title: Effect of a Web-Based Behavior Change Program on Weight Loss and Cardiovascular Risk Factors in Overweight and Obese Adults at High Risk of Developing Cardiovascular Disease: Randomized Controlled Trial.
abstract: BACKGROUND
  Web-based programs are a potential medium for supporting weight loss because of their accessibility and wide reach. Research is warranted to determine the shorter- and longer-term effects of these programs in relation to weight loss and other health outcomes.
  
  
  OBJECTIVE
  The aim was to evaluate the effects of a Web-based component of a weight loss service (Imperative Health) in an overweight/obese population at risk of cardiovascular disease (CVD) using a randomized controlled design and a true control group.
  
  
  METHODS
  A total of 65 overweight/obese adults at high risk of CVD were randomly allocated to 1 of 2 groups. Group 1 (n=32) was provided with the Web-based program, which supported positive dietary and physical activity changes and assisted in managing weight. Group 2 continued with their usual self-care (n=33). Assessments were conducted face-to-face. The primary outcome was between-group change in weight at 3 months. Secondary outcomes included between-group change in anthropometric measurements, blood pressure, lipid measurements, physical activity, and energy intake at 3, 6, and 12 months. Interviews were conducted to explore participants' views of the Web-based program.
  
  
  RESULTS
  Retention rates for the intervention and control groups at 3 months were 78% (25/32) vs 97% (32/33), at 6 months were 66% (21/32) vs 94% (31/33), and at 12 months were 53% (17/32) vs 88% (29/33). Intention-to-treat analysis, using baseline observation carried forward imputation method, revealed that the intervention group lost more weight relative to the control group at 3 months (mean -3.41, 95% CI -4.70 to -2.13 kg vs mean -0.52, 95% CI -1.55 to 0.52 kg, P<.001), at 6 months (mean -3.47, 95% CI -4.95 to -1.98 kg vs mean -0.81, 95% CI -2.23 to 0.61 kg, P=.02), but not at 12 months (mean -2.38, 95% CI -3.48 to -0.97 kg vs mean -1.80, 95% CI -3.15 to -0.44 kg, P=.77). More intervention group participants lost ≥5% of their baseline body weight at 3 months (34%, 11/32 vs 3%, 1/33, P<.001) and 6 months (41%, 13/32 vs 18%, 6/33, P=.047), but not at 12 months (22%, 7/32 vs 21%, 7/33, P=.95) versus control group. The intervention group showed improvements in total cholesterol, triglycerides, and adopted more positive dietary and physical activity behaviors for up to 3 months verus control; however, these improvements were not sustained.
  
  
  CONCLUSIONS
  Although the intervention group had high attrition levels, this study provides evidence that this Web-based program can be used to initiate clinically relevant weight loss and lower CVD risk up to 3-6 months based on the proportion of intervention group participants losing ≥5% of their body weight versus control group. It also highlights a need for augmenting Web-based programs with further interventions, such as in-person support to enhance engagement and maintain these changes.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT01472276; http://clinicaltrials.gov/ct2/show/study/NCT01472276 (Archived by Webcite at http://www.webcitation.org/6Z9lfj8nD).
authors.affiliation: Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom.
authors.forename: Sinead
authors.identifier: http://orcid.org/0000-0001-8204-6472
authors.initials: S
authors.lastname: Watson
authors.forename: Jayne V
authors.identifier: http://orcid.org/0000-0002-5691-4659
authors.initials: JV
authors.lastname: Woodside
authors.forename: Lisa J
authors.identifier: http://orcid.org/0000-0002-9762-4017
authors.initials: LJ
authors.lastname: Ware
authors.forename: Steven J
authors.identifier: http://orcid.org/0000-0001-5737-6250
authors.initials: SJ
authors.lastname: Hunter
authors.forename: Alanna
authors.identifier: http://orcid.org/0000-0002-5249-516X
authors.initials: A
authors.lastname: McGrath
authors.forename: Christopher R
authors.identifier: http://orcid.org/0000-0002-2689-4335
authors.initials: CR
authors.lastname: Cardwell
authors.forename: Katherine M
authors.identifier: http://orcid.org/0000-0001-7045-3564
authors.initials: KM
authors.lastname: Appleton
authors.forename: Ian S
authors.identifier: http://orcid.org/0000-0003-3890-3152
authors.initials: IS
authors.lastname: Young
authors.forename: Michelle C
authors.identifier: http://orcid.org/0000-0003-3386-1504
authors.initials: MC
authors.lastname: McKinley
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D005260:Female; D006801:Humans; D020407:Internet / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D050177:Overweight / Q000150:complications*; D012307:Risk Factors; D012648:Self Care / Q000379:methods; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D015431:Weight Loss / Q000502:physiology*
keywords: Internet; health behavior; obesity; overweight; randomized controlled trial; weight loss