Integrative Medicine Blog: Weight Loss Improved By Computer Automated E-counseling

Behavioral counseling that is computer automated can enhance weight loss for individuals following a web-based weight loss program. This is the finding of a research study appearing in the August 14 issue of Archives of Internal Medicine conducted by researchers at The Miriam Hospital and University of North Carolina. "As consumers continue to seek information on the web, it's essential that we identify and improve on the components of internet weight loss programs that make them successful," says Deborah Tate, PhD, lead author of the study and assistant professor in the School or Public Health at the University of North Carolina. "In past studies, we found that ongoing expert support delivered via email counseling was an effective tool in web-based weight loss programs.

This study's goal was to determine if computer automated guidance could also be advantageous to individuals looking to lose weight through the web." More than 65 percent of Americans are overweight or obese. Prior studies conducted by this research team have found that internet weight loss programs are more effective with the inclusion of email counseling from an expert.

Automating such counseling has the potential to reach larger populations at a fraction of the cost of more intensive interventions. "Compared to email counseling provided by a human, a computer pre-programmed with messages based on specific criteria is a highly efficient treatment approach that can be more widely disseminated among the population in need," says co-author Rena Wing, PhD, Director of the Weight Management and Diabetes Research Center at The Miriam Hospital and Brown Medical School.

One hundred ninety-two overweight or obese adults were randomly assigned to one of three treatment groups: a group receiving no email counseling, a group receiving computer automated counseling, or a group receiving counseling via email from a human. Participants in all groups were oriented and encouraged to follow an internet weight loss program, with the automated and human groups also having access to an electronic diary and message board. In addition, the human group received weekly email feedback from a counselor, while the automated group received computer automated feedback messages.

All three groups were measured at the start of the program, three months and six months. The primary measure was change in body weight although physical activity, dietary intake, and login frequency to the program's website was also monitored. "We found that both the human and computer automated groups lost significantly more weight than the group without counseling after three months," says Tate.

While average weight loss was similar for both groups receiving e-counseling at three months - the authors found that at six months, the human group experienced the greatest overall weight loss, averaging a loss of 13 to 15 pounds. "Findings supported our previous research suggesting that human email counseling improves weight loss, but it also implies that computer automated feedback was sufficient to promote short-term adherence to diet and exercise and result in a weight loss that could have important health benefits," says Tate.

The authors cite that those in the computer automated group averaged an overall weight loss of 8 to 10 pounds and 34 percent achieved a weight loss of more than 5 percent of their initial weight; considered a clinically meaningful weight loss. In addition, participants in the computer automated group achieved weight losses equivalent to human e-counseling for the first three months. "Further research is needed to improve the computerized approach to promote continued adherence over a longer period of time, but from a public health perspective - this is a promising area to explore," says Wing.

### The Miriam Hospital, established in 1926 in Providence, RI, is a not-for-profit hospital affiliated with Brown Medical School. Nationally recognized as a top hospital in cardiovascular care, The Miriam Hospital (http://www.miriamhospital.org/) offers particular expertise in cardiac catheterization, angioplasty and women's cardiac care.

One of 20 designated Center for AIDS Research (CFAR) sites, The Miriam is a leader in the treatment, research and prevention of HIV/AIDS, attracting $17 million of the world's HIV/AIDS research dollars. The Miriam Hospital has been awarded Magnet Recognition for Excellence in Nursing Services three times and is committed to excellence in patient care, research and medical education. The Miriam is a founding member of the Lifespan health system. The University of North Carolina at Chapel Hill (http://www.unc.edu/) was the first state university to open its doors, in 1795.

UNC's academic offerings span more than 100 fields, including bachelor's, master's and doctoral degrees as well as professional degrees in dentistry, medicine, pharmacy and law. Five health schools -- which, with UNC Hospitals, comprise one of the nation's most complete academic medical centers -- are integrated with liberal arts, basic sciences and high-tech academic programs. UNC's School of Public Health, with more than 200 full-time faculty members and 1.600 students, is the nation's top ranked public school of public health (/US News & World Report, 2003/).
Contact: Megan Martin (Miriam Hospital) Lifespan

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