Efficacy of an mHealth‐delivered behavioral intervention on weight loss and cardiometabolic risk in African American postpartum people with overweight or obesity: the SnapBack randomized controlled trial

Abstract Objective The objective of this study was to evaluate the efficacy of a mobile health (mHealth)‐delivered behavioral intervention on changes in postpartum weight and cardiometabolic risk factors (blood pressure [BP], lipids, and hemoglobin A1c) over 12 months. Methods A randomized controlled trial of 300 African American postpartum people with overweight and obesity enrolled in Philadelphia Women, Infants, and Children (WIC) clinics was conducted. Participants were randomized to usual WIC care ( n = 151) or a 12‐month mHealth‐delivered intervention ( n = 149) comprising behavior change goals, interactive self‐monitoring text messages, and counseling support. Results Intervention and usual‐care participants did not significantly differ in 12‐month mean postpartum weight change (1.1 vs. 1.6 kg, p = 0.5; difference −0.6 kg, 95% CI: −2.3 to 1.2). However, high intervention engagement led to weight loss compared with weight gain among those who were less engaged (−0.6 vs. 2.4 kg, p = 0.01; difference −3.0 kg, 95% CI: −5.4 to −0.6). The intervention reduced systolic BP relative to usual care (−1.6 vs. 2.4 mm Hg, p = 0.02; difference −4.0 mm Hg, 95% CI: −7.5 to −0.5), but this effect did not extend to other cardiometabolic risk factors. Conclusions Among African American postpartum people enrolled in WIC, an mHealth‐delivered intervention reduced systolic BP but not additional cardiometabolic risk factors or weight. Intervention participants with high engagement had significantly better postpartum weight outcomes, and thus, next steps include addressing barriers to engagement.