Using the Internet to Translate an Evidence-Based Lifestyle Intervention into Practice

Abstract

Despite evidence-based recommendations for addressing obesity in the clinical setting, lifestyle interventions are lacking in practice. The objective of this study was to translate an evidence-based lifestyle program into the clinical setting by adapting it for delivery via the Internet. We adapted the Diabetes Prevention Program's lifestyle curriculum to an online format, comprising 16 weekly and 8 monthly lessons, and conducted a before-and-after pilot study of program implementation and feasibility. The program incorporates behavioral tools such as e-mail prompts for online self-monitoring of diet, physical activity, and weight, and automated weekly progress reports. Electronic counseling provides further support. Physician referral, automated progress reports, and as-needed communication with lifestyle coaches integrate the intervention with clinical care. We enrolled 50 patients from a large academic general internal practice into a pilot program between November 16, 2006 and February 11, 2007. Patients with a body mass index (BMI) =25 kg/m2, at least one weight-related cardiovascular risk factor, and Internet access were eligible if referring physicians felt the lifestyle goals were safe and medically appropriate. Participants were primarily female (76%), with an average age of 51.94 (standard deviation [SD] 10.82), and BMI of 36.43 (SD 6.78). At 12 months of enrollment, 50% of participants had logged in within 30 days. On average, completers (n = 45) lost 4.79 (SD 8.55) kg. Systolic blood pressure dropped 7.33 (SD 11.36) mm Hg, and diastolic blood pressure changed minimally (+0.44 mm Hg; SD 9.27). An Internet-based lifestyle intervention may overcome significant barriers to preventive counseling and facilitate the incorporation of evidence-based lifestyle interventions into primary care.

A systematic review of the translational research on the Diabetes Prevention Program

“…There were four distinct settings of diabetes prevention translational research: (a) hospital outpatient or diabetes education model of care [23][24][25] with one study a comparative effectiveness study comparing an on-site program to a telehealth program [26], (b) primary care [21,22,27] with one study combining primary care with an online program [28], (c) community settings (i.e., Young Men's Christian Association (YMCA)) [20,[29][30][31], and (d) church or workplace settings [32][33][34][35] ( Tables 2, 3, 4, and 5).…”

“…Inclusion criteria were also expanded in many studies to include adults at-risk for T2D with and without prediabetes. Several studies did include some participants with T2D; however, this group represented a small proportion of the total sample (<50%) [24,25,28,29]. Sample sizes varied considerably across studies from eight participants in a church-based program [33] to 1,003 in a diabetes education model of care provided in a community setting [23].…”

Exploring weight loss services in primary care and staff views on using a web-based programme

“…25,26 A web-based programme has the potential to deliver an effective behaviour change service to many patients with few human resources. [11][12][13]16 However, understanding the priorities and perspectives of primary care staff not only promotes successful integration of web-based services into routine practice, but appears key to enhancing the patient experience. Coordinating web-based weight loss with routine care and primary care staff support are factors reported by patients as important for a positive experience 27 and for promoting patient-centred care.…”

“…Recent research suggests that web-based programmes can achieve clinically significant weight loss and blood pressure reductions in some primary care patients [11][12][13] and may offer primary care a way to deliver less resource-intensive weight loss services. However, successful integration of e-health initiatives into routine practice depends crucially on whether healthcare staff perceive the technology to be compatible with their priorities and working practices.…”

Editorial: Ebesity – E-Health for Obesity – New Technologies for the Treatment of Obesity In Clinical Psychology and Medicine

“…There is a significant interest in the employment of new technologies and devices in order to obtain better results in weightreduction programs: this literature has grown strongly over recent years (Riva et al, 2001, Riva et al, 2002, Simpson et al, 2002, Jeffery et al, 2003, Riva et al, 2003, Simpson et al, 2003, Castelnuovo et al, 2004, Goulis et al, 2004, Sherwood et al, 2006, Haugen et al, 2007, Joo and Kim, 2007, Wister et al, 2007, Kim and Kim, 2008, Krukowski et al, 2008, Morak et al, 2008, Schiel et al, 2008, Shaikh et al, 2008, McTigue et al, 2009, Park et al, 2009, Castelnuovo, 2010.…”