@Article{info:doi/10.2196/17494,
author="Beleigoli, Alline
and Andrade, Andre Q
and Diniz, Maria De Fatima
and Ribeiro, Antonio Luiz",
title="Personalized Web-Based Weight Loss Behavior Change Program With and Without Dietitian Online Coaching for Adults With Overweight and Obesity: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2020",
month="Nov",
day="5",
volume="22",
number="11",
pages="e17494",
keywords="obesity; overweight; healthy eating; diet; digital health; web platform; online coaching; personalized web interventions",
abstract="Background: The effect of computer- or human-delivered personalized feedback on the effectivess of web-based behavior change platforms for weight loss is unclear. Objective: We aimed to compare the effectiveness of a web-based behavior change intervention personalized through either computerized or human-delivered feedback with a nonpersonalized intervention in promoting weight loss in community-based adults with overweight or obesity. Methods: This pragmatic, 3-group, parallel-arm, randomized trial recruited students and staff in a Brazilian public university who were aged 18 to 60 years, had a BMI of ≥25 kg/m2, and were not pregnant. Participants were allocated to one of 3 groups: platform only (24-week behavior change program delivered using a web platform with personalized computer-delivered feedback), platform plus coaching (same 24-week web-based behavior change program plus 12 weeks of personalized feedback delivered online by a dietitian), or waiting list (nonpersonalized dietary and physical activity recommendations delivered through an e-booklet and videos). Self-reported weight at 24 weeks was the primary outcome. Changes in dietary and physical activity habits within 24 weeks were secondary outcomes. Results: Among the 1298 participants, 375 (28.89{\%}) were lost to follow-up. In the intention-to-treat analysis, the platform-only and platform plus coaching groups had greater mean weight loss than the waiting-list group at 24 weeks (--1.08 kg, 95{\%} CI --1.41 to --0.75 vs --1.57 kg, 95{\%} CI --1.92 to --1.22 vs --0.66 kg, 95{\%} CI --0.98 to --0.34, respectively). The platform-only and platform plus coaching groups, compared with the waiting list group, had a greater increase in the consumption of vegetables (3{\%}, 95{\%} CI 1{\%} to 6{\%} vs 5{\%}, 95{\%} CI 2{\%} to 8{\%} vs --3{\%}, 95{\%} CI --5{\%} to 0{\%}) and fruits (9{\%}, 95{\%} CI 6{\%} to 12{\%} vs 6{\%}, 95{\%} CI 2{\%} to 9{\%} vs 2{\%}, 95{\%} CI 0{\%} to 6{\%}) and a larger reduction in ultraprocessed food intake (--18{\%}, 95{\%} CI --23{\%} to --13{\%} vs --25{\%}, 95{\%} CI --30{\%} to --20{\%} vs --12{\%}, 95{\%} CI --16{\%} to --8{\%}). Changes in physical activity did not differ across the groups. Engagement was higher in the platform plus coaching group than in the platform-only group (7.6 vs 5.2 completed sessions; P=.007). Longer usage of the platform was associated with clinically meaningful (≥5{\%}) weight loss (odds ratio 1.02, 95{\%} CI 1.01 to 1.04). Conclusions: The web-based behavior change programs with computer- and human-delivered personalized feedback led to greater, albeit small-magnitude, weight loss within 24 weeks. Improvement in multiple dietary habits, but not physical activity, were also greater in the personalized programs compared with the nonpersonalized one. The human-delivered personalized feedback by the online dietitian coach increased user engagement with the program and was associated with a significantly higher chance of clinically meaningful weight loss. Trial Registration: ClinicalTrials.gov NCT03435445; https://clinicaltrials.gov/ct2/show/NCT03435445 International Registered Report Identifier (IRRID): RR2-10.2196/10.1186/s12889-018-5882-y ",
issn="1438-8871",
doi="10.2196/17494",
url="https://www.jmir.org/2020/11/e17494",
url="https://doi.org/10.2196/17494",
url="http://www.ncbi.nlm.nih.gov/pubmed/33151151"
}