Innovative Technology To Improve Patient Adherence To Weight Loss Recommendations

Overweight/obesity is a major health problem that affects over two-thirds of Americans,
increases morbidity and mortality and has annual medical costs exceeding $75 billion.
Although many Americans indicate that they are trying to lose weight, adherence to weight
loss regimens is often poor. Programs are needed that can improve adherence and weight loss
for overweight/obese individuals. Physicians play an important role in motivating patients
to improve health behaviors and recent reviews suggest that having physicians advise
patients to lose weight and then referring patients to an effective program produces the
best behavior change and maintenance. The problem, however, is that physicians currently
have limited options for such referrals. The challenge for the field is to develop a program
to which physicians can refer their overweight/obese patients. The program must be low cost,
easily accessible, and must promote adherence to the weight loss regimen and consequently
improve weight loss outcomes.

The goal of this Challenge Grant application is to develop and test an innovative web-based
program that would provide an accessible and effective approach to enhancing adherence to
clinical recommendations for weight loss. If effective, the program would provide an
outstanding resource for physicians and their patients and could consequently have important
clinical and public health impact.

We propose to develop a program based on our prior research that uses innovative Internet
technology to provide a low cost, easily disseminated program that captures two critical
elements of effective behavioral weight loss programs—namely, training in key behavioral
weight control strategies and increased participant accountability. Patients, referred by
their physician for weight loss, will be offered a 12 week program that they can view at
their convenience on their computer. The program will use Web-based interactive multi-media
approaches for presentation of the behavioral skills and provide a Web-based form for
submission of self-monitoring and weight data; to maximize patient accountability, the
program will include a system of automated feedback for participants, which comments on
their weight loss to date and their performance within several behavioral weight-loss
domains, with suggestions tailored to the characteristics and performance of the individual.
Periodic reports on the patients' progress will also be sent to the referring physician. We
will test this program in a randomized trial with 250 patients referred by their physicians
who will be randomly assigned to either Internet Education (Control) (N=125) or to the
Innovative Technology program (N=125). Participants in both groups will receive a 12 week
Internet program of either basic weight loss education or the Innovative Technology program
and will be weighed at the start and end of the 3 month program and at 3 month follow-up.
The primary hypothesis is that patients who are assigned to the Innovative Technology
program will achieve larger average weight losses than those in the control group over the
12-week program. Secondary hypotheses are that the Innovative technology group will adhere
better over the 12-weeks (assessed by log-ins to the web site and self-reported changes in
diet and activity) and achieve better weight losses at 6 months than the control group.

The proposed project addresses the significant problem of obesity and uses innovative
technology to improve adherence to a behavioral weight loss strategies. If the program is
effective, it would provide an outstanding resource for physicians to use with their
patients and thus would have tremendous clinical impact.

Inclusion Criteria:

1. BMI between 25 and 45 kg/m2

2. Referred by their physician because of an obesity-related co-morbidity, such as
diabetes, hypertension or metabolic syndrome

3. All ethnic groups will be recruited

4. No health problems that make weight loss or unsupervised exercise unsafe

5. English speaking

6. Have access to a computer and the Internet

Exclusion Criteria:

1. report a heart condition, chest pain during periods of activity or rest, or loss of
consciousness

2. are currently pregnant or intend to become pregnant in the next 12 months

3. are planning to move outside of the state within the next 12 months

4. have participated in a study conducted by the Weight Control & Diabetes Research
Center in the past 2 years