@Article{info:doi/10.2196/jmir.3828,
author="Watson, Sinead
and Woodside, Jayne V
and Ware, Lisa J
and Hunter, Steven J
and McGrath, Alanna
and Cardwell, Christopher R
and Appleton, Katherine M
and Young, Ian S
and McKinley, Michelle C",
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",
journal="J Med Internet Res",
year="2015",
month="Jul",
day="16",
volume="17",
number="7",
pages="e177",
keywords="Internet; randomized controlled trial; health behavior; weight loss; overweight; obesity",
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. Trial Registration: ClinicalTrials.gov NCT01472276; http://clinicaltrials.gov/ct2/show/study/NCT01472276 (Archived by Webcite at http://www.webcitation.org/6Z9lfj8nD). ",
issn="1438-8871",
doi="10.2196/jmir.3828",
url="http://www.jmir.org/2015/7/e177/",
url="https://doi.org/10.2196/jmir.3828",
url="http://www.ncbi.nlm.nih.gov/pubmed/26183659"
}