Supplemental Tables and Appendices

Technology-assisted weight loss interventions in primary care: A systematic review

David Levine, StellaSavarimuthu,Allison Squires,Joseph Nicholson, Melanie Jay

Supplemental Table 1: Delphi and EPOC scores

Delphi Criteria
Source / Randomization adequate? / Tx allocation concealed? / Groups similar at baseline? / Eligibility criteria specified? / Outcome assessor blinded? / Care provider blinded? / Patient blinded? / Point estimates and measures of variability presented? / Included intention-to-treat analysis? / Criteria met (#) / Criteria met (%)
Appel58 / 1 / 1 / 1 / 1 / 1 / 0 / 0 / 1 / 1 / 7 / 78
Bennett59 (2010) / 1 / 1 / 2 / 1 / 1 / 0 / 2 / 1 / 1 / 6 / 67
Bennett60
(2012) / 1 / 1 / 0 / 1 / 2 / 0 / 0 / 1 / 1 / 5 / 56
Christian61 (2008) / 1 / 1 / 1 / 1 / 2 / 0 / 0 / 1 / 1 / 6 / 67
Christian62 (2011) / 1 / 1 / 1 / 1 / 2 / 0 / 2 / 1 / 1 / 6 / 67
Ma63/Xiao / 1 / 1 / 1 / 1 / 2 / 0 / 2 / 1 / 1 / 6 / 67
McConnon64 / 1 / 1 / 1 / 1 / 1 / 0 / 0 / 1 / 1 / 7 / 78
McDoniel65 / 1 / 1 / 1 / 1 / 1 / 0 / 0 / 1 / 1 / 7 / 78
Mehring66 / 1 / 1 / 1 / 1 / 0 / 0 / 0 / 1 / 1 / 6 / 67
Nanchahal (2009)67 / 1 / 1 / 1 / 1 / 2 / 2 / 1 / 1 / 1 / 7 / 78
Nanchahal (2012)68 / 0 / 1 / 0 / 1 / 0 / 0 / 1 / 1 / 1 / 5 / 56
Rothert69 / 1 / 1 / 1 / 1 / 2 / 1 / 1 / 1 / 0 / 7 / 78
Spring70 / 1 / 1 / 1 / 1 / 2 / 2 / 0 / 1 / 1 / 6 / 67
ter Bogt71 / 1 / 2 / 1 / 1 / 2 / 2 / 2 / 1 / 1 / 5 / 56
Verheijden72 / 1 / 1 / 1 / 1 / 1 / 0 / 1 / 1 / 1 / 8 / 89
Wylie-Rosett73 / 1 / 2 / 1 / 1 / 2 / 0 / 2 / 1 / 0 / 4 / 44
Mean / 0.9 / 1.1 / 0.9 / 1 / 1.4 / 0.4 / 0.9 / 1 / 0.9 / 6.1 / 68.1

0=No; 1=Yes; 2=Don't Know

Cochrane Effective Practice and Organisation of Care (EPOC)
Source / Allocation sequence adequately generated? / Allocation adequately concealed? / Baseline outcome measurements? / Baseline characteristics similar? / Incomplete data addressed? / Blinding? / Protected against contamination? / Selective outcome reporting? / Free from other risks of bias? / Criteria met (#) / Criteria met (%)
Appel58 / 0 / 0 / 0 / 0 / 0 / 1 / 0 / 0 / 0 / 8 / 89
Bennett59 (2010) / 0 / 0 / 0 / 2 / 0 / 2 / 2 / 0 / 0 / 6 / 67
Bennett60
(2012) / 0 / 0 / 0 / 2 / 0 / 1 / 0 / 0 / 0 / 7 / 78
Christian61 (2008) / 0 / 1 / 0 / 0 / 0 / 1 / 1 / 0 / 0 / 6 / 67
Christian62 (2011) / 0 / 0 / 0 / 0 / 0 / 1 / 0 / 0 / 1 / 7 / 78
Ma63/Xiao / 0 / 0 / 0 / 0 / 0 / 1 / 0 / 0 / 0 / 8 / 89
McConnon64 / 0 / 0 / 0 / 0 / 1 / 1 / 0 / 1 / 1 / 5 / 56
McDoniel65 / 0 / 0 / 0 / 0 / 0 / 2 / 0 / 0 / 1 / 7 / 78
Mehring66 / 1 / 0 / 0 / 1 / 0 / 1 / 0 / 0 / 1 / 5 / 56
Nanchahal (2009)67 / 0 / 0 / 0 / 0 / 0 / 1 / 0 / 0 / 1 / 7 / 78
Nanchahal (2012)68 / 0 / 0 / 0 / 0 / 0 / 2 / 0 / 0 / 0 / 8 / 89
Rothert69 / 0 / 0 / 0 / 0 / 1 / 0 / 0 / 1 / 1 / 6 / 67
Spring70 / 0 / 0 / 0 / 0 / 0 / 1 / 1 / 0 / 1 / 6 / 67
ter Bogt71 / 0 / 1 / 0 / 0 / 0 / 2 / 1 / 0 / 1 / 5 / 56
Verheijden72 / 0 / 0 / 0 / 0 / 1 / 0 / 0 / 0 / 1 / 7 / 78
Wylie-Rosett73 / 0 / 1 / 0 / 0 / 1 / 2 / 1 / 1 / 0 / 4 / 44
Mean / 0.06 / 0.2 / 0 / 0.3 / 0.3 / 1.2 / 0.4 / 0.2 / 0.6 / 6.4 / 70.8

0 = Low Risk; 1 = High Risk; 2 = Unclear

Supplemental Table 2: Technology-Assisted Weight Loss Interventions in Primary Care

Please note: due to space constraints,some fields were removed from the print Table that are included below

Participants / Intervention / Outcomes
Study / n / Age () / %F / Ethnicity (%) / BMI() / Practice Type / Intervention (n) / Tech Modality / Personnel / Behavior Change Elements / Duration (mos) / Attrition (%) / Weight Δ (kg) / ≥5% weight loss (%)
Appel58 / 415 / 54 / 64 / 56W, 41B / 37 / Mix / All: PCP visit at 6/12/24mos for encouragement
IG1 (138): in-person support, website: self-monitoring, auto feedback, & email reminder to login
IG2 (139): remote support via telephone, same website emails as IG1
CG (138): 1 weight loss coach meeting, brochures, weight loss websites / Int / MD, O / AF, IPF, LC, MDF, Rem, SM / 24 / 16 / IG1: -5.1*
IG2: -4.6*
CG: -0.8 / IG1: 41*
IG2: 38*
CG: 19
Bennett (2010)59 / 101 / 54 / 47 / 50W, 31B, 5H / 35 / IM / IG (51): self-monitoring website, 4 RD visits via phone and in-person
CG (50): usual care basic materials / Int / RD / AF, IPF, LC, SM / 3 / 16 / IG: -2.3*
CG: +0.3 / IG: 26NR
CG: 0
Bennett
(2012)60 / 365 / 55 / 69 / 71B, 13H / 37 / NR / IG (180): web-based tailored behavior change goals, skills training via website or interactive voice response, telephone counseling w trained community health educator, primary care provider endorsement, 12 optional in-person group support sessions, walking kit w pedometer
CG (185): usual care self-help booklet / CS, Int, O / MD, O / AF, Con, IPF, LC, MDF, O, P2P, SM / 24 / 14 / IG: -1.5*
CG: -0.5 / IG: 20
CG: 20
Christian (2008)61 / 310 / 53 / 66 / 100H / 35 / FM/GP / IG (155): goal-setting computer program, then regular MD clinic visits w 3/6/9mos goals reassessment
CG (155): usual careinfo packet / CS, K / MD / AF, MDF / 12 / 12 / IG: -0.08
CG: +0.6 / IG: 21*
CG: 11
Christian (2011)62 / 279 / 50 / 68 / 51W, 44H / 34 / FM/GP / IG (140): goal-setting computer program, then MD clinic visits to reinforce goals, 6mos goals reassessment w computer
CG (139): usual careinfo packet / CS, K / MD / AF, MDF / 12 / 6 / IG: -1.5*
CG: +0.1 / IG: 26*
CG: 8
Ma63/ Xiao†79 / 171 / 53 / 46 / 79W, 4H / 32 / Mix / All: Heart360 website, standardized monthly emails, ability to submit questions online
IG1 (79): 3mo intensive in-person weekly DPP w physical activity food tastings, personalized monthly emails on Heart360 progress
IG2 (81): 3mo intensive at-home DPP DVD, standardized weekly emails
CG (81): usual care / Int, O / O, RD / AF, IPF, LC, Rem, SM / 24 / 29 / IG1: -5.4*
IG2: -4.5*
CG: -2.4 / IG1: 45*
IG2: 30
CG: 17
McConnon64 / 221 / 46 / 77 / 95W / 34 / FM/GP / IG (111): website: tailored advice, tools information to support behavior change in terms of dietary physical activity patterns, reminder emails
CG (110): usual care, small info booklet / Int / None / AF, Rem, SM / 12 / 41 / IG: -1.3
CG: -1.9 / IG: 22NR
CG: 18
McDoniel65 / 111 / 46 / 61 / 78W, 20H / 37 / FM/GP / All: MI counseling at wk4 & wk8; core topic email newsletters weekly
IG (55): MedGem Analyzer for nutrition program & Balance-Log for SM
CG (56): Usual care: 3-day food menu, paper journal) / HC, Int / EP / IPF, LC, SM / 3 / 28 / IG: -3.5
CG: -3.7 / IG: 31
CG: 42
Mehring66 / 186 / 48 / 69 / NR / 34 / FM/GP / IG (109): HausMedeHealthweb-based coaching program w MD input and 3 phone calls from MD or MA at wks 1,5,12 for motivation
CG (77): usual care / CS, Int, Txt / MD, O / AF, IPF, LC, MDF, P2P, Rem, SM / 3 / 20 / IG: -2.9*
CG: -1.6 / IG: 26
CG: 16
Nanchahal (2009)67 / 123 / 47 / 80 / 96W / 36 / FM/GP / IG (61): ProHealthClinical structured lifestyle support w tailored diet, self-monitoring w diary, coping skills, & RN feedback
CG (62): usual care / CS / RN / AF, IPF, LC, SM / 3 / 15 / IG: -4.0*
CG: +1.2 / IG: 17NR
CG: 10
Nanchahal (2012)68 / 381 / 49 / 72 / 73W / 33 / FM/GP / IG (191): structured one-on-one in-person sessions (6 in 1st12wks, 4 in 2nd12wks, 3 in 3rd12wks), perfect-diet-tracker.com for SM; adamsportionpot.com, pedometers
CG (190): usual care & asked to seek weight loss from PCP / HC, Int / O / IPF, LC, O, Rem, SM / 12 / 43 / IG: -2.4
CG: -1.3 / IG: 34*
CG: 19
Rothert‡69 / 2862 / 45 / 83 / 56W, 36B / 32 / Mix / All: 20min computer assessment
IG (1475): Web-tailored weight management program x 6wks w 1/3/6wk email asking participants to enter weight
CG (1387): Web-info-only materials on Kaiser's website / Int / None / AF, P2P, Rem, SM / 6 / 80 / IG: -2.8*
CG: -1.1 / NR
Spring70 / 70 / 58 / 14 / 75W, 25B, 6H / 36 / IM / All: 2wk run-in baseline
IG (35): Weight Loss Phase (mos0-6): twice weekly MOVE sessions, PDA for self-monitoring w automated feedback, coach-derived feedback;Maintenance Phase (mos7-12): monthly MOVE sessions, telephone coach conversationif no data transmitted
CG (34): All MOVE sessions as IG, but no PDA, no coach calls / App / MD, O, RD / AF, IPF, LC, P2P, Rem, SM / 12 / 23 / IG: -2.9*
CG: +0.02 / IG: 30*
CG: 15
ter Bogt71 / 457 / 56 / 52 / NR / 30 / FM/GP / All: baseline online or paper questionnaire
IG (225): 4 visits w NP using software, 1 telephone f/u in yr1, then 1 visit 2 telephone f/u’s in yr2 & yr3
CG (232): MD usual care / CS / MD, NP / IPF, LC, O, SM / 36 / 22 / IG: -1.1
CG: -0.5 / IG: 5
CG: 5
Verheijden72 / 146 / 63 / 45 / NR / 29 / FM/GP / IG (73): Heartweb online program: monthly stage-of-change questionnaire w subsequent tailored nutrition suggestions, bulletin board, dietary fat tracker, low fat recipes
CG (73): usual care / Int / None / AF, P2P, SM / 8 / 9 / NR / NR
Wylie-Rosett‡73 / 588 / 52 / 82 / 83W / 36 / Mix / All: computer assessment
IG1 (236): 6 group workshops, RD/MSW consult (telephone or face-to-face) up to 18times + IG2 + CG
IG2 (236): kiosks weekly (20-30mins) x 3mos, then monthly + CG
CG (116): workbook / K / MSW, RD / LC / 12 / 21 / IG1: -3.4*
IG2: -2.1*
CG: -1.0 / IG1: 31*
IG2: 23*
CG: 15

B-Black; BMI-Body Mass Index (kg/m2); CG-Control Group; Δ-Change; DPP-Diabetes Prevention Program; FM/GP-Family Medicine/General Practitioner; H-Hispanic; IG-Intervention Group; IM-Internal Medicine; NR-Not Reported; PCP-Primary Care Provider; PDA-Personal Digital Assistant;W-White;-Mean

Technology Modality: App-Mobile App; CS-Clinician Software; HC-Home Computer (No Internet); Int-Internet; K-Kiosk; O-Other

Personnel: EP-Exercise Physiologist; MSW-Master of Social Work;MD-Medical Doctor; None-No Personnel; NP-Nurse Practitioner; O-Other; RD-Registered Dietician; RN-Registered Nurse

Elements: AF-Automated Feedback; Con-Contests; IPF-In-personFeedback; LC-Lifestyle Coaching; MDF-MDFeedback; O-Other; P2P-Peer-To-Peer Support; Rem-Reminders; SM-Self Monitoring

*: p < 0.05

†: Xiao et al re-consented the patients from Ma et al and followed them for 9 additional months; we report their data with this extension period. Also, their data is for ≥7% weight loss, not ≥5%.

‡: Completers-only analysis (i.e., not intention to treat)

Supplemental Table 3: PRECIS Scores

PRagmaticExplanatory Continuum Indicator Summary (PRECIS)
Source / Participant eligibility / Flexibility (Experimental) / Practitioner expertise (Experimental) / Flexibility (Comparison) / Practitioner expertise (Comparison) / Follow-up intensity / Primary trial outcome / Participant compliance w prescribed intervention / Practitioner adherence to study protocol / Analysis of primary outcome / Average
Appel58 / 3 / 2 / 1 / 4 / 4 / 0 / 4 / 1 / 1 / 4 / 2.4
Bennett59 (2010) / 2 / 3 / 1 / 4 / 4 / 1 / 4 / 2 / 2 / 4 / 2.7
Bennett60
(2012) / 3 / 2 / 1 / 4 / 4 / 0 / 4 / 2 / 1 / 4 / 2.5
Christian61 (2008) / 0 / 3 / 3 / 4 / 4 / 2 / 4 / 2 / 3 / 4 / 2.9
Christian62 (2011) / 2 / 3 / 3 / 4 / 4 / 3 / 4 / 3 / 3 / 4 / 3.3
Ma63/Xiao / 3 / 3 / 3 / 4 / 4 / 3 / 4 / 2 / 3 / 4 / 3.3
McConnon64 / 3 / 4 / 4 / 4 / 4 / 3 / 4 / 3 / 4 / 3 / 3.6
McDoniel65 / 3 / 2 / 1 / 1 / 1 / 2 / 4 / 2 / 2 / 4 / 2.2
Mehring66 / 2 / 2 / 4 / 4 / 4 / 3 / 4 / 1 / 1 / 4 / 2.9
Nanchahal (2009)67 / 3 / 2 / 2 / 4 / 4 / 3 / 4 / 3 / 3 / 4 / 3.2
Nanchahal (2012)68 / 3 / 1 / 2 / 4 / 3 / 1 / 4 / 2 / 2 / 4 / 2.6
Rothert69 / 3 / 0 / 4 / 0 / 3 / 2 / 4 / 3 / 4 / 1 / 2.4
Spring70 / 3 / 0 / 3 / 1 / 3 / 0 / 4 / 1 / 3 / 4 / 2.2
ter Bogt71 / 3 / 2 / 1 / 4 / 4 / 1 / 4 / 2 / 2 / 4 / 2.7
Verheijden72 / 3 / 1 / 4 / 4 / 4 / 3 / 4 / 3 / 3 / 3 / 3.2
Wylie-Rosett73 / 3 / 2 / 1 / 3 / 4 / 0 / 4 / 2 / 1 / 0 / 2
Average / 2.6 / 2 / 2.4 / 3.3 / 3.6 / 1.8 / 4 / 2.2 / 2.4 / 3.4 / 2.8

0-Completely Explanatory (ideal circumstances) → 4-Completely Pragmatic (real-world circumstances).

Appendix 1: Search Strategy

Search strategies and searched the following databases to identify citations and trials from 2000 to February 28, 2013: PubMed/MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, and Cochrane CENTRAL. Our PubMed search strategy was: ((("behavior therapy" OR "cognitive therapy" OR counseling OR counselling OR diet OR diet, reducing OR health behavior [mh] OR health promotion [mh] OR self care [mh] OR health education [mh] OR "nutrition therapy") AND (computer-assisted instruction OR computers, handheld OR internet OR therapy, computer-assisted OR web-based OR Internet-based OR mobile app* OR computer* OR software OR website OR web site OR technology [tiab] OR mobile [tiab])) AND (body mass index OR body weight OR obesity/pc OR obesity/th OR overweight/pc OR overweight/th OR weight loss OR weight gain OR "weight management" OR "weight control")) AND (randomized controlled trial [pt] OR controlled clinical trial [pt] OR randomized[tiab] OR randomised[tiab] OR randomization[tiab] OR randomisation[tiab] OR placebo[tiab] OR drug therapy[sh] OR randomly[tiab] OR trial[tiab] OR groups[tiab]) NOT (animals[mh] NOT humans[mh]). The authors are happy to discuss search strategies for the other databases upon request. Please also refer to our PROPSERO (CRD42013003998) entry:

Appendix2: Narrative Summation

Appel: The Hopkins POWER trial[i] compared in-person, remote, and self-directed (control) health coach support. Both intervention groups had access to a website for self-monitoring, learning modules, and automated feedback. They also both had 3 PCP visits for encouragement and reflection. In-person support participated in multiple group (9x90mins) and individual (3x20mins) sessions, with tapering frequency after 3 months. Remote support engaged in 1 weekly call for 3 months, then 1 monthly call. Over 24 months (16% attrition), in-person, remote, and self-directed participants lost 5.1kg, 4.5kg, and 0.8kg, corresponding to 41.4%, 38.2%, and 18.8% with >5% weight loss, respectively. While both intervention groups demonstrated significantly more weight loss than control (p<0.001), there was no difference between intervention groups.

Bennett 2010: The Step Up, Trim Down program[ii] combined a self-monitoring website with 2 in-person and 2 telephone follow-ups with a registered dietician. Self-monitoring focused on behavior tracking and providing tailored obesogenic behavior change goals (e.g., “Walk 10,000 steps every day” or “Watch 2 h or less of TV every day”). After 3 months (16% attrition), participants and controls lost 2.3kg and gained 0.28kg, with 25.6% and 0% losing >5% weight loss, respectively (p<0.01, both conditions).

Bennett 2012:The Be Fit, Be Well POWER trial[iii] combined a self-monitoring and skills training website (or interactive voice response) with tailored behavior change goals, community health educator telephone sessions (monthly for 1 year, then every other month), 1 brief PCP endorsement, pedometer walking kit, and 12 optional in-person group support sessions. After 24 months (14% attrition), intervention and control participants lost 1.53kg and 0.5kg (significant by CI), with 20% and 19.5% losing >5% body weight (p NR), respectively.

Christian 2008 & 2011: An in-office 10 minute computer-based assessment[iv] specifically developed for low income patients generated both tailored materials for participants and a bulleted companion report for the physician with patient-specific counseling recommendations to be used at regularly scheduled visits. Goals were readdressed at 6 months through software and subsequent physician counseling. At 12 months (6% attrition), computer and control participants lost 1.5kg and gained 0.15kg, respectively (p=0.004). 26.3% and 8.5% achieved greater than 5% weight loss, respectively (p=0.002). In a separate study by the same authors, type 2 diabetics undergoing the same computer-based assessment had similar findings[v].

Ma/Xiao: The Evaluation of Lifestyle Interventions to Treat Elevated Cardiometabolic Risk in Primary Care (E-LITE) trial[vi] adapted the Diabetes Prevention Program (DPP) to primary care with use of web-based self-monitoring. E-LITE compared controls to both a 3 month intensive in-person DPP versus a self-directed DVD DPP. Participants in both arms received access to heart360.org, a free open-source self-monitoring website from the American Heart Association (AHA) and a secure Q&A email service. Participants in the in-person group received personalized monthly emails regarding their Heart360 progress, whereas DVD DPP participants received only weekly standardized emails. After 15 months (24% attrition), in-person, DVD, and control subjects lost 6.3kg, 4.5kg, and 2.4kg (p<0.001, p=0.02), corresponding to 37%, 35.9%, and 14.4% losing >7% body weight (p=0.003, p=0.004). Of note, Xian and Ma reconsented their participants at 15 months and followed them to 24 months, leading to in-person, DVD, and control subjects lost 5.4kg, 4.5kg, and 2.4kg (p<0.001, p=0.02), corresponding to 45%, 30%, and 17% losing >7% body weight (p=0.003, p=0.14)

McConnon:McConnon and colleagues compared a website with questionnaire-tailored advice, self-monitoring tools, dietary/physical activity information to support behavior change, and automated reminder emails to control[vii]. After 12 months (41% attrition, 29% website utilization), website and control participants lost 1.3kg and 1.9kg, respectively (p=0.56). 22% and 18% (p NR) achieved >5% weight loss, respectively.

McDoniel: The Self-Monitoring and Resting Metabolic Rate Technology (SMART) program[viii] delivered a computer-generated nutrition plan based on resting metabolic rate and other participant inputs, along with 2 counseling sessions with an exercise physiologist regarding the computer-derived plan and weekly informational emails. Compared to a control over 3 months with 28% attrition, SMART participants on average lost 3.5kg body weight, while controls lost 3.7kg body weight (p=0.19). 30.8% and 41.5% of SMART and control participants achieved 5% weight loss, respectively.

Mehring: The HausMedeHealth Services web-based coaching program[ix]used initial MD input to shape a comprehensive online program. 12 one-week modules with 3 phone calls from the patient’s MD or MA at weeks 1,5, and 12 for motivation occurred. After 3 months (20.4% attrition), participants versus controls lost 2.9kg and 1.6kg, respectively (p=0.028). 26% vs 16% lost >5% body weight, respectively (p 0.099).

Nanchahal 2009: Structured technology-assisted lifestyle support (ProHealthClinical package)[x] offered participants a tailored diet, tailored coping skills, and queued a nurse to recommend self-monitoring via diary. In this pilot study of 3 months duration (15% attrition), participants versus controls lost 4.0kg and 1.17kg, respectively (p<0.01). 17% vs 10% lost >5% body weight, respectively (p NR).

Nanchahal 2012: The Camden Weight Loss (CAMWEL)[xi] study delivered highly structured one-on-one in-person weight loss sessions led by a trained “advisor.” Participants attended 6 sessions in the 1st12 weeks, 4 in the 2nd12 weeks, and 3 in the 3rd12 weeks. They also used the perfect-diet-tracker.com (a commercial software package) for self-monitoring, adamsportionpot.com for food selection assistance, pedometers, and a book of local area walks. The control group received usual care, but they were asked to seek weight loss assistance from their PCPs. After 12 months (43% attrition), session and control participants lost 2.39kg and 1.31kg, respectively (p=0.35). 34% and 19% (p=0.04) achieved >5% weight loss, respectively.

Rothert: The Balance program[xii] (HealthMedia, Inc.) was a 6-week self-guided program that connected baseline assessment data with a tailored weight management plan. Balance stressed the connection between disease and obesity and tailored its messages to specific barriers identified by the participant. It also offered email “buddies” to provide informal support. Action plans were delivered at 1, 3, and 6 weeks into the program. Although attrition was high (80%), Balance participants averaged 2.8kg weight loss compared to 1.1kg (p=0.00074) over a 6 month period. >5% weight loss was not reported.

Spring: The MOVE! with personal digital assistant (PDA) trial[xiii] tested the additive benefit of mobile decision support to the established Veterans Affairs MOVE! program[xiv]. Participants attended (months 0-6)1.5hour twice weekly MOVE!sessions andreceived a PDA for self-monitoring and every other week data feedback with a paraprofessional coach. During months7-12, MOVE!sessions were monthly and coach conversations were only held if data was not transmitted. After 12 months (23% attrition), PDA and control subjects lost 2.9kg and 0.02kg (significant by CI), respectively, with 29.6% and 14.8% losing >5% body weight (p NR).

terBogt: The Groningen Overweight and Lifestyle (GOAL) study compared a control group to a software system that guided nurse practitioners in weight loss counseling during several visits. Although 1 year data[xv] was encouraging, 3 year outcomes[xvi] demonstrated 1.1kg and 0.5kg weight loss in counseling and control groups, respectively (p=0.34). 5% of participants lost at least 5% body weight in both groups (p=0.76).

Verheijden: The Heartweb program[xvii] delivered an entirely web-based counseling program that incorporated tailored messaging, recipes, and a group bulletin board. After 8 months (9% attrition, 33% website utilization), no significant difference between Heartweb and control existed, including subgroup analysis.

Wylie-Rosett:The Healthy Highways program[xviii] compared a control group to “kiosk-only” and “kiosk plus staff.” Participants spent approximately 30 minutes completing weekly (monthly after 3 months) online or waiting-room sessions that shuttled participants down three tailored pathways: nutrition, fitness, and emotions. After each session, participants reevaluated their goals and identified barriers to implementation. Those randomized to the plus staff group had up to 18 telephone or in-person meetings with a social worker or registered dietician and 6 group workshops. These reinforced computer sessions and encouraged computer use to identify problems and solutions. Over 12 months and with 21% attrition, kiosk plus staff, kiosk-only, and control participants on average lost 3.4kg, 2.1kg, and 1.0kg, respectively (p<0.01; completer’s only analysis).

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[v]Christian JG, Bessesen DH, Byers TE, et al. Clinic-Based Support to Help Overweight Patients With Type 2 Diabetes Increase Physical Activity and Lose Weight. Archives of Internal Medicine 2008;168(2):141-146.

[vi]Ma J, Yank V, Xiao L, et al. Translating the Diabetes Prevention Program Lifestyle Intervention for Weight Loss Into Primary Care. JAMA Intern Med. 2013 Jan 28;173(2):113-21

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[xiv]Kinsinger LS, Jones KR, Kahwati L, et al. Design and dissemination of the MOVE! weight-management program for veterans. Prev Chronic Dis. 2009;6(3):A98.

[xv]terBogt NCW, Bemelmans WJE, Beltman FW et al. Preventing Weight Gain: One-Year Results of a Randomized Lifestyle Intervention. Am J Prev Med 2009;37(4):270–277

[xvi]terBogt NCW, Bemelmans WJE, Beltman FW et al. Preventing Weight Gain by Lifestyle Intervention in a General Practice Setting: Three-Year Results of a Randomized Controlled Trial. Archives of Internal Medicine 2011;171(4):306-313.

[xvii]Verheijden M, Bakx JC, Akkermans R, et al. Web-Based Targeted Nutrition Counselling and Social Support for Patients at Increased Cardiovascular Risk in General Practice: Randomized Controlled Trial. Journal of Medical Internet Research 2004;6(4):e44.

[xviii]Wylie-Rosett J, Swencionis C, Ginsberg M, et al. Computerized weight loss intervention optimizes staff time: the clinical and cost results of a controlled clinical trial conducted in a managed care setting. Journal of the American Dietetic Association 2001;101:1155-1162.