Internet weight loss counseling: A comparison of
human email counseling, computer-automated
tailored counseling and no counseling
 

Objective:
Studies have shown that email counseling improves weight loss achieved in self-directed Internet programs. The goal of this study was to determine the short-term efficacy of a self-directed internet weight loss program compared with the same program supplemented with behavioral counseling from either a computer automated tailored system or from a human counselor.

Method:
Participants were made up of 192 overweight or obese adults aged 49.2+/- 9.8 years.  They were randomized to 1 of 3 internet treatment groups: no counseling (NC), automated feedback (AF) or human email counseling (HC).  Participants were seen at the clinic at baseline, 3 months and 6 months. 

A standard calorie-restricted diet of 1200 to 1500 calories/day was recommended based on baseline weight. Participants were instructed about the use of structured meals and meal replacements as helpful strategies for meeting caloric goals.  Two meal replacements per day consisting of a weight loss shake (Slim•Fast) were recommended to equal about 440 calories/day of total daily calories.  The remaining calories were to be consumed from foods and beverages of the participants’ choosing.  Participants were encouraged to increase physical activity over time to expend a minimum of 1050 calories/week, equivalent to approximately 30 minutes of walking per day. 

All participants were instructed on how to use the Slim•Fast web site, which is free to the public.  This interactive web site included the following features: weekly reporting and charting of weight, weekly email prompts to report weight, weekly weight loss tips via email, recipes, and an online buddy network. The online buddy network enables users to match themselves with other persons in the US with similar characteristics, and acts as a peer support system for weight loss via emails.

The AF and HC groups received customized feedback.  Weekly feedback was either from a pre-programmed computer that instantaneously returned feedback on a Web page when the weight loss diary was submitted (AF) or via email from a weight loss counselor whom they had not met with in person.

  

Results:
At 3 months, completers in both the computer automated feedback
(-5.3 +/- 4.2 kg) and human email 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 two groups did not differ from each other.  At 6 months, weight losses were significantly greater in the human email 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.

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CONCLUSION:
Providing automated computer-tailored feedback in an internet weight loss program was as effective as human email counseling at 3 months.  Further research is needed to improve the efficacy of automated computer-tailored feedback as a population-based weight loss approach.

Source:
Tate, D. F., Jackvony, E. H., Wing, R. R.  A randomized trial comparing human e-mail counseling, computer-automated tailored counseling, and no counseling in an Internet weight loss program.  Arch Intern Med. 2006;166:1620-1625.