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A 12-week commercial web-based weight-loss program for overweight and obese adults: randomized controlled trial comparing basic versus enhanced features.

Collins CE, Morgan PJ, Jones P, Fletcher K, Martin J, Aguiar EJ, Lucas A, Neve MJ, Callister R - J. Med. Internet Res. (2012)

Bottom Line: Intention-to-treat analysis showed that both intervention groups reduced their BMI compared with the controls (basic: -0.72, SD 1.1 kg/m(2), enhanced: -1.0, SD 1.4, control: 0.15, SD 0.82; P < .001) and lost significant weight (basic: -2.1, SD 3.3 kg, enhanced: -3.0, SD 4.1, control: 0.4, SD 2.3; P < .001) with changes in waist circumference (basic: -2.0, SD 3.5 cm, enhanced: -3.2, SD 4.7, control: 0.5, SD 3.0; P < .001) and waist-to-height ratio (basic: -0.01, SD 0.02, enhanced: -0.02, SD 0.03, control: 0.0, SD 0.02; P < .001), but no differences were observed between the basic and enhanced groups.The addition of personalized e-feedback and contact provided limited additional benefits compared with the basic program.Although the provision of additional personalized feedback did not facilitate greater weight loss after 12 weeks, the impact of superior participant retention on longer-term outcomes requires further study.

View Article: PubMed Central - HTML - PubMed

Affiliation: The University of Newcastle, Callaghan, NSW, Australia. clare.collins@newcastle.edu.au

ABSTRACT

Background: The development and use of Web-based programs for weight loss is increasing rapidly, yet they have rarely been evaluated using randomized controlled trials (RCTs). Interestingly, most people who attempt weight loss use commercially available programs, yet it is very uncommon for commercial programs to be evaluated independently or rigorously.

Objective: To compare the efficacy of a standard commercial Web-based weight-loss program (basic) versus an enhanced version of this Web program that provided additional personalized e-feedback and contact from the provider (enhanced) versus a wait-list control group (control) on weight outcomes in overweight and obese adults.

Methods: This purely Web-based trial using a closed online user group was an assessor-blinded RCT with participants randomly allocated to the basic or enhanced 12-week Web-based program, based on social cognitive theory, or the control, with body mass index (BMI) as the primary outcome.

Results: We enrolled 309 adults (129/309, 41.8% male, BMI mean 32.3, SD 4 kg/m(2)) with 84.1% (260/309) retention at 12 weeks. Intention-to-treat analysis showed that both intervention groups reduced their BMI compared with the controls (basic: -0.72, SD 1.1 kg/m(2), enhanced: -1.0, SD 1.4, control: 0.15, SD 0.82; P < .001) and lost significant weight (basic: -2.1, SD 3.3 kg, enhanced: -3.0, SD 4.1, control: 0.4, SD 2.3; P < .001) with changes in waist circumference (basic: -2.0, SD 3.5 cm, enhanced: -3.2, SD 4.7, control: 0.5, SD 3.0; P < .001) and waist-to-height ratio (basic: -0.01, SD 0.02, enhanced: -0.02, SD 0.03, control: 0.0, SD 0.02; P < .001), but no differences were observed between the basic and enhanced groups. The addition of personalized e-feedback and contact provided limited additional benefits compared with the basic program.

Conclusions: A commercial Web-based weight-loss program can be efficacious across a range of weight-related outcomes and lifestyle behaviors and achieve clinically important weight loss. Although the provision of additional personalized feedback did not facilitate greater weight loss after 12 weeks, the impact of superior participant retention on longer-term outcomes requires further study. Further research is required to determine the optimal mix of program features that lead to the biggest treatment impact over time.

Trial registration: Australian New Zealand Clinical Trials Registry (ANZCTR): 12610000197033.

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Related in: MedlinePlus

Flow of participants through the three groups (control, basic, enhanced) of a web-based weight-loss randomized controlled trial.
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figure1: Flow of participants through the three groups (control, basic, enhanced) of a web-based weight-loss randomized controlled trial.

Mentions: Once written consent was obtained and baseline assessments completed, participants were stratified by sex and BMI category (25 to <30; ≥30 to <35 or ≥35 to 40 kg/m2). They were randomly allocated to one of the three groups between October and December 2009 (Figure 1) using a stratified randomized block design with variable blocks length (either 3 or 6) generated by the statistician. A researcher not involved in data collection distributed sequentially numbered sealed envelopes with allocation details and a login code. Participants were given an instruction sheet and the Web address and asked to set up their own login. We also gave them a toll-free number to call if they experienced any difficulties in logging in. No training on program use was provided to participants in order to mirror the program engagement that commercial users would experience and to increase external validity. The groups were (1) control: a wait-list control group who were not provided with access to the weight-loss program website and were asked to refrain from participating in other weight-loss programs for 12 weeks, (2) basic: who were provided with free access to the basic (standard) Web-based program that was commercially available at that time and did not change, and (3) enhanced: who were provided with free access to an enhanced version of the Web-based program that was provided in a closed test environment. Both basic and enhanced group participants were advised to use the online diary a minimum of 4 times per week to record their dietary intake and physical activity, and to enter a weekly weight. Participants were blinded to allocation for the basic and enhanced groups, but not to the control. Research assistants were blinded to allocation for all groups. At each time point all were reminded to not discuss group allocation at assessments.


A 12-week commercial web-based weight-loss program for overweight and obese adults: randomized controlled trial comparing basic versus enhanced features.

Collins CE, Morgan PJ, Jones P, Fletcher K, Martin J, Aguiar EJ, Lucas A, Neve MJ, Callister R - J. Med. Internet Res. (2012)

Flow of participants through the three groups (control, basic, enhanced) of a web-based weight-loss randomized controlled trial.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3376507&req=5

figure1: Flow of participants through the three groups (control, basic, enhanced) of a web-based weight-loss randomized controlled trial.
Mentions: Once written consent was obtained and baseline assessments completed, participants were stratified by sex and BMI category (25 to <30; ≥30 to <35 or ≥35 to 40 kg/m2). They were randomly allocated to one of the three groups between October and December 2009 (Figure 1) using a stratified randomized block design with variable blocks length (either 3 or 6) generated by the statistician. A researcher not involved in data collection distributed sequentially numbered sealed envelopes with allocation details and a login code. Participants were given an instruction sheet and the Web address and asked to set up their own login. We also gave them a toll-free number to call if they experienced any difficulties in logging in. No training on program use was provided to participants in order to mirror the program engagement that commercial users would experience and to increase external validity. The groups were (1) control: a wait-list control group who were not provided with access to the weight-loss program website and were asked to refrain from participating in other weight-loss programs for 12 weeks, (2) basic: who were provided with free access to the basic (standard) Web-based program that was commercially available at that time and did not change, and (3) enhanced: who were provided with free access to an enhanced version of the Web-based program that was provided in a closed test environment. Both basic and enhanced group participants were advised to use the online diary a minimum of 4 times per week to record their dietary intake and physical activity, and to enter a weekly weight. Participants were blinded to allocation for the basic and enhanced groups, but not to the control. Research assistants were blinded to allocation for all groups. At each time point all were reminded to not discuss group allocation at assessments.

Bottom Line: Intention-to-treat analysis showed that both intervention groups reduced their BMI compared with the controls (basic: -0.72, SD 1.1 kg/m(2), enhanced: -1.0, SD 1.4, control: 0.15, SD 0.82; P < .001) and lost significant weight (basic: -2.1, SD 3.3 kg, enhanced: -3.0, SD 4.1, control: 0.4, SD 2.3; P < .001) with changes in waist circumference (basic: -2.0, SD 3.5 cm, enhanced: -3.2, SD 4.7, control: 0.5, SD 3.0; P < .001) and waist-to-height ratio (basic: -0.01, SD 0.02, enhanced: -0.02, SD 0.03, control: 0.0, SD 0.02; P < .001), but no differences were observed between the basic and enhanced groups.The addition of personalized e-feedback and contact provided limited additional benefits compared with the basic program.Although the provision of additional personalized feedback did not facilitate greater weight loss after 12 weeks, the impact of superior participant retention on longer-term outcomes requires further study.

View Article: PubMed Central - HTML - PubMed

Affiliation: The University of Newcastle, Callaghan, NSW, Australia. clare.collins@newcastle.edu.au

ABSTRACT

Background: The development and use of Web-based programs for weight loss is increasing rapidly, yet they have rarely been evaluated using randomized controlled trials (RCTs). Interestingly, most people who attempt weight loss use commercially available programs, yet it is very uncommon for commercial programs to be evaluated independently or rigorously.

Objective: To compare the efficacy of a standard commercial Web-based weight-loss program (basic) versus an enhanced version of this Web program that provided additional personalized e-feedback and contact from the provider (enhanced) versus a wait-list control group (control) on weight outcomes in overweight and obese adults.

Methods: This purely Web-based trial using a closed online user group was an assessor-blinded RCT with participants randomly allocated to the basic or enhanced 12-week Web-based program, based on social cognitive theory, or the control, with body mass index (BMI) as the primary outcome.

Results: We enrolled 309 adults (129/309, 41.8% male, BMI mean 32.3, SD 4 kg/m(2)) with 84.1% (260/309) retention at 12 weeks. Intention-to-treat analysis showed that both intervention groups reduced their BMI compared with the controls (basic: -0.72, SD 1.1 kg/m(2), enhanced: -1.0, SD 1.4, control: 0.15, SD 0.82; P < .001) and lost significant weight (basic: -2.1, SD 3.3 kg, enhanced: -3.0, SD 4.1, control: 0.4, SD 2.3; P < .001) with changes in waist circumference (basic: -2.0, SD 3.5 cm, enhanced: -3.2, SD 4.7, control: 0.5, SD 3.0; P < .001) and waist-to-height ratio (basic: -0.01, SD 0.02, enhanced: -0.02, SD 0.03, control: 0.0, SD 0.02; P < .001), but no differences were observed between the basic and enhanced groups. The addition of personalized e-feedback and contact provided limited additional benefits compared with the basic program.

Conclusions: A commercial Web-based weight-loss program can be efficacious across a range of weight-related outcomes and lifestyle behaviors and achieve clinically important weight loss. Although the provision of additional personalized feedback did not facilitate greater weight loss after 12 weeks, the impact of superior participant retention on longer-term outcomes requires further study. Further research is required to determine the optimal mix of program features that lead to the biggest treatment impact over time.

Trial registration: Australian New Zealand Clinical Trials Registry (ANZCTR): 12610000197033.

Show MeSH
Related in: MedlinePlus