Features Predicting Weight Loss in Overweight or Obese Participants in a Web-Based Intervention: Randomized Trial Preventing weight gain in first year college students: an online intervention to prevent the "freshman fifteen". Using Internet technology to deliver a behavioral weight loss program. Using Internet and Mobile Phone Technology to Deliver an Automated Physical Activity Program: Randomized Controlled Trial Cost-effectiveness of a long-term Internet-delivered worksite health promotion programme on physical activity and nutrition: a cluster randomized controlled trial A randomized trial comparing human e-mail counseling, computer-automated tailored counseling, and no counseling in an Internet weight loss program. Minimal in-person support as an adjunct to internet obesity treatment 12-month outcomes and process evaluation of the SHED-IT RCT: an internet-based weight loss program targeting men. Feasibility of Internet‐delivered Weight Loss Interventions Among Rural Women Ages 50‐69 Effect of internet support on the long-term maintenance of weight loss. Integrating technology into standard weight loss treatment: a randomized controlled trial. Social media use among patients and caregivers: a scoping review Storytelling as a communication tool for health consumers: development of an intervention for parents of children with croup. Stories to communicate health information Use of a Web-based component of a nutrition and physical activity behavioral intervention with Girl Scouts. Evaluation of a website-delivered computer-tailored intervention for increasing physical activity in the general population. Randomized controlled trial testing an internet physical activity intervention for sedentary adults. Motivation and its relationship to adherence to self-monitoring and weight loss in a 16-week Internet behavioral weight loss intervention. Weight loss on the web: A pilot study comparing a structured behavioral intervention to a commercial program. Evaluation of the Web-based computer-tailored FATaintPHAT intervention to promote energy balance among adolescents: results from a school cluster randomized trial. The efficacy and cost-effectiveness of a community weight management intervention: a randomized controlled trial of the health weight management demonstration. A randomized controlled trial of a commercial internet weight loss program. A comparison of Web and print media for physical activity promotion among adolescent girls. Using a website to build community and enhance outcomes in a group, multi-component intervention promoting healthy diet and exercise in adolescents. Randomized trial of a neighborhood environment-focused physical activity website intervention. My Student Body: Effects of an Internet-Based Prevention Program to Decrease Obesity Among College Students Evaluation of an interactive, Internet-based weight loss program: a pilot study. Results from an Online Computer-Tailored Weight Management Intervention for Overweight Adults: Randomized Controlled Trial CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials A social media-based physical activity intervention: a randomized controlled trial.
Background Obesity remains a serious issue in many countries . Web-based programs offer good potential for delivery of weight loss programs . Yet , many Internet-delivered weight loss studies include support from medical or nutritional experts , and relatively little is known about purely web-based weight loss programs . Objective To determine whether supportive features and personalization in a 12-week web-based lifestyle intervention with no in-person professional contact affect retention and weight loss . Methods We assessed the effect of different features of a web-based weight loss intervention using a 12-week repeated- measures r and omized parallel design . We developed 7 sites representing 3 functional groups . A national mass media promotion was used to attract overweight/obese Australian adults ( based on body mass index [ BMI ] calculated from self-reported heights and weights ) . Eligible respondents ( n = 8112 ) were r and omly allocated to one of 3 functional groups : information-based ( n = 183 ) , supportive ( n = 3994 ) , or personalized-supportive ( n = 3935 ) . Both supportive sites included tools , such as a weight tracker , meal planner , and social networking platform . The personalized-supportive site included a meal planner that offered recommendations that were personalized using an algorithm based on a user ’s preferences for certain foods . Dietary and activity information were constant across sites , based on an existing and tested 12-week weight loss program ( the Total Wellbeing Diet ) . Before and /or after the intervention , participants completed demographic ( including self-reported weight ) , behavioral , and evaluation question naires online . Usage of the website and features was objective ly recorded . All screening and data collection procedures were performed online with no face-to-face contact . Results Across all 3 groups , attrition was high at around 40 % in the first week and 20 % of the remaining participants each week . Retention was higher for the supportive sites compared to the information-based site only at week 12 ( P = .01 ) . The average number of days that each site was used varied significantly ( P = .02 ) and was higher for the supportive site at 5.96 ( SD 11.36 ) and personalized-supportive site at 5.50 ( SD 10.35 ) , relative to the information-based site at 3.43 ( SD 4.28 ) . In total , 435 participants provided a valid final weight at the 12-week follow-up . Intention-to-treat analyses ( using multiple imputations ) revealed that there were no statistically significant differences in weight loss between sites ( P = .42 ) . On average , participants lost 2.76 % ( SE 0.32 % ) of their initial body weight , with 23.7 % ( SE 3.7 % ) losing 5 % or more of their initial weight . Within supportive conditions , the level of use of the online weight tracker was predictive of weight loss ( model estimate = 0.34 , P < .001 ) . Age ( model estimate = 0.04 , P < .001 ) and initial BMI ( model estimate = -0.03 , P < .002 ) were associated with frequency of use of the weight tracker . Conclusions Relative to a static control , inclusion of social networking features and personalized meal planning recommendations in a web-based weight loss program did not demonstrate additive effects for user weight loss or retention . These features did , however , increase the average number of days that a user engaged with the system . For users of the supportive websites , greater use of the weight tracker tool was associated with greater weight loss The transition to college has been identified as a critical period for increases in overweight status . Overweight college students are at-risk of becoming obese adults , and , thus prevention efforts targeting college age individuals are key to reducing adult obesity rates . The current study evaluated an Internet intervention with first year college students ( N=170 ) r and omly assigned to one of four treatment conditions : 1 ) no treatment , 2 ) 6-week online intervention 3 ) 6-week weight and caloric feedback only ( via email ) , and 4 ) 6-week combined feedback and online intervention . The combined intervention group had lower BMI s at post-testing than the other three groups . This study demonstrated the effectiveness and feasibility of an online intervention to prevent weight gain among college students CONTEXT Rapid increases in access to the Internet have made it a viable mode for public health intervention . No controlled studies have evaluated this re source for weight loss . OBJECTIVE To determine whether a structured Internet behavioral weight loss program produces greater initial weight loss and changes in waist circumference than a weight loss education Web site . DESIGN R and omized , controlled trial conducted from April to December 1999 . SETTING AND PARTICIPANTS Ninety-one healthy , overweight adult hospital employees aged 18 to 60 years with a body mass index of 25 to 36 kg/m(2 ) . Analyses were performed for the 65 who had complete follow-up data . INTERVENTIONS Participants were r and omly assigned to a 6-month weight loss program of either Internet education ( education ; n = 32 with complete data ) or Internet behavior therapy ( behavior therapy ; n = 33 with complete data ) . All participants were given 1 face-to-face group weight loss session and access to a Web site with organized links to Internet weight loss re sources . Participants in the behavior therapy group received additional behavioral procedures , including a sequence of 24 weekly behavioral lessons via e-mail , weekly online su bmi ssion of self-monitoring diaries with individualized therapist feedback via e-mail , and an online bulletin board . MAIN OUTCOME MEASURES Body weight and waist circumference , measured at 0 , 3 , and 6 months , compared the 2 intervention groups . RESULTS Repeated- measures analyses showed that the behavior therapy group lost more weight than the education group ( P = .005 ) . The behavior therapy group lost a mean ( SD ) of 4.0 ( 2.8 ) kg by 3 months and 4.1 ( 4.5 ) kg by 6 months . Weight loss in the education group was 1.7 ( 2.7 ) kg at 3 months and 1.6 ( 3.3 ) kg by 6 months . More participants in the behavior therapy than education group achieved the 5 % weight loss goal ( 45 % vs 22 % ; P = .05 ) by 6 months . Changes in waist circumference were also greater in the behavior therapy group than in the education group at both 3 months ( P = .001 ) and 6 months ( P = .005 ) . CONCLUSIONS Participants who were given a structured behavioral treatment program with weekly contact and individualized feedback had better weight loss compared with those given links to educational Web sites . Thus , the Internet and e-mail appear to be viable methods for delivery of structured behavioral weight loss programs Background The Internet has potential as a medium for health behavior change programs , but no controlled studies have yet evaluated the impact of a fully automated physical activity intervention over several months with real-time objective feedback from a monitor . Objective The aim was to evaluate the impact of a physical activity program based on the Internet and mobile phone technology provided to individuals for 9 weeks . Methods A single-center , r and omized , stratified controlled trial was conducted from September to December 2005 in Bedfordshire , United Kingdom , with 77 healthy adults whose mean age was 40.4 years ( SD = 7.6 ) and mean body mass index was 26.3 ( SD = 3.4 ) . Participants were r and omized to a test group that had access to an Internet and mobile phone – based physical activity program  ( n = 47 ) or to a control group ( n = 30 ) that  received no support . The test group received tailored solutions for perceived barriers , a schedule to plan weekly exercise sessions with mobile phone and email reminders , a message board to share their experiences with others , and feedback on their level of physical activity . Both groups were issued a wrist-worn accelerometer to monitor their level of physical activity ;  only the test group received real-time feedback via the Internet . The main outcome measures were accelerometer data and self-report of physical activity . Results At the end of the study period , the test group reported a significantly greater increase over baseline than did the control group for perceived control ( P < .001 ) and intention/expectation to exercise ( P < .001 ) . Intent-to-treat analyses of both the accelerometer data ( P = .02 ) and leisure time self-report data ( P = .03 ) found a higher level of moderate physical activity in the test group . The average increase ( over the control group ) in accelerometer-measured moderate physical activity was 2 h 18 min per week . The test group also lost more percent body fat than the control group ( test group : −2.18 , SD = 0.59 ; control group : −0.17 , SD = 0.81 ; P = .04 ) . Conclusions A fully automated Internet and mobile phone – based motivation and action support system can significantly increase and maintain the level of physical activity in healthy adults This study aims to evaluate the cost-effectiveness of a long-term workplace health promotion programme on physical activity ( PA ) and nutrition . In total , 924 participants enrolled in a 2-year cluster r and omized controlled trial , with departments ( n = 74 ) within companies ( n = 6 ) as the unit of r and omization . The intervention was compared with a st and ard programme consisting of a physical health check with face-to-face advice and personal feedback on a website . The intervention consisted of several additional website functionalities : action-oriented feedback , self-monitoring , possibility to ask questions and monthly e-mail messages . Primary outcomes were meeting the guidelines for PA and fruit and vegetable intake . Secondary outcomes were self-perceived health , obesity , elevated blood pressure , elevated cholesterol level and maximum oxygen uptake . Direct and indirect costs were calculated from a societal perspective , and a process evaluation was performed . Of the 924 participants , 72 % participated in the first and 60 % in the second follow-up . No statistically significant differences were found on primary and secondary outcomes , nor on costs . Average direct costs per participant over the 2-year period were € 376 , and average indirect costs were € 9476 . In conclusion , no additional benefits were found in effects or cost savings . Therefore , the programme in its current form can not be recommended for implementation BACKGROUND Several studies have shown that e-mail counseling improves weight loss achieved in self-directed Internet programs . Computer-tailored feedback offers a population -based alternative to human e-mail counseling . METHODS One hundred ninety-two adults , aged 49.2 + /- 9.8 years , having a body mass index ( calculated as weight in kilograms divided by height in meters squared ) of 32.7 + /- 3.5 , were r and omized to 1 of 3 Internet treatment groups : No counseling , computer-automated feedback , or human e-mail counseling .  All participants received 1 weight loss group session , coupons for meal replacements , and access to an interactive Web site . The human e-mail counseling and computer-automated feedback groups also had access to an electronic diary and message board . The human e-mail counseling group received weekly e-mail feedback from a counselor , and the computer-automated feedback group received automated , tailored messages . RESULTS Retention was 82 % at 3 months and 80 % at 6 months for all 3 groups . At 3 months , completers in both the computer-automated feedback ( -5.3 + /- 4.2 kg ) and human e-mail counseling ( -6.1 + /- 3.9 kg ) groups had significantly greater weight losses compared with the no counseling group ( -2.8 + /- 3.5 kg ) and these groups did not differ from each other . At 6 months , weight losses were significantly greater in the human e-mail counseling group ( -7.3 + /- 6.2 kg ) than in the computer-automated feedback ( -4.9 + /- 5.9 kg ) or no counseling ( -2.6 + /- 5.7 kg ) groups . Intent-to-treat analyses using single or multiple imputation techniques showed the same pattern of significance . CONCLUSIONS Providing automated computer-tailored feedback in an Internet weight loss program was as effective as human e-mail counseling at 3 months . Further research is needed to improve the efficacy of automated computer-tailored feedback as a population -based weight loss approach Background : Internet-based weight-loss programs appear promising in the short-term but , to data , have not been able to produce the level of weight loss seen in traditional in-person treatment ; thus , novel approaches are necessary . Using a combination of interactive technology and in-person support has been beneficial in other areas of medicine . Purpose : The aim of this study is to compare 12-month weight-loss outcomes of an Internet-only behavioral weight-loss treatment with the same program supplemented with monthly in-person meetings . Methods : One hundred and twenty-three participants were r and omized to an Internet-only ( n=62 ) or an Internet + in-person treatment ( I+IPS ; n=61 ) . All participants then participated in a 12-month behavioral weight-loss program conducted over the Internet . The groups met online weekly for the first 6 months and biweekly for the second half of the intervention . The I+IPS group had access to the same Web site as the Internet-only group but , once a month , attended an in-person meeting in place of an online chat . Assessment s included body weight , program adherence , and social support measures . Results : An intent-to-treat analysis ( n=123 ) revealed there were no significant Group x Time differences ( p=.15 ) in weight loss at either 6 ( −6.8±7.8 vs. −5.1±4.8 , p=.15 ) or 12 months ( −5.1±7.1 kg vs. −3.5±5.1 kg , p=.17 , for Internet-only and I+IPS , respectively ) . Differences between groups for those completing all measures ( n=77 ) also revealed no significant differences at 6 months ( −9.2±7.0 kg vs. −6.9±4.2 kg , p=.08 ) or 12 months ( −8.0±7.5 kg vs. −5.6±5.5 kg , p=.10 for the Internet-only and I+IPS conditions , respectively ) . Conclusions : Supplementation of an Internet weight-loss treatment with monthly in-person meetings did not result in greater weight losses over 12 months . Dynamic , socially supportive , and interactive elements of the Web site may have obviated the need for further interpersonal behavioral counseling This article reports the 12-month follow-up results and process evaluation of the SHED-IT ( Self-Help , Exercise , and Diet using Information Technology ) trial , an Internet-based weight loss program exclusively for men . Sixty-five overweight/obese male staff and students at the University of Newcastle ( Callaghan , Australia ) ( mean ( s.d . ) age = 35.9 ( 11.1 ) years ; BMI = 30.6 ( 2.8 ) ) were r and omly assigned to either ( i ) Internet group ( n = 34 ) or ( ii ) Information only control group ( n = 31 ) . Both received one face-to-face information session and a program booklet . Internet group participants were instructed to use the study website for 3 months . Participants were assessed at baseline , 3- , 6- , and 12-month follow-up for weight , waist circumference , BMI , blood pressure , and resting heart rate . Retention at 3- and 12-months was 85 % and 71 % , respectively . Intention-to-treat ( ITT ) analysis using linear mixed models revealed significant and sustained weight loss of -5.3 kg ( 95 % confidence interval ( CI ) : -7.5 , -3.0 ) at 12 months for the Internet group and -3.1 kg ( 95 % CI : -5.4 , -0.7 ) for the control group with no group difference . A significant time effect was found for all outcomes ( P < 0.001 ) . Per- protocol analysis revealed a significant group-by-time interaction for weight , waist circumference , BMI , and systolic blood pressure . Internet group compliers ( who self-monitored as instructed ) maintained greater weight loss at 12 months ( -8.8 kg ; 95 % CI -11.8 , -5.9 ) than noncompliers ( -1.9 kg ; 95 % CI -4.8 , 1.0 ) and controls ( -3.0 kg ; 95 % CI -5.2 , -0.9 ) . Qualitative analysis by question naire and interview highlighted the acceptability and satisfaction with SHED-IT . Low-dose approaches to weight loss are feasible , acceptable , and can achieve clinical ly important weight loss in men after 1-year follow-up Purpose : The increased availability and use of the Internet by midlife and older women who seek health information may provide an innovative method for delivering weight loss interventions . This preliminary study examined the feasibility and efficacy of web‐based interventions for promoting weight loss among rural overweight and obese women ages 50‐69 ( M = 55.5 ± 4.9 ) over a 3‐month period . Methods : Twenty‐one Caucasian women with body mass index of 28‐34.5 ( M = 30.69 ± 2.58 ) were r and omly assigned to either a Web site only or Web site augmented with a peer‐led support group . The Web site included recommended approaches to healthy eating and activity , weekly newsletters , and other re sources . Body weight , eating , and activity measures were assessed at baseline and postintervention . Data analysis included 2‐way repeated measures ANOVAs with effect sizes reported as appropriate for a pilot study . Results : Sixteen women ( 76.2 % ) completed the study ; 14 lost from 2 % to 10 % of their body weight , and 2 gained 2 % of their weight . Large effect sizes were found over time for body weight , estimated VO2max , and percentage of calories from fat . For time by group interaction , large effect sizes favoring the Web site plus peer‐led support group were found for body weight , waist circumference , percent body fat , whole grain servings , and both systolic and diastolic blood pressure . Process evaluations indicated that 85.7 % of women accessed the Web site weekly . There were a total of 305 hits in the Web site only group versus 658 hits in the peer‐led support groups . Conclusions : Internet delivered interventions appeared feasible for these rural women with weight loss and improvement in selected eating and activity measures after 3 months OBJECTIVE To investigate the efficacy of an Internet weight maintenance program . RESEARCH METHODS AND PROCEDURES Two hundred fifty-five healthy overweight and obese adults ( mean + /- SD BMI , 31.8 + /- 4.1 kg/m(2 ) ) men ( 18 % ; mean + /- SD age , 45.8 + /- 8.9 yrs ) participated in a 6-month behavioral weight control program conducted over interactive television . Treatment was followed by a 12-month weight maintenance program with three conditions : frequent in-person support ( F-IPS ) , minimal in-person support ( M-IPS ) and internet support ( IS ) . Main outcome measures included body weight , program adherence , and social influence components . RESULTS There were no significant differences among the groups in weight loss ( mean + /- SD ) from baseline to 18 months ( 7.6 + /- 7.3 kg vs. 5.5 + /- 8.9 kg vs. 5.1 + /- 6.5 kg , p = 0.23 for the IS , M-IPS , and F-IPS , respectively ) . DISCUSSION Participants assigned to an internet-based weight maintenance program sustained comparable weight loss over 18 months compared with individuals who continued to meet face-to-face . Therefore , the internet appears to be a viable medium for promoting long-term weight maintenance BACKGROUND A challenge in intensive obesity treatment is making care scalable . Little is known about whether the outcome of  physician-directed weight loss treatment can be improved by adding mobile technology . METHODS We conducted a 2-arm , 12-month study ( October 1 , 2007 , through September 31 , 2010 ) . Seventy adults ( body mass index > 25 and ≤40 [ calculated as weight in kilograms divided by height in meters squared ] ) were r and omly assigned either to st and ard-of-care group treatment alone ( st and ard group ) or to the st and ard and connective mobile technology system ( + mobile group ) . Participants attended biweekly weight loss groups held by the Veterans Affairs outpatient clinic . The + mobile group was provided personal digital assistants to self-monitor diet and physical activity ; they also received biweekly coaching calls for 6 months . Weight was measured at baseline and at 3- , 6- , 9- , and 12-month follow-up . RESULTS Sixty-nine adults received intervention ( mean age , 57.7 years ; 85.5 % were men ) . A longitudinal intent-to-treat analysis indicated that the + mobile group lost a mean of 3.9 kg more ( representing 3.1 % more weight loss relative to the control group ; 95 % CI , 2.2 - 5.5 kg ) than the st and ard group at each postbaseline time point . Compared with the st and ard group , the + mobile group had significantly greater odds of having lost 5 % or more of their baseline weight at each postbaseline time point ( odds ratio , 6.5 ; 95 % CI , 2.5 - 18.6 ) . CONCLUSIONS The addition of a personal digital assistant and telephone coaching can enhance short-term weight loss in combination with an existing system of care . Mobile connective technology holds promise as a scalable mechanism for augmenting the effect of physician-directed weight loss treatment . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00371462 Objective To map the state of the existing literature evaluating the use of social media in patient and caregiver population s. Design Scoping review . Data sources Medline , CENTRAL , ERIC , PubMed , CINAHL Plus Full Text , Academic Search Complete , Alt Health Watch , Health Source , Communication and Mass Media Complete , Web of Knowledge and ProQuest ( 2000–2012 ) . Study selection Studies reporting primary research on the use of social media ( collaborative projects , blogs/microblogs , content communities , social networking sites , virtual worlds ) by patients or caregivers . Data extraction Two review ers screened studies for eligibility ; one review er extracted data from relevant studies and a second performed verification for accuracy and completeness on a 10 % sample . Data were analysed to describe which  social media tools  are being used , by whom , for what purpose and how they are being evaluated . Results Two hundred eighty-four studies were included .  Discussion forums were highly prevalent and constitute 66.6 % of the sample . Social networking sites ( 14.8 % ) and blogs/microblogs ( 14.1 % ) were the next most commonly used tools . The intended purpose of the tool was to facilitate self-care in 77.1 % of studies . While there were clusters of studies that focused on similar conditions ( eg , lifestyle/weight loss ( 12.7 % ) , cancer ( 11.3 % ) ) , there were no patterns in the objectives or tools used . A large proportion of the studies were descriptive ( 42.3 % ) ; however , there were also 48 ( 16.9 % ) r and omised controlled trials ( RCTs ) . Among the RCTs , 35.4 % reported statistically significant results favouring the social media intervention being evaluated ; however , 72.9 % presented positive conclusions regarding the use of social media . Conclusions There is an extensive body of literature examining the use of social media in patient and caregiver population s. Much of this work is descriptive ; however , with such widespread use , evaluations of effectiveness are required . In studies that have examined effectiveness , positive conclusions are often reported , despite non-significant findings Background Stories may be an effective tool to communicate with and influence patients because of their ability to engage the reader . The objective of this paper is to describe the development of a story-based intervention for delivery of health evidence to parents of children with croup for use in a r and omized controlled trial . Methods A creative writer interviewed parents of children with croup presenting to the pediatric emergency department ( ED ) and drafted stories . We revised the stories based on written participant feedback and edited the stories to incorporate research evidence and health information . An illustrator and graphic design er developed story booklets which were evaluated through focus groups . Results Ten participants provided feedback on the five stories drafted by the creative writer . Participants liked the concept but found the writing overly sophisticated and wanted more character development and more medical/health information . Participants highlighted specific story content that they liked and disliked . The revised stories were evaluated through focus groups involving eight individuals . Feedback was generally positive ; one participant question ed the associated costs . Participants liked the graphics and layout ; felt that they could identify with the stories ; and felt that it was easier to get information compared to a st and ard medical information sheet . Participants provided feedback on the story content , errors and inconsistencies , and preferences of writing style and booklet format . Feedback on how to package the stories was provided by attendees at a national meeting of pediatric emergency research ers . Conclusions Several challenges arose during the development of the stories including : staying true to the story versus being evidence based ; addressing the use of the internet by consumers as a source of health information ; balancing the need to be comprehensive and widely applicable while being succinct ; considerations such as story length , reading level , narrative mode , representation of different demographics and illness experiences , graphics and layout . The process was greatly informed by feedback from the end-user group . This allowed us to shape our products to ensure accuracy , credibility , and relevance . Our experience is valuable for further work in the area of stories and narratives , as well as more broadly for identifying and developing communication strategies for healthcare consumers This study describes the development and usage of a Web-based component of a nutrition and physical activity behavioral intervention to promote bone health  among preadolescent girls . Thirty Girl Scout troops were r and omized to either an intervention or control group for a 2-year period . Girls in the intervention troops ( aged 10 to 12 years , N=194 ) were exposed to grade -specific Web sites that were developed to reinforce the content of the broader , face-to-face intervention . In 5th grade , 82 % of the girls logged on once and 48 % logged on more than once , compared to 56 % and 23 % of 6th grade rs , respectively . Results suggest that although Web-site usage decreased over time , a Web-site program may be useful as a component of a face-to-face , multicomponent intervention . More research is needed to determine ways to enhance and maintain Web-site use over time among youth in health-behavior intervention programs OBJECTIVE To examine if a website-delivered physical activity intervention , that provides participants with computer-tailored feedback , can improve physical activity in the general population . METHODS Healthy adults ( n=434 ) , recruited from parents and staff of 14 primary and secondary schools in Belgium in the spring of 2005 , were allocated into one of two intervention groups ( receiving intervention with or without repeated feedback ) or a no-intervention control group .  Physical activity-levels were self-reported at baseline and at 6 months ( n=285 ) , using a computerized long version of the International Physical Activity Question naire online . Repeated measures analysis of co-variances were used to examine differences between the three groups . RESULTS Intent-to-treat analysis showed significant time by group interaction effects in favor of both intervention groups compared with the control group . Significant increases were found for active transportation ( + 20 , + 24 , + 11 min/week respectively ) and leisure-time physical activity ( + 26 , + 19 , -4 min/week respectively ) ; a significant decrease for minutes sitting on weekdays ( -22 , -34 , + 4 min/day respectively ) . No significant differences were found between both intervention groups . CONCLUSION A website-delivered intervention , including computer-tailoring , was able to increase physical activity when compared to a no-intervention control group . High drop-out rate and the low number of participants who received repeated feedback indicated that engagement and retention are important challenges in e-health studies OBJECTIVE Internet-based physical activity ( PA ) interventions have shown promise , although findings remain equivocal . We used formative research to enhance a previously demonstrated program ( Step into Motion ) with the goal of developing an Internet program poised for dissemination . METHODS We conducted focus groups to identify Internet features targeted to theoretical constructs ( social cognitive theory ) predictive of PA behavior and rated as " useful for increasing PA . " We identified 5 theory-targeted Internet features as useful for increasing PA : ( 1 ) a PA tracking/logging calendar targeting self-monitoring and goal setting ; ( 2 ) geographic mapping tools targeting perceived environment ; ( 3 ) a discussion forum targeting social support ; ( 4 ) exercise videos targeting observational learning ; and ( 5 ) regular up date s of peer PA progress targeting situation . We then tested the efficacy of the enhanced program ( enhanced Internet , EI ; N = 25 ) in relation to publicly available PA Websites ( st and ard Internet , SI ; N = 28 ) among 53 participants in a r and omized controlled trial . RESULTS The EI arm increased PA in relation to the SI arm at 3 months ( 18.4 to 186.0 min/wk vs. 20.9 to 57.3 min/wk ; p = .03 ) but between-groups differences were not observed at 6 months ( 176.8 vs. 133.5 min/wk ; p = .44 ) . EI participants maintained PA from 3 to 6 months ( 186.0 to 176.8 min/wk ) , and the SI group increased PA ( 57.3 to 133.5 min/wk ) . CONCLUSION The EI program was efficacious at improving PA levels in relation to publicly available Websites initially , but differences in PA levels were not maintained at 6 months . Future research should identify Internet features that promote long-term maintenance OBJECTIVE To examine changes in motivation and the relationship of motivation to adherence to self-monitoring and weight loss in a 16-week Internet behavioral weight-loss intervention . DESIGN Two-group r and omized design . SETTING This study was conducted over the Internet . PARTICIPANTS Sixty-six women , ages 22 - 65 , with a body mass index ( BMI ) between 25 and 40 , and with a home computer with Internet access , participated . INTERVENTION These data are from an Internet behavioral weight-loss program in which all participants received a face-to-face initial session followed by the 16-week Internet program . MAIN OUTCOME MEASURES Adherence to self-monitoring and weight loss were the main outcome measures . ANALYSIS Linear regression and mediation analysis using the Baron and Kenny method were conducted . RESULTS Autonomous motivation increased initially and remained high for those who ultimately achieved a 5 % weight loss , but declined over time for participants who did not achieve a 5 % weight loss . Autonomous motivation at 4 weeks was a predictor of adherence to self-monitoring and 16-week weight loss . Adherence mediated the relationship between autonomous motivation and weight loss . CONCLUSIONS AND IMPLICATION S These results suggest that autonomous motivation may be a promising intervention target for promoting program procedure adherence and weight loss OBJECTIVE Internet weight loss programs have become widely available as alternatives to st and ard treatment , but few data are available on their efficacy . This study aim ed to investigate the effectiveness of a structured behavioral weight loss website ( VTrim ) vs. a commercial weight loss website ( eDiets.com ) . RESEARCH METHODS AND PROCEDURES A r and omized , controlled trial was conducted from February 2003 to March 2005 , in 124 overweight and obese subjects ages 18 years and older with a BMI of 25 to 39.9 kg/m2 ( mean age , 47 + /- 9 years ; BMI , 32 + /- 3 kg/m2 ; 20 % men ) . Analyses were performed for the 88 subjects who had complete follow-up data . Participants were r and omly assigned to 12-month VTrim ( n = 62 ) or eDiets.com ( n = 62 ) intervention . VTrim participants had access to a therapist-led structured behavioral weight loss program delivered on-line . eDiets.com subjects had access to a self-help commercial on-line weight loss program .  Body weight , social support , and use of website components were measured at 0 , 6 , and 12 months . RESULTS Repeated- measures analyses showed that the VTrim group lost significantly more weight than the eDiets.com group at 6 months ( 8.3 + /- 7.9 kg vs. 4.1 + /- 6.2 kg ; p = 0.004 ) and maintained a greater loss at 12 months ( 7.8 + /- 7.5 kg vs. 3.4 + /- 5.8 kg ; p = 0.002 ) . More participants in the VTrim group maintained a 5 % weight loss goal ( 65 % vs. 37.5 % ; p = 0.01 ) at 12 months . DISCUSSION An on-line , therapist-led structured behavioral weight loss website produced greater weight loss than a self-help commercial website . Because commercial sites have great potential public health impact , future research should investigate the feasibility of incorporating a more structured behavioral program into a commercial application OBJECTIVE To evaluate the short- and long-term results of FATaintPHAT , a Web-based computer-tailored intervention aim ing to increase physical activity , decrease sedentary behavior , and promote healthy eating to contribute to the prevention of excessive weight gain  among adolescents . DESIGN Cluster r and omized trial with an intervention group and a no-intervention control group . SETTING Twenty schools in the Netherl and s. PARTICIPANTS A total of 883 students ( aged 12 - 13 years ) . INTERVENTION The FATaintPHAT ( VETisnietVET in Dutch ) Web-based computer-tailored intervention . OUTCOME MEASURES Self-reported behaviors ( diet , physical activity , sedentary behavior ) and pedometer counts were measured at baseline and at 4-month and 2-year follow-up ; body mass index ( BMI ) , waist circumference , and fitness were measured at baseline and at 2-year follow-up . Descriptive and multilevel regression analyses were conducted among the total study population and among students not meeting behavioral recommendations at baseline ( students at risk ) . RESULTS The complete case analyses showed that FATaintPHAT had no effect on BMI and waist circumference . However , the intervention was associated with lower odds ( 0.54 ) of drinking more than 400 mL of sugar-sweetened beverages per day and with lower snack intake ( β = -0.81 snacks/d ) and higher vegetable intake ( β = 19.3 g/d ) but also with a lower step count ( β = -10 856 steps/wk ) at 4-month follow-up . In addition , among students at risk , FATaintPHAT had a positive effect on fruit consumption ( β = 0.39 g/d ) at 4-month follow-up and on step count ( β = 14 228 steps/wk ) at 2-year follow-up but an inverse effect on the odds of sports participation ( odds ratio , 0.45 ) at 4-month follow-up . No effects were found for sedentary behavior . CONCLUSION The FATaintPHAT intervention was associated with positive short-term effects on diet but with no effects or unfavorable effects on physical activity and sedentary behavior PURPOSE The study investigated the efficacy and cost-effectiveness of a cognitive-behavioral weight management program , complemented by an interactive Web site and brief telephone/e-mail coaching . METHODS In 2006 - 2007 , 1755 overweight , non-active-duty TRICARE beneficiaries were r and omized to one of three conditions with increasing intervention intensity : written material s and basic Web access ( RCT 1 ) , plus an interactive Web site ( RCT 2 ) , plus brief telephone/e-mail coaching support ( RCT 3 ) . The study assessed changes in weight , blood pressure , and physical activity from baseline to 6 , 12 , and 15 - 18 months . ( Study retention was 31 % at 12 months . ) Average and incremental cost-effectiveness and cost-offset analyses were conducted . RESULTS Participants experienced significant weight loss ( -4.0 % , -4.0 % , and -5.3 % , respectively , in each RCT group after 12 months and -3.5 % , -3.8 % , and -5.1 % , respectively , after 15 to 18 months ) , increased physical activity , and decreased blood pressure . Cost-effectiveness ratios were $ 900 to $ 1100/ quality -adjusted life year ( QALY ) for RCT 1 and RCT 2 and $ 1900/QALY for RCT 3 . The cost recovery period to the government was 3 years for RCTs 1 and 2 and 6 years for RCT 3 . CONCLUSION A relatively inexpensive cognitive-behavioral weight management intervention improved patient outcomes . Extrapolation of savings for the entire TRICARE population would significantly reduce direct medical costs OBJECTIVE To assess , in a 1-year r and omized controlled trial , the efficacy of eDiets.com ( a commercial Internet weight loss program ) in improving weight , cardiovascular health , and quality of life . RESEARCH METHODS AND PROCEDURES Participants were 47 women with a mean age of 43.7 + /- 10.2 ( SD ) years and a mean BMI of 33.5 + /- 3.1 kg/m2 . They were r and omly assigned to either : 1 ) eDiets.com , a commercial Internet-based program available to the public ; or 2 ) a weight loss manual ( i.e. , LEARN Program for Weight Control 2000 ) . At baseline , participants in both groups met briefly with a psychologist who instructed them to follow the components of their program as closely as possible . Additional brief visits were provided at weeks 8 , 16 , 26 , and 52 to review their progress . Change in weight was the main outcome measure . RESULTS At week 16 , participants in eDiets.com lost 0.9 + /- 3.2 % of initial weight compared with 3.6 + /- 4.0 % for women assigned to the weight loss manual . At week 52 , losses increased to 1.1 + /- 4.0 % and 4.0 + /- 5.1 % , respectively . Results of a last-observation-carried-forward analysis found that women in the manual group lost significantly ( p < 0.05 ) more weight ( at both times ) than those treated by eDiets.com . ( Results , however , of baseline-carried-forward and completers analyses did not reach statistical significance . ) There were no significant differences between groups in changes in cardiovascular risk factors or quality of life . DISCUSSION This study provides consumers with important information about the probable benefits they can expect from participating in a popular Internet-based weight loss program PURPOSE To compare the effectiveness of a Web-based physical activity ( PA ) intervention with identical content delivered in a printed workbook among a sample of adolescent girls . METHODS Participants consisted of 319 girls with home Internet access enrolled in four middle schools within one school district . A r and omized trial design was used to compare changes in PA self-efficacy and intentions after two weeks of exposure to either a Web- or print-based intervention delivered to their home . Self-reported physical activity was assessed as a secondary outcome . Analysis of covariance was conducted to determine changes between the intervention groups while controlling for baseline levels of PA constructs . RESULTS Both Web and print groups had significant changes in physical activity self-efficacy ( Web : t[155 ] = 2.58 , p = .01 ; print : t[156 ] = 3.11 , p = .002 ) and intentions ( Web : t[157 ] = 2.27 , p = .02 ; print : t[159 ] = 6.32 , p < or = .001 ) . The print group demonstrated significantly greater increases in intentions compared with the Web group ( F [ 1,315 ] = 13.53 , p < or = .001 ) . Self-reported physical activity increased significantly in the print group only ( t[159 ] = 3.21 , p = .002 ) . CONCLUSIONS It can not be assumed that new media technologies are superior to traditional media such as print for health communication to adolescents . These results suggest that a printed workbook was more effective than an identical website for increasing physical activity intentions and behavior among a sample of middle school girls OBJECTIVE This article describes website use and behavioral outcomes in a multi-component lifestyle intervention promoting healthy diet and exercise . METHODS A 2-year r and omized clinical trial to improve  bone density in 228 adolescent girls , the intervention included a website design ed to enhance intervention adherence , retention of participants , and behavioral outcomes . Measures included diet and exercise recalls , surveys , and web-usage data . RESULTS Website use was associated with increases in calcium intake ( ss = 69.72 , p = .01 , ES = 0.15 ) and high-impact activity ( ss = 10.93 , p = .04 , ES = .13 ) . Use of web pages related to behavioral feedback and communications was not significantly associated with behavioral outcomes . The most visited website pages had content related to incentive points , caption contests , and fun facts . CONCLUSIONS Web elements of a multi-component intervention may promote retention and engagement in target behaviors . Such websites may be most acceptable to adolescent participants if they blend fun and behavioral elements , rather than exclusively focusing on behavioral changes OBJECTIVE To evaluate the use of a local neighborhood environment-focused physical activity website and its effects on walking and overall physical activity in middle-aged adults . METHOD One-hundred and six ( 72 % women ) inactive adults aged 52+/-4.6 years were r and omly allocated to receive access to a neighborhood environment-focused website , ( Neighborhood group , n=52 ) or a motivational-information website ( Comparison group n=54 ) . Participants also received eleven emails over the 26 weeks . Study outcomes were objective ly-monitored website use , and self-reported total walking ( min/wk ) , total physical activity ( min/wk ) and neighborhood walking ( min/wk ) collected at baseline , 12 and 26 weeks . The study was conducted between August 2005 and February 2006 in Brisbane , Australia . RESULTS Website use was significantly greater among Neighborhood participants ( p=0.01 ) . Statistically significant increases in walking and total physical activity were observed in both groups . There was also a statistically significant interaction effect for total physical activity , with Neighborhood group participants maintaining more of their initial increase in physical activity at week-26 ( p<0.05 ) . Further , those in the Neighborhood group who used the website more often reported significantly more walking along the community trail at week-26 ( p=0.05 ) compared with those who did not . CONCLUSIONS A local neighborhood-environment focused physical activity website was more effective at engaging participants than a motivational-information website . Moreover , its use result ed in meaningful increases in physical activity relative to the comparison website Abstract Objective : To determine the impact of My Student Body (MSB)–Nutrition , an Internet-based obesity prevention program for college students . Participants : Three hundred and twenty ethnically diverse undergraduate students were r and omly assigned to 1 of 3 conditions : MSB-Nutrition program , an on-campus weight management course , and a comparison group . Methods : Students completed baseline and follow-up surveys regarding their nutrition and physical activity behaviors , self-efficacy , stress , attitudes , and body weight . Results : Compared with the on-campus course and a comparison group , the MSB-Nutrition program increased fruit and vegetable consumption , reduced stress , and increased fruit and vegetable self-efficacy but had no significant effect on students ’ exercise self-efficacy , exercise behavior , or weight loss . Conclusions : The MSB-Nutrition program was effective in changing students ’ nutrition behaviors but had no effect on physical activity behaviors or weight loss . Suggestions for improving Internet-based interventions aim ed at decreasing obesity rates among college students are offered The Internet can access a large number of consumers in a more cost-effective manner than other information delivery channels . In this pilot study , we assessed whether an online weight reduction program including dietary advice plus exercise ( ED ) was more effective in reducing weight than an exercise-only program ( EX ) > 12 weeks . Participants were r and omized to either the ED or EX group and attended a center for anthropometric measurements and dietary assessment .  Both groups wore a pedometer and set weekly goals to increase daily steps through an interactive Web site . The ED group set weekly dietary goals via the Web site and received tailored e-mail assistance .  Seventy-three participants commenced and 53 ( 73 % ) completed the study [ EX n = 26 ; ED n = 27 ; body mass index-mean ( st and ard deviation ) : 29.7 ( 2.5 ) kg m(-2 ) , age 46.3 ( 10.8 ) ; 21 % male ] . Percent weight changes were EX , 2.1 (0.6)% and ED , 0.9 (0.6)% ( P = 0.15 ) . Both groups increased their daily steps with no difference between groups . Only the ED group significantly reduced their energy intake . Despite a greater fall in energy intake reported by the ED group and a similar increase in physical activity in both groups , setting individual dietary goals did not enhance weight loss Background Prevention of weight gain has been suggested as an important strategy in the prevention of obesity and people who are overweight are a specifically important group to target . Currently there is a lack of weight gain prevention interventions that can reach large numbers of people . Therefore , we developed an Internet-delivered , computer-tailored weight management intervention for overweight adults . The focus of the intervention was on making small ( 100 kcal per day ) , but sustained changes in dietary intake ( DI ) or physical activity ( PA ) behaviors in order to maintain current weight or achieve modest weight loss . Self-regulation theory was used as the basis of the intervention . Objective This study aims to evaluate the efficacy of the computer-tailored intervention in weight-related anthropometric measures ( Body Mass Index , skin folds and waist circumference ) and energy balance-related behaviors ( physical activity ; intake of fat , snacks and sweetened drinks ) in a r and omized controlled trial . Methods The tailored intervention ( TI ) was compared to a generic information website ( GI ) . Participants were 539 overweight adults ( mean age 47.8 years , mean Body Mass Index ( BMI ) 28.04 , 30.9 % male , 10.7 % low educated ) who where recruited among the general population and among employees from large companies by means of advertisements and flyers .  Anthropometric measurements were measured by trained research assistants at baseline and 6-months post-intervention .  DI and PA behaviors were assessed at baseline , 1-month and 6-month post-intervention , using self-reported question naires . Results Repeated measurement analyses showed that BMI remained stable over time and that there were no statistically significant differences between the study groups ( BMI : TI=28.09 , GI=27.61 , P=.09 ) . Similar results were found for waist circumference and skin fold thickness . Amount of physical activity increased and intake of fat , snacks and sweetened drinks decreased during the course of the study , but there were no differences between the study groups ( eg , fat intake : TI=15.4 , GI=15.9 , P=.74 ) . The first module of the tailored intervention was visited by almost all participants , but only 15 % completed all four modules of the tailored intervention , while 46 % completed the three modules of the general information intervention . The tailored intervention was considered more personally relevant ( TI=3.20 , GI=2.83 , P=.001 ) , containing more new information ( TI=3.11 , GI=2.73 , P=.003 ) and having longer texts ( TI=3.20 , GI=3.07 , P=.01 ) , while there were no group differences on other process measures such as attractiveness and comprehensibility of the information ( eg , attractive design : TI=3.22 , GI=3.16 , P=.58 ) . Conclusions The online , computer-tailored weight management intervention result ed in changes in the desired direction , such as stabilization of weight and improvements in dietary intake , but the intervention was not more effective in preventing weight gain or modifying dietary and physical activity behaviors than generic information . A possible reason for the absence of intervention effects is sub-optimal use of the intervention and the self-regulation components . Further research is therefore needed to gain more insight into how the intervention and exposure to its contents can be improved . Trial Registration NTR1862 ; http://apps.who.int/trial search /trial.aspx?trialid = The CONSORT statement is used worldwide to improve the reporting of r and omised controlled trials . Kenneth Schulz and colleagues describe the latest version , CONSORT 2010 , which up date s the reporting guideline based on new method ological evidence and accumulating experience . To encourage dissemination of the CONSORT 2010 Statement , this article is freely accessible on bmj.com and will also be published in the Lancet , Obstetrics and Gynecology , PLoS Medicine , Annals of Internal Medicine , Open Medicine , Journal of Clinical Epidemiology , BMC Medicine , and Trials BACKGROUND Online social networks , such as Facebook ™ , have extensive reach , and they use technology that could enhance social support , an established determinant of physical activity . This combination of reach and functionality makes online social networks a promising intervention platform for increasing physical activity . PURPOSE To test the efficacy of a physical activity intervention that combined education , physical activity monitoring , and online social networking to increase social support for physical activity compared to an education-only control . DESIGN RCT . Students ( n=134 ) were r and omized to two groups : education-only controls receiving access to a physical activity-focused website ( n=67 ) and  intervention participants receiving access to the same website with physical activity self-monitoring and enrollment in a Facebook group  ( n=67 ) . Recruitment and data collection occurred in 2010 and 2011 ; data analyses were performed in 2011 . SETTING / PARTICIPANTS Female undergraduate students at a large southeastern public university . INTERVENTION Intervention participants were encouraged through e-mails , website instructions , and moderator communications to solicit and provide social support related to increasing physical activity through a physical activity-themed Facebook group . Participants received access to a dedicated website with educational material s and a physical activity self-monitoring tool . MAIN OUTCOME MEASURES The primary outcome was perceived social support for physical activity ; secondary outcomes included self-reported physical activity . RESULTS Participants experienced increases in social support and physical activity over time but there were no differences in perceived social support or physical activity between groups over time . Facebook participants posted 259 times to the group . Two thirds ( 66 % ) of intervention participants completing a post- study survey indicated that they would recommend the program to friends . CONCLUSIONS Use of an online social networking group plus self-monitoring did not produce greater perceptions of social support or physical activity as compared to education-only controls . Given their promising features and potential reach , efforts to further underst and how online social networks can be used in health promotion should be pursued . TRIAL REGISTRATION This study is registered at clinical trials.govNCT01421758
OBJECTIVES To conduct a systematic review of r and omised controlled trials ( RCTs ) examining the use of social media to promote healthy diet and exercise in the general population .