Clinical Question: How effective are Internet weight loss programs?

Setting: Outpatient (any)

Study Design: Randomized controlled trial (nonblinded)

Synopsis: Many patients turn to the Internet for information about weight loss. In this study, 92 participants with a mean age of 48.5 years and a mean body mass index of 33.1 were randomized (uncertain allocation concealment) to a basic Internet weight loss program or to an Internet plus behavioral E-mail counseling program.

Both groups received face-to-face counseling during a one-hour weight loss session. The basic study program provided a tutorial on weight loss, a new tip and Web address link each week, and a directory of selected weight loss resources. Participants in the behavioral E-mail counseling group underwent the same procedures as persons in the basic Internet group, plus they communicated regularly with an assigned weight loss counselor, initially five times per week for a month and then at least once weekly for 11 months. Counselors' E-mails provided feedback on self-monitoring records, answers to questions, recommendations, and general support.

Weight loss was measured in the clinic at baseline and again at three, six, and 12 months. Eighty-four percent of subjects completed the 12-month follow-up. Using intention-to-treat analysis, subjects in the behavioral E-counseling group lost significantly more weight than those in the basic Internet group (4.4 kg [9.7 lb] versus 2.0 kg [4.4 lb]; P =.04).

Bottom Line: Internet weight loss programs that provide one-to-one E-mail counseling feedback are more effective than those that simply provide written instructions. Another study in the same issue of this journal concludes that group interactive weight loss programs, such as Weight Watchers, are more effective than simply providing patients with written diet instructions. (Level of Evidence: 1b)