Objective: Internet weight loss programs have become widely available as alternatives to standard treatment, but few data are available on their efficacy. This study aimed to investigate the effectiveness of a structured behavioral weight loss website (VTrim) vs. a commercial weight loss website (http://eDiets.com). Research Methods and Procedures: A randomized, controlled trial was conducted from February 2003 to March 2005, in 124 overweight and obese subjects ages 18 years and older with a BMI of 25 to 39.9 kg/m2 (mean age, 47 ± 9 years; BMI, 32 ± 3 kg/m2; 20% men). Analyses were performed for the 88 subjects who had complete follow‐up data. Participants were randomly assigned to 12‐month VTrim (n = 62) or http://eDiets.com (n = 62) intervention. VTrim participants had access to a therapist‐led structured behavioral weight loss program delivered on‐line. http://eDiets.com subjects had access to a self‐help commercial on‐line weight loss program. Body weight, social support, and use of website components were measured at 0, 6, and 12 months. Results: Repeated‐measures analyses showed that the VTrim group lost significantly more weight than the http://eDiets.com group at 6 months (8.3 ± 7.9 kg vs. 4.1 ± 6.2 kg; p = 0.004) and maintained a greater loss at 12 months (7.8 ± 7.5 kg vs. 3.4 ± 5.8 kg; p = 0.002). More participants in the VTrim group maintained a 5% weight loss goal (65% vs. 37.5%; p = 0.01) at 12 months. Discussion: An on‐line, therapist‐led structured behavioral weight loss website produced greater weight loss than a self‐help commercial website. Because commercial sites have great potential public health impact, future research should investigate the feasibility of incorporating a more structured behavioral program into a commercial application.

HARVEY-BERINO, JEAN AND JANINE ROURKE.Obesity prevention in preschool Native-American children: results of a pilot study using home visiting. Obes Res. 2003; 11:606-611. Objective: To determine whether maternal participation in an obesity prevention plus parenting support (OPPS) intervention would reduce the prevalence of obesity in high-risk Native-American children when compared with a parenting support (PS)-only intervention. Research Methods and Procedures: Forty-three mother/ child pairs were recruited to participate. Mothers were 26.5 Ϯ 5 years old with a mean BMI of 29.9 Ϯ 3 kg/m 2 . Children (23 males) were 22 Ϯ 8 months old with mean weight-for-height z (WHZ) scores of 0.73 Ϯ 1.4. Mothers were randomly assigned to a 16-week OPPS intervention or PS alone. The intervention was delivered one-on-one in homes by an indigenous peer educator. Baseline and week 16 assessments included weight and height (WHZ score and weight-for-height percentile for children), dietary intake (3-day food records), physical activity (measured by accelerometers), parental feeding style (Child Feeding Questionnaire), and maternal outcome expectations, self-efficacy, and intention to change diet and exercise behaviors. Results: Changes in WHZ scores showed a trend toward significance, with WHZ scores decreasing in the PS condition and increasing among the OPPS group (Ϫ0.27 Ϯ 1.1 vs. 0.31 Ϯ 1.1, p ϭ 0.06). Children in the OPPS condition also significantly decreased energy intake (Ϫ316 Ϯ 835 kcal/d vs. 197 Ϯ 608 kcal/d, p Ͻ 0.05). Scores on the restriction subscale of the Child Feeding Questionnaire decreased significantly in the OPPS condition (Ϫ0.22Ϯ 0.42 vs. 0.08Ϯ 0.63, p Ͻ 0.05), indicating that mothers in the OPPS group were engaging in less restrictive child feeding practices over time. Discussion: A home-visiting program focused on changing lifestyle behaviors and improving parenting skills showed promise for obesity prevention in high-risk Native-American children.

Results: There were no significant differences among the groups in weight loss (mean Ϯ SD) from baseline to 18 months (7.6 Ϯ 7.3 kg vs. 5.5 Ϯ 8.9 kg vs. 5.1 Ϯ 6.5 kg, p ϭ 0.23 for the IS, M-IPS, and F-IPS, respectively). Discussion: Participants assigned to an internet-based weight maintenance program sustained comparable weight loss over 18 months compared with individuals who continued to meet face-to-face. Therefore, the internet appears to be a viable medium for promoting long-term weight maintenance.

OBJECTIVE:The purpose of this study was to investigate the effectiveness of a weight maintenance program conducted over the Internet. DESIGN: Longitudinal, clinical behavioral weight loss trial with 6-month in-person behavioral obesity treatment followed by a 12-month maintenance program conducted both in-person (frequent in-person support; F-IPS, minimal in-person support; M-IPS) and over the Internet (Internet support; IS). SUBJECTS: A total of 122 healthy, overweight adults (age ¼ 48.4 AE 9.6, BMI ¼ 32.2 AE 4.5 kg=m 2 , 18 male) MEASUREMENTS: Body weight, dietary intake, energy expended in physical activity, attendance, self-monitoring, comfort with technology. RESULTS: Results (n ¼ 101) showed that weight loss did not differ by condition during treatment (8.0 AE 5 vs 11 AE 6.5 vs 9.8 AE 5.9 kg, P ¼ 0.27 for IS, M-IPS and F-IPS, respectively). The IS condition gained significantly more weight than the F-IPS group during the first 6 months of weight maintenance ( þ 2.2 AE 3.8 vs 0 AE 4 kg, P < 0.05) and sustained a significantly smaller weight loss than both in-person support groups at the 1 y follow-up ( 7 5.7 AE 5.9 vs 7 10.4 AE 9.3 vs 7 10.4 AE 6.3 kg, P < 0.05 for IS, M-IPS and F-IPS, respectively). Attendance at maintenance meetings was greater for the F-IPS than the IS condition over the 1 y maintenance program (54 vs 39%, P ¼ 0.04). Acceptability of assigned condition was higher for subjects in the F-IPS than IS condition. CONCLUSION: The results of this study suggest that Internet support does not appear to be as effective as minimal or frequent intensive in-person therapist support for facilitating the long-term maintenance of weight loss.

Objectives To evaluate the efficacy of an Internet behavioral weight loss program; and determine if adding periodic in-person sessions to an Internet intervention improves outcomes. Methods 481 healthy overweight adults (28% minority) were randomized to one of 3 delivery methods of a behavioral weight loss program with weekly meetings: Internet (n=160), InPerson (n=159), or Hybrid (Internet+InPerson, n=162). Outcome variables were weight at baseline and 6 months and percent of subjects achieving a 5 and 7% weight loss. The study took place in two centers in Vermont and Arkansas from 2003 to 2008. Results Conditions differed significantly in mean weight loss [8.0 (6.1)kg vs. 5.5 (5.6)kg vs. 6.0 (5.5)kg], for InPerson, Internet, and Hybrid respectively, p<0.01, n=462). Weight loss for InPerson was significantly greater than the Internet and Hybrid conditions (p<0.05). Although the proportion reaching a 5% weight loss did not differ, the proportion losing 7% did differ significantly (56.3% vs. 37.3% vs. 44.4% for InPerson, Internet, and Hybrid respectively, p<0.01). Conclusions These results demonstrate that the Internet is a viable alternative to in-person treatment for the delivery and dissemination of a behavioral weight-control intervention. The addition of periodic in-person sessions did not improve outcomes.