Weight, Blood Pressure, and Dietary Benefits After 12 Months of a Web-based Nutrition Education Program (DASH for Health): Longitudinal Observational Study

Abstract

Background The dietary habits of Americans are creating serious health concerns, including obesity, hypertension, diabetes, cardiovascular disease, and even some types of cancer. While considerable attention has been focused on calorie reduction and weight loss, approaches are needed that will not only help the population reduce calorie intake but also consume the type of healthy, well-balanced diet that would prevent this array of medical complications.Objective To design an Internet-based nutrition education program and to explore its effect on weight, blood pressure, and eating habits after 12 months of participation.Methods We designed the DASH for Health program to provide weekly articles about healthy nutrition via the Internet. Dietary advice was based on the DASH diet (Dietary Approaches to Stop Hypertension). The program was offered as a free benefit to the employees of EMC Corporation, and 2834 employees and spouses enrolled. Enrollees voluntarily entered information about themselves on the website (food intake), and we used these self-entered data to determine if the program had any effect. Analyses were based upon the change in weight, blood pressure, and food intake between the baseline period (before the DASH program began) and the 12th month. To be included in an outcome, a subject had to have provided both a baseline and 12th-month entry.Results After 12 months, 735 of 2834 original enrollees (26%) were still actively using the program. For subjects who were overweight/obese (body mass index > 25; n = 151), weight change at 12 months was -4.2 lbs (95% CI: -2.2, -6.2; P < .001). For subjects with hypertension or prehypertension at baseline (n = 62), systolic blood pressure fell 6.8 mmHg at 12 months (CI: -2.6, -11.0; P < .001; n = 62). Diastolic pressure fell 2.1 mmHg (P = .16). Based upon self-entered food surveys, enrollees (n = 181) at 12 months were eating significantly more fruits, more vegetables, and fewer grain products. They also reduced consumption of carbonated beverages. Enrollees who had visited the website more often tended to have greater blood pressure and weight loss effect, suggesting that use of the DASH for Health program was at least partially responsible for the benefits we observed.Conclusions We have found that continued use of a nutrition education program delivered totally via the Internet, with no person-to-person contact with health professionals, is associated with significant weight loss, blood pressure lowering, and dietary improvements after 12 months. Effective programs like DASH for Health, delivered via the Internet, can provide benefit to large numbers of subjects at low cost and may help address the nutritional public health crisis.

Educational strategies for the prevention of diabetes, hypertension, and obesity

“…Based on self-recorded surveys about food, participants reported that they began a diet rich in fruits, vegetables, and grains, as well as reducing the consumption of carbonated drinks. 59 In another investigation lasting 12 weeks, patients with diabetes sent daily messages via the internet or mobile phone with their glucose levels, and every week the nurses responded with ideal and individual recommendations for each patient through short, simple, and direction information. Constant messaging contributed to greater adherence to treatment, the practice of physical exercises and foot care.…”

Adherence to the Dietary Approaches to Stop Hypertension (DASH) diet in relation to obesity among Iranian female nurses

“…They also reported similar findings in another dietary intervention study on type 2 diabetes mellitus patients (21) . Furthermore, Moore et al showed that participating in an Internet-based nutrition education programme on the DASH diet could result in significantly reduced body weight after 12 months (22) .…”

Effect Of Dash Diet On Pre- And Stage-1 Hypertensive Individuals In A Free-living Environment

“…23 To the best of our knowledge there has only been a single study that previously evaluated the efficacy of the original DASH diet with no other behavioral modifications in a free-living environment on individuals who follow a typical American diet. 16 That previous study utilized an internet-based instructional method whereas the present study uses a traditional person-to-person instructional technique. Presently, individuals following the DASH diet in a free-living environment exhibited a significantly greater reduction in SBP relative to controls; however, DBP was not significantly altered in either group.…”

“…Despite, the success of the clinical feeding trials 10,13 and subsequent clinical interventions combining the DASH diet with other behavioral modifications, 14,15 the ability of adopting the original DASH diet followed in a free-living environment where no pre-measured meals are provided and without any additional behavioral modifications has only been evaluated in a single study. 16 This previous study assessed the effect of an internet-based nutrition education program, which was based on the DASH diet, on body weight and blood pressure over 12 months. While this intervention resulted in significantly reduced body weight and blood pressure, only 26% of the participants who began the program, completed all 12 months.…”