Electronic therapeutic contact for adolescent weight management: the Loozit® study

Objective: To examine adolescent and facilitator participation in the first 10 months of an obesity management intervention including electronic contact (e-contact) via e-mail and short message service (SMS) communication. Materials and Methods: Participants (n=49) were overweight and obese (13-16 year olds) and were randomized to receive e-contact in the Loozit® trial. Adolescents were sent brief, semipersonalized health messages approximately monthly, from 2 to 12 months. We analyzed adolescents' response patterns, reply content, satisfaction with e-contact intervention, and facilitator responsiveness. Two coding systems described the general attributes and content of adolescent replies and facilitator responses. Results: Adolescents' overall reply rate was 22%. There was no difference in age, sex, socioeconomic status, body mass index z-score, or initial group program attendance between the 27 adolescents who replied to 0-2 messages and the 22 who replied to ≥3 messages. Adolescent SMS replies had less characters and a quicker response time compared with e-mail replies. Adolescent responses were largely relevant to initial health messages sent (91%), with few using "SMS language" (17%) or emoticons (7%). Most adolescents rated e-contact as "somewhat helpful." Facilitators responded to 93% of adolescent replies, and most responses were personalized (93%), encouraging (88%), and educational (75%). Conclusions: Although adolescent engagement was modest, SMS and e-mail communication is a feasible and acceptable adjunct to group lifestyle intervention and telephone coaching in overweight and obese adolescents. Healthy eating messages and those concluding with "please reply" elicited the highest reply rates, and thus these message types should be included in future adolescent e-contact interventions.