UMMS Affiliation

Department of Medicine, Division of Preventive and Behavioral Medicine; Department of Quantitative Health Sciences; UMass Worcester Prevention Research Center

Publication Date


Document Type



Behavioral Disciplines and Activities | Behavior and Behavior Mechanisms | Clinical Psychology | Community Health and Preventive Medicine | Epidemiology | Health Information Technology | Health Psychology | Health Services Administration | Preventive Medicine


BACKGROUND: Lifestyle interventions are efficacious at reducing risk for diabetes and cardiovascular disease but have not had a significant public health impact given high cost and patient and provider burden.

OBJECTIVE: Online social networks may reduce the burden of lifestyle interventions to the extent that they displace in-person visits and may enhance opportunities for social support for weight loss.

METHODS: We conducted an iterative series of pilot studies to evaluate the feasibility and acceptability of using online social networks to deliver a lifestyle intervention.

RESULTS: In Study 1 (n=10), obese participants with depression received lifestyle counseling via 12 weekly group visits and a private group formed using the online social network, Twitter. Mean weight loss was 2.3 pounds (SD 7.7; range -19.2 to 8.2) or 1.2% (SD 3.6) of baseline weight. A total of 67% (6/9) of participants completing exit interviews found the support of the Twitter group at least somewhat useful. In Study 2 (n=11), participants were not depressed and were required to be regular users of social media. Participants lost, on average, 5.6 pounds (SD 6.3; range -15 to 0) or 3.0% (SD 3.4) of baseline weight, and 100% (9/9) completing exit interviews found the support of the Twitter group at least somewhat useful. To explore the feasibility of eliminating in-person visits, in Study 3 (n=12), we delivered a 12-week lifestyle intervention almost entirely via Twitter by limiting the number of group visits to one, while using the same inclusion criteria as that used in Study 2. Participants lost, on average, 5.4 pounds (SD 6.4; range -14.2 to 3.9) or 3.0% (SD 3.1) of baseline weight, and 90% (9/10) completing exit interviews found the support of the Twitter group at least somewhat useful. Findings revealed that a private Twitter weight-loss group was both feasible and acceptable for many patients, particularly among regular users of social media.

CONCLUSIONS: Future research should evaluate the efficacy and cost-effectiveness of online social network-delivered lifestyle interventions relative to traditional modalities.


Twitter, digital health, obesity, online social networking, peer-to-peer health care, social networks, weight loss, UMCCTS funding

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©Sherry L Pagoto, Molly E Waring, Kristin L Schneider, Jessica L Oleski, Effie Olendzki, Rashelle B Hayes, Bradley M Appelhans, Matthew C Whited, Andrew M Busch, Stephenie C Lemon. Originally published in JMIR Research Protocols (, 23.10.2015. This is an open-access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Research Protocols, is properly cited. The complete bibliographic information, a link to the original publication on, as well as this copyright and license information must be included.

DOI of Published Version



Pagoto SL, Waring ME, Schneider KL, Oleski JL, Olendzki E, Hayes RB, Appelhans BM, Whited MC, Busch AM, Lemon SC. Twitter-Delivered Behavioral Weight-Loss Interventions: A Pilot Series. JMIR Res Protoc. 2015 Oct 23;4(4):e123. doi:10.2196/resprot.4864. PubMed PMID: 26500186. Link to article on publisher's website

Journal/Book/Conference Title

JMIR Research Protocols

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