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      Web-based interventions for weight loss and weight maintenance among rural midlife and older women: protocol for a randomized controlled trial

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          Abstract

          Background

          Weight loss is challenging and maintenance of weight loss is problematic among midlife and older rural women. Finding effective interventions using innovative delivery methods that can reach underserved and vulnerable populations of overweight and obese rural women is a public health challenge.

          Methods/Design

          This Women Weigh-In for Wellness (The WWW study) randomized-controlled trial is designed to compare the effectiveness of theory-based behavior-change interventions using (1) website only, (2) website with peer-led support, or (3) website with professional email-counseling to facilitate initial weight loss (baseline to 6 months), guided continuing weight loss and maintenance (7-18 months) and self-directed weight maintenance (19-30 months) among rural women ages 45-69 with a BMI of 28-45. Recruitment efforts using local media will target 306 rural women who live within driving distance of a community college site where assessments will be conducted at baseline, 3, 6, 12, 18, 24 and 30 months by research nurses blinded to group assignments. Primary outcomes include changes in body weight, % weight loss, and eating and activity behavioral and biomarkers from baseline to each subsequent assessment. Secondary outcomes will be percentage of women achieving at least 5% and 10% weight loss without regain from baseline to 6, 18, and 30 months and achieving healthy eating and activity targets. Data analysis will use generalized estimating equations to analyze average change across groups and group differences in proportion of participants achieving target weight loss levels.

          Discussion

          The Women Weigh-In for Wellness study compares innovative web-based alternatives for providing lifestyle behavior-change interventions for promoting weight loss and weight maintenance among rural women. If effective, such interventions would offer potential for reducing overweight and obesity among a vulnerable, hard-to-reach, population of rural women.

          Trial Registration

          ClinicalTrials.gov: NCT01307644

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          Most cited references34

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          The development of scales to measure social support for diet and exercise behaviors.

          J Sallis, R M Grossman, R Pinski … (1987)
          The purpose of this study was to develop measures of perceived social support specific to health-related eating and exercise behaviors. In Study I, specific supportive and nonsupportive behaviors were identified through interviews with 40 individuals making health-behavior changes. In Study II, items derived from the interviews were administered to 171 subjects. Support from family and friends was assessed separately for both diet and exercise habits. Meaningful factors were identified for each of the four scales, and some factors were similar for family and friend scales. Both test-retest and internal consistency reliabilities were acceptable, and six factors can be used as subscales. Social support scales were correlated with respective self-reported dietary and exercise habits, providing evidence of concurrent criterion-related validity. A measure of general social support was not related to the specific social support scales or to reported health habits. These scales are among the first measures of social support behaviors specific to dietary- and exercise-habit change.
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            Effects of Internet behavioral counseling on weight loss in adults at risk for type 2 diabetes: a randomized trial.

            Deborah Tate, Elizabeth H Jackvony, Rena R Wing (2003)
            Weight loss programs on the Internet appear promising for short-term weight loss but have not been studied for weight loss in individuals at risk of type 2 diabetes; thus, the longer-term efficacy is unknown. To compare the effects of an Internet weight loss program alone vs with the addition of behavioral counseling via e-mail provided for 1 year to individuals at risk of type 2 diabetes. A single-center randomized controlled trial conducted from September 2001 to September 2002 in Providence, RI, of 92 overweight adults whose mean (SD) age was 48.5 (9.4) years and body mass index, 33.1 (3.8). Participants were randomized to a basic Internet (n = 46) or to an Internet plus behavioral e-counseling program (n = 46). Both groups received 1 face-to-face counseling session and the same core Internet programs and were instructed to submit weekly weights. Participants in e-counseling submitted calorie and exercise information and received weekly e-mail behavioral counseling and feedback from a counselor. Measured weight and waist circumference at 0 and 12 months. Intent-to-treat analyses showed the behavioral e-counseling group lost more mean (SD) weight at 12 months than the basic Internet group (-4.4 [6.2] vs -2.0 [5.7] kg; P =.04), and had greater decreases in percentage of initial body weight (4.8% vs 2.2%; P =.03), body mass index (-1.6 [2.2] vs -0.8 [2.1]; P =.03), and waist circumference (-7.2 [7.5] vs -4.4 [5.7] cm; P =.05). Adding e-mail counseling to a basic Internet weight loss intervention program significantly improved weight loss in adults at risk of diabetes.
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              Development and psychometric evaluation of the exercise benefits/barriers scale.

              N Pender, Adam Walker, K Sechrist (1987)
              Initial psychometric evaluation of an instrument to measure perceived benefits of exercise and perceived barriers to exercise was based on the responses of 650 adults and included item analysis, factor analysis, and reliability measures. Factor analysis yielded nine factors, five benefits and four barriers, which explained 64.9% of the variance in the 43-item instrument. Second order factor analysis resulted in a two-factor solution, one a benefits factor and the other a barriers factor. The standardized Cronbach's alpha reliability coefficients were: .952 for the total scale, .953 for the benefits scale, and .886 for the barriers scale. Use of the instrument in research involving perceptions of the benefits of exercise and the barriers to exercise appears warranted.
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                Author and article information

                Journal
                Journal ID (nlm-ta): BMC Public Health
                Title: BMC Public Health
                Publisher: BioMed Central
                ISSN (Electronic): 1471-2458
                Publication date Collection: 2011
                Publication date (Electronic): 30 June 2011
                Volume: 11
                Page: 521
                Affiliations
                [1 ]Physical Therapy Education, School of Allied Health Professions, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
                [2 ]College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA
                [3 ]College of Nursing, University of Nebraska Medical Center, Lincoln, NE, USA
                [4 ]Panhandle Research and Extension, University of Nebraska-Lincoln, Scottsbluff, Nebraska, USA
                Article
                Publisher ID: 1471-2458-11-521
                DOI: 10.1186/1471-2458-11-521
                PMC ID: 3152906
                PubMed ID: 21718512
                SO-VID: f4bf8f83-6476-4cc8-84af-ddc3bfd88c91
                Copyright © Copyright ©2011 Hageman et al; licensee BioMed Central Ltd.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 27 June 2011
                Date accepted : 30 June 2011
                Categories
                Subject: Study Protocol

                ScienceOpen disciplines: Public health
                Data availability:
                ScienceOpen disciplines: Public health

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