The Internet for weight control in an obese sample: Results of a randomised controlled trial

Food, Consumer Behaviour and Health Research Centre, University of Surrey, Guildford, Surrey, UK.
BMC Health Services Research (Impact Factor: 1.71). 02/2007; 7(1):206. DOI: 10.1186/1472-6963-7-206
Source: PubMed


Rising levels of obesity coupled with the limited success of currently available weight control methods highlight the need for investigation of novel approaches to obesity treatment. This study aims to determine the effectiveness and cost-effectiveness of an Internet-based resource for obesity management.
A randomised controlled trial conducted in a community setting, where obese volunteers (n = 221) were randomly assigned to Internet group (n = 111) or usual care group (n = 110). Objective measures of weight and height were obtained. Questionnaires were used to collect dietary, lifestyle, physical activity and quality of life data. Data were collected at baseline, six months and 12 months.
Data were collected on 54 (49%) participants in the Internet group and 77 (70%) participants in the usual care group at 12 months. Based on analysis conducted on all available data, the Internet group lost 1.3 kg, compared with 1.9 kg weight loss in the usual care group at 12 months, a non-significant difference (difference = 0.6 kg; 95% CI: -1.4 to 2.5, p = 0.56). No significant differences in change in secondary outcome measures between the two groups at six or 12 months were revealed. Total costs per person per year were higher in the Internet group than the usual care group ( pound992.40 compared to pound276.12), primarily due to the fixed costs associated with setting up the website, and QALYs were similar (0.78 and 0.77) for both groups.
This trial failed to show any additional benefit of this website in terms of weight loss or secondary outcome measures compared with usual care. High attrition and low compliance limits the results of this research. The results suggest that the Internet-based weight control resource was not a cost-effective tool for weight loss in the obese sample studied.
ISRCTN 58621669.

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Available from: Sara F L Kirk
    • "UK Obese adults with a BMI ≥ 30 kg/m 2 Base case model for average 50 year old male Results reported by sex sub-group. Most other analyses on men only Primary care An E-learning device, based on that reported in McConnon et al. [32], used to provide advice, tools and information to support behaviour change in dietary and exercise patterns. Based on patient self-management and individualised based on their own needs. "
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    ABSTRACT: Increasing obesity related health conditions have a substantial burden on population health and healthcare spending. Obesity may have a sex-specific impact on disease development, men and women may respond differently to interventions, and there may be sex-specific differences to the cost-effectiveness of interventions to address obesity. There is no clear indication of cost-effective treatments for men. This systematic review summarises the literature reporting the cost-effectiveness of non-surgical weight-management interventions for men. Studies were quality assessed against a checklist for appraising decision modelling studies. Although none of the included studies explicitly set out to determine the cost-effectiveness of treatment for men, seven studies reported results for subgroups of men. Interventions were grouped into lifestyle interventions (five studies) and Orlistat (two studies). The retrieved studies showed promising evidence of cost-effectiveness, especially when interventions were targeted at high-risk groups, such as those with impaired glucose tolerance. There appears to be some sex-specific elements to cost-effectiveness, however, there were no clear trends or indications of what may be contributing to this. The economic evidence was highly uncertain, and limited by variable methodological quality of the included studies. It was therefore not possible to draw strong conclusions on cost-effectiveness. Future studies are required to demonstrate the cost-effectiveness of interventions specifically targeted towards weight loss for men. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.
    No preview · Article · Apr 2015 · Obesity Research & Clinical Practice
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    • "This feasibility trial identified some important issues relevant to optimising both the intervention and trial procedures. With regard to adherence to the intervention, patient completion of online sessions appeared comparable to most web-based weight management interventions, in which attrition is typically high [39], and importantly was better than the attrition rates typically observed in interventions with no health professional contact [10,40,41]. Since session completion rates were very similar across all intervention groups, including the web-based only group, this suggests that even the basic contact with primary care involved in nurse recruitment and weight monitoring for the trial at 6 and 12 months may have been sufficient to reduce patient attrition. "
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    ABSTRACT: There is a need for cost-effective weight management interventions that primary care can deliver to reduce the morbidity caused by obesity. Automated web-based interventions might provide a solution, but evidence suggests that they may be ineffective without additional human support. The main aim of this study was to carry out a feasibility trial of a web-based weight management intervention in primary care, comparing different levels of nurse support, to determine the optimal combination of web-based and personal support to be tested in a full trial. This was an individually randomised four arm parallel non-blinded trial, recruiting obese patients in primary care. Following online registration, patients were randomly allocated by the automated intervention to either usual care, the web-based intervention only, or the web-based intervention with either basic nurse support (3 sessions in 3 months) or regular nurse support (7 sessions in 6 months). The main outcome measure (intended as the primary outcome for the main trial) was weight loss in kg at 12 months. As this was a feasibility trial no statistical analyses were carried out, but we present means, confidence intervals and effect sizes for weight loss in each group, uptake and retention, and completion of intervention components and outcome measures. All randomised patients were included in the weight loss analyses (using Last Observation Carried Forward). At 12 months mean weight loss was: usual care group (n = 43) 2.44 kg; web-based only group (n = 45) 2.30 kg; basic nurse support group (n = 44) 4.31 kg; regular nurse support group (n = 47) 2.50 kg. Intervention effect sizes compared with usual care were: d = 0.01 web-based; d = 0.34 basic nurse support; d = 0.02 regular nurse support. Two practices deviated from protocol by providing considerable weight management support to their usual care patients. This study demonstrated the feasibility of delivering a web-based weight management intervention supported by practice nurses in primary care, and suggests that the combination of the web-based intervention with basic nurse support could provide an effective solution to weight management support in a primary care context. Trial registration Current Controlled Trials ISRCTN31685626.
    Full-text · Article · May 2014 · International Journal of Behavioral Nutrition and Physical Activity
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    • "A number of economic evaluations of web-based interventions to promote weight loss have previously been published [24,45-47]. McConnon et al. [24] concluded that it cost about £40,000 per additional QALY if an internet programme replaced usual care, while the two other studies reported ICERs nearer US$5,000 to $7,000 per life-year gained. "
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    ABSTRACT: The prevalence of obesity is over 25 % in many developed countries. Obesity is strongly associated with an increased risk of fatal and chronic conditions such as cardiovascular disease and type 2 diabetes. Therefore it has become a major public health concern for many economies. E-learning devices are a relatively novel approach to promoting dietary change. The new generation of devices are 'adaptive' and use interactive electronic media to facilitate teaching and learning. E-Learning has grown out of recent developments in information and communication technology, such as the Internet, interactive computer programmes, interactive television and mobile phones. The aim of this study is to assess the cost-effectiveness of e-learning devices as a method of promoting weight loss via dietary change. An economic evaluation was performed using decision modelling techniques. Outcomes were expressed in terms of Quality-Adjusted Life-Years (QALYs) and costs were estimated from a health services perspective. All parameter estimates were derived from the literature. A systematic review was undertaken to derive the estimate of relative treatment effect. The base case results from the e-Learning Economic Evaluation Model (e-LEEM) suggested that the incremental cost-effectiveness ratio was approximately £102,000 per Quality-Adjusted Life-Year (QALY) compared to conventional care. This finding was robust to most alternative assumptions, except a much lower fixed cost of providing e-learning devices. Expected value of perfect information (EVPI) analysis showed that while the individual level EVPI was arguably negligible, the population level value was between £37 M and £170 M at a willingness to pay between £20,000 to £30,000 per additional QALY. The current economic evidence base suggests that e-learning devices for managing the weight of obese individuals are unlikely to be cost-effective unless their fixed costs are much lower than estimated or future devices prove to be much more effective.
    Full-text · Article · Jul 2012 · BMC Health Services Research
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