From Medscape Medical News
Robert Lowes
July 27, 2010 — Once a person loses excess weight, the next great battle is keeping those pounds from coming back a year or 2 later.
Calling a personal coach every month about the latest scale reading or hamburger binge is one solution. Another — one more within reach of the average patient — is consistently logging in to an interactive Internet version of a personal coach, according to a study from the Kaiser Permanente Center for Health Research.
The key word is "consistently." Participants in a study funded by the National Institutes of Health who visited a weight-management Web site almost every month maintained more of their weight loss than patients who checked in sporadically. However, those assigned to a personal coach regained the least amount of weight overall compared with participants who used the Web sites and those whose weight maintenance was self-directed.
The study, published online today in the Journal of Medical Internet Research, was part of a 30-month, 4-center, randomized clinical trial that examined 3 ways to keep lost weight from returning. Enrollees were obese or overweight, as defined by body mass index, and were taking medication for hypertension or hyperlipidemia.
For 6 months preceding the trial, patients reduced caloric intake and exercised in an effort to slim down. Those who lost 4 kg or more — the average reduction was 8.6 kg, or 19 pounds — were randomly assigned to 3 groups for weight maintenance. One group was self-directed, another contacted a health counselor once a month, and a third group relied on an interactive Web site.
On the Web site, participants could record their weight, caloric intake, and minutes of exercise and compare that information with the goals they had set for themselves. A bulletin board allowed them to read other patients' success stories and share their own, as well as get advice from experts on exercise and behavior change. Those who did not log on to the site as often received email reminders, and when they failed to enter data, they were automatically prompted to do so.
At the end of 30 months, participants assigned to a personal coach regained the least amount of weight — 4 kg — of the 3 groups. The rebound was 5.2 kg for patients in the Web site group and 5.5 kg for those in the self-directed group.
Consistent Use of Web Site Almost as Good as Personal Coach
Although the results for the Internet approach as a whole fell short of those achieved with a personal coach, the Web site worked better for people who used it more consistently. Consistent users — defined as patients who recorded their weight at the Web site at least once a month for 26 months of a 28-month portion of the trial — regained 4.5 kg, or only a half a kilogram more than the figure posted by patients with personal coaches. The next most faithful subcategory of Web site users recorded their weight for 14 to 25 months and regained 6.3 kg, whereas minimal users checked in for 13 months or less and put back on 7.4 kg.
The consistent users, who represented 61% of all the patients assigned to the Internet group, came into the trial with the lowest weight and body mass index of the 3 user categories and lost the most weight during the initial 6 months. Compared with minimal users, consistent users were more likely to be older, men, more educated, and not black.
Success with the Web site requires persistence, but not an onerous amount of time, noted study lead author Kristine Funk, MS, RD, a research associate for the Kaiser Permanente Center for Health Research. Individual sessions on average lasted only 3 to 5 minutes.
"It wasn't so much the amount of time, but the regularity that counted," Ms. Funk told Medscape Medical News.
A weight-management Web site appears to be a good alternative to a living, breathing personal coach, who may not be affordable or practical for many patients, she noted. Patients should look for a site where they can enter data on weight, caloric consumption, and exercise, and receive reminders when they do not supply this information.
"You want a Web site that asks you to be accountable," said Ms. Funk.
The site, she added, should allow users to connect online to experts and other patients "who are going through similar struggles." Another must is accurate health information in educational articles.
Ms. Funk said she was not in a position to recommend weight-management sites, but that "they're out there." The one employed in the study no longer exists.
The study was funded by the National Institutes of Health. The authors have disclosed no relevant financial relationships.
J Med Internet Res. Published online July 27, 2010.
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