Adding Evidence-Based Behavioral Weight Loss Strategies to a Statewide Wellness Campaign: A Randomized Clinical Trial

Objectives. We determined the efficacy and cost-effectiveness of adding an evidence-based Internet behavioral weight loss intervention alone or combined with optional group sessions to ShapeUp Rhode Island 2011 (SURI), a 3-month statewide wellness campaign.Methods. We randomized participants (n = 230; body mass index = 34.3 ±6.8 kg/m²; 84% female) to the standard SURI program (S) or to 1 of 2 enhanced programs: SURI plus Internet behavioral program (SI) or SI plus optional group sessions (SIG). The primary outcome was weight loss at the end of the 3-month program.Results. Weight losses differed among all 3 conditions (S: 1.1% ±0.9%; SI: 4.2% ±0.6%; SIG: 6.1% ±0.6%; Ps ≤ .04). Both SI and SIG increased the percentage of individuals who achieved a 5% weight loss (SI: 42%; SIG: 54%; S: 7%; Ps < .001). Cost per kilogram of weight loss was similar for S ($39) and SI ($35); both were lower than SIG ($114).Conclusions. Although weight losses were greatest at the end of SURI with optional group sessions, the addition of an Internet behavioral program was the most cost-effective method to enhance weight losses.Excess adiposity is associated with increased health risk.1,2 Behavioral weight loss programs are the treatment of choice for overweight and moderate obesity. These programs produce weight losses of 8 to 10 kilograms during the initial months of treatment,3 which are associated with significant health improvements.4,5 However, the programs are intensive, expensive, and only accessible to a small portion of individuals in need. Thus, there is critical need to develop cost-effective weight loss programs that are accessible to large numbers of overweight and obese individuals.Community weight loss campaigns are typically offered via the Internet and reach large numbers of people. However, weight losses produced in these programs are modest. Thus, the challenge is to use these wide-reaching community programs to attract large numbers of individuals and enhance the weight losses without substantially increasing cost. We have begun to programmatically test ways to improve weight outcomes in ShapeUp Rhode Island (SURI), an annual 3-month Internet-based community initiative that attracts thousands of overweight and obese adults. In an earlier trial,6 we showed that providing SURI participants with behavioral weight loss strategies via e-mail (i.e., sending weekly PowerPoint slides and providing feedback) significantly improved 3-month weight losses (–3.1 kg vs –1.2 kg). If providing access to evidence-based weight loss strategies was found to be both effective and cost-effective, the potential public health impact would be substantial. In addition, it is important to evaluate other approaches that might further enhance SURI outcomes.This trial extended our previous work. Based on the content of our previous e-mail intervention, we developed an Internet behavioral weight loss Web site and examined whether it improved weight loss outcomes in SURI 2011. In addition, we examined whether adding optional group sessions to the new Internet program further improves weight losses. Secondary aims explored the cost-effectiveness of these strategies and examined weight loss trajectories following treatment. We hypothesized that SURI weight losses might be increased if, in addition to adding an Internet behavioral program, participants were offered optional group sessions. However, because adding group meetings would likely increase cost, we examined whether the expected increased weight loss would justify the increased cost. The primary endpoint was 3 months.