Automated Computer-Tailored Feedback Effective for Weight Loss

Providing automated computer-tailored feedback in an Internet weight loss program is as effective as human email counseling at 3 months.

https://www.diabetesincontrol.com/modules.php?name=News&file=article&sid=4051

"Several studies have shown that e-mail counseling improves weight loss achieved in self-directed Internet programs," write Deborah F. Tate, PhD, from the University of North Carolina, Chapel Hill, and colleagues. "Computer-tailored feedback offers a population-based alternative to human e-mail counseling."

In this study, 192 adults were randomized to 1 of 3 Internet treatment groups: no counseling, computer-automated feedback, or human email counseling. Mean age was 49.2 ± 9.8 years, and mean body mass index was 32.7 ± 3.5 kg/m2. All participants received 1 weight loss group session, coupons for meal replacements, and access to an interactive Web site, and the human email counseling and computer-automated feedback groups also had access to an electronic diary and message board. The human email counseling group received weekly email feedback from a counselor, whereas the computer-automated feedback group received automated, tailored messages.

For all 3 groups, retention was 82% at 3 months and 80% at 6 months. Compared with the no counseling group, completers in both the computer-automated feedback and human email counseling groups had significantly greater weight losses at 3 months, and these 2 groups were not significantly different from each other (-5.3 ± 4.2, -6.1 ± 3.9, -2.8 ± 3.5 kg, respectively).

At 6 months, weight losses were significantly greater in the human email counseling group (-7.3 ± 6.2 kg) than in the computer-automated feedback group (-4.9 ± 5.9 kg) or the no counseling group (-2.6 ± 5.7 kg). Analysis by intent-to-treat using single or multiple imputation techniques did not change this pattern of significance.

"Providing automated computer-tailored feedback in an Internet weight loss program was as effective as human e-mail counseling at 3 months," the authors write. "Further research is needed to improve the efficacy of automated computer tailored feedback as a population-based weight loss approach."

Study limitations include use of an automated system message library that repeated every 6 weeks, fewer participants interacted with the automated system each month, fairly homogeneous and educated sample, lack of cost-effectiveness data, and short duration of treatment.

"Further research is needed to improve the computer-tailored approach," the authors conclude. "Specifically, strategies to promote continued adherence to computer-tailored systems and ways to combine such systems with other more intensive approaches (via Internet or periodic face-to-face meetings) should be examined. Population-based intervention approaches are a necessary part of combating the obesity epidemic."

The authors have disclosed no relevant financial relationships. The Slim-Fast Nutrition Institute supported this study.

Arch Intern Med. 2006;166:1620-1625.

Practice Pearls

· Weekly automated computer feedback and human counseling via email supplementing a structured weight loss program are similarly effective for weight loss at 3 months.
· Human counseling by weekly email is more effective than automated computer feedback and no counseling within a structured program for weight loss at 6 months.
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