Refer patients to Twitter for weight loss

Lifestyle interventions are effective, but require multiple visits of behavioral, nutrition, and exercise counseling over 6 months to 2 years if delivered true to original form.  Few medical centers offer such services, leaving this care to be handled by commercial vendors or simply leaving patients to deal with their weight on their own. This predicament is likely a factor in the development of a $60 billion fad diet industry, which further leads our patients astray for how to manage their weight. The sort-of good news is that the Center for Medicaid and Medicare Services recently decided to allow primary care physicians to bill for behavioral counseling for obesity; but with PCPs in short supply, lacking time for intensive counseling, and lacking training in behavioral modification, nutrition, and exercise science, it is not certain this decision will have any impact on the clinical care of obesity at all. This leaves us is with no affordable clinical services for obesity.

As a clinical psychologist with research and clinical expertise in lifestyle interventions, I decided to take my skills to social media, via Twitter and a blog as a way to disseminate my knowledge of evidence-based strategies for weight loss to the public. When I joined Twitter I sought out other professionals doing the same, including dietitians, behaviorists, exercise physiologists, trainers, physicians and the like. I was surprised to find them in such abundance and that many are purveyors of high quality information. I also came across a subculture of Twitter users who use Twitter as a weight loss community.  I found more people than I can count whom I call real life “biggest losers” because they have lost fairly substantial amounts of weight via lifestyle changes. They actively use Twitter and blogging to document their journey, share the secrets of their success, and connect with others who are on the same path. I love checking my Twitter stream and reading the chatter about morning workouts, friendly fitness challenges, and weight loss successes. I find myself congratulating strangers on their accomplishments and getting encouragement for my own.  One day I made a tweet “commitment” that I would be doing 1 abdominal plank each day (#plankaday) to overcome my dreadful history with core exercise. Over the months, 2,000+ joined me. I was astonished. I don’t know my followers personally and I’m far from famous on Twitter. What it comes down to is the power of social networks for behavior change.

All of this got me thinking about Drs. Nicholas Christakis’ and James Fowler’s work showing obesity and unhealthy behaviors spread almost infectiously through social networks. I believe the same is true for healthy behavior. Healthy behavior can spread through social networks, and the spread may be accelerated in online social networks which are more dynamic.  We need to connect our patients with healthy communities that may become “infected” by healthy behaviors. I now encourage all of my patients to join the social media healthy subculture of experts and peers so that they can get the social support, accountability, positive reinforcement, strategies, and motivation they need to be successful on their weight loss journey. I’m excited to see that many have followed my advice and appear to be really benefiting. Surely social media is not a substitute for clinical care, but in the absence of clinical services for obesity, it is a free-of-cost resource that may be of tremendous benefit to the patient who has few options.

Sherry Pagoto is Associate Professor of Medicine, Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School. She blogs at Welcome to FU Diet and can be reached on Twitter @DrSherryPagoto.

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  • R. Bauman

    As a fan of PlankADay, I couldn’t agree more with this article.  Everyone needs a little motivation now and again and there’s no better way then to use the support of others out there on Twitter trying to accomplish the same goal all around the world.  It makes you realize that you’re not alone.  Great read Dr. Sherry Pagoto!  

  • Susan Druker

    This article really spoke to me.  I really believe that the more I hear about others eating healthy and being physically active the more motivated I am to keep on doing the same!

    • Jason Boies

      Agreed, many of my FB friends post pics of the healthy meals they’re preparing.  It’s encouraged me to start making some healthier choices myself.  Even someone updating their status with something like “Great workout today, feeling great.” or something to that effect can help motivate me to NOT skip the gym that day.  :)

  • Jessica Oleski

    I have found Dr. Pagoto’s posts on her blog and her tweets very helpful in my own life. Social networking has helped me become motivated in areas of my life that I never have been before. I’ve also been able to motivate many family members to join in and help them live a healthier lifestyle.

  • Emily Panza

     This article is dead-on. The power of social networks for spreading healthy behavior change, and for helping people STICK TO their health goals, is such an important message to highlight. Not only is it cost-effective, but the Twitter and blog community allow for the QUICK, TIMELY dialogue and feedback that is often so needed for people who are trying to stick with healthy behaviors. For example, someone who has a specific problem or question about weight loss can easily tweet or email someone like Dr. Pagoto or KevinMD to get a good answer, and FAST. Someone who is having a wild craving for sugar or thinking of skipping their workout, can turn to their Twitter network for in-the-moment motivation. This opportunity for quick, reliable feedback is simply not possible with PCPs, and as long as the sources that you’re following are accurate and qualified, the power of networks like Twitter for advancing health behavior change is incredible.

  • Susan Bakke

     great post a follower of Twitter & PlankADay it is so refreshing to know that we are a community of followers who support and motivate each other for a common good..we can’t do it alone!! we are a family and we care about one another!!!

  • Julie

    I couldn’t agree more with this article by Dr. Sherry Pagoto. As a Physical Therapist I have also been using social media both personally and professionally. I have connected with other physicians and PT’s across the world interested in exercise and health promotion as part of a medical care plan for patients. I have come across articles and made connections with professionals and organizations I otherwise would have never even knew existed. I do not dispense specific medical information, but I have discovered people need direction and guidance in how to navigate the health care system. On a personal level I have found a subculture of marathoners and triathletes whose connections have been priceless.  I have found these fellow athletes to be a plethora of information and also just some good old fashioned encouragement. When I tweet that I had a horrible training run,someone always chimes in with a friendly word. Having community of people in a technical world is priceless in trying to change behaviors and become healthy. It’s good to know I am far from alone!

  • Brian Smith, PhD

    This is an excellent post, which is not at all surprising given the quality of writing, insight, and science-backed rigor that is typical on Dr. Pagoto’s blog.  From a public health perspective, given the importance of social support as well as considering the social context of behavior, I strongly concur that there is tremendous potential in applying social network-based tools to understand health behavior and foster health promotion efforts.  And as a fellow health scientist, I personally find Dr. Pagoto’s work leveraging social media to these ends to be very inspiring.

  • Michael Bauman

    Awesome post Dr. Pagoto, It’s spot on! I have used social media to help me get healthy
    and lose 60 lbs.  I could not have doneit alone. 
    I have used Twitter and Myfitinesspal to build a healthy and supportive community for myself.  Twitter has become the largest part of my “healthy community.” I get tons of encouragement from runners & health conscious people. A great example would be the day before Thanksgiving, I tweeted that I
    wanted to get a Big Mac & fries.  Within 1 minute, I got 5 tweets back encouraging me not to do it! Throughout the rest of the day, I also got follow up tweets from people asking me what I ended up doing.  For those interested, I ended up eating grilled chicken and apple slices with a diet pop.

  • Kevin Ronayne

    Based on my own experience I would have to agree.  While struggling with weight loss I started to use and believe in tools on the web to help me along.  Some of those tools, such as the DailyPlate on promote the use of social media and the website hosts a supportive community. The advice, support, and encouragement I receive on Twitter helps keep me motivated.    

  • Jen McElroy

    This is so true!  I’ve sought out other people who tweet or blog about fitness or healthy lifestyles.  I’ve been a Weight Watchers member for 18+ months and find inspiration between meetings from other people who are or have gone through the same journey.  I also find motivation to be more active from other bloggers who talk about training for races or other activities.  While I don’t know any of these people personally I appreciate their honesty whether they make 100% healthy choices or not and it inspires me to really try my best so that I can blog/tweet about something I’ve done to make my day a little bit healthier.

  • Anonymous

    Best and cheapest diet ? – eat smaller portions .

  • Dani Holmes-Kirk

    I could not agree with Dr. Sherry more!! I am a person who has lost 63 lbs with the help of Weight Watcher and social media. I started my WW journey November 2, 2009 and joined twitter in June 2010. Twitter has given me a bigger and better support system than I could’ve ever imagined. There are fellow WW members all over the world there to help give advice, give a “virtual” shoulder to cry on, to celebrate with me when I had a milestone or to answer my big question “how many points is a pint of guiness?” (thanks to  @theskinnydoll – i found out it was 6). But those are just a few of the things my Twitter family has done for me. I can’t really put in to words how much I owe to social media. I began my blog ( in May of 2011. I started it as a place to jot down my own thoughts – to finally get out of my own head – but really it has become a place for me to break out of my comfort zone and to be more open than I ever have before. To share with the world what i have been holding on to inside for awhile – which in turn helped with my weight loss, my confidence and my overall transformation.

  • Matt Whited

    You’ve really built a sweet healthy online social network. I hope other professionals continue to follow your lead and engage social networks to promote healthier living by spreading the word on what they’ve learned from their own research/clinical work/personal experience.

  • jennifermf

    What about Health At Every Size?

    I (and everyone I know) will block weight loss-promoting accounts as spam on twitter. Focusing on weight loss (rather than health, like the Health At Every Size approach) is just bad medicine and bad science. Everyone should try to do a plank a day if they’re physically able, not just those undesirable fatties who need to change their bodies so people stop making assumptions about their health and health outcomes.

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