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Background  The incidence of obesity among adolescents is increasing. Text messages are a primary communication form for adolescents and potentially a scalable strategy for delivering population health interventions.    Objective  This study aimed to determine the effectiveness of text message interventions in reducing BMI in adolescents and describe characteristics that are common to effective interventions.    Methods  This systematic review included randomized controlled trials of text message lifestyle interventions involving adolescents aged 10 to 19 years with outcomes focused on obesity prevention or management. Primary outcome was objective or self-report change in BMI.    Results  In total, 4362 records were identified, and 215 full-text articles were assessed for eligibility. A total of 8 unique studies were identified, including 767 participants, mean age 14.3 (SD 0.9) years, BMI 29.7 (SD 1.6) kg/m2 and 53.1% (407/767) female (31/101, 30.7%-172/172, 100.0%). All interventions were multicomponent. The median active intervention period was 4.5 months. During the active and extended intervention phases, text messages accounted for >50% (8 studies) and >85% (3 studies) of contact points, respectively. Text messages were heterogeneous, with a median of 1.5 text messages sent per week (range: 1-21). A total of 4 studies utilized two-way text message communication with health professionals Of the 8 studies, 7 demonstrated reductions in BMI or BMI z-score in the intervention group compared with the control at the end of the final follow-up. The effect was only statistically significant in 1 study at 6 months. Over 6 months, reductions in BMI (kg/m2) ranged from 1.3% to 4.5% and BMI z-score ranged from 4.2% to 28.1%. Overall quality of the studies was low.    Conclusions  Further research is required to elucidate the effectiveness and potential impact of text message interventions on weight and weight-related behaviors in adolescents.

Effectiveness of Text Message Interventions for Weight Management in Adolescents: Systematic Review