collected in-window for 45 (36.3%) at 3 months and 51 (41.1%) at 6 months. Mean weight loss at 3 months was 2.5 kg greater in the intervention group compared with standard care (95% confidence interval [CI], −4.3 to −0.6; P < .001), and 3.4 kg greater (95% CI, −5.2 to −1.7; P = .001) at 6 months. Degree of engagement with messages was correlated with weight loss.


      While attrition was high, this study supports a tailored, interactive text-message intervention to enhance weight loss among obese African-American adults.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Svetkey L.P.
        • Stevens V.J.
        • Brantley P.J.
        • et al.
        Comparison of strategies for sustaining weight loss: the weight loss maintenance randomized controlled trial.
        JAMA. 2008; 299: 1139-1148
        • Wing R.R.
        • Epstein L.H.
        • Nowalk M.P.
        • Koeske R.
        • Hagg S.
        Behavior change, weight loss, and physiological improvements in type II diabetic patients.
        J Consult Clin Psychol. 1985; 53: 111-122
        • Ogden C.L.
        Disparities in obesity prevalence in the United States: black women at risk.
        Am J Clin Nutr. 2009; 89: 1001-1002
        • French S.A.
        • Neumark-Sztainer D.
        • Story M.
        • Jeffery R.W.
        Reducing barriers to participation in weight-loss programs in low-income women.
        J Am Diet Assoc. 1998; 98: 198-200
        • Shaw R.
        • Bosworth H.
        Short message service (SMS) text messaging as an intervention medium for weight loss: a literature review.
        Health Informatics J. 2012; 18: 235-250
        • Stephens J.
        • Allen J.
        Mobile phone interventions to increase physical activity and reduce weight: a systematic review.
        J Cardiovasc Nurs. 2013; 28: 320-329
      1. Duggan M. Cell Phone Activities 2013. Pew Internet. Available at: Accessed May 15, 2014.

        • Haapala I.
        • Barengo N.C.
        • Biggs S.
        • Surakka L.
        • Manninen P.
        Weight loss by mobile phone: a 1-year effectiveness study.
        Public Health Nutr. 2009; 12: 2382-2391
        • Shapiro J.R.
        • Koro T.
        • Doran N.
        • et al.
        Text4Diet: a randomized controlled study using text messaging for weight loss behaviors.
        Prev Med. 2012; 55: 412-417
        • Ogden C.L.
        • Carroll M.D.
        • Curtin L.R.
        • McDowell M.A.
        • Tabak C.J.
        • Flegal K.M.
        Prevalence of overweight and obesity in the United States, 1999-2004.
        JAMA. 2006; 295: 1549-1555
        • Flegal K.M.
        • Carroll M.D.
        • Kit B.K.
        • Ogden C.L.
        Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010.
        JAMA. 2012; 307: 491-497
        • Centers for Disease Control and Prevention
        Differences in Prevalence of Obesity Among Black, White, and Hispanic Adults — United States, 2006-2008.
        MMWR. 2009; 58: 740
        • de Niet J.
        • Timman R.
        • Bauer S.
        • et al.
        The effect of a short message service maintenance treatment on body mass index and psychological well-being in overweight and obese children: a randomized controlled trial.
        Pediatr Obes. 2012; 7: 205-219
        • Liu G.F.
        • Lu K.
        • Mogg R.
        • Mallick M.
        • Mehrotra D.V.
        Should baseline be a covariate or dependent variable in analyses of change from baseline in clinical trials?.
        Stat Med. 2009; 28: 2509-2530
        • Knowler W.C.
        • Barrett-Connor E.
        • Fowler S.E.
        • et al.
        Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.
        N Engl J Med. 2002; 346: 393-403
        • Wing R.R.
        • Look AHEAD Research Group
        Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: four-year results of the Look AHEAD trial.
        Arch Intern Med. 2010; 170: 1566-1575
        • The Trials of Hypertension Prevention Collaborative Research Group
        Effects of weight loss and sodium reduction intervention on blood pressure and hypertension incidence in overweight people with high-normal blood pressure: the Trials of Hypertension Prevention, phase II.
        Arch Intern Med. 1997; 157: 657-667
        • Yancey A.K.
        • Ory M.G.
        • Davis S.M.
        Dissemination of physical activity promotion interventions in underserved populations.
        Am J Prev Med. 2006; 31: S82-S91
        • Mcnabb W.
        • Quinn M.
        • Kerver J.
        • Cook S.
        • Karrison T.
        The PATHWAYS church-based weight loss program for urban African-American women at risk for diabetes.
        Diabetes Care. 1997; 20: 1518-1523
      2. Zickuhr K, Smith A. Digital differences. Pew Internet. Available at: Accessed May 15, 2014.

        • Bleich S.N.
        • Pickett-Blakely O.
        • Cooper L.A.
        Physician practice patterns of obesity diagnosis and weight-related counseling.
        Patient Educ Couns. 2011; 82: 123-129
        • Teixeira P.J.
        • Going S.B.
        • Houtkooper L.B.
        • et al.
        Pretreatment predictors of attrition and successful weight management in women.
        Int J Obes Relat Metab Disord. 2004; 28: 1124-1133
        • McManus K.
        • Antinoro L.
        • Sacks F.
        A randomized controlled trial of a moderate-fat, low-energy diet compared with a low fat, low-energy diet for weight loss in overweight adults.
        Int J Obes Relat Metab Disord. 2001; 25: 1503-1511
        • Honas J.J.
        • Early J.L.
        • Frederickson D.D.
        • O'Brien M.S.
        Predictors of attrition in a large clinic-based weight-loss program.
        Obes Res. 2003; 11: 888-894