Using Internet Technology to Deliver a Behavioral Weight Loss Program

TLDR

Rapid growth in Internet access has made it a viable platform for public health interventions. The study aimed to determine whether a structured Internet behavioral weight loss program yields greater initial weight loss and waist circumference reductions than a weight loss education website. In a 6‑month randomized controlled trial, 91 overweight adults received either an Internet education site or a behavior‑therapy program that included weekly email lessons, self‑monitoring diaries with individualized therapist feedback, an online bulletin board, and one face‑to‑face group session. Participants in the behavior‑therapy group lost significantly more weight (4.0 kg at 3 months, 4.1 kg at 6 months) and waist circumference than the education group (1.7 kg and 1.6 kg, respectively), with 45 % achieving a 5 % weight‑loss goal versus 22 %.

Abstract

ContextRapid increases in access to the Internet have made it a viable mode for public health intervention. No controlled studies have evaluated this resource for weight loss.ObjectiveTo determine whether a structured Internet behavioral weight loss program produces greater initial weight loss and changes in waist circumference than a weight loss education Web site.DesignRandomized, controlled trial conducted from April to December 1999.Setting and ParticipantsNinety-one healthy, overweight adult hospital employees aged 18 to 60 years with a body mass index of 25 to 36 kg/m2. Analyses were performed for the 65 who had complete follow-up data.InterventionsParticipants were randomly assigned to a 6-month weight loss program of either Internet education (education; n = 32 with complete data) or Internet behavior therapy (behavior therapy; n = 33 with complete data). All participants were given 1 face-to-face group weight loss session and access to a Web site with organized links to Internet weight loss resources. Participants in the behavior therapy group received additional behavioral procedures, including a sequence of 24 weekly behavioral lessons via e-mail, weekly online submission of self-monitoring diaries with individualized therapist feedback via e-mail, and an online bulletin board.Main Outcome MeasuresBody weight and waist circumference, measured at 0, 3, and 6 months, compared the 2 intervention groups.ResultsRepeated-measures analyses showed that the behavior therapy group lost more weight than the education group (P = .005). The behavior therapy group lost a mean (SD) of 4.0 (2.8) kg by 3 months and 4.1 (4.5) kg by 6 months. Weight loss in the education group was 1.7 (2.7) kg at 3 months and 1.6 (3.3) kg by 6 months. More participants in the behavior therapy than education group achieved the 5% weight loss goal (45% vs 22%; P = .05) by 6 months. Changes in waist circumference were also greater in the behavior therapy group than in the education group at both 3 months (P = .001) and 6 months (P = .005).ConclusionsParticipants who were given a structured behavioral treatment program with weekly contact and individualized feedback had better weight loss compared with those given links to educational Web sites. Thus, the Internet and e-mail appear to be viable methods for delivery of structured behavioral weight loss programs.