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Weight loss social support in 140 characters or less: use of an online social network in a remotely delivered weight loss intervention

Translational Behavioral Medicine


Little is known about how online social networking can help enhance weight loss. To examine the types of online social support utilized in a behavioral weight loss intervention and relationship of posting and weight loss. A sub-analysis of the content and number of posts to Twitter among participants (n = 47) randomized to a mobile, social network arm as part of a 6-month trial among overweight adults, examining weight loss, use of Twitter, and type of social support (informational, tangible assistance, esteem, network, and emotional support). A number of Twitter posts were related to % weight loss at 6 months (p < 0.001). Initial reported weight loss predicted engagement with Twitter (p < 0.01) but prior Twitter use or initial Twitter engagement did not. Most Twitter posts (total posts n = 2,630) were Informational support (n = 1,981; 75 %), with the predominant subtype of Teaching (n = 1,632; 62 %), mainly in the form of a status update (n = 1,319). Engagement with Twitter was related to weight loss and participants mainly used Twitter to provide Information support to one another through status updates.

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  1. Umberson D, Montez JK. Social relationships and health: a flashpoint for health policy. Journal of Health and Social Behavior. 2010; 51(Suppl):S54-S66.

    Article  PubMed  Google Scholar 

  2. Stewart MJ, Kushner KE, Greaves L, Letourneau N, Spitzer D, Boscoe M. Impacts of a support intervention for low-income women who smoke. Social Science & Medicine. 2010; 71(11):1901-1909.

    Article  Google Scholar 

  3. Shaya FT, Yan X, Farshid M, et al. Social networks in cardiovascular disease management. Expert Review of Pharmacoeconomics & Outcomes Research. 2010; 10(6):701-705.

    Article  Google Scholar 

  4. van Dam HA, van der Horst FG, Knoops L, Ryckman RM, Crebolder HF, van den Borne BH. Social support in diabetes: a systematic review of controlled intervention studies. Patient Education and Counseling. 2005; 59(1):1-12.

    Article  PubMed  Google Scholar 

  5. Heard E, Whitfield KE, Edwards CL, Bruce MA, Beech BM. Mediating effects of social support on the relationship among perceived stress, depression, and hypertension in African Americans. Journal of the National Medical Association. 2011; 103(2):116-122.

    PubMed  Google Scholar 

  6. Greaves CJ, Sheppard KE, Abraham C, et al. Systematic review of reviews of intervention components associated with increased effectiveness in dietary and physical activity interventions. BMC Public Health. 2011; 11(1):119.

    Article  PubMed  Google Scholar 

  7. Jeffery RW, Bjornson-Benson WM, Rosenthal BS, Lindquist RA, Kurth CL, Johnson SL. Correlates of weight loss and its maintenance over two years of follow-up among middle-aged men. Preventive Medicine. 1984; 13(2):155-168.

    Article  PubMed  CAS  Google Scholar 

  8. Verheijden MW, Bakx JC, van Weel C, Koelen MA, van Staveren WA. Role of social support in lifestyle-focused weight management interventions. European Journal of Clinical Nutrition. 2005; 59(Suppl 1):S179-S186.

    Article  PubMed  Google Scholar 

  9. Kelsey K, Earp JAL, Kirkley BG. Is social support beneficial for dietary change? A review of the literature. Family & Community Health. 1997; 20(3):70-82.

    Article  Google Scholar 

  10. Anderson-Bill ES, Winett RA, Wojcik JR, Winett SG. Web-based guide to health: relationship of theoretical variables to change in physical activity, nutrition and weight at 16-months. Journal of Medical Internet Research. 2011; 13(1):e27.

    Article  PubMed  Google Scholar 

  11. Tate DF. A series of studies examining Internet treatment of obesity to inform Internet interventions for substance use and misuse. Substance Use & Misuse. 2011; 46(1):57-65.

    Article  Google Scholar 

  12. Tate DF, Jackvony EH, Wing RR. Effects of Internet behavioral counseling on weight loss in adults at risk for type 2 diabetes: a randomized trial. JAMA. 2003; 289(14):1833-1836.

    Article  PubMed  Google Scholar 

  13. Tate DF, Wing RR, Winett RA. Using Internet technology to deliver a behavioral weight loss program. JAMA. 2001; 285(9):1172-1177.

    Article  PubMed  CAS  Google Scholar 

  14. McConnon A, Kirk SF, Ransley JK. Process evaluation of an internet-based resource for weight control: use and views of an obese sample. Journal of Nutrition Education and Behavior. 2009; 41(4):261-267.

    Article  PubMed  Google Scholar 

  15. Webber KH, Tate DF, Michael Bowling J. A randomized comparison of two motivationally enhanced Internet behavioral weight loss programs. Behaviour Research and Therapy. 2008; 46(9):1090-1095.

    Article  PubMed  Google Scholar 

  16. Binks M, van Mierlo T. Utilization patterns and user characteristics of an ad libitum Internet weight loss program. Journal of Medical Internet Research. 2010; 12(1):e9.

    Article  PubMed  Google Scholar 

  17. Cutrona CE, Suhr JA. Controllability of stressful events and satisfaction with spouse support behaviors. Communication Research. 1992; 19(2):154-174.

    Article  Google Scholar 

  18. Hwang KO, Ottenbacher AJ, Green AP, et al. Social support in an Internet weight loss community. International Journal of Medical Informatics. 2010; 79(1):5-13.

    Article  PubMed  Google Scholar 

  19. Van De Belt TH, Engelen LJ, Berben SA, Schoonhoven L. Definition of Health 2.0 and Medicine 2.0: a systematic review. Journal of Medical Internet Research. 2010; 12(2):e18.

    Article  Google Scholar 

  20. Madden, M., Zickuhr, K. (2011) Pew Internet and american life project. 65 % of online adults use social networking sites. Archived at Accessed 9 January 2012.

  21. Turner-McGrievy G, Tate D. Tweets, Apps, and Pods: results of the 6-month mobile pounds off digitally (mobile POD) randomized weight-loss intervention among adults. Journal of Medical Internet Research. 2011; 13(4):e120.

    Article  PubMed  Google Scholar 

  22. Bandura A. Health promotion by social cognitive means. Health Education & Behavior. 2004; 31(2):143-164.

    Article  Google Scholar 

  23. Turner-McGrievy GM, Campbell MK, Tate DF, Truesdale KP, Bowling JM, Crosby L. Pounds Off Digitally study: a randomized podcasting weight-loss intervention. American Journal of Preventive Medicine. 2009; 37(4):263-269.

    Article  PubMed  Google Scholar 

  24. Viera AJ, Garrett JM. Understanding interobserver agreement: the kappa statistic. Family Medicine. 2005; 37(5):360-363.

    PubMed  Google Scholar 

  25. Eysenbach G, Powell J, Englesakis M, Rizo C, Stern A. Health related virtual communities and electronic support groups: systematic review of the effects of online peer to peer interactions. BMJ. 2004; 328(7449):1166.

    Article  PubMed  Google Scholar 

  26. Fox, S., Zickuhr, K., Smith, A (2009) Pew Internet and american life project: Twitter and status updating. Archived at Accessed 8 February 2012.

  27. Smith, A. (2011) Pew Internet and american life project: Twitter update. Archived at Accessed 15 March 2012.

  28. Nackers L, Ross K, Perri M. The association between rate of initial weight loss and long-term success in obesity treatment: does slow and steady win the race? International Journal of Behavioral Medicine. 2010; 17(3):161-167.

    Article  PubMed  Google Scholar 

  29. Haferkamp N, Kramer NC. Social comparison 2.0: examining the effects of online profiles on social-networking sites. Cyberpsychology, Behavior and Social Networking. 2011; 14(5):309-314.

    Article  PubMed  Google Scholar 

  30. Masamichi, T., Masakazu, F., Nobuhiro, Y. (2003) The active lurker: influence of an in-house online community on its outside environment. Proceedings of the 2003 international ACM SIGGROUP conference on Supporting group work. Sanibel Island, Florida.

  31. Nonnecke, B., Preece, J. (2000) Lurker demographics: Counting the silent. Proceedings of the SIGCHI conference on Human factors in computing systems. The Netherlands: The Hague.

  32. Hogan BE, Linden W, Najarian B. Social support interventions: do they work? Clinical Psychology Review. 2002; 22(3):383-442.

    Article  PubMed  Google Scholar 

  33. Clarke KK, Freeland-Graves J, Klohe-Lehman DM, Bohman TM. Predictors of weight loss in low-income mothers of young children. Journal of the American Dietetic Association. 2007; 107(7):1146-1154.

    Article  PubMed  Google Scholar 

  34. Kim C, McEwen LN, Kieffer EC, Herman WH, Piette JD. Self-efficacy, social support, and associations with physical activity and body mass index among women with histories of gestational diabetes mellitus. Diabetes Education. 2008; 34(4):719-728.

    Article  Google Scholar 

  35. Kumanyika SK, Wadden TA, Shults J, et al. Trial of family and friend support for weight loss in African American adults. Archives of Internal Medicine. 2009; 169(19):1795-1804.

    Article  PubMed  Google Scholar 

  36. Chuang, K., Yang, C.C. (2010) Social support in Online Healthcare Social Networking. Paper presented at: iConference 2010 Papers 2010.

  37. Bender JL, Jimenez-Marroquin MC, Jadad AR. Seeking support on facebook: a content analysis of breast cancer groups. Journal of Medical Internet Research. 2011; 13(1):e16.

    Article  PubMed  Google Scholar 

  38. Scanfeld D, Scanfeld V, Larson EL. Dissemination of health information through social networks: twitter and antibiotics. American Journal of Infection Control. 2010; 38(3):182-188.

    Article  PubMed  Google Scholar 

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The authors would like to thank Alaina Boyle, Jordan Wong, and Megan McMullins for their assistance with coding the messages in the study. In addition, the authors thank the UNC Lineberger Comprehensive Cancer Center Population Sciences Award and the UNC Interdisciplinary Obesity Center (NIHM 5-T32-MH75854-05) for providing funding for this research.

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The authors have no financial disclosures.

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Correspondence to Gabrielle M Turner-McGrievy PhD, MS, RD.

Additional information

This trial was registered on

Clinical Trials Registration ID: NCT01139255.


Practice: As part of a behavior weight loss program, engagement in a social network, such as Twitter, mainly provides informational social support, which may assist with weight loss.

Policy: Before investing in making extensive online social networks as part of remotely delivered weight loss programs, resources should be devoted to exploring who benefits from these social networks and how to engage people more effectively.

Research: Research is needed to explore how to engage users in online social networks, or provide them with alternate methods of support, during remotely delivered behavioral weight loss interventions.

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Turner-McGrievy, G.M., Tate, D.F. Weight loss social support in 140 characters or less: use of an online social network in a remotely delivered weight loss intervention. Behav. Med. Pract. Policy Res. 3, 287–294 (2013).

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