title: Efficacy of standard versus enhanced features in a Web-based commercial weight-loss program for obese adults, part 2: randomized controlled trial.
abstract: BACKGROUND
  Commercial Web-based weight-loss programs are becoming more popular and increasingly refined through the addition of enhanced features, yet few randomized controlled trials (RCTs) have independently and rigorously evaluated the efficacy of these commercial programs or additional features.
  
  
  OBJECTIVE
  To determine whether overweight and obese adults randomized to an online weight-loss program with additional support features (enhanced) experienced a greater reduction in body mass index (BMI) and increased usage of program features after 12 and 24 weeks compared to those randomized to a standard online version (basic).
  
  
  METHODS
  An assessor-blinded RCT comparing 301 adults (male: n=125, 41.5%; mean age: 41.9 years, SD 10.2; mean BMI: 32.2 kg/m(2), SD 3.9) who were recruited and enrolled offline, and randomly allocated to basic or enhanced versions of a commercially available Web-based weight-loss program for 24 weeks.
  
  
  RESULTS
  Retention at 24 weeks was greater in the enhanced group versus the basic group (basic 68.5%, enhanced 81.0%; P=.01). In the intention-to-treat analysis of covariance with imputation using last observation carried forward, after 24 weeks both intervention groups had reductions in key outcomes with no difference between groups: BMI (basic mean -1.1 kg/m(2), SD 1.5; enhanced mean -1.3 kg/m(2), SD 2.0; P=.29), weight (basic mean -3.3 kg, SD 4.7; enhanced mean -4.0 kg, SD 6.2; P=.27), waist circumference (basic mean -3.1 cm, SD 4.6; enhanced mean -4.0 cm, SD 6.2; P=.15), and waist-to-height ratio (basic mean -0.02, SD 0.03; enhanced mean -0.02, SD 0.04, P=.21). The enhanced group logged in more often at both 12 and 24 weeks, respectively (enhanced 12-week mean 34.1, SD 28.1 and 24-week mean 43.1, SD 34.0 vs basic 12-week mean 24.6, SD 25.5 and 24-week mean 31.8, SD 33.9; P=.002).
  
  
  CONCLUSIONS
  The addition of personalized e-feedback in the enhanced program provided limited additional benefits compared to a standard commercial Web-based weight-loss program. However, it does support greater retention in the program and greater usage, which was related to weight loss. Further research is required to develop and examine Web-based features that may enhance engagement and outcomes and identify optimal usage patterns to enhance weight loss using Web-based programs.
  
  
  BACKGROUND
  Australian New Zealand Clinical Trials Registry (ANZCTR) trial number: ACTRN12610000197033; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=335159 (Archived by WebCite at http://www.webcitation.org/6HoOMGb8j).
authors.affiliation: Priority Research Centre in Nutrition and Physical Activity, Nutrition and Dietetics, School of Health Sciences, Faculty of Health, University of Newcastle, Callaghan, Australia. Clare.Collins@newcastle.edu.au.
authors.forename: Clare E
authors.initials: CE
authors.lastname: Collins
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Morgan
authors.forename: Melinda J
authors.initials: MJ
authors.lastname: Hutchesson
authors.forename: Robin
authors.initials: R
authors.lastname: Callister
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000628:therapy*; D015397:Program Evaluation; D015431:Weight Loss
keywords: Internet; intervention studies; randomized controlled trial; reducing diet; telemedicine; weight loss