Why it works

Does internet-based support and interaction enhance weight loss?



People who connect with, and receive support from a health professional lose more than twice the weight as those who go at it alone.

Web-based weight loss programs are a dime a dozen. Claims that participants will shed pounds by implementing their strategies abound, but only a few will make good on such promises. The major factor that determines their ultimate success or failure? Human interaction.

Human interaction can take place in person, over the phone, or via the internet, and each modality can support weight loss. Since people spend more time than ever before on their smart-phones, particularly on social networking apps, we’ll focus on app- and web-based nutrition interventions in this post.

Researchers at Brown University found that people participating in an interactive, web-based behavior therapy program lost more weight after 6 months than did participants receiving a web-based nutrition education program. Since the study didn’t identify whether the health professionals themselves, were a key to the program’s success, the research team ran a subsequent trial to see whether connecting to an actual person was was truly necessary or even helpful. Here’s what they did:

92 overweight adults (average BMI 33.1, average age 48) at risk for type II diabetes were randomly to assigned to one of two groups:

  1. Internet-based weight loss program + 1 face-to-face counseling session but without any further human interaction
  2. Internet-based weight loss program + 1 face-to-face counseling session + e-counseling

What did the Internet-based weight loss program include? NOT ENOUGH. Like many websites, it offered:

  • A tutorial on weight loss
  • A new tip and link each week
  • A directory of selected Internet weight loss resources

What constituted “e-counseling?” Counselor e-mails provided:

  • Feedback on food records
  • Reinforcement
  • Recommendations for change
  • Answers to questions
  • General support

How often did they do this? The therapist e-mailed participants:

  • 5 times each week for the first month
  • 1 time each week for the remaining 11 months


  • The e-counseling group lost more than twice the weight than the basic internet group.
  • Percentage of body weight loss also increased by more than double.
  • BMI and waist circumference reduced significantly more for those receiving counseling
  • The weight loss observed in the behavioral e-counseling group at one year was enough to reduce risk for diabetes.

Points of interest and take-aways:

  • E-counselors came from all fields. Some were health educators, while others were dietitians or psychologists. In other words, many different types of health professionals are qualified to deliver e-counseling.
  • The average age of participants was 48! This is important because it tells us that middle-aged adults are willing to, and interested in participating in web-based nutrition counseling.
  • While e-mailing clients each workday for the first month may seem cumbersome, note that health professionals scaled back considerably to just one e-mail per week for the next 11 months. In other words, low workload meets effective therapy. This reduced time demand is encouraging to those looking to grow their business with negligible additional time commitment.

What do you think? Did you expect that clients would adhere to the weight loss program for an entire year, meeting face-to-face only once across that time period? If the authors conducted the study using an app instead, do you think that would affect the outcome?


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