Obesity. 2016 Jan;24(1):44-50.
Using synchronous distance education to deliver a weight loss intervention: a randomized trial.
Dunn C1, Olabode-Dada O2, Whetstone L3, Thomas C2, Aggarwal S1, Nordby K1, Thompson S2, Johnson M1, Allison C4.
1Department of Youth, Family, and Community Sciences, North Carolina State University, Raleigh, North Carolina, USA.
2North Carolina Division of Public Health, Department of Health and Human Services, Raleigh, NC, USA.
3University of California, Nutrition Policy Institute, Nutrition Education and Obesity Prevention Research and Evaluation Unit, Berkeley, California, USA
4NC State Health Plan for Teachers and State Employees, Raleigh, North Carolina, USA.
Objective: To implement a randomized trial to evaluate the effectiveness of a weight loss program delivered using synchronous distance education compared with a wait-list control group with 6-month follow-up.
Methods: Adults with a body mass index (BMI) ≥25 were randomized to the intervention (n=42) or waitlist control group (n=38). The intervention group participated in a synchronous, online, 15-week weight loss program; weight loss was the primary outcome. Secondary measures included height, BMI, and confidence in ability to be physically active and eat healthy. Assessments occurred at three and four time points in the intervention and control group, respectively.
Results: Participants who completed the program lost significantly more weight (1.8 kg) than those in the wait-list control group (0.25 kg) at week 15 [F(1,61) = 6.19, P = 0.02] and had a greater reduction in BMI (0.71 vs. 0.14 kg/m2), [F(1,61) = 7.45, P = 0.01]. There were no significant differences between the intervention and the wait-list control groups for change in confidence in ability to be physically active or eat healthy. Weight loss was maintained at 6 months.
Conclusions: Use of synchronous distance education is a promising approach for weight loss. The results of this study will help to inform future research that employs Web-based interventions.
The issue of overweight and obesity is a growing public health concern, as more than two-thirds of US adults have a Body Mass Index (BMI) of 25 or greater (1). Overweight and obesity have been linked to increased risk of heart disease, stroke, and type 2 diabetes (2). Public health guidelines have attempted to address this epidemic by recommending strategies to help people achieve and maintain a healthy weight, including reducing caloric intake, increasing physical activity, or a combination (3,4,5). An approach that has shown promise to help individuals achieve and maintain a healthy weight is the small steps approach (6,7). Weight management programs that are based on this approach have the potential to reduce overweight and obesity (6,7). Researchers in this study employed the Internet as a means to deliver a weight loss program using synchronous distance education technology (lessons delivered in real-time with a live instructor) compared to a control group that received delayed intervention. Both the intervention and control groups were also evaluated at a 6-month follow-up.
Eighty state employees covered by the North Carolina State Health Plan for Teachers and State Employees (69 female and 11 male) who were registered for an upcoming session of Eat Smart, Move More, Weigh Less (ESMMWL), an online weight loss program, were recruited to participate in the study. If eligibility criteria was met, study participants were randomized into the intervention group (n = 42) that began participating in the ESMMWL program immediately or a wait-list control group (n = 38) that participated in the ESMMWL program approximately 15 weeks later. Study coordinators conducted in-person measurements of height and weight and administered an online questionnaire of physical activity and eating patterns. Participants in the intervention group were seen in-person at week 0, week 15, and 6 months after completion of the ESMMWL program. Participants in the wait-list control group were seen at week 0, pre-intervention at week 15, upon completion of the ESMMWL program (week 30), and 6 months after completion of the online weight loss program.
Both the intervention group (started intervention at week 0) and control groups (started intervention at week 15) participated in ESMMWL, 15-week weight loss program based on the Theory of Planned Behavior, mindfulness, and small steps to change. The program included 15 weekly lessons that focused on evidence-based healthy eating and physical activity behaviors (8). Lesson topics included eating fewer calories, preparing and eating more meals at home, being physically active, and drinking fewer calorie-containing beverages. The weekly, hour-long sessions were led by a trained instructor and delivered in a real-time online environment where the participants could see and hear their instructor through a computer. Participants could also communicate with the instructor as well as other participants in class by typing questions and comments in the chat box (similar to a webinar environment). The program curriculum was designed in order to maximize interactivity between the participants and their instructor. An overview video to highlight the delivery method of ESMMWL is available at: https://esmmweighless.com/how-it-works. The instructor also offered personalized support and answers to questions in-between classes through communication in the ESMMWL Weekly Tracker. The Weekly Tracker is a personal, secure portal where participants track their progress, enter their SMART goal(s), and can reflect on their eating and physical activity behaviors (9) – see Figure 1.
Figure 1. Weekly Tracker, a secure portal where participants enter their beginning and ending measurements, weekly weight, weekly minutes of physical activity, and can communicate privately with their instructor outside of weekly class.
Participants in the intervention group were assessed at 15 weeks and 6 months after conclusion of the ESMMWL program. Follow-up assessments for those in the wait-list control group were done at 15 weeks after baseline during which time they received no intervention, at week 30 which was after they participated in ESMMWL, and 6 months after they had participated in the ESMMWL program.
Study results showed that participants who completed the ESMMWL program (defined as attending least 10 of the 15 classes) in the intervention group lost significantly more weight and had a greater reduction in BMI compared to those in the delayed intervention control group. Participants in the intervention group who completed ESMMWL lost an average of 1.76 kg (~4 pounds) vs. those in the control group lost an average of .25 kg (~.5 pound). There were no differences observed between the intervention group and the control group for change in physical activity or healthy eating confidence. Data was also analyzed for all program completers in the intervention and control groups combined. These combined results indicate that there was an increase in engagement (ranging from rarely or never to usually or always) for 12 out of 17 healthy behaviors addressed during the program and weight loss was maintained at 6 months after conclusion of the ESMMWL program.
This study is important because the results reinforce the findings that web-based interventions can be effective in achieving weight loss (10,11), particularly, interventions with human feedback via email (12,13). This study is unique as it utilizes synchronous distance education technology with a small-changes approach. The success of the study is also due in part to the inclusion of five necessary components that have been identified as essential to ensuring a web-based weight loss intervention is effective: self-monitoring, counselor feedback and communication, social support, use of a structured program, and the use of an individually tailored program (14). The ESMMWL program produced a meaningful weight loss for those participants that completed the program. A weight loss of 2.5 to 5.5 kg (or a loss of at least 5% of initial body weight) has been associated with increased health benefits such as reduced risk for type 2 diabetes and cardiovascular disease (4). Though the current study did not produce clinically significant weight loss, the results suggest that synchronous distance education technology can be a promising approach to expand the reach of weight loss programs to adults with a BMI > 25, regardless of geographic location.
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