Internet Obesity Treatment Enhanced With Motivational Interviewing (iReach2)

Internet-based weight control programs have been shown effective in producing weight loss, but in-person delivery of behavioral weight control produces significantly greater weight loss than on-line delivery of the same program. Motivational Interviewing has been shown to increase weight loss when delivered as an adjunct to in-person weight loss programs but has not been examined in conjunction with web-based obesity treatment. Therefore, the overall goal of this project is to determine if the addition of on-line Motivational Interviewing to a web-based group behavioral obesity treatment program will augment weight loss outcomes.

This randomized controlled trial is designed to determine whether weight losses in a group behavioral weight loss intervention conducted over the Internet are increased with the inclusion of individual, online MI sessions. All participants will receive the same online 6-month group-based behavioral weight loss program followed by 12 months of weight maintenance. Overweight and obese adults at two study sties (N=426) will be randomized to (1) Internet intervention; or 2) Internet intervention with individual MI sessions occurring at three month intervals on a fixed schedule (Internet+MI-Fixed). Assessments will be conducted every six months and will include measures of body weight and height, diet and exercise behaviors, Quality of Life, adherence measures (eg., attendance, compliance with self-monitoring), social influence components, motivation, treatment satisfaction, demographic data and descriptive information regarding use of website components. A third arm was added for the final 3 intervention cohorts. All participants received the program as described above with the addition of motivational interviewing contingent on participants' attendance in classes.

Participants will attend weekly class sessions on line and track food and exercise in an on-line journal.

Participants will attend weekly classes on line, record food and exercise in an on-line journal, and will have no more than 6 individual motivational interviewing sessions.

Intervention is the same as for the MI arm, however participants will only receive MI if meeting certain treatment participation conditions.

Participants will engage in self monitoring, will receive skills training to help cope with environmental triggers, and will receive nutrition advice.

In addition to weekly group meetings, self-monitoring through recording calorie and fat intake daily as well as exercise, participants will meet one-on-one with an MI counselor on-line in order to augment an individual's motivation to change behavior.

Participants will attend weekly behavioral internet meetings. They may or may not receive Motivational Interviewing depending on their class attendance.

Weights will be taken in street clothes without shoes using a hospital quality digital floor model scale.

Weights will be taken in street clothes without shoes using a hospital quality digital floor model scale. Height will be taken at baseline using a wall-mounted stadiometer and BMI will be calculated as weight (kg)/height(m2)

Items will include attendance at chat group meetings and completion of online food diaries and exercise records.

We will assess participant motivation for participating in a weight reduction program and adhering to the program.

Inclusion Criteria: must be over 18 must have a BMI between 18 and 50 must live within 60 minutes driving distance of University of Arkansas, Little Rock, AR, or University of Vermont, Burlington, Vermont must be able to walk for exercise Exclusion Criteria:

Harvey J, Krukowski R, Priest J, West D. Log Often, Lose More: Electronic Dietary Self-Monitoring for Weight Loss. Obesity (Silver Spring). 2019 Mar;27(3):380-384. doi: 10.1002/oby.22382.

West DS, Harvey JR, Krukowski RA, Prewitt TE, Priest J, Ashikaga T. Do individual, online motivational interviewing chat sessions enhance weight loss in a group-based, online weight control program? Obesity (Silver Spring). 2016 Nov;24(11):2334-2340. doi: 10.1002/oby.21645. Epub 2016 Sep 12.

Krukowski RA, DiLillo V, Ingle K, Harvey JR, West DS. Design and Methods of a Synchronous Online Motivational Interviewing Intervention for Weight Management. JMIR Res Protoc. 2016 Apr 19;5(2):e69. doi: 10.2196/resprot.5382.