Hybrid of online support, therapy helps maintain weight loss

By Laura Lovett
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Keeping weight off after a successful diet has traditionally posed a difficult challenge for dieters, but researchers in Oulu Finland have just published a study in the that highlighted how a hybrid web-based intervention could help for the long run. 

The study's authors found that cognitive behavioral therapy (CBT) counseling combined with an online health behavior change support system (HBCSS) helped subjects lose and maintain their weight. More specifically, when participants underwent CBT with the online HBCSS, they lost 4.1 percent of their body weight after 12 months of the intervention, and 3.4 percent of their body weight from baseline at a 24-month follow up, according to the study. Participants who just had the online HBCSS were also able to keep off some of that weight over time, seeing an average decrease of 1.6 percent their body weight over 24 months. 

"Modifiable tools based on scientific evidence are needed for personalized treatment of obesity. HBCSS combined with cognitive behavioral group therapy or as a stand-alone treatment provides us with such a modifiable method for personalized medicine," Dr. Tuire Salonurmi, co-leading author of the paper and research scientist at the University of Oulu and Oulu University Hospital in Finland, said in a statement.

It’s common for folks to regain weight after a period of loss — in fact, the researchers noted that one year after someone has lost weight, they have typically gained 50 percent of that weight back. But if the weight loss is maintained over two years, the dieter’s chance of gaining the weight back goes down significantly, according to the paper.

That’s where this study came in, with researchers deciding to create a new type of program that could help people get support so that they didn’t revert. The authors came up with a program that combines multiple types of interventions, including group counseling based on CBT with an information and communication technology (ICT) health behavior support, and HBCSS. 

The trial recruited 532 people between the ages of 20 and 50 years that were categorized as overweight or obese (BMI 27-35). The study, which lasted 24-months, split participants up into six groups. Participants were placed into one of six groups receiving a different 12-month intervention: CBT‐based group counseling, self‐help guidance‐based group counseling, and controls, each with or without HCBSS, according to the study. 

“In this randomized long‐term lifestyle change trial, an internet‐based HBCSS was effective in improving weight loss and reduction in waist circumference for up to 2 years,” the authors of the study wrote. “Interventions using the HBCSS had significantly higher success rates regardless of the type of group counseling (CBT or SHG), compared to counseling alone. In addition, the success rate was also high in participants in the control group who received HBCSS (but no face‐to‐face counseling).”

Participants were screened at 12 and 24-months. In these screenings participants had blood levels sampled, waist circumferences measured, and BMIs calculated. 

The researchers found that participants who were in the CBT group and also had the HCBSS intervention lost the most weight (4.1 percent). Additionally, 33 percent of participants in this group had a weight loss of 5 percent or more at 24-months, according to the paper. 

They also saw that people’s chances of losing more than 10 percent of their body weight increased by three-fold when they were in an intervention arm with HBCSS. In fact, 8.6 to 11.3 percent of participants that were receiving HCBSS lost more than 10 percent of their body weight, regardless of whether they were getting group therapy or not.

Researchers also found that participants who were obese had a greater weight loss than overweight subjects in all arms. 

“In conclusion, this randomized trial showed that an HBCSS based on PSD and CBT methods can facilitate weight loss, and weight loss maintenance, when delivered in combination with group counseling (mainly CBT‐based) and also, to some extent, without face‐to‐face counseling,” authors wrote. “The latter may prove to be important in implementing new cost‐effective means to prevent obesity and the development of cardiovascular disease risk factors.”