Disseminating Effective Habits for Long-Term Weight Loss

Overweight and obesity are serious threats to public health. Over the last 20 years, the
percentage of overweight and obese Americans, as well as the rate of diabetes, have grown
tremendously (Cowie, Rust et al. 2006).

Few individuals are successful at long-term weight loss. Long-term weight loss is an
elusive, yet sought after goal for many Americans (2000). Fewer than 5% of adults are
successful in maintaining a 20 pound weight loss for at least 2 years (Klem, Wing et al.
1997). While medications can be effective, they produce only small amounts of weight loss,
carry a significant cost and appear to be effective only while being taken (2000). Surgery
is an effective option, though the procedure has tremendous costs and potential
complications (2000). This points to the need for innovative and effective treatments that
helps individuals over the longer-term.

Some, but not all, web-based treatments for weight loss have been shown to be effective. A
recent study by Tate and colleagues showed that individuals who received counseling emails
from a human or automated emails from a computer lost more weight than individuals who
received neither(7.3 kg lost v. 4.9 kg and 2.6 kg, respectively) (Tate, Jackvony et al.
2006) (Tate, Jackvony et al. 2003). The feedback in the emails was based on diet and
physical activity information that the individuals entered online. Dr. Harvey-Berino and
colleagues has shown that social support delivered via the Internet can help weight loss
efforts to the same degree as in person support (Harvey-Berino, Pintauro et al. 2004). Other
studies have been mixed in their effects (Williamson, Walden et al. 2006) (Gold, Burke et
al. 2007) (Wing, Tate et al. 2006), though there has generally been an effect from human
feedback delivered via a computer. Other than the recent study by Tate and colleagues, no
fully automated website has been effective at producing weight loss. It is our belief that
fully automated systems are needed to meet the needs, in a cost-effective manner, of the 80
million overweight Americans who will need life-long help in losing weight and in
maintaining their weight loss.

During an earlier phase of the study, 50 in-depth interviews were conducted with individuals
who have been successful at losing weight and keeping it off. These individuals were asked
specifically about which habits they use to maintain their weight loss, how these habits are
implemented and how barriers to using these habits are overcome. These interviews were
transcribed and the data entered into a website, to be used as part of the intervention to
be tested in this clinical trial.

Inclusion Criteria:

- Age 21-65

- BMI 27-40 kg/m2

- Fluently speaks and reads English

- Access to the Internet at home or at work

- Valid email address

- Access to a scale for weekly weigh-ins

- Agree not to seek additional weight loss treatment

- Agree to come back regardless of amount of weight lost

- Participant in NCT00377208

Exclusion Criteria:

- Current, planned, or previous pregnancy within 12 months

- Planned or past weight loss surgery

- Recent weight loss of >= 15 lbs in the past 6 months

- History of:

- Myocardial infarction

- Stroke

- Type 1 and Type 2 diabetes

- Unstable angina

- Congestive heart failure

- Inability to exercise due to severe arthritis or other musculoskeletal problems

- Cancer (except non-melanoma skin cancer)

- Evidence of severe cognitive impairment or major psychiatric illness

- Plans to move in the next 6 months

- Answering yes to any question on the Physical Activity Readiness Questionnaire
(PAR-Q)