How Useful Are Computer-Based Weight Management Interventions?
Monday, September 3, 2012
As most readers are probably well aware, there is an ever increasing number of internet and app-based weight management programs ranging in cost from virtually free with automated responses to moderately expensive virtual trainers.
But how effective are such programs really?
This is the subject of a recent Cochrane Review by Wieland and colleagues from the Maryland School of Medicine in Baltimore.
The authors looked at all randomized controlled or quasi-randomized controlled trials that evaluated interactive computer-based weight loss or weight maintenance programs in adults with overweight or obesity. Interventions of less than four week duration or with greater than 20% lost-to-follow-up were excluded.
The researchers identified 14 weight loss studies with a total of 2537 participants, and four weight maintenance studies with a total of 1603 participants with treatment durations ranging between four weeks and 30 months.
At six months, computer-based interventions led to an about 1.5 Kg greater weight loss than minimal interventions (e.g. handing the patient a brochure) but about 2 Kg less weight loss than in-person treatments.
At six months, computer-based interventions were marginally superior to a minimal control intervention in limiting weight regain (about -0.7 Kg) but not superior to infrequent in-person treatment (about 0.5 Kg).
Overall the authors note that they did not observe consistent differences in dietary or physical activity behaviors between intervention and control groups in either weight loss or weight maintenance trials.
Although several studies compared cost, the authors felt that either the costs were outdated or not representative of current programs.
The one study for which they presented the cost-effectiveness, the ratio for a weekly in-person weight loss intervention relative to a computer-based intervention was about US$ 7,000 per life year gained.
None of the studies reported data on adverse events, morbidity, complications or health-related quality of life.
Thus, the authors conclude that,
“Compared to no intervention or minimal interventions (pamphlets, usual care), interactive computer-based interventions are an effective intervention for weight loss and weight maintenance. Compared to in-person interventions, interactive computer-based interventions result in smaller weight losses and lower levels of weight maintenance. The amount of additional weight loss, however, is relatively small and of brief duration, making the clinical significance of these differences unclear.”
If you have experience with an internet or computer based weight management program, I’d certainly be interested in hearing about it.
AMS
London, UK
photo credit: RussellReno via photo pin cc
Wieland LS, Falzon L, Sciamanna CN, Trudeau KJ, Brodney S, Schwartz JE, & Davidson KW (2012). Interactive computer-based interventions for weight loss or weight maintenance in overweight or obese people. Cochrane database of systematic reviews (Online), 8 PMID: 22895964
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Monday, September 3, 2012
Can we agree that anything with less than five year’s followup + very low dropout rates is old hat and not terribly interesting?
Monday, September 3, 2012
Dr. Sharma, as you have been championing, one-stop solutions have restricted benefit. Obesity is a complex phenomenon with numerous aetiologies and sustaining mechanisms once present. I have tried internet approaches, and like all guidance, if followed and adhered to, have efficacy. But obese patients need more: ongoing support, counseling, therapy, observation with corrective and preventative interventions, family buy-in and support, and training in developing and sustaining strategies for living “unusual” lifestyles in an obesogenic environment. My experience with on-line systems was success during compliance and site use, discontinued after first failure due to shamed feelings, returned to previous weight plus.
Monday, September 3, 2012
I have used both Weight Watchers e-tools and MyFitnessPal app. It is like anything else with weight management. If you use it consistently and actually stay within your recommended caloric targets, you will lose weight. If every little indiscretion you have you do not record, it doesn’t work all that great!
Monday, September 3, 2012
I have been successful losing a fair amount of work while getting back in shape (I recognize BMI is not a reasonable measure, but I went from a BMI of about 29 to 20.3 and maintain a 20.3 to 20.5 range)
I found a computer program extremely useful for its diary function – along with a kitchen scale and the fact I prepare 95% of my own meals. I also used a good friend’s encouragement to cheer me on through the hard bits. All of these are still very useful – even essential – during my maintenance phase.
The messaging the program gives aren’t terribly useful, but the diary nature is really important to me.
here is the technique is used during weight loss – maintenance is pretty much the same thing
http://tingilinde.typepad.com/starstuff/2011/06/recommendations-for-losing-weight.html
Tuesday, September 4, 2012
I used LoseIt on an iPod Touch (I recognize the screencap above!) and credit it almost entirely for making me realize that reducing calories did actually work. I lost 23 kg/50lb at a rate of about 1-1.5 lb a week and got to a 22.5 bmi which I never would have dreamed when I started. (Although I am in my 40s I never seriously went on a diet before; I gained slowly after grad school and in my first job, and was of the attitude that I was just “fluffy”.) I have maintained (less than +/- 5lb) for two years, and still use it almost daily. Although now more for tracking my nutrition — protein and fiber intake, saturated fat — because over time it helped me develop my own internal sense of proper portion intake. Being able to look and say, no, that’s not real hunger, I just had 600 calories 2 hours ago also helped to identify my cravings and the reasons for them, stress, boredom etc.
Thursday, September 6, 2012
This does not surprise me in the least. I once did a long-term study (well, not really a study but recording weights) of weight loss bloggers (of which I am one) and the average loss was about zero. Conclusion: weight loss blogging probably has a positive effect on some people, no effect on others and a negative effect on some.
This really surprised me but then I realised that blogging was maybe 10 or so minutes a day, not enough to have an effect on a persons losing weight mindset.