Jean Harvey-Berino

Weight loss on the web: A pilot study comparing a structured behavioral intervention to a commercial program.

Objective: Internet weight loss programs have become widely available as alternatives to standard treatment, but few data are available on their efficacy. This study aimed to investigate the effectiveness of a structured behavioral weight loss website (VTrim) vs. a commercial weight loss website (eDiets.com).

Does using the Internet facilitate the maintenance of weight loss

OBJECTIVE: The purpose of this study was to investigate the effectiveness of a weight maintenance program conducted over the Internet.DESIGN: Longitudinal, clinical behavioral weight loss trial with 6-month in-person behavioral obesity treatment followed by a 12-month maintenance program conducted both in-person (frequent in-person support; F-IPS, minimal in-person support; M-IPS) and over the Internet (Internet support; IS).SUBJECTS: A total of 122 healthy, overweight adults (age=48.4±9.6, BMI=32.2±4.5 kg/m2, 18 male)MEASUREMENTS: Body weight, dietary intake, energy expended in physical activity, attendance, self-monitoring, comfort with technology.RESULTS: Results (n=101) showed that weight loss did not differ by condition during treatment (8.0±5 vs 11±6.5 vs 9.8±5.9 kg, P=0.27 for IS, M-IPS and F-IPS, respectively). The IS condition gained significantly more weight than the F-IPS group during the first 6 months of weight maintenance (+2.2±3.8 vs 0±4 kg, P<0.05) and sustained a significantly smaller weight loss than both in-person support groups at the 1 y follow-up (−5.7±5.9 vs −10.4±9.3 vs −10.4±6.3 kg, P<0.05 for IS, M-IPS and F-IPS, respectively). Attendance at maintenance meetings was greater for the F-IPS than the IS condition over the 1 y maintenance program (54 vs 39%, P=0.04). Acceptability of assigned condition was higher for subjects in the F-IPS than IS condition.CONCLUSION: The results of this study suggest that Internet support does not appear to be as effective as minimal or frequent intensive in-person therapist support for facilitating the long-term maintenance of weight loss.

Internet delivered behavioral obesity treatment

OBJECTIVES To evaluate the efficacy of an Internet behavioral weight loss program; and determine if adding periodic in-person sessions to an Internet intervention improves outcomes. METHODS 481 healthy overweight adults (28% minority) were randomized to one of 3 delivery methods of a behavioral weight loss program with weekly meetings: Internet (n=161), InPerson (n=158), or Hybrid (Internet+InPerson, n=162). Outcome variables were weight at baseline and 6 months and percent of subjects achieving a 5 and 7% weight loss. The study took place in two centers in Vermont and Arkansas from 2003 to 2008. RESULTS Conditions differed significantly in mean weight loss [8.0 (6.1) kg vs. 5.5 (5.6) kg vs. 6.0 (5.5) kg], for InPerson, Internet, and Hybrid respectively, p<0.01, n=462). Weight loss for InPerson was significantly greater than the Internet and Hybrid conditions (p<0.05). Although the proportion reaching a 5% weight loss did not differ, the proportion losing 7% did differ significantly (56.3% vs. 37.3% vs. 44.4% for InPerson, Internet, and Hybrid respectively, p<0.01). CONCLUSIONS These results demonstrate that the Internet is a viable alternative to in-person treatment for the delivery and dissemination of a behavioral weight-control intervention. The addition of periodic in-person sessions did not improve outcomes.

The feasibility of using Internet support for the maintenance of weight loss

This pilot study examined the acceptability and feasibility of conducting a weight loss maintenance intervention over the Internet. Obese adults participated in a 15-week behavioral weight control intervention and were then randomly assigned to one of the following three maintenance conditions: (a) in-person, therapist-led (TL); (b) Internet, therapist-led (I); and (c) control (C). Both maintenance interventions met biweekly for 22 weeks using the same program content. Results showed that TL participants were more likely to attend their meetings and feel more satisfied with their group assignment. Ho wever, there were no differences between the TL and I groups in overall attrition or number of peer support contacts made. There was also no significant difference in weight loss between the groups. Thus, the Internet may hold promise as a method for maintaining contact with patients to facilitate long-term behavior change.

High-Calorie-Expenditure Exercise A New Approach to Cardiac Rehabilitation for Overweight Coronary Patients

Background— More than 80% of patients entering cardiac rehabilitation (CR) are overweight, and >50% have metabolic syndrome. Current CR exercise protocols result in little weight loss and minimal changes in cardiac risk factors. We sought to design an exercise protocol that would lead to greater weight loss and risk factor change. Methods and Results— We performed a randomized controlled clinical trial to evaluate the effect of high-calorie-expenditure exercise (3000- to 3500-kcal/wk exercise-related energy expenditure) compared with standard CR exercise (7 to 800 kcal/wk) on weight loss and risk factors in 74 overweight patients with coronary heart disease. Both groups were counseled for weight loss and taking evidence-based preventive medications. High-calorie-expenditure exercise resulted in double the weight loss (8.2±4 versus 3.7±5 kg; P<0.001) and fat mass loss (5.9±4 versus 2.8±3 kg; P<0.001) and a greater waist reduction (−7±5 versus −5±5 cm; P=0.02) than standard CR exercise at 5 months. High-calorie-expenditure exercise reduced insulin resistance, measured with the euglycemic hyperinsulinemic clamp, along with the ratio of total to high-density lipoprotein cholesterol and components of the metabolic syndrome, more than standard CR exercise (each P<0.01). Overall, fat mass loss best predicted improved metabolic risk, and the prevalence of metabolic syndrome decreased from 59% to 31%. Changes in cardiac risk factors included decreased insulin resistance, increased high-density lipoprotein cholesterol, and decreased measures of insulin, triglycerides, blood pressure, plasminogen activator inhibitor-1, and the ratio of total to high-density lipoprotein cholesterol (each P<0.05). Significant weight loss was maintained at 1 year. Conclusion— High-calorie-expenditure exercise promotes greater weight loss and more favorable cardiometabolic risk profiles than standard CR for overweight coronary patients.Background Over 80% of patients entering cardiac rehabilitation (CR) are overweight and >50% have metabolic syndrome. Current CR exercise protocols result in little weight loss and minimal changes in cardiac risk factors. We sought to design an exercise protocol that would lead to greater weight loss and risk factor change.

Effects of Television Viewing Reduction on Energy Intake and Expenditure in Overweight and Obese Adults: A Randomized Controlled Trial

BACKGROUND The average adult watches almost 5 hours of television (TV) per day, an amount associated with increased risks for obesity. This trial examines the effects of TV reduction on energy intake (EI), energy expenditure (EE), energy balance, body mass index (BMI), (calculated as weight in kilograms divided by height in meters squared), and sleep in overweight and obese adults. METHODS Randomized controlled trial of 36 adults with a BMI of 25 to 50 who self-reported a minimum of 3 h/d of TV viewing. Participants were enrolled in home-based protocols from January through July 2008. After a 3-week observation phase, participants were stratified by BMI and randomized to an observation-only control group (n = 16) or an intervention group (n = 20) for 3 additional weeks. The intervention consisted of reducing TV viewing by 50% of each participants objectively measured baseline enforced by an electronic lock-out system. RESULTS Although not statistically significant, both groups reduced their EI (-125 kcal/d [95% CI, -303 to 52] vs -38 [95% CI, -265 to 190]) (P = .52) for intervention and control group participants, respectively, where CI indicates confidence interval. The intervention group significantly increased EE (119 kcal/d [95% CI, 23 to 215]) compared with controls (-95 kcal/d [95% CI, -254 to 65]) (P = .02). Energy balance was negative in the intervention group between phases (-244 kcal/d [95% CI, -459 to -30]) but positive in controls (57 kcal/d [95% CI, -216 to 330]) (P = .07). The intervention group showed a greater reduction in BMI (-0.25 [95% CI, -0.45 to -0.05] vs -0.06 [95% CI, -0.43 to 0.31] in controls) (P = .33). There was no change in sleep. CONCLUSION Reducing TV viewing in our sample produced a statistically significant increase in EE but no apparent change in EI after 3 weeks of intervention. Trial Registration clinicaltrials.gov Identifier: NCT00622050.

Associations of Internet Website Use With Weight Change in a Long-term Weight Loss Maintenance Program

Background The Weight Loss Maintenance Trial (WLM) compared two long-term weight-maintenance interventions, a personal contact arm and an Internet arm, with a no-treatment control after an initial six-month Phase I weight loss program. The Internet arm focused on use of an interactive website for support of long-term weight maintenance. There is limited information about patterns of website use and specific components of an interactive website that might help promote maintenance of weight loss. Objective This paper presents a secondary analysis of the subset of participants in the Internet arm and focuses on website use patterns and features associated with long-term weight maintenance. Methods Adults at risk for cardiovascular disease (CVD) who lost at least 4 kilograms in an initial 20-week group-based, behavioral weight-loss program were trained to use an interactive website for weight loss maintenance. Of the 348 participants, 37% were male and 38% were African American. Mean weight loss was 8.6 kilograms. Participants were encouraged to log in at least weekly and enter a current weight for the 30-month study period. The website contained features that encouraged setting short-term goals, creating action plans, and reinforcing self-management habits. The website also included motivational modules, daily tips, and tailored messages. Based on log-in and weight-entry frequency, we divided participants into three website use categories: consistent, some, and minimal. Results Participants in the consistent user group (n = 212) were more likely to be older (P = .002), other than African American (P = .02), and more educated (P = .01). While there was no significant difference between website use categories in the amount of Phase I change in body weight (P = .45) or income (P = .78), minimal website users (n = 75) were significantly more likely to have attended fewer Phase I sessions (P = .001) and had a higher initial body mass index (BMI) (P < .001). After adjusting for baseline characteristics including initial BMI, variables most associated with less weight regain included: number of log-ins (P = .001), minutes on the website (P < .001), number of weight entries (P = .002), number of exercise entries (P < .001), and sessions with additional use of website features after weight entry (P = .002). Conclusion Participants defined as consistent website users of an interactive behavioral website designed to promote maintenance of weight loss were more successful at maintaining long-term weight loss. Trial Registration NCT00054925; http://clinicaltrials.gov/ct2/show/NCT00054925 (Archived by WebCite at http://www.webcitation.org/5rC7523ue)

Comparing Behavioral Weight Loss Modalities: Incremental Cost‐Effectiveness of an Internet‐Based Versus an In‐Person Condition

The objective of this study was to assess the costs associated with a group behavioral weight loss intervention and compare cost‐effectiveness based on treatment delivery modality (in‐person vs. Internet). A randomized controlled trial examined efficacy of a group behavioral obesity intervention across in‐person and Internet treatment modalities. Participants (N = 323, 93% women, mean BMI = 35.8) from two centers were randomized to treatment modality, and contact time was matched between conditions. Primary outcome was weight loss. Cost‐effectiveness measures calculated life years gained (LYG) from changes in weight at 6 months, based on excess years of life lost (YLL) algorithm and the cost of the two modalities. In‐person participants had significantly greater weight losses (−8.0 ± 6.1 kg) than Internet participants (−5.5 ± 5.6 kg), whereas differences in LYG were insignificant. Estimated LYG was 0.58 (95% confidence interval: 0.45, 0.71) and 0.47 (95% confidence interval: 0.34, 0.60) for the in‐person and Internet condition, respectively. Total cost of conducting the in‐person condition was

The Treatment of Obesity in Cardiac Rehabilitation

706 per person and the Internet condition was

Contrasting effects of resistance and aerobic training on body composition and metabolism after diet-induced weight loss.

372 per person with the difference mainly due to increased travel cost of