Research article
Weight Management Using the Internet: A Randomized Controlled Trial

https://doi.org/10.1016/j.amepre.2007.09.026Get rights and content

Background

Most weight-loss research targets obese individuals who desire large weight reductions. However, evaluation of weight-gain prevention in overweight individuals is also critical as most Americans become obese as a result of a gradual gain of 1–2 pounds per year over many years.

Method

This study evaluated the efficacy of an Internet-based program for weight-loss and weight-gain prevention with a two-group, prospective, randomized controlled trial. A military medical research center with a population of 17,000 active-duty military personnel supplied 446 overweight individuals (222 men; 224 women) with a mean age of 34 years and a mean BMI of 29. Recruitment and study participation occurred 2003–2005 and data were analyzed in 2006. Participants were randomly assigned to receive the 6-month behavioral Internet treatment (BIT, n=227) or usual care (n=224). Change in body weight, BMI, percent body fat, and waist circumference; presented as group by time interactions, were measured.

Results

After 6 months, completers who received BIT lost 1.3 kg while those assigned to usual care gained 0.6 kg (F(df=366)=24.17; I<0.001). Results were similar for the intention-to-treat model. BIT participants also had significant changes in BMI (–0.5 vs +0.2 kg/m2; F(df=366)=24.58); percent body fat (–0.4 vs +0.6%; F(df=366)=10.45); and waist circumference (–2.1 vs –0.4 cm; F(df=366)=17.09); p<0.001 for all.

Conclusions

Internet-based weight-management interventions result in small amounts of weight loss, prevent weight gain, and have potential for widespread dissemination as a population health approach.

Trial Registration

NCT00417599.

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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