title: Web-based weight loss in primary care: a randomized controlled trial.
abstract: Evidence is lacking regarding effective and sustainable weight loss approaches for use in the primary care setting. We conducted a 12-week randomized controlled trial to evaluate the short-term efficacy of a web-based weight loss intervention among 101 primary care patients with obesity and hypertension. Patients had access to a comprehensive website that used a moderate-intensity weight loss approach designed specifically for web-based implementation. Patients also participated in four (two in-person and two telephonic) counseling sessions with a health coach. Intent-to-treat analysis showed greater weight loss at 3 months (-2.56 kg; 95% CI -3.60, -1.53) among intervention participants (-2.28 +/- 3.21 kg), relative to usual care (0.28 +/- 1.87 kg). Similar findings were observed among intervention completers (-3.05 kg; 95% CI -4.24, -1.85). High rates of participant retention (84%) and website utilization were observed, with the greatest weight loss found among those with a high frequency of website logins (quartile 4 vs. 1: -4.16 kg; 95% CI -1.47, -6.84). The intervention's approach promoted moderate weight loss at 12 weeks, though greater weight loss was observed among those with higher levels of website utilization. Efficacious web-based weight loss interventions can be successfully offered in the primary care setting.
authors.affiliation: Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, Massachusetts, USA. gary.bennett@duke.edu
authors.forename: Gary G
authors.initials: GG
authors.lastname: Bennett
authors.forename: Sharon J
authors.initials: SJ
authors.lastname: Herring
authors.forename: Elaine
authors.initials: E
authors.lastname: Puleo
authors.forename: Evelyn K
authors.initials: EK
authors.lastname: Stein
authors.forename: Karen M
authors.initials: KM
authors.lastname: Emmons
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Gillman
mesh_terms: D003376:Counseling; D005260:Female; D006040:Goals; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000706:statistics & numerical data; D006801:Humans; D006973:Hypertension / Q000150:complications*; D020407:Internet / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D010349:Patient Compliance; D011320:Primary Health Care / Q000706:statistics & numerical data; D012648:Self Care; D013997:Time Factors; D016896:Treatment Outcome; D015431:Weight Loss
references.citation: JAMA. 2001 Mar 7;285(9):1172-7
references.pmid: 11231746
references.citation: Ann Intern Med. 1993 Oct 1;119(7 Pt 2):714-8
references.pmid: 8363203
references.citation: Int J Obes (Lond). 2006 Oct;30(10):1565-73
references.pmid: 16552408
references.citation: Acad Med. 2004 Feb;79(2):156-61
references.pmid: 14744717
references.citation: J Med Internet Res. 2005 Mar 31;7(1):e11
references.pmid: 15829473
references.citation: Obesity (Silver Spring). 2006 Aug;14(8):1412-20
references.pmid: 16988084
references.citation: Obesity (Silver Spring). 2006 Feb;14(2):266-72
references.pmid: 16571852
references.citation: Adv Data. 2007 Jun 29;(388):1-15
references.pmid: 17784725
references.citation: Health Psychol. 1999 Jul;18(4):364-8
references.pmid: 10431937
references.citation: Prev Med. 2005 Aug;41(2):488-502
references.pmid: 15917045
references.citation: Prev Med. 2004 Jun;38(6):819-27
references.pmid: 15193904
references.citation: Cochrane Database Syst Rev. 2001;(2):CD000984
references.pmid: 11405970
references.citation: Prev Med. 1995 Nov;24(6):546-52
references.pmid: 8610076
references.citation: JAMA. 2003 Apr 9;289(14):1833-6
references.pmid: 12684363
references.citation: J Intern Med. 2006 Oct;260(4):388-98
references.pmid: 16961676
references.citation: Obesity (Silver Spring). 2007 Apr;15(4):825-30
references.pmid: 17426316
references.citation: Am J Prev Med. 2003 Jan;24(1):93-100
references.pmid: 12554028
references.citation: Obes Rev. 2007 Sep;8(5):459-65
references.pmid: 17716303
references.citation: Diabetes Care. 1997 Oct;20(10):1503-11
references.pmid: 9314625
references.citation: JAMA. 1999 Oct 27;282(16):1576-8
references.pmid: 10546698
references.citation: JAMA. 2006 Apr 5;295(13):1549-55
references.pmid: 16595758
references.citation: Ann Behav Med. 2007 Feb;33(1):49-56
references.pmid: 17291170
references.citation: Am J Public Health. 2004 Oct;94(10):1736-42
references.pmid: 15451743
references.citation: Arch Intern Med. 2006 Aug 14-28;166(15):1620-5
references.pmid: 16908795
references.citation: JAMA. 1997 Mar 19;277(11):925-6
references.pmid: 9062334
references.citation: Annu Rev Public Health. 2009;30:273-92
references.pmid: 19296777
references.citation: Am J Cardiol. 2007 Jul 1;100(1):73-5
references.pmid: 17599444
references.citation: Arch Intern Med. 2001 Mar 12;161(5):685-93
references.pmid: 11231700
references.citation: Obes Res. 2001 Nov;9 Suppl 4:321S-325S
references.pmid: 11707560
references.citation: Diabetes Educ. 2006 Jul-Aug;32(4):557-61
references.pmid: 16873593