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Social media applications are promising adjuncts to online weight management interventions through facilitating education, engagement, and peer support. However, the precise impact of social media on weight management is unclear.
The objective of this study was to systematically describe the use and impact of social media in online weight management interventions.
PubMed, PsycINFO, EMBASE, Web of Science, and Scopus were searched for English-language studies published through March 25, 2013. Additional studies were identified by searching bibliographies of electronically retrieved articles. Randomized controlled trials of online weight management interventions that included a social media component for individuals of all ages were selected. Studies were evaluated using 2 systematic scales to assess risk of bias and study quality.
Of 517 citations identified, 20 studies met eligibility criteria. All study participants were adults. Because the included studies varied greatly in study design and reported outcomes, meta-analysis of interventions was not attempted. Although message boards and chat rooms were the most common social media component included, their effect on weight outcomes was not reported in most studies. Only one study measured the isolated effect of social media. It found greater engagement of participants, but no difference in weight-related outcomes. In all, 65% of studies were of high quality; 15% of studies were at low risk of bias.
Despite the widespread use of social media, few studies have quantified the effect of social media in online weight management interventions; thus, its impact is still unknown. Although social media may play a role in retaining and engaging participants, studies that are designed to measure its effect are needed to understand whether and how social media may meaningfully improve weight management.
Obesity is a major US public health problem that is associated with lower quality of life, stigma, medical complications, and higher health care costs [
Over one-half of adults in the United States use social media platforms, such as Facebook, Twitter, MySpace, and LinkedIn [
For these reasons, we conducted a systematic review of the literature to understand whether and how online weight-management interventions have used social media to improve weight-related outcomes, such as weight loss, diet, and physical activity.
We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations in conducting this systematic review [
Studies were included if they were (1) randomized controlled trials (RCTs); (2) published in peer-reviewed literature; (3), reported weight-related outcomes, such as body mass index (BMI) or weight, dietary intake, or physical activity; and (4) included a social media component. As defined by Kaplan et al [
Two authors (TC and SW) independently abstracted variables by using a standardized template. Abstracted data included study variables (recruitment criteria, setting), participant variables (mean age, gender, mean BMI), intervention variables (brief description of weight-management intervention, intervention duration, type of social media used), outcome variables (eg, BMI, waist circumference, physical activity level, dietary intake), and quality variables (eg, data on randomization, control group, isolation of social media component). When encountered, discrepancies were resolved by consensus during a series of face-to-face and email discussions between 2 investigators (TC and SW).
The risk for bias in each RCT was assessed using the Jadad scale, which incorporates study domains including randomization, blinding, and description of withdrawals and dropouts [
In addition, because our main interest was the effect of social media on online weight interventions, study quality was also rated using methodology developed by Norman et al [
Because the included studies varied greatly on study design, participants, measures, outcomes, and social media components, meta-analysis of interventions was not attempted or performed.
In total, 517 studies were identified by our electronic searches. Following application of eligibility criteria, 20 studies [
Study flow.
Summary study characteristics.a
Source | Population | Type of social media | Primary outcomes | Results | Risk of bias |
Quality score | |||||
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n | RRb (%) | Mean age | % Female | Mean BMI |
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Verheijden et al (2004) [ |
146 | 89 | 63 | 24.0 | 29.4 | Bulletin board | Social support, BMI, waist-to-hip ratio, blood pressure, and cholesterol levels | No statistically significant differences in outcomes | Low | High |
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Hurling et al (2007) [ |
77 | 100 | 40.4 | 66.2 | 26.3 | Chat room–style message board | Change in moderate physical activity | Higher level of moderate physical activity and more percent body fat lost in the test group | Mod | High |
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Ferney et al (2009) [ |
106 | 87.7 | 52.1 | 71.7 | NR | Bulletin board | Self-reported walking and physical activity | No statistically significant differences in outcomes | Mod | Mod |
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Liebreich et al (2009) [ |
49 | 89.8 | 54.1 | 59 | 33.9 | Message board | Self-reported BMI, physical activity, and social cognitive measures | Significant improvement in total vigorous and moderate minutes of physical activity in intervention group | High | Mod |
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Richardson et al (2010) [ |
324 | 76.2 | 52 | 65 | 33.2 | Online community with message board | Change in average daily step counts from baseline, valid days of pedometer data, and online community use | No statistically significant differences in outcomes | Mod | High |
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Cavallo et al (2012) [ |
134 | 89.6 | NR | 100 | NR | Self-report social support and physical activity | No statistically significant differences in outcomes | High | High | |
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Tate et al (2001) [ |
91 | 71.4 | 40.9 | 89.0 | 29.0 | Bulletin board | Body weight and waist circumference | Behavior therapy group lost more weight and had greater changes in waist circumference | Mod | Mod |
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Tate et al (2003) [ |
92 | 100 | 48.5 | 89.1 | 33.1 | Message boards | Body weight, BMI, and waist circumference | Behavioral e-counseling group had greater reduction in weight, percentage of initial body weight, BMI, and waist circumference | Mod | High |
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Womble et al (2004) [ |
47 | 66.0 | 43.7 | 100 | 33.5 | Online meetings, online bulletin board | Weight change | Manual group lost significantly more weight than the eDiets.com intervention | Mod | High |
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Tate et al (2006) [ |
192 | 80.7 | 49.2 | 84.4 | 32.7 | Bulletin board | Weight loss, dietary intake, and physical activity | Weight losses were significantly greater in the human email-counseling group than computer-automated feedback or no counseling groups | Mod | High |
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Gold et al (2007) [ |
124 | 71.0 | 47.7 | 81.5 | 32.4 | Discussion board, online chats/meetings | Change in body weight | VTrim group lost significantly more weight than the eDiets.com group at 6 months and maintained a greater loss at 12 months | Mod | Mod |
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Webber et al (2008) [ |
66 | 98.5 | 50 | 100 | 31.1 | Separate message board for each website group, and online chat | Body weight | Minimal group lost more than the enhanced group | High | High |
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Morgan et al (2009) [ |
65 | 100 | 35.9 | 0 | 30.6 | Bulletin board | Weight, waist circumference, BMI | Greater weight loss for the Internet group | Low | High |
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Sternfield et al (2009) [ |
787 | 69.8 | 40.1 | 78.1 | in categories | Discussion board | Self-reported change in dietary intake and physical activity | Intervention group had increased physical activity, and increased consumption of fruits and vegetables | High | Mod |
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Harvey-Berino et al (2010) [ |
481 | 96.0 | 46.6 | 93 | 35.7 | Chat rooms and a bulletin board | Body weight and BMI | Weight loss for InPerson was significantly greater than the Internet and Hybrid conditions | Mod | High |
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Turner-McGrievy et al (2011) [ |
96 | 89.6 | 42.9 | 75 | 32.5 | Body weight | No statistically significant differences in outcomes | Mod | High | |
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Brindal et al (2012) [ |
8112 | 5.2 | 45.0 | 83 | 34.0 | Social networking platform: friend networks, blogs, discussion forums, and news feeds | Body weight | No statistically significant differences in outcomes | Low | Mod |
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Napolitano et al (2013) [ |
52 | 96 | 20.5 | 86.5 | 31.4 | BMI | Facebook Plus group had significantly greater weight loss than Facebook and waiting list | High | High | |
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Harvey-Berino et al (2004) [ |
255 | 69 | 45.8 | 82 | 31.8 | Chat room and bulletin board | Body weight, height, energy intake, and energy expended | No statistically significant differences in outcomes | Mod | High |
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Cussler et al (2008) [ |
161 | 69 | 48 | 100 | 31.1 | Bulletin board and chat rooms | BMI, body fat percentage, and total body fat mass | No statistically significant differences in outcomes | High | Mod |
aFor detailed study characteristics, risk of bias, and quality scores, please see
bRR: response rate.
Only one study (n=146) [
Five studies featured interventions targeting physical activity (n=690) [
Only one study specifically isolated and measured the effect of the social media component, by including it in only 1 arm (online community) of the study [
Among the remaining 4 studies, 2 reported the usage of the social media component [
Twelve studies featured interventions that included both diet and physical activity components (n=10,205) [
Most interventions in this category featured bulletin/message boards, chat rooms, or both as their social media component. Tate et al [
Data regarding the frequency of use of the social media component were rarely reported, although when it was, use was low. For example, Tate et al [
Although the correlation between social media use and weight loss was generally positive, it was only reported in a few studies and could be because of greater adherence to the interventions overall. In the studies by Gold et al [
Although the influence of social media on weight-related measures was not specifically tested in any of these studies, findings were heterogeneous. For instance, 2 studies reported positive outcomes (greater weight loss, increased physical activity, increased consumption of fruits and vegetables, and marginally decreased sugar intake) in those randomized to interventions containing social media [
Two studies (n=416) featured interventions focused on weight maintenance after weight loss. The social media components of the online weight maintenance interventions included both online bulletin boards and chat rooms. Overall, inclusion of social media did not result in differences in weight outcomes. In the study by Harvey-Berino et al [
The median Jadad score overall was 2 out of 5 points (median 2, range 1-5) representing moderate risk for bias in the included studies (
Using the scale developed by Norman et al [
In our systematic review of RCTs evaluating online weight-management interventions, we found that few studies implemented social media in a manner in which its impact could be measured and assessed. Therefore, the effect of social media is difficult to ascertain in the available literature. Our findings are consistent with previous systematic reviews on Internet-based behavioral interventions and electronic peer-to-peer support group interventions, which have found that the effect of the technology being studied was not isolated; thus, their effectiveness is not known [
However, some salient points emerged from the only study in our review that isolated its social media component from a broader intervention [
We also observed that social media was incorporated into online interventions largely through the use of discussion boards and chat rooms. Mainstream social media platforms (eg, Facebook, Twitter) were used in only 15% of studies and mainly in more recent publications (2011-2013). This may indicate a move from program-specific, investigator-developed interventions to those that capitalize on media that participants already frequent. Furthermore, the extent of actual social media use in these studies was inconsistently reported and when reported, use was mostly low.
Why has social media not had as much uptake in weight-based interventions compared to other areas of life? One reason for this disparity may be the artificial nature of the types of social media (discussion boards and chat rooms) used on websites developed for weight management. The majority of current mainstream social media use relies on sophisticated, user-friendly, vibrant platforms that incorporate a rich, pleasing, graphical environment allowing for instantaneous transfer of information to a large community of users. Conversely, the components designed for weight-management studies may not have the same usability, access, or appeal. Furthermore, although the majority of Americans associate social media with positive terms such as good, great, fun, interesting, and convenient, the use of social media for weight management may diminish these positive feelings by associating its use with a health-specific and sensitive condition: weight management [
Studies often reported that social media components were included to encourage support from other participants and to build community, although no study reported increased levels of social support after use of the social media components. A possible explanation relates to how social media has evolved over the years. Social media began as virtual communities and computer-mediated communication, which was based on the assumption that people participating would be using these platforms to connect with new people who shared similar interests or life experiences [
Our systematic review has some limitations. First, outcomes varied within the included studies so that studies could not be analyzed together or compared with one another. Second, most studies did not isolate the unique impact of social media on weight outcomes; thus, the role of social media in these interventions remains unknown. Third, risk of bias and study quality varied considerably within the included studies. Fourth, social media applications and platforms are evolving rapidly and it is possible, despite a rigorous search strategy, that studies of certain mobile devices with social media capabilities will be missed by our review. Finally, we limited our inclusion to RCTs only; other study designs may have been used to examine the use of this relatively novel technology in weight management.
Despite these limitations, our systematic review provides a comprehensive review of how social media is being used in online weight-management interventions to date. We found that social media is being incorporated in online weight-management interventions largely through message boards and chat rooms with unclear benefits. Although social media may play a role in retaining and engaging participants in online weight loss interventions, studies that are designed to measure the effect of social media are needed to understand whether and how social media may meaningfully improve weight management.
Full PubMed search strategy.
Detailed study characteristics.
Jadad scale.
Quality scores.
body mass index
Medical Subject Heading
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
randomized controlled trial
The authors would like to acknowledge Patricia Anderson (Senior Associate Librarian for Emerging Technologies, Health Sciences Libraries, University of Michigan, Ann Arbor, MI) for her assistance in the development of the search strategies of the medical literature. The authors would also like to thank Kyle Bevier for his work as a research assistant. Dr Chang receives salary support from the Robert Wood Johnson Foundation Clinical Scholars Program.
None declared.