title: Utilization patterns and user characteristics of an ad libitum Internet weight loss program.
abstract: BACKGROUND
  The Internet holds promise for the delivery of evidence-based weight loss treatment to underserved populations. However, most studies do not reflect the more naturalistic and common ad libitum, or freely at will, use of the Internet. Randomized clinical trials, for example, typically include at least some direct contact with participants and often have restrictive selection criteria. There is a paucity of research examining utilization patterns of online weight loss programs, particularly in the rapidly expanding direct-to-consumer arena.
  
  
  OBJECTIVE
  To examine self-reported characteristics (age, body mass index [BMI], gender), behaviors, and Internet site utilization patterns of a sample of users of a direct-to-consumer ad libitum Internet weight loss program.
  
  
  METHODS
  This study is based on analysis of archival data from the initial 15 weeks of an ongoing, free, evidence-based, direct-to-consumer Internet weight loss program, the Healthy Weight Center, which included standard information about nutrition, fitness, and behavioral strategies; monitoring tools; and moderated support group message boards. Participants encountered the program through self-directed Internet searches and anonymously registered to utilize the site. Self-reported user characteristics and electronically tracked utilization data were extracted from existing program data, compiled, and examined. Pearson correlations were computed to examine the association of program utilization with age and BMI. One-way analysis of variance (ANOVA) was used for gender comparisons.
  
  
  RESULTS
  We examined data from the first 204 adult users of the program who were classified as either overweight (BMI 25 to < 30 kg/m(2)) or obese (BMI > or = 30 kg/m(2)). The mean age of participants was 42.0 years (SD 11.7), 81.9% (167/204) were women, and mean BMI was 32.01 kg/m(2) (SD 6.26). The percent of participants who used program tools was as follows: 13.7%, meal planner; 10.8%, nutrition lookup: 17.6%, activity log; 14.2%, journal; and 22.1%, weight tracker. Participants also used the following educational resources: nutrition, 13.2%; fitness, 6.4%; and behavioral, 7.4%. Of the personal self-assessments available through the program, 57.8% of participants assessed personal barriers, and 50.5% assessed relationship with food. Only 7.8% used the support group message boards. No significant associations between site utilization and age, gender, or BMI were found. Reasons for wanting to lose weight were: health, 87%; appearance, 74%; mobility, 44%; doctor recommendation, 23%; and spouse/friend suggested, 12%. The age participants reported first becoming overweight was young adulthood, 31%; late adulthood, 28%; childhood, 22%; adolescence, 17%; and as a toddler, 3%. Self-perceived factors contributing to weight gain were lack of exercise for 70% of participants, emotions for 62%, overeating for 61%, and slow metabolism for 33%.
  
  
  CONCLUSIONS
  Internet weight loss programs reach many people who cannot access traditional treatment. However, users appear not to be optimally utilizing key aspects of the weight loss intervention, such as education, monitoring, and support. This study provides insight into the patterns of ad libitum use of an online weight loss program across multiple treatment-related domains in a naturalistic Internet environment.
authors.affiliation: Binks Behavioral Health PLLC, 2801 Canter Drive, Hillsborough, NC 27278, USA. mbinks@binksbehavioralhealth.com
authors.forename: Martin
authors.initials: M
authors.lastname: Binks
authors.forename: Trevor
authors.initials: T
authors.lastname: van Mierlo
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D020407:Internet / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009042:Motivation; D009765:Obesity / Q000453:epidemiology / Q000628:therapy*; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010353:Patient Education as Topic / Q000706:statistics & numerical data*; D015397:Program Evaluation; D012648:Self Care / Q000706:statistics & numerical data; D020377:Self Efficacy; D012944:Social Support; D014481:United States / Q000453:epidemiology; D015431:Weight Loss; D055815:Young Adult