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Meta-Analysis
. 2012 Aug 15;2012(8):CD007675.
doi: 10.1002/14651858.CD007675.pub2.

Interactive computer-based interventions for weight loss or weight maintenance in overweight or obese people

L Susan Wieland  1 , Louise Falzon, Chris N Sciamanna, Kimberlee J Trudeau, Suzanne Brodney, Joseph E Schwartz, Karina W Davidson
Affiliations
Meta-Analysis

Interactive computer-based interventions for weight loss or weight maintenance in overweight or obese people

L Susan Wieland et al. Cochrane Database Syst Rev. .

Abstract

Background: The World Health Organization (WHO) estimates that the number of obese or overweight individuals worldwide will increase to 1.5 billion by 2015. Chronic diseases associated with overweight or obesity include diabetes, heart disease, hypertension and stroke.

Objectives: To assess the effects of interactive computer-based interventions for weight loss or weight maintenance in overweight or obese people.

Search methods: We searched several electronic databases, including CENTRAL, MEDLINE, EMBASE, CINAHL, LILACS and PsycINFO, through 25 May 2011. We also searched clinical trials registries to identify studies. We scanned reference lists of included studies and relevant systematic reviews.

Selection criteria: Studies were included if they were randomized controlled trials or quasi-randomized controlled trials that evaluated interactive computer-based weight loss or weight maintenance programs in adults with overweight or obesity. We excluded trials if the duration of the intervention was less than four weeks or the loss to follow-up was greater than 20% overall.

Data collection and analysis: Two authors independently extracted study data and assessed risk of bias. Where interventions, control conditions, outcomes and time frames were similar between studies, we combined study data using meta-analysis.

Main results: We included 14 weight loss studies with a total of 2537 participants, and four weight maintenance studies with a total of 1603 participants. Treatment duration was between four weeks and 30 months. At six months, computer-based interventions led to greater weight loss than minimal interventions (mean difference (MD) -1.5 kg; 95% confidence interval (CI) -2.1 to -0.9; two trials) but less weight loss than in-person treatment (MD 2.1 kg; 95% CI 0.8 to 3.4; one trial). At six months, computer-based interventions were superior to a minimal control intervention in limiting weight regain (MD -0.7 kg; 95% CI -1.2 to -0.2; two trials), but not superior to infrequent in-person treatment (MD 0.5 kg; 95% -0.5 to 1.6; two trials). We did not observe consistent differences in dietary or physical activity behaviors between intervention and control groups in either weight loss or weight maintenance trials. Three weight loss studies estimated the costs of computer-based interventions compared to usual care, however two of the studies were 11 and 28 years old, and recent advances in technology render these estimates unlikely to be applicable to current or future interventions, while the third study was conducted in active duty military personnel, and it is unclear whether the costs are relevant to other settings. One weight loss study reported the cost-effectiveness ratio for a weekly in-person weight loss intervention relative to a computer-based intervention as USD 7177 (EUR 5678) per life year gained (80% CI USD 3055 to USD 60,291 (EUR 2417 to EUR 47,702)). It is unclear whether this could be extrapolated to other studies. No data were identified on adverse events, morbidity, complications or health-related quality of life.

Authors' conclusions: Compared to no intervention or minimal interventions (pamphlets, usual care), interactive computer-based interventions are an effective intervention for weight loss and weight maintenance. Compared to in-person interventions, interactive computer-based interventions result in smaller weight losses and lower levels of weight maintenance. The amount of additional weight loss, however, is relatively small and of brief duration, making the clinical significance of these differences unclear.

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Conflict of interest statement

L. Susan Wieland: none known.

Louise Falzon: none known.

Chris N. Sciamanna is developing and testing a web‐based weight loss program. It is a university‐based, grant‐funded project.

Kimberlee J. Trudeau: none known.

Suzanne Brodney: none known.

Joseph E. Schwartz: none known.

Karina W. Davidson: none known.

Figures

1
1
Study flow diagram.
2
2
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
4
4
Forest plot of comparison: 1 Weight loss: computer vs minimal intervention, outcome: 1.2 Weight at 6 mo [kg].
5
5
Forest plot of comparison: 5 Weight maintenance: computer vs minimal intervention, outcome: 5.2 Weight at 12 mo [kg].
6
6
Forest plot of comparison: 6 Weight maintenance: computer vs infrequent in‐person support, outcome: 6.2 Weight at 12 mo [kg].
1.1
1.1. Analysis
Comparison 1 Weight loss: computer vs minimal interventions, Outcome 1 Weight at 3 mo.
1.2
1.2. Analysis
Comparison 1 Weight loss: computer vs minimal interventions, Outcome 2 Weight at 6 mo.
1.3
1.3. Analysis
Comparison 1 Weight loss: computer vs minimal interventions, Outcome 3 Weight at 12 mo.
1.4
1.4. Analysis
Comparison 1 Weight loss: computer vs minimal interventions, Outcome 4 Change in weight at 3 mo.
1.5
1.5. Analysis
Comparison 1 Weight loss: computer vs minimal interventions, Outcome 5 Change in weight at 12 mo.
1.6
1.6. Analysis
Comparison 1 Weight loss: computer vs minimal interventions, Outcome 6 BMI at 3 to 4 mo.
1.7
1.7. Analysis
Comparison 1 Weight loss: computer vs minimal interventions, Outcome 7 BMI at 6 to 7 mo.
1.8
1.8. Analysis
Comparison 1 Weight loss: computer vs minimal interventions, Outcome 8 BMI at 12 mo.
1.9
1.9. Analysis
Comparison 1 Weight loss: computer vs minimal interventions, Outcome 9 Waist circumference at 3 mo [cm].
1.10
1.10. Analysis
Comparison 1 Weight loss: computer vs minimal interventions, Outcome 10 Waist circumference at 6 mo.
1.11
1.11. Analysis
Comparison 1 Weight loss: computer vs minimal interventions, Outcome 11 Waist circumference at 12 mo.
1.12
1.12. Analysis
Comparison 1 Weight loss: computer vs minimal interventions, Outcome 12 Energy intake at 3 to 4 mo.
1.13
1.13. Analysis
Comparison 1 Weight loss: computer vs minimal interventions, Outcome 13 Energy intake at 6 mo.
1.14
1.14. Analysis
Comparison 1 Weight loss: computer vs minimal interventions, Outcome 14 Energy intake at 12 mo.
1.15
1.15. Analysis
Comparison 1 Weight loss: computer vs minimal interventions, Outcome 15 Energy intake from fat at 6 mo.
1.16
1.16. Analysis
Comparison 1 Weight loss: computer vs minimal interventions, Outcome 16 Energy intake from fat at 12 mo.
1.17
1.17. Analysis
Comparison 1 Weight loss: computer vs minimal interventions, Outcome 17 Dietary fibre at 6 mo.
1.18
1.18. Analysis
Comparison 1 Weight loss: computer vs minimal interventions, Outcome 18 Physical activity at 3 mo.
1.19
1.19. Analysis
Comparison 1 Weight loss: computer vs minimal interventions, Outcome 19 Physical activity at 6 mo.
1.20
1.20. Analysis
Comparison 1 Weight loss: computer vs minimal interventions, Outcome 20 Physical activity at 12 mo.
2.1
2.1. Analysis
Comparison 2 Weight loss: computer vs in‐person interventions, Outcome 1 Weight at 6 mo.
2.2
2.2. Analysis
Comparison 2 Weight loss: computer vs in‐person interventions, Outcome 2 Change in weight at 6 mo.
3.1
3.1. Analysis
Comparison 3 Weight loss: computer‐delivered interaction as adjunct to Internet program, Outcome 1 Weight at 3 to 4 mo.
3.2
3.2. Analysis
Comparison 3 Weight loss: computer‐delivered interaction as adjunct to Internet program, Outcome 2 Weight at 6 mo.
3.3
3.3. Analysis
Comparison 3 Weight loss: computer‐delivered interaction as adjunct to Internet program, Outcome 3 Weight at 12 mo.
3.4
3.4. Analysis
Comparison 3 Weight loss: computer‐delivered interaction as adjunct to Internet program, Outcome 4 Change in weight at 3 mo.
3.5
3.5. Analysis
Comparison 3 Weight loss: computer‐delivered interaction as adjunct to Internet program, Outcome 5 Change in weight at 6 mo.
3.6
3.6. Analysis
Comparison 3 Weight loss: computer‐delivered interaction as adjunct to Internet program, Outcome 6 Change in weight at 12 mo.
3.7
3.7. Analysis
Comparison 3 Weight loss: computer‐delivered interaction as adjunct to Internet program, Outcome 7 BMI at 12 mo.
3.8
3.8. Analysis
Comparison 3 Weight loss: computer‐delivered interaction as adjunct to Internet program, Outcome 8 Waist circumference at 3 mo.
3.9
3.9. Analysis
Comparison 3 Weight loss: computer‐delivered interaction as adjunct to Internet program, Outcome 9 Waist circumference at 12 mo.
3.10
3.10. Analysis
Comparison 3 Weight loss: computer‐delivered interaction as adjunct to Internet program, Outcome 10 Calories at 3 to 4 mo.
3.11
3.11. Analysis
Comparison 3 Weight loss: computer‐delivered interaction as adjunct to Internet program, Outcome 11 Calories at 6 mo.
3.12
3.12. Analysis
Comparison 3 Weight loss: computer‐delivered interaction as adjunct to Internet program, Outcome 12 Calories from fat at 3 to 4 mo.
3.13
3.13. Analysis
Comparison 3 Weight loss: computer‐delivered interaction as adjunct to Internet program, Outcome 13 Calories from fat at 6 mo.
3.14
3.14. Analysis
Comparison 3 Weight loss: computer‐delivered interaction as adjunct to Internet program, Outcome 14 Calories from fat at 12 mo.
3.15
3.15. Analysis
Comparison 3 Weight loss: computer‐delivered interaction as adjunct to Internet program, Outcome 15 Physical activity at to 4 mo.
3.16
3.16. Analysis
Comparison 3 Weight loss: computer‐delivered interaction as adjunct to Internet program, Outcome 16 Physical activity at 6 mo.
3.17
3.17. Analysis
Comparison 3 Weight loss: computer‐delivered interaction as adjunct to Internet program, Outcome 17 Physical activity at 12 mo.
4.1
4.1. Analysis
Comparison 4 Weight loss: Computer intervention as adjunct to in‐person program, Outcome 1 Weight at 10 weeks.
4.2
4.2. Analysis
Comparison 4 Weight loss: Computer intervention as adjunct to in‐person program, Outcome 2 Weight at 6 mo after end of treatment.
5.1
5.1. Analysis
Comparison 5 Weight maintenance: computer vs minimal intervention, Outcome 1 Weight at 6 mo [kg].
5.2
5.2. Analysis
Comparison 5 Weight maintenance: computer vs minimal intervention, Outcome 2 Weight at 12 mo [kg].
5.3
5.3. Analysis
Comparison 5 Weight maintenance: computer vs minimal intervention, Outcome 3 Weight at 18 mo [kg].
5.4
5.4. Analysis
Comparison 5 Weight maintenance: computer vs minimal intervention, Outcome 4 Weight at 24 mo [kg].
5.5
5.5. Analysis
Comparison 5 Weight maintenance: computer vs minimal intervention, Outcome 5 Weight at 30 mo.
5.6
5.6. Analysis
Comparison 5 Weight maintenance: computer vs minimal intervention, Outcome 6 Change in weight at 30 mo [%].
5.7
5.7. Analysis
Comparison 5 Weight maintenance: computer vs minimal intervention, Outcome 7 BMI at 12 mo.
5.8
5.8. Analysis
Comparison 5 Weight maintenance: computer vs minimal intervention, Outcome 8 Energy intake at 12 mo.
5.9
5.9. Analysis
Comparison 5 Weight maintenance: computer vs minimal intervention, Outcome 9 Energy intake at 30 mo [kcal/day].
5.10
5.10. Analysis
Comparison 5 Weight maintenance: computer vs minimal intervention, Outcome 10 Energy expenditure at 12 mo.
6.1
6.1. Analysis
Comparison 6 Weight maintenance: computer vs infrequent in‐person support, Outcome 1 Weight at 6 mo [kg].
6.2
6.2. Analysis
Comparison 6 Weight maintenance: computer vs infrequent in‐person support, Outcome 2 Weight at 12 mo [kg].
6.3
6.3. Analysis
Comparison 6 Weight maintenance: computer vs infrequent in‐person support, Outcome 3 Weight at 18 mo [kg].
6.4
6.4. Analysis
Comparison 6 Weight maintenance: computer vs infrequent in‐person support, Outcome 4 Weight at 24 mo [kg].
6.5
6.5. Analysis
Comparison 6 Weight maintenance: computer vs infrequent in‐person support, Outcome 5 Weight at 30 mo.
6.6
6.6. Analysis
Comparison 6 Weight maintenance: computer vs infrequent in‐person support, Outcome 6 Change in weight at 30 mo [%].
6.7
6.7. Analysis
Comparison 6 Weight maintenance: computer vs infrequent in‐person support, Outcome 7 Energy intake at 30 mo [kcal/day].
7.1
7.1. Analysis
Comparison 7 Weight maintenance: computer vs frequent in‐person support, Outcome 1 Weight at 6 mo.
7.2
7.2. Analysis
Comparison 7 Weight maintenance: computer vs frequent in‐person support, Outcome 2 Weight at 12 mo.
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James 2001 {published data only}
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Jones 1997 {published data only}
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Kristal 2000 {published data only}
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Magnusdottir 2010 {published data only}
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Marcus 2007 {published data only}
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References to ongoing studies

Harvey‐Berino NCT01232699 {published data only}
    1. Harvey‐Berino JR. Internet obesity treatment enhanced with motivational interviewing. Clinicaltrials.gov.

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