Collins Clare E, Morgan Philip J, Hutchesson Melinda J, Callister Robin
Priority Research Centre in Nutrition and Physical Activity, Nutrition and Dietetics, School of Health Sciences, Faculty of Health, University of Newcastle, Callaghan, Australia.
J Med Internet Res. 2013 Jul 22;15(7):e140. doi: 10.2196/jmir.2626.
Commercial Web-based weight-loss programs are becoming more popular and increasingly refined through the addition of enhanced features, yet few randomized controlled trials (RCTs) have independently and rigorously evaluated the efficacy of these commercial programs or additional features.
To determine whether overweight and obese adults randomized to an online weight-loss program with additional support features (enhanced) experienced a greater reduction in body mass index (BMI) and increased usage of program features after 12 and 24 weeks compared to those randomized to a standard online version (basic).
An assessor-blinded RCT comparing 301 adults (male: n=125, 41.5%; mean age: 41.9 years, SD 10.2; mean BMI: 32.2 kg/m(2), SD 3.9) who were recruited and enrolled offline, and randomly allocated to basic or enhanced versions of a commercially available Web-based weight-loss program for 24 weeks.
Retention at 24 weeks was greater in the enhanced group versus the basic group (basic 68.5%, enhanced 81.0%; P=.01). In the intention-to-treat analysis of covariance with imputation using last observation carried forward, after 24 weeks both intervention groups had reductions in key outcomes with no difference between groups: BMI (basic mean -1.1 kg/m(2), SD 1.5; enhanced mean -1.3 kg/m(2), SD 2.0; P=.29), weight (basic mean -3.3 kg, SD 4.7; enhanced mean -4.0 kg, SD 6.2; P=.27), waist circumference (basic mean -3.1 cm, SD 4.6; enhanced mean -4.0 cm, SD 6.2; P=.15), and waist-to-height ratio (basic mean -0.02, SD 0.03; enhanced mean -0.02, SD 0.04, P=.21). The enhanced group logged in more often at both 12 and 24 weeks, respectively (enhanced 12-week mean 34.1, SD 28.1 and 24-week mean 43.1, SD 34.0 vs basic 12-week mean 24.6, SD 25.5 and 24-week mean 31.8, SD 33.9; P=.002).
The addition of personalized e-feedback in the enhanced program provided limited additional benefits compared to a standard commercial Web-based weight-loss program. However, it does support greater retention in the program and greater usage, which was related to weight loss. Further research is required to develop and examine Web-based features that may enhance engagement and outcomes and identify optimal usage patterns to enhance weight loss using Web-based programs.
Australian New Zealand Clinical Trials Registry (ANZCTR) trial number: ACTRN12610000197033; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=335159 (Archived by WebCite at http://www.webcitation.org/6HoOMGb8j).
基于网络的商业减肥项目越来越受欢迎，并且通过增加增强功能而日益完善，然而很少有随机对照试验（RCT）对这些商业项目或附加功能的疗效进行独立且严格的评估。
确定与随机分配到标准在线版本（基础版）的超重和肥胖成年人相比，随机分配到具有额外支持功能（增强版）的在线减肥项目的成年人在12周和24周后体重指数（BMI）的降低幅度是否更大，以及项目功能的使用频率是否增加。
一项评估者设盲的随机对照试验，比较了301名成年人（男性：n = 125，41.5%；平均年龄：41.9岁，标准差10.2；平均BMI：32.2kg/m²，标准差3.9），这些人是线下招募并登记的，随机分配到一个基于网络的商业减肥项目的基础版或增强版，为期24周。
增强版组在24周时的留存率高于基础版组（基础版68.5%，增强版81.0%；P = 0.01）。在使用末次观察值结转进行插补的意向性分析协方差中，24周后两个干预组的关键结局均有降低，组间无差异：BMI（基础版平均降低-1.1kg/m²，标准差1.5；增强版平均降低-1.3kg/m²，标准差2.0；P = 0.29）、体重（基础版平均降低-3.3kg，标准差4.7；增强版平均降低-4.0kg，标准差6.2；P = 0.27）、腰围（基础版平均降低-3.1cm，标准差4.6；增强版平均降低-4.0cm，标准差6.2；P = 0.15）以及腰高比（基础版平均降低-0.02，标准差0.03；增强版平均降低-0.02，标准差0.04，P = 0.21）。增强版组在12周和24周时登录频率分别更高（增强版12周平均登录34.1次，标准差28.1，24周平均登录43.1次，标准差34.0；基础版12周平均登录24.6次，标准差25.5，24周平均登录31.8次，标准差33.9；P = 0.002）。
与标准的基于网络的商业减肥项目相比，增强版项目中添加的个性化电子反馈提供的额外益处有限。然而，它确实有助于提高项目的留存率和使用率，这与体重减轻有关。需要进一步研究来开发和检验可能增强参与度和结局的基于网络的功能，并确定最佳使用模式以通过基于网络的项目增强体重减轻效果。
澳大利亚新西兰临床试验注册中心（ANZCTR）试验编号：ACTRN12610000197033；https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=335159（由WebCite存档于http://www.webcitation.org/6HoOMGb8j）。
