By Susan Van Dusen
For many people, groups are a great motivator. Take a group of likeminded people, put them in a room together and watch them get positive results.
That’s one reason why behavioral-based weight-loss programs often occur in a group setting.
But what about people who live in isolated areas or don’t have transportation? Should they be denied the benefits that a group-based weight loss program can offer?
Delia Smith West, Ph.D., doesn’t think so.
That’s why, for about nine years, she has studied the benefits of an online group-based behavioral weight-loss program. “The appeal of the Internet is being able to reach people who might not otherwise have access to group programs. If we can take our expertise and make it accessible for these folks, we can have a greater impact,” said West, director of the Center for the Study of Obesity at the UAMS College of Public Health.
In collaboration with a colleague at the University of Vermont, West received a $3.7 million grant from the National Institutes of Health (NIH) in 2005 to look at the effectiveness of delivering an identical weight-loss program in person, online or as a hybrid of the two methods.
The five-year study involved 481 people in Arkansas and Vermont. Each participant signed on for 18 months, six months of which were dedicated to weight loss and the remainder to weight maintenance.
Each participant had an equal chance of being chosen for one of the three delivery methods. Each group of 10-15 participants met weekly for six months and monthly thereafter, either face to face or in a password-protected chat room online. A trained facilitator presented information, helped the group problem solve and promoted skills needed to maintain long-term weight loss.
“In the end, we found that in-person delivery actually produced greater weight loss than the online or hybrid delivery,” West said.
However, the story didn’t end there.
Although the online participants lost about 2 percent less than their counterparts, more than half of them lost at least 5 percent of their body weight. “A 5 percent weight loss is considered clinically significant and produces a cascade of health benefits, including improved blood pressure and blood sugar, as well as improvements in depressive symptoms,” she said.
In addition, the Internet program was more cost effective, largely due to the reductions in commute time, and warranted further investigation.
“We learned that although online wasn’t quite as good as in person, it had potential,” said West, also a professor of health behavior and health education in the UAMS College of Public Health.
A competitive renewal of the initial NIH grant was awarded in 2010 and examines how further to improve online delivery. The study added a counseling technique called motivational interviewing.
“Motivational interviewing is about helping people figure out what’s important to them and how behavioral changes fit into their long-term personal goals,” West said, adding that most participants discuss focusing on improving their family and social experiences.
“When you get down to the core why they want to change, it’s about quality of life,” West said.
After the study ends in 2015, West and her colleagues will examine the data to determine their next steps. “The Internet delivery seems an effective way to go. The question going forward is how we continue to refine it.”