iReach1

Internet Assisted Obesity Treatment

Study Overview

Behavioral weight control programs are effective in helping overweight and obese individuals lose weight and improve their health.  The “gold standard” programs are delivered in-person and require individuals to attend sessions at the clinic on a weekly basis for 4 to 6 months, which can be burdensome.  Further, some areas do not have a center of excellence which delivers high quality behavioral treatment.  Treatment delivered by Internet could faciliate greater access to high quality services.  However, outcomes of online weight control programs are modest, but this may be because these programs did not include effective behavioral elements.  This study was the first to examine the same behavioral program delivered in-person compared with online; the only aspect in which these programs differed was the channel by which it was delivered.

Four hundred and eighty eight (30% minority) overweight and obese adults recruited from two study sites (Arkansas and Vermont) were randomized to one of three group-based intervention programs:  (1) Behavioral weight-loss intervention delivered online (Internet); (2) Behavioral weight-loss intervention delivered in-person (In person); (3) Behavioral weight-loss intervention delivered predominantly online with periodic in-person meetings (Hybrid).  Session content was the same for all arms, with an emphasis on changing dietary and physical activity habits, guided by calorie and fat goals, with graded exercise goals.  Behavioral strategies to assist in making these habit changes were provided, with a strong emphasis on self-monitoring and problem solving.  Participants met in groups, with weekly meetings for 6 months followed by 12 monthly meetings.  Group meetings were conducted as either in-person groups or synchronous online chats with 15-17 group members; those in the hybrid and were provided with an online self monitoring journal for recording dietary intake and physical activity, and other tools during to support their behavior change efforts.  This was followed by a year of monthly meetings concentrating on maintaining behavior changes and weight loss.

Primary outcomes were weight loss and treatment adherence (attendance at sessions, self-monitoring frequency, etc) and treatment costs.  Data were collected at 6, 12 and 18-months.

Funding

National Institutes of Health (NIDDK) (RO1  DK56746 ; 2005- 2010)

Research Team

Dual PIs:
Delia West PhD-USC, Ex Sci
Jean Harvey, PhD-University of Vermont, Dept. of Nutrition and Food Sciences

 

Co-Investigators:
Rebecca A Krukowski, PhD, University of Tennessee Health Sciences Center
Taka Ashikaga, PhD, University of Vermont
Elaine Prewitt, DrPH, University of Arkansas for Medical Sciences
Alan VanBiervliet, PhD

Major Findings

At 6-months, average weight loss for the In-person group was significantly greater (17 lbs) than average weight loss for those in the Internet group (12 lb) and the Hybrid group (13 lb).  Some weight regain was evident such that there was no difference between the conditions by 18 months, with each delivery channel experiencing similar rates of regain after the frequency of intervention sessions decreased.  Thus, group-based behavioral weight control programs offered online have a long-term efficacy similar to that of in-person delivered program, with greater potential geographic reach.  Further, cost evaluations of the Internet versus In-person programs indicated that the Internet delivered approach was more cost effective, largely because of savings to the participant (rather than the provider).   Although the weight losses achieved with our Internet-delivered program are among the largest reported in the literature to date and comparable to those of In-person program, they were relatively modest.  Now that the online program has been demonstrated efficacious, research into methods to increase the weight losses achieved is warranted.

Current Status

Study is completed.

Selected Publications

Comparing Behavioral Weight Loss Modalities: Incremental Cost-effectiveness of an Internet-based Versus an In-Person Condition
Rebecca A. Krukowski, J. Mick Tilford, Jean Harvey-Berino, Delia Smith West
Obesity (Silver Spring). 2011 August; 19(8): 1629–1635. Published online 2011 January 20. doi: 10.1038/oby.2010.341
PMCID: PMC3137759

Internet Delivered Behavioral Obesity Treatment
Jean Harvey-Berino, Delia West, Rebecca Krukowski, Elaine Prewitt, Alan VanBiervliet, Takamaru Ashikaga, Joan Skelly
Prev Med. 2010 August; 51(2): 123–128. Published online 2010 May 15. doi: 10.1016/j.ypmed.2010.04.018
PMCID: PMC3101104 

The Accuracy of Weight Reported in a Web-Based Obesity Treatment Program
Jean Harvey-Berino, Rebecca A. Krukowski, Paul Buzzell, Doris Ogden, Joan Skelly, Delia S. West
Telemed J E Health. 2011 November; 17(9): 696–699. doi: 10.1089/tmj.2011.0032
PMCID: PMC3241925

Differences in home food availability of high- and low-fat foods after a behavioral weight control program are regional not racial
Krukowski RA, Harvey-Berino J, West DS. Int J Behav Nutr Phys Act. 2010 Sep 24;7:69. doi: 10.1186/1479-5868-7-69. http://www.ijbnpa.org/content/7/1/69)
PMID:  20868503 [PubMed]  PMCID: PMC2954950

Pretreatment weight change is associated with obesity treatment outcomes
West DS, Harvey-Berino J, Krukowski RA, Skelly J. Obesity (Silver Spring). 2011 Sep;19(9):1791-5. doi: 10.1038/oby.2011.22. Epub 2011 Feb 17.
PMID: 21331064 [PubMed – indexed for MEDLINE] PMCID: PMC3158822

Patterns of Success: Online Self-Monitoring in a Web-based Behavioral Weight Control Program
Krukowski RA, Harvey-Berino J, Bursac Z, Ashikaga T, West D. Health Psychol. 2013 Feb;32(2):164-70. doi: 10.1037/a0028135. Epub 2012 Apr 30.
PMID: 22545978 [PubMed – indexed for MEDLINE]