Internet Weight-Loss Sites Only Work For People Who Use ThemWednesday, August 4, 2010
Regular readers of these pages may recall a previous post on the fact that drugs only work in people who take them.
Perhaps, not so surprisingly, the same is true for any kind of weight loss intervention.
Diets only work for people who stick to them, food journals only work for people who keep them, calorie counting only works for people who count calories, and guess what, web-based weight-loss interventions only work for people who use such programs.
The latter is pretty much the finding from a study by Kristine Funk and colleagues from Kaiser Permanente, Center for Health Research, Portland, USA published in the latest issue of the Journal of Medical Internet Research.
The researchers compared two long-term weight-maintenance interventions: a personal contact arm and an internet arm, with a no-treatment control after an initial 20-week weight loss program, during which participants lost about 9 Kg.
This paper focusses on the website use patterns and weight maintenance outcomes in the internet arm of the study (n=348). The interactive website designed to support of long-term weight maintenance, contained features that encouraged setting short-term goals, creating action plans, and reinforcing self-management habits. The website also included motivational modules, daily tips, and tailored messages.
Participants were were encouraged to log in at least weekly and enter a current weight for the 30-month study period.
After adjusting for baseline characteristics including initial BMI, variables most associated with less weight regain included: number of log-ins, minutes on the website, number of weight entries, number of exercise entries, and sessions with additional use of website features after weight entry.
In other words, the participants who used the site most ended up regaining the least weight; people who used the site less regained more weight.
Older and more educated participants were more likely to use the website consistently; higher baseline weight and less attendance at the initial group sessions was associated with minimal website use.
Because a substantial proportion of participants did not use the site consistently (40%), one may easily conclude that such internet sites are of limited use. On the other hand, the data could also be used to support the idea that such sites can be very effective in people who use them (60% of participants in this study).
Thus, as with all interventions (including pharmacotherapy or surgery), outcomes are highly dependent on the level of compliance and adherence.
In fact, come to think of it, I can’t say I am aware of any treatments that work in people who don’t use them.
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Hat tip to Sebely for pointing me to this article!
Funk KL, Stevens VJ, Appel LJ, Bauck A, Brantley PJ, Champagne CM, Coughlin J, Dalcin AT, Harvey-Berino J, Hollis JF, Jerome GJ, Kennedy BM, Lien LF, Myers VH, Samuel-Hodge C, Svetkey LP, & Vollmer WM (2010). Associations of Internet Website Use With Weight Change in a Long-term Weight Loss Maintenance Program. Journal of medical Internet research, 12 (3) PMID: 20663751
Wednesday, August 4, 2010
It constantly amazes me how the medical profession repeatedly “discovers” effects like this when industrial engineering identified it back in the 1930s. The Hawthorne Effect, named for the Western Electric Hawthorne Works, simply identifies the tendency that any human behaviour observed improves, as long as those being observed are aware of the observation.
The theory is that the behaviour observed shifts from the unconscious “this is how we do it” towards the conscious “this is how we should do it” simply because someone is paying attention. Studies do tend to show, however, that once the observation ceases, the behaviour drifts back towards the pre-observation pattern.
With respect to weight loss, then, the act of keeping a food diary, of logging into a weight loss site, of following a diet (thus being aware of what one eats) tends to reduce the negative behaviour of eating high-calorie, high fat foods, resulting in better diets and healthier weights. Once one stops paying attention to the behaviour, though, the tendency is to return to the previous behaviour pattern – eating the less-healthy foods.
Really, the only surprise is that the medical profession’s need to study something that has been known by the engineering and industrial psychology professions for over 75 years.
Wednesday, August 4, 2010
@Ross: actually, to be fair, the medical profession has known the “Hawthorne” effect since ancient times. Medical literature has always emphasized the importance of long-term relationships and follow-up with their patients. Self- and external monitoring are a fundamental cornerstone of chronic disease management. It is just that when it comes to obesity, people are hoping for a “miracle” cure – something they can do for a while and then stop doing – unfortunately it simply does not work that way – whether in chronic disease or on engineering production lines.
Friday, August 6, 2010
“In fact, come to think of it, I can’t say I am aware of any treatments that work in people who don’t use them.”
lol very well said. this was a good post
Tuesday, January 11, 2011
I have been a member of an online weight loss community for many years. In fact I enjoy being the Welcome Wagon quite often. The most depressing aspect of this hobby of mine? Folks who come on the message boards … introduce themselves … and never come back.
About me? 35 lbs lost and maintained. Of course I use my online resource.