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.

Case managers are at the forefront of managed care as they seek creative ways to advocate for the best interests of patients, while adhering to the increasingly stringent utilization guidelines and cost constraints of managed care. Nurse care managers are in the ideal position to act as effective advocates because they have the skills needed to "work the system" both within and outside the hospital to ensure that the patient's needs are met.