Research articleWeight Management Using the Internet: A Randomized Controlled Trial
Introduction
The average body weight of adults in the United States has increased dramatically over the past 3 decades1, 2, 3 and nearly two thirds of adults are now overweight (BMI≥25) or obese (BMI≥30). Most weight-management studies have targeted significantly overweight or obese individuals who desire moderate to large reductions in weight.4, 5, 6 However, most Americans become overweight or obese as a result of a gradual weight gain of 1–2 pounds per year over many years.7, 8, 9 Although clinic-based behavioral weight-loss programs can produce safe and meaningful weight loss,10, 11 they are inefficient for the escalating needs of the U.S. population.12
The Internet offers a potential platform for a broader approach to weight management,13, 14 and most adults prefer the Internet over face-to-face professional encounters.15 Several randomized trials evaluating Internet weight-management interventions have demonstrated efficacy for producing meaningful weight loss and preventing weight regain.16, 17, 18, 19, 20, 21, 22 In sum, these researchers found that increased contact and tailored interaction although the web, including e-mail, tailored messages, chat rooms, and food/exercise diary feedback, improved weight-loss and weight-maintenance outcomes compared to less-interactive educational web-based formats.16, 23 However, most of the existing research has been conducted in academic centers with samples that are over forty, female, predominantly obese, and have a co-morbid health condition such as diabetes.16, 17, 18 In the one published study that included a large and diverse sample, the findings were limited by the poor retention at follow-up (20%) and the fact that weight outcomes were based on participants’ self-reports.22
Additional research is thus required to examine the effectiveness of an Internet weight-management program in a more diverse sample and in people without co-morbid health conditions. Evaluation in diverse samples and other settings will provide information about the replicability and generalizability of the early findings. Further, research is needed to test Internet programs for small-to-moderate weight loss and prevention of weight gain as this may be a more realistic population-health–based goal.14 The current study evaluated the effectiveness of a behavioral treatment program for weight management using the Internet as compared to usual care in a diverse sample of primarily overweight adults. It was hypothesized that those in the Internet-based program would, as a group, demonstrate the prevention of weight gain or small-to-moderate weight losses. It was further hypothesized that participants in the usual-care condition would not show any weight loss and would, in fact, gain weight over the 6-month period from baseline to reassessment.
Section snippets
Participants
The U.S. Air Force (USAF) was identified as a favorable population for study because of the high percentage of men, ethnic minorities, and younger adults. As noted, these groups are often underrepresented in most Internet weight-management trials. Despite an emphasis on physical fitness, 59.8% of USAF personnel are overweight and 13.4% of these are obese.24 Similar to civilian populations,7, 8 USAF personnel gained an average of 1–2 pounds per year over the past 5 years,9 and the rate of
Participants
Baseline participant demographic characteristics are presented in Table 1. A total of 227 participants were randomized to receive the BIT intervention and 224 to usual care. However, five participants were excluded from analyses due to pregnancy after randomization, leaving 224 and 222 participants in the BIT and usual-care groups, respectively. Both groups included 50% men and women. Participants had similar distribution in age and rank as the eligible population, but more women and more
Discussion
The Internet has become a primary source for health information, and is a promising tool for the delivery of interventions to change health behavior.13, 14, 16, 17, 18, 20, 21, 22, 23 While the weight change in this study was not as large as in early Internet-based weight-management studies, that may be due to the considerable differences in the samples studied and the added emphasis in this study on prevention of weight gain in a predominately overweight population. However, despite these
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2020, Preventive MedicineCitation Excerpt :Five trials (Appel et al., 2011; Collins et al., 2012; Kraschnewski et al., 2011; Tate et al., 2003, 2006) implemented a reminder function. Different feedback modes were also used: human only (Hunter et al., 2008; Martin et al., 2015; Morgan et al., 2011a, 2011b; Tate et al., 2003; Tate et al., 2001), computer only (Kraschnewski et al., 2011; Naimark et al., 2015; Steinberg et al., 2013; Tate et al., 2006) and both (Appel et al., 2011; Chambliss et al., 2011; Collins et al., 2012; Kerr et al., 2016). One-way, two-way and combined interactions were adopted through synchronous and asynchronous communication, and the duration ranged from 12 weeks (Appel et al., 2011) to 48 weeks (Tate et al., 2003).
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2019, Contemporary Clinical TrialsCitation Excerpt :In keeping with our pilot study, we provided interpersonal support via two mechanisms: coach counseling and Facebook. Digital health interventions paired with interpersonal support from a human interventionist produce significantly greater weight losses than digital health interventions alone [65,66]. One of two health coaches that were trained in the behavioral treatment of obesity through required readings and role play, either a registered nurse or clinical psychologist, oriented/problem solved with participants in person (baseline) or by phone (follow-ups) when a goal change occurred or new goal was introduced.
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2018, Journal of Biomedical InformaticsCitation Excerpt :However, even moderate weight loss can significantly reduce the risk of health problems like cardiovascular disease, and with a 5% reduction in body weight there is a significant improvement in glycemic control for diabetics [7–9]. Several studies have presented the potential of web information systems supporting weight loss and weight management [10–14]. According to the International Telecommunication Union’s statistics [15], in 2017, Internet penetration was already at 48% of the world’s population.