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Social support in an Internet weight loss community

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Abstract

To describe social support for weight loss shared by members of a large Internet weight loss community. We conducted a mixed-methods study with surveys (n=193) and interviews (n=13) of community members along with a content analysis of discussion forum messages (n=1924 messages). Qualitative data were analyzed for social support themes. Survey respondents were primarily white (91.4%) and female (93.8%) with mean age 37.3 years and mean body mass index 30.9. They used forums frequently, with 56.8% reading messages, 36.1% replying to messages, and 18.5% posting messages to start a discussion related to weight loss on a daily or more frequent basis. Major social support themes were encouragement and motivation, mentioned at least once by 87.6% of survey respondents, followed by information (58.5%) and shared experiences (42.5%). Subthemes included testimonies, recognition for success, accountability, friendly competition, and humor. Members valued convenience, anonymity, and the non-judgmental interactions as unique characteristics of Internet-mediated support. This Internet weight loss community plays a prominent role in participants' weight loss efforts. Social support within Internet weight loss communities merits further evaluation as a weight loss resource for clinicians to recommend to patients. Understanding these communities could improve how health professionals evaluate, build, harness, and manipulate social support for weight loss.
Social support in an Internet weight loss community
Kevin O. Hwanga,*, Allison J. Ottenbachera,b, Angela P. Greenc,d, M. Roseann Cannon-
Diehle, Oneka Richardsona, Elmer V. Bernstama,f, and Eric J. Thomasa
aThe University of Texas Medical School at Houston, Department of Internal Medicine, Division of
General Medicine, 6410 Fannin St, UPB 1100.41, Houston, TX 77030, United States
bThe University of Texas School of Public Health, Houston, TX, United States
cTexas Woman’s University, Houston, TX, United States
dMemorial Hermann Hospital, Sugarland, TX, United States
eBaylor College of Medicine, Department of Anesthesiology, Houston, TX, United States
fThe University of Texas School of Health Information Sciences at Houston, Houston, TX, United
States
Abstract
Purpose—To describe social support for weight loss shared by members of a large Internet
weight loss community.
Methods—We conducted a mixed-methods study with surveys (n = 193) and interviews (n = 13)
of community members along with a content analysis of discussion forum messages (n = 1924
messages). Qualitative data were analyzed for social support themes.
Results—Survey respondents were primarily white (91.4%) and female (93.8%) with mean age
37.3 years and mean body mass index 30.9. They used forums frequently, with 56.8% reading
messages, 36.1% replying to messages, and 18.5% posting messages to start a discussion related
to weight loss on a daily or more frequent basis. Major social support themes were encouragement
and motivation, mentioned at least once by 87.6% of survey respondents, followed by information
(58.5%) and shared experiences (42.5%). Subthemes included testimonies, recognition for
success, accountability, friendly competition, and humor. Members valued convenience,
anonymity, and the non-judgmental interactions as unique characteristics of Internet-mediated
support.
Conclusion—This Internet weight loss community plays a prominent role in participants’
weight loss efforts. Social support within Internet weight loss communities merits further
evaluation as a weight loss resource for clinicians to recommend to patients. Understanding these
communities could improve how health professionals evaluate, build, harness, and manipulate
social support for weight loss.
© 2009 Elsevier Ireland Ltd. All rights reserved.
*Corresponding author. Tel.: +1 713 500 6441; fax: +1 713 500 0766. Kevin.o.hwang@uth.tmc.edu, kevinhwangmd@gmail.com
(K.O. Hwang).
Conflict of interest statement
None of the authors have any conflict of interest, financial or otherwise, relevant to the conduct or reporting of this study.
Contributions. K. Hwang, A. Ottenbacher, A. Green, M. Cannon-Diehl, and O. Richardson contributed substantially to study design;
data collection, analysis and interpretation; preparation of the manuscript; and final approval of the submitted version. E. Bernstam
and E. Thomas contributed substantially to study design; data analysis and interpretation; preparation of the manuscript; and final
approval of the submitted version.
NIH Public Access
Author Manuscript
Int J Med Inform. Author manuscript; available in PMC 2011 March 18.
Published in final edited form as:
Int J Med Inform
. 2010 January ; 79(1): 5–13. doi:10.1016/j.ijmedinf.2009.10.003.
NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript
Keywords
Internet; Social support; Obesity
1. Introduction
The purpose of this study was to explore the nature and potential benefit of social support
for weight loss shared among participants of a public Internet weight loss community. Social
support includes informational, emotional, instrumental (tangible), appraisal (feedback), and
network support exchanged among peers [1–5]. Observational and experimental data
suggest that social support facilitates weight control [2,6–9]. However, some individuals
lack access to social support for their weight management efforts [10–12].
Internet health communities offer new opportunities to share social support via discussion
forums, chat rooms, and blogs [4,5,13–15]. Potential advantages of online support include
access to many peers with the same health concerns, convenient communication spanning
geographic distances, and anonymity (if desired) for discussion of sensitive issues [16,17].
The literature offers little information about how existing members of large Internet
communities experience social support for weight loss. Clinical trials have tested online
weight loss interventions involving professional counseling, either with no peer support [18]
or with peer support solely from other study participants [19,20]. In a trial comparing human
e-counseling, automated counseling, and no counseling, all participants were encouraged to
use the free Slim-Fast website, which offered peer social support venues [21]. Participants in
the counseling groups could also share support with each other via the study website. Two
trials examined the efficacy of a commercial online weight loss program with social support
features (eDiets.com) [22,23]. However, the eDiets.com participants rarely used the social
support features. Overall, the stand-alone or incremental effect of social support from public
online weight loss communities has not been adequately assessed. Before conducting future
trials, an in-depth exploration of the nature and potential benefit of social support in these
communities might yield preliminary insight into their utility as weight loss resources.
Therefore, we conducted a mixed-methods study to explore the characteristics of social
support for weight loss exchanged among members of the SparkPeople.com online weight
loss community. We surveyed and interviewed members to assess demographic and clinical
characteristics, use of social support features, and social support experiences. We
corroborated survey and interview findings with a review of random discussion forum
messages. From the surveys, interviews, and messages, we identified and tabulated social
support themes.
2. Methods
2.1. Environment and study participants
SparkPeople (www.SparkPeople.com) is a free Internet weight loss community. More than
250,000 unique members log in to the website monthly [personal communication, David
Heilmann, Chief Operating Officer, SparkPeople, May 21, 2008]. In November 2008, it had
the third most visits among weight loss websites and fifth most pages viewed among health
websites [24]. We focused on the SparkPeople community because of its popularity and the
willingness of administrators to collaborate in research efforts. Study data consisted of
surveys and telephone interviews of SparkPeople members and messages posted on
SparkPeople discussion forums. Informed consent was obtained for the surveys and
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interviews. The study was approved by the Committee for Protection of Human Subjects at
the University of Texas Health Science Center at Houston.
2.2. Surveys
The purpose of the survey was to assess demographic and clinical characteristics, use of
social support features, and social support experiences of SparkPeople members. We used
the SurveyMonkey online survey tool (www.SurveyMonkey.com).
SparkPeople administrators posted an announcement on two general discussion forums, after
which 31 individuals began eligibility screening. Since SparkPeople administrators do not
repeat posts on forums within a short time frame, they conducted a second recruitment wave
via email. Recruitment emails were sent to 3000 randomly selected members who had (1)
had given permission to receive email; (2) joined at least 3 weeks prior; and (3) logged in
within 24h before the emails were sent (approximately 9:00 a.m. Central Standard Time,
April 24, 2008). We limited recruitment to those who had logged in within 24h in order to
obtain a sample of recent users of the SparkPeople website. All respondents took the same
survey regardless of recruitment mode. From this pool (recruited by forum posting or by
email), members were eligible if they were at least 18 years old, were trying to lose weight
over the past 4 weeks, and received any support for weight loss from other SparkPeople
members over the past 4 weeks. The honorarium was a $5 Amazon.com gift certificate. Due
to budgetary constraints, we set the survey to close automatically after the first 250
individuals had undergone eligibility screening.
Closed-ended survey questions addressed demographic and clinical parameters; usage of
social support features of the community; and perceptions of other community members. An
open-ended question asked “What kinds of things have SparkPeople members said or done
to help with your weight loss effort in the past 4 weeks?” Participants could enter up to 10
answers.
A survey can have several different response rates, depending on the numerator and
denominator chosen among the many available. We calculated the response rate as the
number of individuals who answered the open-ended question divided by the number who
passed eligibility screening.
2.3. Interviews
The purpose of the telephone interview was to gain further insight into members’ social
support experiences. We invited a random sample of approximately 25% of survey
respondents who indicated possible interest in an interview. The honorarium was a $10
Amazon.com gift certificate. The interviewer asked four main questions: (1) “Tell me about
your experiences with using SparkPeople.” (2) “What do you value most about using
SparkPeople?” (3) “How have other SparkPeople members helped with your weight loss
effort?” (4) “In thinking about your interactions with SparkPeople members, how are those
interactions different from your interactions with other people in your life?” The interviews
were recorded and transcribed verbatim.
2.4. Discussion forum messages
In order to corroborate and expand upon the findings from the survey and interviews, we
reviewed messages on SparkPeople discussion forums posted by a broader sample of
members (not just survey/interview participants). We analyzed six general forums related to
weight loss and weight loss behaviors. Since SparkPeople also has member-initiated interest
groups (SparkTeams) with their own forums, we also analyzed three forums within the most
active SparkTeams dedicated to weight loss and weight loss behaviors (Table 1). Within
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each forum, we focused on discussion threads which were started on a randomly selected
day from January 1 to March 31, 2008, which represented the three most recent full months
prior to commencing the study. We imported the text into a database after omitting
identifying information.
2.5. Qualitative analysis of social support themes
The data for qualitative analysis were answers to the survey question (“What kinds of things
have SparkPeople members said or done to help with your weight loss effort in the past 4
weeks?”), interviews, and discussion forum messages. While at least 30 definitions of social
support have been described in the literature, they were not developed in the context of
Internet weight loss communities [3]. The unique combination of weight loss behavior,
Internet communication, and demographics of community members suggests that social
support definitions developed in other contexts may not fit well with Internet weight loss
communities. Thus, we used an inductive, grounded theory approach to identify social
support themes in our data [25,26]. Two investigators (A.G. and R.C.), with no prior
awareness of published social support definitions, independently reviewed the survey
responses, interviews, and forum postings to identify themes. They met with K.H. to
construct categories of social support themes. The categories were refined in iterative cycles
until saturation and final consensus were reached.
2.6. Tabulating social support types
We tabulated the frequency of major social support types, focusing on the survey because
forum postings lacked a consistent structure and there were too few interviews for
quantitative analysis. From the dominant social support types which emerged from the open-
ended survey question, two investigators (A.G. and R.C.) independently categorized all
responses into these types or “other.” Since each survey respondent could give 1–10
answers, we did not consider multiple answers from a given respondent to be independent.
Percent agreement ranged from 88.6 to 100% and Kappa ranged from 0.83 to 1.00 for the 10
answers slots, indicating excellent inter-rater reliability. Differences were resolved by
consensus. Quantitative analysis was performed with SPSS Statistics 17.0 (SPSS Inc.,
Chicago, IL) and SAS 9.1 (SAS Institute Inc., Cary, NC).
3. Results
3.1. Surveys
The overall response rate was 88% (Table 2). The sample consisted of 193 SparkPeople
members who gave a total of 893 and a mean of 4.6 (SD 2.5) responses to the open-ended
question. They were primarily white women from the US (Table 3). More than 75% were
obese or overweight and 48.1% reported at least one weight-related comorbidity. The gender
and age profile was similar to that of the general SparkPeople membership (mean age 39
years and 88% female) [personal communication, David Heilmann, Chief Operating Officer,
SparkPeople, January 21, 2009].
Survey respondents were frequent users of SparkPeople social support features (Fig. 1).
They did the following activities at least once a day over the previous 4 weeks: read
messages related to weight loss on the discussion forums (56.8%), replied to messages
related to weight loss on the forums (36.1%), posted a message related to weight loss on the
forums to start a discussion (18.5%), and used the Internet for anything (94.2%).
Survey respondents generally reported that other SparkPeople members were available,
responsive to questions, empathetic, and welcoming (Table 4). Approximately 60% agreed
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or strongly agreed that SparkPeople members were more helpful than other people with
regards to weight loss support.
3.2. Interviews
Of the 121 survey respondents who indicated initial interest in being interviewed, 28 were
randomly invited, and 13 completed the semi-structured telephone interviews. The
interviewees were white women with mean age 36 (SD 11) years and mean BMI 31 (SD 8)
from the US (12) and Canada (1).
3.3. Qualitative analysis of social support themes
Several themes emerged from the qualitative analysis of surveys, interviews, and forum
postings. Some themes were related to types of interactions, such as sharing information or
encouragement. Other themes were related to cross-cutting characteristics of interactions,
such as convenience and anonymity. Representative quotes from the surveys are provided.
3.3.1. Types of interactions: major themes Information—Members receive
information and advice related to weight loss. They receive personalized advice in response
to a question they had posted on a forum. They also access information by observing
interactions on forums and blogs without posting messages (“lurking”). The topics are
mainly diet/nutrition and exercise/fitness.
“They offer good tips for burning extra calories doing regular everyday things.”
“People have helped in giving ideas on healthy food and snacks when you get
bored of the same old “diet” food.”
“Brought to light several unexpected areas that influence my diet (excessive butter
use in restaurants).”
Encouragement and motivation: Members receive encouragement and motivation to
persist with the lifestyle changes, recover from mistakes, and overcome barriers. Various
interactions cause members to feel that they receive encouragement or motivation. For
example, members are encouraged and motivated by reading a testimony about someone
else’s experience (efforts, success), receiving recognition for success, and keeping each
other accountable with regards to nutrition and physical activity behaviors.
“They encourage you to never give up, but keep on striving for your goals.”
“The photos we can post showing our weight loss journey is a big encouragement
to keep going.”
“They never criticize you for making wrong choices, like a burger at McDonald’s,
and just encourage you to get right back on track.”
Shared experiences: Members discuss and share common goals, struggles, and experiences.
This shared understanding sometimes produces empathy. They also participate in friendly
competition to strive towards a specific goal. This sense of sharing things with other
members leads to non-judgmental interactions and accountability. They described a feeling
of belonging to a team or being among family.
“They have been through the same obstacles”
“We can do this together”
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3.3.2. Types of interactions: subthemes
Testimony: Members read personal accounts of how other members have succeeded in
losing weight. This sometimes provides encouragement and motivation.
“Seeing what others in your same circumstances can accomplish encourages you to
try things that you though [sic] were not possible for you to do.”
“Members writing their success stories really inspires me to not give up when I am
not losing.”
Recognition for success: Members enjoy receiving recognition for success in areas such as
diet, exercise, and actual weight loss. This recognition in turn sometimes provides
encouragement and motivation to persist.
“Lots of congratulations for losing five pounds.”
“Many congratulations when I completed my first half-marathon.”
Accountability: This refers to the process by which members keep each other accountable
for diet and exercise behaviors. Mutual accountability is somewhat based on shared
experiences. Sometimes this leads to encouragement and motivation to persist.
“The accountability from my teams of the weigh-ins has been really helpful in
keeping me in line on the weekends.”
“We check on each other if we haven’t posted in a few days to make sure we are
okay.”
“Another friend and I are Sparkmailing each day to give each other our goals for
the next day and telling how we did the previous day. We will sometimes
communicate multiple times a day.”
Friendly competition: Members participate in individual or team-based challenges to reach
specific short-term goals, such as losing a certain number of pounds within a certain
timeframe. This characteristic is also related to shared experiences.
“Participating in team challenges has helped me “trim the fat” so to speak from my
weight loss plan and get the scale moving downward again.”
“I participate in a few “challenges” that other members have designed. Knowing
that I’m going to be documenting and sharing information about a behavior makes
me far more likely to carry it out.”
“Being a part of a team, gives it somewhat of a competitive nature to try to exercise
more to climb up the team leader-board for exercise minutes. That’s definitely a
help to my weight loss efforts.”
Humor: Members laugh with each other and at themselves as they encounter and deal with
struggles in their weight loss journey.
“We can laugh about our problems with weight control”
Face-to-face interactions: Some members reported that they met other local members for
group exercise sessions.
“We have organized walks planned and meet once a month.”
“They are available to exercise with me (walking, jogging, etc.)”
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3.3.3. Characteristics of interactions
Anonymous: Members appreciate the option to remain anonymous. The anonymity gives
members the freedom to discuss sensitive topics in an honest fashion. The anonymity also
creates an environment in which interactions are non-judgmental.
“Having the anonymity helps as you can “talk” and no one holds that against you or
throws it back in your face at a later time.”
Non-judgmental: Members feel that other members don’t judge them negatively when they
report failures or struggles. Although members can (and often do) attach pictures of
themselves to their forum postings, they don’t have to do so. This saves them from being
judged by their physical appearance. This is related to anonymity.
“Support and understanding without judgement from people with the same
problem.”
Convenient: The sheer volume of members creates a dynamic environment in which
members can receive responses to questions at any time of the day or night, often within
minutes or hours, regardless of physical location. Members who are geographically isolated
from other people trying to lose weight find this convenient.
“Participating in the forums keeps me distracted during times when I might be
tempted to eat out of boredom.”
Different from other interactions: Members report experiencing convenient, non-
judgmental, supportive, empathetic interactions with other members which they otherwise
would not experience with other people in their life (e.g. spouse and family). Much of this
support is based on shared experiences. Additionally, members don’t tempt each other to go
out and eat unhealthy food as a group.
“I can share good news and get great responses. In my daily interactions with
people face to face, diet and exercise discussions are often met with screwed up
faces and jealousy, or flat out disdain for my commitment.”
“They’re like a family. No one tears you down or believes your statements/
questions are dumb. They’re better than family, actually. A great support group.”
“It’s encouraging to just talk with others who need to lose weight also and know
how difficult it can be especially when the people around you don’t have the same
weight issues.”
Reciprocal support: Some members also mentioned how they enjoy giving support to
others:
“They shared a problem that got me thinking of ways to help - and in helping them
I help myself learn too”
In addition to corroborating findings from the surveys and interviews, discussion forum
messages yielded additional insight into how community members communicate. Many
messages had permanent features, akin to signatures in emails. These features included a
weight tracker (listing the starting, current, and goal weight), photos of the message poster,
motivational quotes, future rewards for achieving goals (e.g. pedicure for losing next 10
pounds), and links to the poster’s personal SparkPage.
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3.4. Tabulating social support types
From the qualitative data, we identified the three most common types of social support
interactions for quantitative analysis: encouragement and motivation, information, and
shared experiences. We applied these categories to the free-text answers to the open-ended
survey question “What kinds of things have SparkPeople members said or done to help with
your weight loss effort in the past 4 weeks?” Encouragement and motivation was the most
commonly reported type of support, mentioned at least once by 87.6% (169/193) of survey
respondents, followed by information (58.5%) and shared experiences (42.5%).
4. Discussion
Members of a large Internet weight loss community exchange social support in the form of
encouragement and motivation, information, and shared experiences. The support is similar
to face-to-face social support, but also offers the unique aspects of convenience, anonymity,
and non-judgmental interactions. Our findings have implications for the potential role of
Internet weight loss communities as a resource for clinicians to recommend to patients.
A strength of this study was the use of multiple data sources. Studies of online social support
in other health domains analyzed forum postings [4,5] or conducted surveys of members
[14,15,27]. We evaluated forum postings, surveys, and interviews. We also employed a
context-specific, inductive approach to explore social support as described by members of
the online community [3], rather than constraining the evaluation to previous definitions of
social support developed in other contexts. To our knowledge, this is the first description of
social support among members of a public Internet weight loss community.
The study also had several limitations. First, findings may not generalize to other weight
loss communities, although the specific communication avenues (e.g. forums, email, and
blogs) are not likely to vary widely between online communities. Second, survey and
interview participants were mostly white women. However, the predominance of white
women is consistent with the general SparkPeople membership, other online health
communities [14,15,27,28], and, to a lesser extent, US internet users [29]. Third, we could
not calculate all possible response rates for the survey. We do not know how many members
viewed the study announcement on the forums. Nor do we know how many of the 3000
members invited by email would have participated if there was no cap of 250. The response
rates using known denominators were acceptable (Table 2). Fourth, selection bias likely
occurred, such that survey respondents may have been more active in the SparkPeople
community or had more positive social support interactions compared to nonrespondents.
However, survey respondents were similar in age and gender to the general membership. We
also analyzed discussion forum messages from a broader sample of members to corroborate
findings from the survey and interviews. Fifth, questions about interactions with other
SparkPeople members (Table 4) were worded positively, which might have led to social
desirability bias in how respondents answered the questions. However, the response scale
was balanced, with two positive and two negative choices flanking a neutral middle choice.
Nevertheless, the possibility of these biases suggests that our findings depict social support
benefits of active participants in an Internet weight loss community, rather than a definitive
summation of experiences. Accessing people who quit due to negative experiences or
explicitly asking current participants about negative experiences would yield additional
information about these communities. Lastly, we did not explore the use of other community
features which may also aid weight management, such as nutrition and physical activity
tracking tools.
Consistent with descriptions of face-to-face social support [1–3], the major types of online
social support for weight loss in this study are encouragement and motivation, information,
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and shared experiences. These themes are not mutually exclusive. Because of their shared
experience of trying to lose weight, SparkPeople members share day-to-day encouragement/
motivation and information frequently not available from “offline” contacts. These types of
support are also shaped by unique characteristics of convenience, anonymity, and non-
judgment.
For example, the prominence of encouragement and motivational support, similar to
emotional and appraisal support, is appropriate considering the chronic behavioral
modifications necessary for weight loss. Reading testimonies from peers who have lost
weight may be particularly helpful, since weight loss is correlated with the weight loss
success of peer supporters [8]. Online peers may be more accessible and helpful than
clinicians or offline friends who are not experiencing the same challenges. SparkPeople
members value the ability to receive such support conveniently and without fear of
judgment.
The importance of informational support to our participants is consistent with our previous
work [30–32] and other descriptions of online and traditional social support [1,3–
5,14,15,27]. Not only has the Internet supplanted clinicians as the primary source of health
information for the American public [33], but the primacy of read-only Web resources
created by a central core of experts (“Web 1.0”) is giving way to online communities which
offer the collective wisdom of peers (“Web 2.0”) [13].
The shared experiences aspect of online support for weight loss is akin to the concept of
network support [4,5]. The sense of unity among SparkPeople members is forged not by
geographic proximity, but by the common endeavor to lose weight. Our findings resonate
with a previous depiction of Internet health communities as “weak tie” networks,
characterized by relatively low time commitment, emotional intensity, and intimacy [17,34].
The SparkPeople community offers benefits of weak tie networks, such as diverse sources of
support and a safe environment to disclose information without judgment or stigmatization,
which lead to integration within the community [17,34].
As traditionally defined, instrumental (tangible) support was not a major type of support
described by SparkPeople members. However, this dimension is growing. SparkPeople
members occasionally meet in their local communities for group exercise sessions. There
were also two national conventions for members in 2009. Furthermore, if instrumental
support is that which helps a person lose weight (rather than just cope with being
overweight), then many interactions among SparkPeople members might be cast as
instrumental support. For example, members reported that advice, encouragement,
accountability, and friendly competition empowered them to perform behaviors which
directly led to weight loss.
In this aspect, the benefits of online support for weight loss may surpass the benefits of
support for other health conditions, although this hypothesis would be difficult to test. For
example, online social support for psoriasis [14], infertility [15], Huntington’s disease [4],
and HIV [5] can help an individual cope with the psychosocial stressors associated with the
health condition, make informed health decisions, and find healthcare providers. In this
study, members of the Internet weight loss community reported similar benefits, but also
reported that the support actually helped them lose weight.
This online weight loss community, by providing a venue for social support, functions as a
valuable weight loss resource for active participants. As the obesity epidemic overwhelms
the capacity of clinicians to provide weight loss counseling [35–39], it is unrealistic to
expect clinicians to create and maintain venues for social support. Instead, they could refer
patients to sustainable social support resources, such as SparkPeople.com and other similar
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online communities. Ideally, these communities would provide social support as an adjunct
to structured counseling. While concerns exist about the accuracy of online health
information, we have previously shown that weight loss advice in this community (and
others) is generally accurate compared to clinical guidelines [30].
However, several questions remain unanswered. First, which types of people will join and
participate in these communities when referred by clinicians? Current SparkPeople members
are primarily white women, but a more sophisticated understanding of psychosocial,
socioeconomic, and clinical predictors of community participation is needed. Second, can
modifications to these communities increase participation of men and ethnic minorities, or
are other interventions needed? Most importantly, what is the objective effect of online
social support via these communities in terms of weight loss and other patient-valued
outcomes? These questions require prospective studies.
In conclusion, this Internet weight loss community plays a prominent role in participants’
weight loss efforts—roles which might not be adequately filled by clinicians or offline
family and friends. Internet-mediated support provides similar benefits as face-to-face
support, with unique convenience, anonymity, and lack of judgment. Participants report that
the support from this Internet community helps them lose weight as well as cope with being
overweight. Internet weight loss communities merit further evaluation as a potential
resource for clinicians to recommend to patients, especially communities which are free and
open to the public.
Summary points
What was already known:
Face-to-face peer social support facilitates weight loss efforts.
Internet health communities allow individuals to interact with peers who share
similar health issues and concerns.
What this study adds:
Online social support interactions play a prominent role in the weight loss
efforts of members of a large, public Internet weight loss community.
The support is manifested as encouragement and motivation, information, and
shared experiences and it is characterized as convenient, anonymous (if desired),
and non-judgmental.
Community members report that the social support helps them cope with being
overweight and helps them lose extra weight.
Acknowledgments
We thank David Heilmann at SparkPeople for assistance with recruiting participants for the surveys. We also thank
Lynn Medeiros for transcribing the interviews. This study was supported in part by a Clinical Investigator Award
(Center for Clinical Research and Evidence-Based Medicine) and a Pilot Project Award (Center for Clinical and
Translational Sciences), both from The University of Texas Health Science Center at Houston. The funding sources
had no role in designing the study; collecting, analyzing, or interpreting the data; or preparing or submitting the
manuscript for publication.
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Fig. 1.
Use of social support features over the previous 4 weeks.
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Table 1
Discussion forums.
Forum Threads Messages
General forums
“SparkPeople Fast Break”
forum 5 15
“Fitness and Exercise” forum 39 188
“Diet and Nutrition” forum 61 492
“Staying Motivated” forum 25 217
“Panic! Button for Immediate
Help” forum 17 107
“Woo Hoo! Button to
Celebrate Success!” forum 26 173
Within SparkTeams
Forums within “Fitness and
Exercise” SparkTeams 12 121
Forums within “Nutrition
and Cooking” SparkTeams 6 120
Forums within “Weight
Issues” SparkTeams 26 491
Total 217 1924
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Table 2
Survey response rate.a.
Began eligibility screening Eligible Answered open-ended question Response rate
Recruited via forum posting 31 30 24 80%
Recruited via email 250b190 169 89%
Total 281 220 193 88%
aResponse rate calculated as the number of individuals who answered the open-ended question divided by the number who passed eligibility
screening.
bPre-set cap of 250.
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Table 3
Demographic and clinical characteristics of 193 survey participants.
Characteristic Total n
available n (%) or
mean (SD)
Age, mean (SD) 191 37.3 (11.5)
Female, n (%) 191 181 (93.8)
Ethnicity and race, n (%) 187
White, non-Hispanic 166 (88.8)
White, Hispanic 5 (2.7)
Black, non-Hispanic 10 (5.3)
Asian, non-Hispanic 2 (1.1)
Native Hawaiian/Pacific Islander,
non-Hispanic 0
American Indian/Alaska Native,
non-Hispanic 1 (0.5)
Multiracial 3 (1.6)
Married, n (%) 191 121 (63.4)
Highest education completed, n (%) 191
Graduate or professional school 37 (19.4)
College or university 106 (55.5)
High school 48 (25.1)
Employment status, n (%) 190
Full time 117 (61.6)
Part time 22 (11.6)
Homemaker 25 (13.2)
Retired 3 (1.6)
Student 16 (8.4)
Unable to work/disabled 3 (1.6)
Unemployed 4 (2.1)
Geographic location, n (%) 191
United States (37 states) 180 (94.2)
Canada 7 (3.7)
United Kingdom 1 (0.5)
Other 3 (1.6)
Annual household income, n (%) 186
≥$80,000 55 (29.6)
$70,000–79,999 22 (11.8)
$60,000–69,999 19 (10.2)
$50,000–59,999 23 (12.4)
$40,000–49,999 24 (12.9)
$30,000–39,999 17 (9.1)
$20,000–29,999 14 (7.5)
$10,000–19,999 7 (3.8)
$0–9999 5 (2.7)
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Characteristic Total n
available n (%) or
mean (SD)
BMIa, mean (SD) 190 30.9 (7.5)
BMIa categories, n (%) 190
Less than 25 46 (24.2)
25 to 29.99 53 (27.9)
30 to 34.99 45 (23.7)
35 or greater 46 (24.2)
Weight-related comorbidities, n (%)
Diabetes 185 8 (4.3)
Borderline or pre-diabetes 184 12 (6.5)
Hypertension 185 21 (11.4)
High cholesterol or triglycerides 188 45 (23.9)
Sleep apnea 184 17 (9.2)
Arthritis 184 36 (19.6)
Esophageal reflux 185 30 (16.2)
polycystic ovary syndrome 182 14 (7.7)
aBody mass index.
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Table 4
Views about other SparkPeople members.
Statement Strongly agree
N (%) Agree
N (%) Neutral
N (%) Disagree
N (%) Strongly disagree
N (%) Total
N (%)
They are available when
I need help. 97 (50.3) 80 (41.5) 16 (8.3) 0 (0.0) 0 (0.0) 193
They respond quickly to
my questions or
requests.
89 (46.1) 77 (39.9) 25 (13.0) 2 (1.0) 0 (0.0) 193
They understand what
I’m going through. 140 (72.5) 51 (26.4) 2 (1.0) 0 (0.0) 0 (0.0) 193
They make me feel part
of a group. 105 (54.4) 73 (37.8) 14 (7.3) 1 (0.5) 0 (0.0) 193
My interactions with
them are anonymous. 57 (29.5) 47 (24.4) 45 (23.3) 32 (16.6) 12 (6.2) 193
They are more helpful
than other people in
my life.
45 (23.6) 70 (36.6) 54 (28.3) 20 (10.5) 2 (1.0) 191
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... Besides, consumers seek support and accountability through their social networks (Pagoto et al., 2014) which can substitute for health-oriented group sessions, one-to-one counseling and other kind of health interventions (Davies et al., 2012;Hales, Davidson and Turner-McGrievy, 2014;Harvey-Berino et al., 2010). Social media platforms including Facebook (Merchant et al., 2014;Napolitano et al., 2012), Twitter Tate, 2011, 2013), and online support communities (Hwang et al., 2010) have been used to provide social support during weight loss interventions. ...
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Acknowledgments For sharing their personal stories and professional insights with me and readers of this report, I thank: Jack Barrette, WEGOHealth; Eugene Barsky, University of British Columbia; Bonnie Becker, Yahoo! Health; Robert Coffield, Esquire, Flaherty, Sensabaugh & Bonasso; Beth Comstock, NBC Universal; Noah Elkin, Steak Media (formerly of iCrossing); Susannah Fox, Pew Internet & American Life Project; Dean Giustini, University of British Columbia; Bruce Grant, Digitas Health; Ben Heywood, PatientsLikeMe; Daniel Hoch, M.D., Harvard Medical School; Matthew Holt, Health 2.0 Conference and The Health Care Blog; Fard Johnmar, Envision Solutions; David Kibbe, M.D., American Association of Family Practice, Center for Health Information Technology; Dmitriy Kruglyak, Trusted.MD; Michelle Lee, WiserWiki/ Elsevier; Monique Levy, JupiterMedia; Jude O’Reilley, Trusera; Carolina Petrini, ComScore Networks; Sarah Radwanick, ComScore Networks; Meredith Abreu Ressi, Manhattan Research; Joshua Seidman, Center for Information Therapy; Scott Shreeve, M.D., Crossover Healthcare; Ted Smith, MedTrackAlert; Neal Sofian, Resolution Health; Chloe Stromberg, Forrester Research; Amy Tenderich, DiabetesMine; Debbie Weil, corporate blogging and social media consultant; and Matthew Zachary, I’m Too
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