SAN DIEGO – There were no significant differences in the amount of weight lost at 18-month follow-up among adults randomized to a weight management program delivered online, compared with those randomized to the same program delivered in person.
However, a significantly greater proportion of self-monitoring records were submitted by adults assigned to the online group, compared with those assigned to the in-person group.
Dr. Delia Smith West
"We didn’t know whether or not the delivery channel impacts weight loss maintenance, but there are reasons to think it might be different online," Delia Smith West, Ph.D., said at the annual meeting of the Obesity Society. "We know that the maintenance phase is characterized by a decrease in session attendance. It can be a fairly marked decrease between the initial weekly sessions of weight loss reduction and weight maintenance. We also know that self-monitoring falls off. The ability to attend your session online might be associated with a decreased burden and therefore greater adherence."
For the study, known as iREACH, Dr. West and her associates evaluated weight maintenance and treatment adherence among 481 adults who received the identical group weight-loss program at clinics in Arkansas and Vermont. The treatment goals were to help participants modify eating and exercise habits, with modest calorie restriction, 25% or fewer calories from fat, exercise up to 200 minutes per week, and daily self-monitoring of dietary intake and physical activity. For this component, the participants who were randomized to the in-person group tracked their progress in a paper-based journal while the online group tracked their progress in a computer-based journal. Behavioral strategies covered during the sessions included self-monitoring, problem solving, goal setting, stimulus control, relapse prevention, assertiveness training, social support, and homework.
Of the 481 patients, 161 were randomized to online delivery of the program during weekly sessions for 6 months, 159 were randomized to in-person group delivery of the program during weekly in-person sessions for 6 months, and 161 were randomized to receive a mix of both weekly online and in-person delivery sessions for 6 months. Maintenance continued for 12 months, said Dr. West of the Fay W. Boozman College of Public Health at the University of Arkansas for Medical Sciences, Little Rock. The in-person group met face to face for monthly sessions while the online group "met" for monthly synchronous online chats in real time, moderated by a facilitator. The hybrid group alternated between the two delivery methods.
The mean age of patients was 47 years, 28% were black, and 93% were female. Their mean weight was 97 kg, their mean body mass index was 36 kg/m2, and 65% reported being a college graduate.
Dr. West reported that at 6 months, the amount of weight loss significantly favored the in-person group (a mean of 18 lbs., compared with a mean of 14 lbs. for the hybrid group and a mean of 12 lbs for the online group). However, there were no statistically significant differences in total weight loss between the groups at 18 months (a mean of 12 lbs. for the in-person group, a mean of 9 lbs. for the hybrid group, and a mean of 6 lbs for the online group).
The overall rate of weight regain at 18 months was similar between the groups (a mean of 6 lbs. for the in-person group, a mean of 4 lbs. for the hybrid group, and a mean of 5 lbs. for the online group).
The proportion of study participants who were able to attend all scheduled sessions over the 12 months of the maintenance program did not differ between the groups (37% for the in-person group, 33% for the hybrid group, and 41% for the online group), but a significantly greater proportion of self-monitoring records were submitted by the Internet group (28%, compared with 14% by the in-person group and 20% by the hybrid group).
"One of the questions that come to mind is, given the very strong association between continued self-monitoring and long-term weight maintenance success, what would have happened if we followed these folks for more than 18 months?" Dr. West asked. "You might assume that a longer-term horizon of follow-up would eventually confer some advantages for the Internet group, but that remains to be answered."
The study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases.
Dr. West said that she had no relevant financial disclosures to make.