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Nearly two-thirds of the US population is overweight or obese, making the discovery of successful weight loss interventions an important public health issue. Group behavioral weight loss programs are among the most widely researched treatments and consistently induce an 8% to 10% reduction in initial weight in 6 months. These programs, however, are time intensive, requiring weekly on-site meetings. Time and travel demands may contribute to the typical attrition rate of 20% in 4 to 6 months, with greater attrition in longer programs. Recent research has investigated interventions designed to decrease the demands of on-site behavioral programs. Such efforts have included the use of telephone and interactive television. Several studies also have shown that behavioral weight control can be successfully provided through Internet and e-mail contact. In addition to being accessible 24 hours a day, the Internet offers anonymity that could possibly encourage obese individuals who are embarrassed about their weight to seek treatment. Interventions with reduced time and travel demands also could make treatment more available to the millions of Americans who need it. Several commercial Internet programs are now offered to the public including Weight Watchers, Jenny Craig, Nutrisystem, Diet Smart, andeDiets.com. None of these programs has reported results of its Internet-based program as determined in randomized controlled trials.

This study assessed weight losses over 1 year for overweight and obese individuals who were randomly assigned to eDiets.com, a popular commercial Internet weight loss program. Weight losses of these participants were compared with those of individuals who received a widely used weight loss manual. Because participants in the eDicts.tom group could receive unlimited social support from on-line meetings and bulletin board support groups, the researchers predicted that they would lose significantly more weight than those who received the manual. This study represents the first investigation of a commercial Internet weight loss program.

Participants were 47 women with a mean age of 43.7 [+ or -] 10.2 (SD) years and a mean BMI of 33.5 [+ or -] 3.1 kg/[m.sup.2]. They were randomly assigned to either: 1) eDiets.com, a commercial Internet-based program available to the public; or 2) a weight loss manual (that is, LEARN Program for Weight Control 2000). At baseline, participants in both groups met briefly with a psychologist who instructed them to follow the components of their program as closely as possible. Additional brief visits were provided at weeks 8, 16, 26, and 52 to review their progress. Change in weight was the main outcome measure.

At week 16, participants in eDiets.com lost 0.9 [+ or -] 3.2% of initial weight compared with 3.6 [+ or -] 4.0% for women assigned to the weight loss manual. At week 52, losses increased to 1.1 [+ or -] 4.0% and 4.0 [+ or -]5.1%, respectively. Results of a last-observation-carried-forward analysis found that women in the manual group lost significantly more weight (at both times) than those treated by eDicts.com. There were no significant differences between groups in changes in cardiovascular risk factors or quality of life. Participants treated by eDiets.com kept food records a mean of 18.3 [+ or -] 21.7 days of a possible 112 days (that is, 16 weeks) compared with 29.0 [+ or -] 35.3 days for participants assigned to the LEARN manual. The difference between groups was not statistically significant. However, the number of food records kept by participants (during the first 16 weeks) correlated positively with weight loss at week 16 and at week 52.

This study's principal finding was that eDiets.com produced minimal weight loss and was not as effective as a traditional manual-based approach. Participants in eDicts.com lost only 0.9% of initial weight after 16 weeks and only 1.1% at 1 year. In contrast, women who received the weight loss manual lost 3.6% and 4.0% of initial weight after 16 weeks and 52 weeks of treatment, respectively. Both interventions prescribed similar weight loss techniques that included a reduced calorie diet, increased physical activity, and recommendations to record food intake. A major difference between the interventions was that participants in eDiets.com had unlimited access to social support, including on-line meetings that were moderated by a professional, online bulletin board support groups, and a 24-hr help desk staffed by customer service representatives.

Two factors seemed to limit the potential benefits of eDicts.com. First, the participants apparently made minimal use of the services available to them, as reflected by their logging on to the Website an average of only 17.7 times during the first 16 weeks. Women in the high log-on group (who averaged 33.0 log-ons) lost significantly more weight than those in the low log-on group (mean of 1.0 log-on). Even the high users, however, logged on an average of only twice a week, far less than the researchers had expected they would.

The second factor concerned structure. Although eDiets.com and the LEARN manual encouraged similar behaviors--including food monitoring, exercise, and calorie counting--eDicts.com did not seem to be as structured as the step-by-step LEARN approach. The LEARN manual provided 16 weekly behavioral weight control lessons that built on one another. For example, each lesson in the manual reiterated the importance of keeping food records and counting calories, eDiets.com participants had self-guided access to food records on the Website, but the program did not emphasize record keeping and calorie counting in a manner comparable with the regimented approach in LEARN. When recording an entry in the eDiets.com food journal, members were asked to record the food eaten, time, quantity, with whom, and mood. They were not specifically asked to record and total their calories. By contrast, participants who used the LEARN manual understood that keeping daily food and calorie records was an essential part of the program.

These findings suggest that consumers are unlikely to achieve clinically significant weight loss by using Internet programs that provide primarily information about diet and physical activity. Successful Interact interventions seem to incorporate practices--including record keeping, personalized feedback, and accountability--that are found in traditional behavioral weight control programs. It remains to be seen whether commercial Interact programs can incorporate such practices.

L Womble, T Wadden, B McGuckin, S Sargent, R Rothman, S Krauthamer-Ewing. A randomized controlled trial of a commercial Internet weight loss program. Obes Res 12:1011-1018 (June 2004) [Correspondence:Leslie G. Womble, University of Pennsylvania, Weight and Eating Disorders Program, 3535 Market St., Suite 3029, Philadelphia, PA 19104. E-mail: womble@mail.med.upenn.edu]