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Tate DF, Wing RR, Winett RA. Using Internet Technology to Deliver a Behavioral Weight Loss Program. JAMA. 2001;285(9):1172–1177. doi:10.1001/jama.285.9.1172
Author Affiliations: Brown Medical School/Miriam Hospital, Providence, RI (Drs Tate and Wing) and Virginia Polytechnic Institute and State University, Blacksburg, Va (Dr Winett).
Context Rapid increases in access to the Internet have made it a viable mode
for public health intervention. No controlled studies have evaluated this
resource for weight loss.
Objective To determine whether a structured Internet behavioral weight loss program
produces greater initial weight loss and changes in waist circumference than
a weight loss education Web site.
Design Randomized, controlled trial conducted from April to December 1999.
Setting and Participants Ninety-one healthy, overweight adult hospital employees aged 18 to 60
years with a body mass index of 25 to 36 kg/m2. Analyses were performed
for the 65 who had complete follow-up data.
Interventions Participants were randomly assigned to a 6-month weight loss program
of either Internet education (education; n = 32 with complete data) or Internet
behavior therapy (behavior therapy; n = 33 with complete data). All participants
were given 1 face-to-face group weight loss session and access to a Web site
with organized links to Internet weight loss resources. Participants in the
behavior therapy group received additional behavioral procedures, including
a sequence of 24 weekly behavioral lessons via e-mail, weekly online submission
of self-monitoring diaries with individualized therapist feedback via e-mail,
and an online bulletin board.
Main Outcome Measures Body weight and waist circumference, measured at 0, 3, and 6 months,
compared the 2 intervention groups.
Results Repeated-measures analyses showed that the behavior therapy group lost
more weight than the education group (P = .005).
The behavior therapy group lost a mean (SD) of 4.0 (2.8) kg by 3 months and
4.1 (4.5) kg by 6 months. Weight loss in the education group was 1.7 (2.7)
kg at 3 months and 1.6 (3.3) kg by 6 months. More participants in the behavior
therapy than education group achieved the 5% weight loss goal (45% vs 22%; P = .05) by 6 months. Changes in waist circumference were
also greater in the behavior therapy group than in the education group at
both 3 months (P = .001) and 6 months (P = .005).
Conclusions Participants who were given a structured behavioral treatment program
with weekly contact and individualized feedback had better weight loss compared
with those given links to educational Web sites. Thus, the Internet and e-mail
appear to be viable methods for delivery of structured behavioral weight loss
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