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Can the Internet successfully deliver a weight loss programme?

 

Although group behavioural programmes are one of the most effective ways to treat overweight and obesity, the Internet could provide an alternative method to deliver these programmes. The advantages of an Internet based programme include increasing accessibility and catering for those who dislike face-to-face contact. This study aims to determine whether the Internet could provide a viable way to deliver behavioural weight loss programmes. It compares the efficacy of a typical, widely available weight-loss information site with a structured behavioural weight loss programme, designed to include some of the essential features of face-to-face programmes.

Message

As an initial feasibility and efficacy trial this study shows that structured behavioural weight loss programmes delivered via the Internet provide a useful alternative to face-to-face programmes for those who would otherwise not seek treatment (e.g. the physically disabled, geographically isolated or those disliking face-to-face contact).

Reference

DF Tate et al. Using Internet technology to deliver a behavioral weight loss program. Journal of the American Medical Association 2001 285: 1172-1177.

Study

Participants in this randomised controlled trial were 91 healthy overweight adult hospital employees, aged 18 to 60 years, with a body mass index of 25 to 36 kg/m2. There were 81 women and 10 men. Participants, who had access to e-mail and the Internet, were recruited through two e-mail messages and an advertisement on the Intranet web site. The study was conducted from April to December 1999.

Participants were randomly assigned to a six-month Internet weight loss programme of either education or behaviour therapy.

Internet education group

Participants received a one-hour face-to-face group lesson on behavioural weight control by a clinical psychologist. A calorie restricted diet of 1,200 to 1,500 kcals a day and a daily fat intake of less than 20% of total energy was recommended. They were also instructed to gradually increase their physical activity to burn a minimum of 1,000 kcals a week. They had access to a web site which provided basic information on weight loss with links to selected sites on diet, exercise, self-monitoring and other topics (e.g. social support, stimulus control and managing stress).

Internet behaviour therapy group

Participants in this group received the above with the following additions: 24-weekly e-mail lessons on behavioural weight loss; weekly online submission of self-monitoring diaries; weekly personal feedback including recommendations and reinforcement via e-mail; the opportunity for questions/comments to the therapist via e-mail; access to an online bulletin board for social support among this group's participants.

All participants were seen at the start of the trial, and at three and six months, to obtain objective weight, waist circumference, physical activity and dietary intake measurements. Height was also measured and use of the web site was tracked.

Results

There were no differences between the two groups in age, weight, body mass index, waist circumference or Internet experience. Attrition rates were 15% and 22% at three and six months respectively, leaving 32 participants in the education group and 33 in the behaviour therapy group with completed assessments.

Participants in the behaviour therapy group lost significantly more weight than those in the education group during the first three months and both groups maintained their weight loss in the next three months. Weight loss in the behaviour therapy group was 4.0 kg at three months and 4.1 kg at six months. Weight loss in the education group was 1.7 kg at three months and 1.6 kg at 6 months.

Waist circumference reductions were also significantly greater in the behaviour therapy group with measurements of 6.7 cm at three months and 6.4 cm at six months compared with 3.0 cm at three months and 3.1 cm at six months in the education group.

An intention-to-treat analysis was also performed with all participants (i.e. including those who did not complete the programme). Although weight loss was less, significant differences remained between the two groups.

As expected, participants in the behaviour therapy group logged on to the web site more often than those in the education group with an average of 19 versus 9 times during the first three months and seven times versus once during months three to six.

Comment

Although this study showed that participants who received a structured Internet programme lost more weight than those who only had access to weight loss web sites, the following need to be considered:

Further studies are therefore needed to address these points, e.g. to look at whether Internet programmes successfully deliver long-term weight loss among a much larger, and more equal, number of men and women.

Despite these issues, this study raises an important possibility. Internet programmes may not be able to match the weight losses accomplished by face-to-face treatments, but they may provide a useful alternative to them. For those who would otherwise not seek treatment (due to accessibility or disliking group face-to-face meetings for example) an Internet programme that produces some weight loss can only be a good thing. Furthermore, Internet programmes are in their infancy; further research may improve their effectiveness.

One final comment : it is essential to verify that the online programme is reputable and that the therapist is qualified and experienced (e.g. by checking the online directory of their professional association).