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Use of the internet in the treatment of obesity and prevention of type 2 diabetes in primary care

  • Kathleen M. McTigue (a1) and Molly B. Conroy (a1)

Cardiovascular prevention, including emphasising healthy diet and physical activity patterns for weight loss and diabetes prevention, is an important focus of primary care medicine, yet provision of intensive lifestyle counselling in the primary care setting remains uncommon. Online approaches for providing lifestyle counselling are emerging as a new avenue for bringing support to outpatient patient populations. Features of successful programmes include the use of a structured behavioural programme, electronic counselling support and feedback, and uncomplicated user interfaces. Online tools may be used independently or to complement in-person approaches. Limited data also suggest that the internet can be used to support the maintenance of weight loss. In addition, the internet may help overcome various clinical barriers to lifestyle support, including significant time limitations, a need to prioritise acute care and maintain clinical workflow, and the high cost of counselling. Furthermore, the continuity of the primary care patient–provider(s) relationship provides an established source of long-term support which has been difficult to create in other community settings. As the field of online lifestyle counselling matures, nutrition and physical activity experts will face new challenges in providing asynchronous counselling without the assistance of traditional non-verbal communication cues. However, the potential for reaching a wider population in a convenient and accessible manner also creates unique opportunities for providing lifestyle support.

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* Corresponding author: Dr Kathleen M. McTigue, fax +1 412-692-4838, email
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This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

1. S Wild , G Roglic , A Green (2004) Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 27, 10471053.

2. A Must , J Spadano , EH Coakley (1999) The disease burden associated with overweight and obesity. JAMA 282, 15231529.

5. KM McTigue , R Harris , B Hemphill (2003) Screening and interventions for obesity in adults: summary of the evidence for the U.S. Preventive services task force. Ann Intern Med 139, 933949.

6. A Peeters , L Bonneux , WJ Nusselder (2004) Adult obesity and the burden of disability throughout life. Obes Res 12, 11451151.

7. SP Messier , RF Loeser , GD Miller (2004) Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis: the Arthritis, Diet, and Activity Promotion Trial. Arthritis Rheum 50, 15011510.

9. A Berghofer , T Pischon , T Reinhold (2008) Obesity prevalence from a European perspective: a systematic review. BMC Public Health 8, 200.

10. J Tuomilehto , J Lindstrom , JG Eriksson (2001) Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 344, 13431350.

12. J Anhoj & AH Jensen (2004) Using the internet for life style changes in diet and physical activity: a feasibility study. J Med Internet Res 6, e28.

13. AG Tsai & TA Wadden (2005) Systematic review: an evaluation of major commercial weight loss programs in the United States. Ann Intern Med 142, 5666.

14. S Heshka , JW Anderson , RL Atkinson (2003) Weight loss with self-help compared with a structured commercial program: a randomized trial. JAMA 289, 17921798.

15. CD Gardner , A Kiazand , S Alhassan (2007) Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women: the A TO Z Weight Loss Study: a randomized trial. JAMA 297, 969977.

17. E Frank & T Kunovich-Frieze (1995) Physicians’ prevention counseling behaviors: current status and future directions. Prev Med 24, 543545.

18. JC Livaudais , CP Kaplan , JS Haas (2005) Lifestyle behavior counseling for women patients among a sample of California physicians. J Womens Health (Larchmt) 14, 485495.

20. RF Kushner (1995) Barriers to providing nutrition counseling by physicians: a survey of primary care practitioners. Prev Med 24, 546552.

21. DY Hung , TG Rundall , AF Tallia (2007) Rethinking prevention in primary care: applying the chronic care model to address health risk behaviors. Milbank Q 85, 6991.

22. E Wagner (1996) Organizing care for patients with chronic illness. Milbank Q 74, 511544.

24. EH Wagner (2004) Effective teamwork and quality of care. Med Care 42, 10371039.

25. EH Wagner , SM Bennett , BT Austin (2005) Finding common ground: patient-centeredness and evidence-based chronic illness care. J Altern Complement Med 11, Suppl. 1, S7S15.

26. L Toop (1998) Primary care: core values. Patient centred primary care. Br Med J 316, 18821883.

29. J Manson , P Skerrett , P Greenland (2004) The escalating pandemics of obesity and sedentary lifestyle. A call to action for clinicians. Arch Intern Med 164, 249258.

30. P Libby (2005) The forgotten majority: unfinished business in cardiovascular risk reduction. J Am Coll Cardiol 46, 12251228.

31. JG Scott , D Cohen , B DiCicco-Bloom (2004) Speaking of weight: how patients and primary care clinicians initiate weight loss counseling. Prev Med 38, 819827.

32. CB Ruser , L Sanders , GR Brescia (2005) Identification and management of overweight and obesity by internal medicine residents. J Gen Intern Med 20, 11391141.

33. LR Simkin-Silverman , KA Gleason , WC King (2005) Predictors of weight control advice in primary care practices: patient health and psychosocial characteristics. Prev Med 40, 7182.

34. CC Wee , EP McCarthy , RB Davis (1999) Physician counseling about exercise. JAMA 282, 15831588.

36. MA White , PD Martin , RL Newton (2004) Mediators of weight loss in a family-based intervention presented over the internet. Obes Res 12, 10501059.

37. DF Tate , RR Wing & RA Winett (2001) Using Internet technology to deliver a behavioral weight loss program. JAMA 285, 11721177.

38. J Harvey-Berino , D West , R Krukowski (2010) Internet delivered behavioral obesity treatment. Prev Med 51, 123128.

40. RA Winett , DF Tate , ES Anderson (2005) Long-term weight gain prevention: a theoretically based Internet approach. Prev Med 41, 629641.

41. DF Tate , EH Jackvony & RR Wing (2003) Effects of Internet behavioral counseling on weight loss in adults at risk for type 2 diabetes: a randomized trial. JAMA 289, 18331836. Available at: Accessed November 2002.

42. J Harvey-Berino , S Pintauro , P Buzzell (2004) Effect of internet support on the long-term maintenance of weight loss. Obes Res 12, 320329.

43. RR Wing , DF Tate , AA Gorin (2006) A self-regulation program for maintenance of weight loss. N Engl J Med 355, 15631571.

44. LJ Appel , JM Clark , HC Yeh (2011) Comparative effectiveness of weight-loss interventions in clinical practice. N Engl J Med 365, 19591968.

46. RA Winett , ES Anderson , JR Wojcik (2007) Guide to health: nutrition and physical activity outcomes of a group-randomized trial of an Internet-based intervention in churches. Ann Behav Med 33, 251261.

47. A McConnon , SF Kirk , JE Cockroft . (2007) The Internet for weight control in an obese sample: results of a randomised controlled trial. BMC Health Serv Res 7, 206.

48. N Micco , B Gold , P Buzzell (2007) Minimal in-person support as an adjunct to internet obesity treatment. Ann Behav Med 33, 4956.

49. PJ Morgan , DR Lubans , CE Collins (2011) 12-month outcomes and process evaluation of the SHED-IT RCT: an internet-based weight loss program targeting men. Obesity (Silver Spring) 19, 142151.

51. LG Womble , TA Wadden , BG McGuckin (2004) A randomized controlled trial of a commercial internet weight loss program. Obes Res 12, 10111018.

52. J Wylie-Rosett , C Swencionis , M Ginsberg . (2001) Computerized weight loss intervention optimizes staff time: the clinical and cost results of a controlled clinical trial conducted in a managed care setting. J Am Diet Assoc 101, 11551162; quiz 1163–1154.

53. GG Bennett , SJ Herring , E Puleo (2010) Web-based weight loss in primary care: a randomized controlled trial. Obesity (Silver Spring) 18, 308313.

54. K Rothert , VJ Strecher , LA Doyle (2006) Web-based weight management programs in an integrated health care setting: a randomized, controlled trial. Obesity (Silver Spring) 14, 266272.

55. LP Svetkey , VJ Stevens , PJ Brantley (2008) Comparison of strategies for sustaining weight loss: the weight loss maintenance randomized controlled trial. JAMA 299, 11391148.

56. KL Funk , VJ Stevens , LJ Appel . (2010) Associations of internet website use with weight change in a long-term weight loss maintenance program. J Med Internet Res 12, e29.

57. EC Cussler , PJ Teixeira , SB Going (2008) Maintenance of weight loss in overweight middle-aged women through the Internet. Obesity (Silver Spring) 16, 10521060.

58. BC Gold , S Burke , S Pintauro (2007) Weight loss on the web: A pilot study comparing a structured behavioral intervention to a commercial program. Obesity (Silver Spring) 15, 155164.

59. J Harvey-Berino , SJ Pintauro & EC Gold (2002) The feasibility of using Internet support for the maintenance of weight loss. Behav Modif 26, 103116.

60. RA Krukowski , J Harvey-Berino , T Ashikaga (2008) Internet-based weight control: the relationship between web features and weight loss. Telemed J E Health 14, 775782.

61. GD Foster , TA Wadden , AP Makris (2003) Primary care physicians' attitudes about obesity and its treatment. Obes Res 11, 11681177.

62. ET Hebert , MO Caughy & K Shuval (2012) Primary care providers' perceptions of physical activity counselling in a clinical setting: a systematic review. Br J Sports Med 46, 625631.

63. I Melin , B Karlstrom , L Berglund (2005) Education and supervision of health care professionals to initiate, implement and improve management of obesity. Patient Educ Couns 58, 127136.

64. L Treyzon (2005) Assessment of obesity management in medical examination. Nutr J 4, 10.

66. CC Wee , MB Hamel , RB Davis (2004) Assessing the value of weight loss among primary care patients. J Gen Intern Med 19, 12061211.

67. TA Wadden , DA Anderson , GD Foster (2000) Obese women's perceptions of their physicians’ weight management attitudes and practices. Arch Fam Med 9, 854860.

68. KM McTigue , R Hess , CL Bryce . (2006) Perception of “healthy” body weight by patients with diabetes. Diabetes Care 29, 695697.

69. S Katz , A Feigenbaum , S Pasternak (2005) An interactive course to enhance self-efficacy of family practitioners to treat obesity. BMC Med Educ 5, 4.

70. KS Yarnall , KI Pollak , T Ostbye (2003) Primary care: is there enough time for prevention? Am J Public Health 93, 635641.

71. L Getz , JA Sigurdsson & I Hetlevik (2003) Is opportunistic disease prevention in the consultation ethically justifiable? Br Med J 327, 498500.

73. AG Tsai , DA Asch & TA Wadden (2006) Insurance coverage for obesity treatment. J Am Diet Assoc 106, 16511655.

74. DK Ahern , JM Phalen & RE Mockenhaupt (2003) Science and the advancement of eHealth: a call to action. Am J Prev Med 24, 108109.

75. KO Hwang , HL Stuckey , MC Chen . (2012) Primary care providers’ perspectives on online weight-loss programs: a big wish list. J Med Internet Res 14, e16.

76. KM McTigue , MB Conroy , L Bigi (2009) Weight loss through living well: translating an effective lifestyle intervention into clinical practice. Diabetes Educ 35, 199204, 208.

77. KM McTigue , MB Conroy , R Hess (2009) Using the internet to translate an evidence-based lifestyle intervention into practice. Telemed JE Health 15, 851858.

78. KM McTigue , T Bhargava , CL Bryce (2011) Patient perspectives on the integration of an intensive online behavioral weight loss intervention into primary care. Patient Educ Couns 83, 261264.

86. A Bleakley , CR Merzel , NL VanDevanter (2004) Computer access and Internet use among urban youths. Am J Public Health 94, 744746.

87. T Kind , ZJ Huang , D Farr (2005) Internet and computer access and use for health information in an underserved community. Ambul Pediatr 5, 117121.

88. KD Mandl , S Feit , BM Pena (2000) Growth and determinants of access in patient e-mail and Internet use. Arch Pediatr Adolesc Med 154, 508511.

89. R Hess , A Santucci , K McTigue (2008) Patient difficulty using tablet computers to screen in primary care. J Gen Intern Med 23, 476480.

90. JE Barnett (2005) Online counseling: new entity, new challenges. Counsel Psychol 33, 872880.

91. EA Ensher , C Heun & A Blanchard (2003) Online mentoring and computer-mediated communication: New directions in research. J Voc Behav 63, 264288.

92. AB Rochlen , JS Zack & C Speyer (2004) Online therapy: Review of relevant definitions, debates, and current empirical support. J Clin Psychol 60, 269283.

93. MJ Mallen , DL Vogel & AB Rochlen (2005) The practical aspects of Online counseling: Ethics, training, technology, and competency. Couns Psychol 33, 776818.

94. LR Simkin-Silverman , MB Conroy , T Bhargava (2011) Development of an online diabetes prevention lifestyle intervention coaching protocol for use in primary care practice. Diabetes Educ 37, 263268.

95. DB Bahr , RC Browning , HR Wyatt (2009) Exploiting social networks to mitigate the obesity epidemic. Obesity (Silver Spring) 17, 723728.

96. KO Hwang , AJ Ottenbacher , AP Green (2010) Social support in an Internet weight loss community. Int J Med Inform 79, 513.

97. VA Reed , KE Schifferdecker , ME Rezaee (2012) The effect of computers for weight loss: a systematic review and meta-analysis of randomized trials. J Gen Intern Med 27, 99108.

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