1. Improving Online Weight Loss and Dissemination Potential RC1 HL100002

2. Behavioral Weight Loss Programs Are Recommended For Overweight/Obese Adults Diet Exercise Behavior Modification Weekly group meetings

3. Behavioral Programs Produce Clinically Significant Outcomes Average weight loss 6 – 8 kg at 1 year Over 50% lose 5% or more Improves glycemic control, blood pressure & a variety of health problems

4. Behavioral Programs Are Typically Done In Face-To-Face Groups Participants must attend weekly meetings Trained group leaders Costly Available to only a selected group

5. 12-week internet based, state-wide campaign Teams competed in one or more categories: –Pedometer Steps, Weight Loss, Hours of Exercise Minimal registration fee Participants receive a pedometer, silicon wristband, access to reporting website, and weekly electronic newsletters Disseminating Effective Treatments Attracts large numbers of participants but weight losses are modest

6. Can we Improve SURI? Study 1: –To assess the impact of adding short, behavioral weight loss lessons to the Shape Up RI (SURI) program on weight loss outcomes. –Randomly assigned 90 participants to standard SURI and 89 participants to SURI + lessons –Weighed all participants at start and end of 12 week SURI program

7. Study 1: 12-week Results

8. Study 2 Participants randomized by team into: –Standard SURI Same procedures as Study 1 –Enhanced SURI Access to all SURI components Received access to weekly, online behaviors lessons posted on SURI website Weekly reminder emails when new videos posted Participants reported daily weight, calorie and fat intake, minutes of physical activity, and pedometer steps Received weekly automated feedback on progress toward weight loss, calorie, and exercise minute goals

9. You are doing a fantastic job in the program –you met your weight loss goal last week and you’ve lost over 6-pounds. Good for you! It's great to see that you recorded your food intake and met your calorie goal –these are 2 behaviors that are very important for continued weight loss success. Your weight loss is going very well and you have a lot to feel good about. Be sure to watch this week’s lesson – it provides important information on how to cope with negative thoughts and emotions that could otherwise derail your weight loss efforts. Have a good week! + Automated Feedback Video Lessons Disseminating Treatment via the Internet

10. Study 2: Results * Means and 95% confidence intervals; Intent-to-Treat: Baseline carried forward

11. Purpose: –Provide a nearly fully-automated online weight loss program to physicians and their patients. –Capitalize on physician advice to promote weight loss. –Deliver empirically validated behavioral strategies. –Simplify the program for an audience of older adults who may have low computer literacy. Improving Online Weight Loss and Dissemination Potential NHLBI: RC1 HL100002

12. Improving Online Weight Loss and Dissemination Potential Randomized controlled trial of a 12-week Internet- based weight loss program with N = 154 patients referred by their physician. –Internet behavioral intervention (IBI) –Internet delivered eating and activity (IDEA) NHLBI: RC1 HL100002

13. Improving Online Weight Loss and Dissemination Potential Internet Behavioral Intervention (IBI) –12 weekly interactive multimedia lessons –Reporting of daily weight, dietary intake, fat intake, and physical activity –Automated feedback messages –Periodic feedback to physicians (cc’d to patient) Control group received weekly printed lessons downloaded from the study website. NHLBI: RC1 HL100002

14. Improving Online Weight Loss and Dissemination Potential Internet Delivered Eating and Activity (IDEA) Control group –Weekly lessons downloaded from study website. NHLBI: RC1 HL100002

18. Nice job weighing yourself regularly and checking in. As you’ve seen, just weighing yourself is not enough for weight loss. To lose weight, you need to eat less and exercise more. Think about what might be getting in the way of this. Now is a good time to make a personal commitment to change your eating and exercise habits. It is great that you are recording your intake. From your records, I can see that you are staying under your calorie goal, but at the same time you are not losing weight. To make sure that you are accurately recording everything you eat and drink, I suggest that you try to simplify the job by using some prepackaged meals (like Lean Cuisine or Healthy Choice). Since the calories and fat grams are listed right on the package, using these items will make it easier to accurately record your intake and stay under your calorie goal. Congratulations on getting started with physical activity. As we talked about during last week’s lesson, changing both your eating and exercise is the best way to lose weight and improve your health. Work hard on your weight loss this week! Next week your doctor will be getting a report of your progress. To get your weight loss going, be sure to use prepackaged foods like Lean Cuisine in replace of your typical lunch and/or dinner. Also, remember to watch this week’s lesson on how to manage “triggers” for eating and activity. I look forward to hearing from you next week!

19. Results N = 154 84.4% Completion Website used 9.4 out of the 12 weeks. NHLBI: RC1 HL100002

20. Results More frequent website use associated with larger weight loss (r=.37, p=.003). Greater adoption of healthy weight loss behaviors in the Internet Behavioral Intervention. NHLBI: RC1 HL100002