Texting can be good for your health

Studies have shown that success in losing weight is affected by how often patients see a health-care professional.

Patients benefit from the doctor's advice and reminders on nutrition, exercise, stress management, time management, and tips on finding healthy, affordable food. Regrettably, though, most patients only see their doctors for 30 minutes every 6-to-12 months, which is not enough time to change their behavior.

But what if we could take advantage of the power of digital communication and use text messaging to reiterate supportive messages to improve a patient's health? That was the question we sought to answer in our clinic with obese patients who also have non-alcoholic fatty liver disease (NAFLD), and the preliminary results show exciting potential for success.

We shared the results of our study this week with other health-care professionals at Digestive Disease Week® (DDW) 2017, because we believe this forum — the world's largest gathering of physicians and researchers in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery — could encourage widespread adoption of this promising practice.

Obesity increases the incidence of NAFLD, a potentially life-threatening condition that can progress to advanced liver disease, liver cirrhosis and even cancer.

Because there are no medications approved by the U.S. Food and Drug Administration, weight loss is the only known method to effectively treat patients with NAFLD. Even a modest loss can dramatically improve NAFLD and reduce the risk of further complications and progression of the disease.

We performed this randomized study on 22 NAFLD patients with an average weight of about 240 pounds. A control group of 14 patients received instructions from their health-care provider on healthy diet and daily exercise. A second group of eight patients got the same type of instructions, but also received three text messages per week for 22 weeks, reiterating all the supportive messages they received during clinical visits.

After six months, patients in the texting group lost an average of 11.2 pounds, compared to an average of 2.2 pounds gained in the control group. This weight loss was enough that we saw dramatic differences in levels of a liver enzyme known as ALT, which shows the presence of liver damage. The group receiving text messages significantly reduced their ALT levels, while the control group did not see any significant change. Similar change was also seen in cholesterol, especially triglyceride levels in the blood.

We believe that this additional digital engagement is important, because it's difficult to make real impact with the current doctor-patient paradigm. When we surveyed patients in the texting group after the study, they all indicated that they liked the increased contact with their care team. Based on this success, we'll be conducting additional larger studies over a longer period to examine the impact of this strategy on harder clinical outcomes. We all know that it can be relatively easy to lose weight at first, so we were pleased to learn that text messaging can help people over the longer term.

After completing an AASLD-sponsored advanced fellowship in transplant hepatology at the Mayo Clinic, Rochester, MN, Dr. Singal joined the University of Alabama at Birmingham in August 2012, where he is currently an associate professor and co-director of the porphyria center. Dr. Singal is active in clinical and translational research with important contributions in steatohepatitis (due to alcohol use, as well as due to non-alcohol fatty liver disease), porphyria cutanea tarda, and renal dysfunction in cirrhosis. His research is currently funded from the American College of Gastroenterology, NIAAA and the NIDDK. With his service nationally to the Practice Guidelines Committee of the ACG, Research Awards Panel of the AGA, and Research Awards Committee of the AASLD, Dr. Singal has published over 100 papers in journals of national and international repute, and has edited two books on hepatitis B.

Dr. Singal presented data from the study "Text Messaging Approach Improves Weight Loss and ALT Levels in Patients with NAFLD," abstract 355, on Sunday, May 7, at 3:30 p.m. CT, at McCormick Place in Chicago. For more information about featured studies, as well as a schedule of availability for featured researchers, please visit www.ddw.org/press.

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