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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