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.
“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 reduction and weight maintenance. We also know that self-monitoring falls off,” she added.
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 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 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/m
Dr. West reported that at 6 months, the mean amount of weight loss significantly favored the in-person group (18 lbs, vs. 14 lbs for the hybrid group and 12 lbs for the online group). At 18 months, however, total mean weight loss did not differ significantly between the groups (12 lbs, 9 lbs, 6 lbs, respectively). The overall mean weight regain at 18 months was similar between the groups (6 lbs, 4 lbs, and 5 lbs).
The proportion of participants who attended 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).
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.
The weight-loss advantage in patients attending in-person sessions at 6 months faded a year later.
Source DR. WEST