The more frequently you log on, the more weight you can keep off, study finds

The National Institutes of Health-funded study evaluated an Internet-based weight maintenance intervention involving 348 participants. Consistent website users who logged on and recorded their weight at least once a month for two-and-a-half years maintained the most weight loss, the study found.

"Consistency and accountability are essential in any weight maintenance program. The unique part of this intervention was that it was available on the Internet, whenever and wherever people wanted to use it," said study lead author Kristine L. Funk, MS, RD, a researcher at the Kaiser Permanente Center for Health Research in Portland, Ore.

"This study shows that if people use quality weight management websites consistently, and if they stick with their program, they are more likely to keep their weight off," said study co-author Victor J. Stevens, PhD, co-author and senior investigator at the Kaiser Permanente Center for Health Research. "Keeping weight off is even more difficult than losing it in the first place, so the fact that so many people (in the study) were able to maintain a good portion of their weight loss is very encouraging to us."

This internet-based weight maintenance intervention was part of the Weight Loss Maintenance Trial, one of the largest and longest weight maintenance trials ever conducted -- lasting three years and including more than 1,600 people at four study sites across the United States. To enroll in the trial, participants had to be overweight or obese based on their Body Mass Index and taking medication for high blood pressure or high cholesterol. For the first six months, participants tried to lose weight by attending weekly group meetings at which they were weighed, encouraged to keep food diaries, and given extensive information about exercise and healthy eating.

Participants had to lose at least nine pounds to remain in the trial for the weight loss maintenance phase, which lasted an additional two-and-a-half years and included three groups of randomized participants: one with no intervention, one that had monthly contact with a personal health coach, and one that was given unlimited access to a weight-maintenance website created specifically for the trial.

The internet group included 348 participants who were encouraged to log in at least once a week. If they didn't, they received e-mail reminders and follow-up automated phone messages. Once on the website, participants were prompted to record their weight, their minutes of exercise, and the number of days they kept food diaries. If they went longer than seven days without recording a weight, the other parts of the website were disabled until they did record their weight. The website included an interactive bulletin board on which participants could talk with others involved in the study and pose questions to nutrition and exercise experts.

During the first six months of the trial, while they were attending group sessions and before they had access to the website, participants who ended up in the internet group had lost an average of 19 pounds. Once they were given website access, their objective was to keep off as much of that weight as possible. Consistent users who logged in and recorded their weight at least once a month for 24 months maintained the greatest weight loss -- keeping off an average of nine of the 19 pounds they'd lost during the initial weight loss phase of the trial. Those who logged on less consistently -- at least once a month for 14 months -- kept off an average of five pounds. Those who logged on less than that kept off an average of only three pounds of their original weight loss.

At the end of the study, 65 percent of the participants were still logging on to the website. The study authors say they are encouraged by this level of participation because they say it is rare to see that kind of commitment -- even in shorter-term weight maintenance studies that use the internet.

While the study website is no longer available, there are many useful weight management websites that people can access. The study authors advise consumers to look for these important elements:

• Sites that encourage accountability by asking users to consistently record weight, exercise, and calories consumed
• Sites that include tailored or personalized information
• Sites with interactive features that allow users to communicate with each other and with nutrition and exercise experts
• Sites with accurate health information.

This study was funded by a grant from the National Health, Lung and Blood Institute, which is part of the National Institutes of Health. Authors include Kristine L. Funk, MS, RD, Victor J. Stevens, PhD, Alan Bauck, Jack Hollis, PhD, and William M. Vollmer, PhD, from the Kaiser Permanente Center for Health Research in Portland, Ore.; Lawrence J. Appel, MD, Janelle W. Coughlin, PhD, Arlene T. Dalcin, RD, from Johns Hopkins University School of Medicine in Baltimore, Md.; Phillip J. Brantley, PhD, Catherine M. Champagne, PhD, Betty M. Kennedy, PhD, and Valerie H. Myers, PhD, from Pennington Biomedical Research Center in Baton Rouge, La.; Jean Harvey-Berino, PhD, RD, from the University of Vermont in Burlington; Gerald J. Jerome, PhD, from Towson University, Department of Kinesiology, Townson, Md.; and Lillian F. Lien, MD, Carmen D. Samuel-Hodge, PhD, and Laura Svetsky, MD, from Duke University Medical Center in Durham, N.C.