title: Weight change in a commercial web-based weight loss program and its association with website use: cohort study.
abstract: BACKGROUND
  There is a paucity of information in the scientific literature on the effectiveness of commercial weight loss programs, including Web-based programs. The potential of Web-based weight loss programs has been acknowledged, but their ability to achieve significant weight loss has not been proven.
  
  
  OBJECTIVE
  The objectives were to evaluate the weight change achieved within a large cohort of individuals enrolled in a commercial Web-based weight loss program for 12 or 52 weeks and to describe participants' program use in relation to weight change.
  
  
  METHODS
  Participants enrolled in an Australian commercial Web-based weight loss program from August 15, 2007, through May 31, 2008. Self-reported weekly weight records were used to determine weight change after 12- and 52-week subscriptions. The primary analysis estimated weight change using generalized linear mixed models (GLMMs) for all participants who subscribed for 12 weeks and also for those who subscribed for 52 weeks. A sensitivity analysis was conducted using the last observation carried forward (LOCF) method. Website use (ie, the number of days participants logged on, made food or exercise entries to the Web-based diary, or posted to the discussion forum) was described from program enrollment to 12 and 52 weeks, and differences in website use by percentage weight change category were tested using Kruskal-Wallis test for equality of populations.
  
  
  RESULTS
  Participants (n = 9599) had a mean (standard deviation [SD]) age of 35.7 (9.5) years and were predominantly female (86% or 8279/9599) and obese (61% or 5866/9599). Results from the primary GLMM analysis including all enrollees found the mean percentage weight change was -6.2% among 12-week subscribers (n = 6943) and -6.9% among 52-week subscribers (n = 2656). Sensitivity analysis using LOCF revealed an average weight change of -3.0% and -3.5% after 12 and 52 weeks respectively. The use of all website features increased significantly (P < .01) as percentage weight change improved.
  
  
  CONCLUSIONS
  The weight loss achieved by 12- and 52-week subscribers of a commercial Web-based weight loss program is likely to be in the range of the primary and sensitivity analysis results. While this suggests that, on average, clinically important weight loss may be achieved, further research is required to evaluate the efficacy of this commercial Web-based weight loss program prospectively using objective measures. The potential association between greater website use and increased weight loss also requires further evaluation, as strategies to improve participants' use of Web-based program features may be required.
authors: School of Health Sciences, University of Newcastle, Callaghan, NSW, Australia. melinda.neve@newcastle.edu.au
authors: Melinda
authors: M
authors: Neve
authors: Philip J
authors: PJ
authors: Morgan
authors: Clare E
authors: CE
authors: Collins
mesh_terms: D000328:Adult; D001315:Australia; D015331:Cohort Studies; D005260:Female; D006801:Humans; D020407:Internet / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000473:pathology / Q000628:therapy; D050177:Overweight / Q000473:pathology / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome; D015431:Weight Loss; D061217:Weight Reduction Programs / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data