Using the Internet to help lose weight

You don't need to hear me say it again, but here I go: Obesity is one of our most significant public health problems here in Canada. We are not unique. If you look not only at our neighbours to the south, but in fact, over the world, there has been a new term coined: "globesity."

You are all aware that obesity is a risk factor for a plethora of diseases including cancer and cardiovascular disease. Over and over again, we have seen studies looking at different diets and behavioural interventions. Successful weight loss is about finding a long term lifestyle approach to both exercise and nutrition. With all the tools that are available to us, it is clear that both adherence and persistence are critical for long term weight loss and maintenance of the goal.

We also know that in addition to turning to the medical profession for health care advice, a vast majority of Canadians turn to the Internet for advice and information.

In the United States, there is data that tells us 74% have used the Internet and as many as 44% use the Internet as a source of fitness and exercise information. Another third turn to the Internet for online weight control information.

In this week's Journal of Medical Internet Research is an interesting study looking at the Internet as a way of helping individuals to achieve weight loss goals. Funded by the National Heart, Lung and Blood Institute, the study was called the Weight Loss Maintenance Trial, and was one of the longest running and largest weight maintenance trials to date.

In the first part of the study, all the participants had a 6-month initial weight loss program focusing on reducing calories and increasing exercise. The authors note that a 4 kg weight loss is considered clinically significant for a health benefit. In the next phase, those who had lost 4 kg or greater were randomized to different treatment arms. One arm was an Internet maintenance program. These participants used an interactive website to self-monitor weight and enter information about their diet, level of physical activity, setting goals, making action plans and getting on line support. The website was designed to provide unlimited access., so users sould sign on when it was convenient at any time of the night or day.

At the 28-month mark, 65% of the initial group of 348 people were still actively logging on to the web site. Over the 28 months, about half the participants logged on at least 107 time and sessions lasted about 3 to 5 minutes.

For those users who were consistent, they had better weight outcomes compared to those who did not log on as frequently. They had significantly lower proportional weight regain and better absolute results when it came to weight regain.

The results suggest that an Internet-based tool can help with some of the most important known features to help individuals achieve success-accountability and feedback. It is important to continue to be engaged in the program and that engagement is what continues to reinforce and offer support to move forward in following the proposed diet and exercise regimes. Intrinsic to the success of this program were automated email and telephone prompts.

While the study website is no longer available, there are lessons learnt that can help in choosing this can of supportive tools. The authors of this study suggest:

Find a site that encourages accountability

consistently record weight

record exercise

record calories consumed

The site should have tailored  and personalized information

Sites with interactive features allow communication with other users and experts in nutrition and exercise

The site must have accurate information

Avoid sites that are trying to sell products