Randomized Controlled Trial

A - Click here for explanation of classification scheme.

NEUTRAL: See Quality Criteria Checklist below.

To assess the feasibility and acceptability of conducting a weight maintenance program over the Internet.

• At least 18 years of age
• 30 pounds or more above ideal body weight
• Free of major medical problems and not taking prescription medications
• Provided written informed consent.

Participants who did not have access to the Internet.

Recruitment

Subjects were recruited for the study from newspaper advertisements.

Design

Randomized controlled trial.

Blinding Used 

Implied with measurements.

Intervention

• Subjects initially took part in a 15-week behavioral weight control program and were then randomized to one of three maintenance conditions:
  • In-person, therapist-led (TL)
  • Internet, therapist-led (I)
  • Control (C).
• Both maintenance interventions met biweekly for 22 weeks using the same program content
• The therapist lead group met in person biweekly for 22 weeks. Participants turned in their self-monitoring diaries, were weighed and participated in a discussion facilitated by the group therapist. During weeks where in-person meetings were not held, subjects received a phone call from the group therapist and had the opportunity to submit their self-monitoring data, subjects also took part in a social influence peer support program.
• Participants in the Internet group attended biweekly meetings in the form of an Internet chat session. Subjects entered the chat room at a prearranged time and the discussion was facilitated by a group therapist. During the weeks where Internet sessions were not held, participants received an e-mail from the therapist and had the opportunity to enter their weekly self-monitoring data on a Web Site form.
• Group therapists were the researchers; one was a registered dietitian.

Timing of Measurements

Measurements made at baseline and after 22 weeks.

Dependent Variables

• Weight was measured on a balance-beam scale with participants wearing their street clothes and height was self-reported
• Both body mass index (BMI in kg per m²) and absolute weight were used as measures of obesity
• Feasibility of conducting a program over the Internet was assessed by keeping recruitment records to determine the number of people screened out for not having appropriate computer hardware and access to the Internet
• Further measures of acceptability and adherence to behavior change were used such as attendance at maintenance group sessions, adherence to self-monitoring goals, energy and total fat intake by three-day food records, the use of the Paffenberger Activity questionnaire to assess calories expended, peer support and acceptability of both maintenance conditions assessed at week 18 by having participants complete a five-item questionnaire that measured their perceptions with regard to the I or TL conditions.

Independent Variables

• Subjects initially took part in a 15-week behavioral weight control program and were then randomized to one of three maintenance conditions:
  • In-person, therapist-led (TL)
  • Internet, therapist-led (I)
  • Control (C).
• Both maintenance interventions met biweekly for 22 weeks using the same program content
• The therapist lead group met in person biweekly for 22 weeks. Participants turned in their self-monitoring diaries, were weighed and participated in a discussion facilitated by the group therapist. During weeks where in-person meeting were not held, subjects received a phone call from the group therapist and had the opportunity to submit their self-monitoring data, subjects also took part in a social influence peer support program.
• Participants in the Internet group attended biweekly meetings in the form of an Internet chat session. Subjects entered the chat room at a pre-arranged time and the discussion was facilitated by a group therapist. During the weeks where Internet sessions were not held, participants received an e-mail from the therapist and had the opportunity to enter their weekly self-monitoring data on a Web Site form.
• Group therapists were the researchers; one was a registered dietitian.

• Initial N: 94 men and women expressed interest and 46 (nine men, 37 women) were randomized
• Attrition (final N): Two participants (4%) dropped out during treatment; 90% completed the Week 15 assessment and 93% completed the Week 37 assessment.The number of participants with complete data was 41 (89%). 11 were in the therapist-led group and 12 were in the Internet group.
• Age: Range 31 to 60 years, mean 46.3±7.4 years
• Ethnicity: Predominantly white
• Other relevant demographics: 95.6% employed full-time
• Anthropometrics: Groups were similar at baseline
• Location: Vermont.

Key Findings

• Results showed that TL participants were more likely to attend their meetings and feel more satisfied with their group assignment (58%±22% vs. 33%±23%, P<0.005)
• There were no differences between the TL and I groups in overall attrition or number of peer support contacts made
• There was also no significant differences between the groups in weight loss, BMI, diet or exercise change during the maintenance conditions (-19.8±17.2, -15.5±23.4, -17.3±15.3, P=0.83 for TL, I and C, respectively).

 

The Internet may hold promise as a method for maintaining contact with patients to facilitate long-term behavior change.

Government:	USDA Hatch Act Funds (HA-516)
University/Hospital:	Office of Patient Oriented Research at Fletcher Allen Health Care

• Small numbers of subjects in groups.
• Methodology for statistical analysis not reported.
• The authors noted that the limited sample size and maintenance program length prohibits drawing conclusions with regard to the effectiveness of the Internet for sustaining behavior change.