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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)
Abstract

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
* Corresponding author: Dr Kathleen M. McTigue, fax +1 412-692-4838, email kmm34@pitt.edu
References
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1. Wild S, Roglic G, Green A et al. (2004) Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 27, 10471053.
2. Must A, Spadano J, Coakley EH et al. (1999) The disease burden associated with overweight and obesity. JAMA 282, 15231529.
3. NHS Centre for Reviews and Dissemination (1997) The prevention and treatment of obesity. Eff Health Care 97, 112.
4. NHLBI Obesity Education Initiative (1998). Clinical guidelines on the identification, evaluation and treatment of overweight and obesity in adults: the Evidence Report. NIH Publication No. 98-4083. Bethesda, MD: U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Heart, Lung and Blood Institute.
5. McTigue KM, Harris R, Hemphill B et al. (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. Peeters A, Bonneux L, Nusselder WJ et al. (2004) Adult obesity and the burden of disability throughout life. Obes Res 12, 11451151.
7. Messier SP, Loeser RF, Miller GD et al. (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.
8. National Center for Health Statistics (2012) Health, United States, 2011: with special feature on socioeconomic status and health. Hyattsville, MD. http://www.cdc.gov/nchs/data/hus/hus11.pdf Accessed October 2012.
9. Berghofer A, Pischon T, Reinhold T et al. (2008) Obesity prevalence from a European perspective: a systematic review. BMC Public Health 8, 200.
10. Tuomilehto J, Lindstrom J, Eriksson JG et al. (2001) Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 344, 13431350.
11. Knowler WC, Barrett-Connor E, Fowler SE et al. (2002) Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 346, 393403.
12. Anhoj J & Jensen AH (2004) Using the internet for life style changes in diet and physical activity: a feasibility study. J Med Internet Res 6, e28.
13. Tsai AG & Wadden TA (2005) Systematic review: an evaluation of major commercial weight loss programs in the United States. Ann Intern Med 142, 5666.
14. Heshka S, Anderson JW, Atkinson RL et al. (2003) Weight loss with self-help compared with a structured commercial program: a randomized trial. JAMA 289, 17921798.
15. Gardner CD, Kiazand A, Alhassan S et al. (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.
16. American Heart Association (2002) Media Advisory: American Heart Association Statement on High-Protein, Low-Carbohydrate Diet Study Presented at Scientific Sessions, 19 November 2002.
17. Frank E & Kunovich-Frieze T (1995) Physicians’ prevention counseling behaviors: current status and future directions. Prev Med 24, 543545.
18. Livaudais JC, Kaplan CP, Haas JS et al. (2005) Lifestyle behavior counseling for women patients among a sample of California physicians. J Womens Health (Larchmt) 14, 485495.
19. Tsui JI, Dodson K & Jacobson TA (2004) Cardiovascular disease prevention counseling in residency: resident and attending physician attitudes and practices. J Natl Med Assoc 96, 10801083, 10881091.
20. Kushner RF (1995) Barriers to providing nutrition counseling by physicians: a survey of primary care practitioners. Prev Med 24, 546552.
21. Hung DY, Rundall TG, Tallia AF et al. (2007) Rethinking prevention in primary care: applying the chronic care model to address health risk behaviors. Milbank Q 85, 6991.
22. Wagner E (1996) Organizing care for patients with chronic illness. Milbank Q 74, 511544.
23. Wagner EH (1998) Chronic disease management: what will it take to improve care for chronic illness? Eff Clin Pract 1, 24.
24. Wagner EH (2004) Effective teamwork and quality of care. Med Care 42, 10371039.
25. Wagner EH, Bennett SM, Austin BT et al. (2005) Finding common ground: patient-centeredness and evidence-based chronic illness care. J Altern Complement Med 11, Suppl. 1, S7S15.
26. Toop L (1998) Primary care: core values. Patient centred primary care. Br Med J 316, 18821883.
27. National Institute for Health and Clinical Excellence National Collaborating Centre for Primary Care (2006) Obesity: The Prevention, Identification, Assessment and Management of Overweight and Obesity in Adults and Children. Available at: http://www.nice.org.uk/nicemedia/live/11000/38294/38294.pdf. Accessed July 2012.
28. Douketis JD, Feightner JW, Attia J et al. (1999) Periodic health examination, 1999 update: 1. Detection, prevention and treatment of obesity. Canadian Task Force on Preventive Health Care. CMAJ 160, 513525.
29. Manson J, Skerrett P, Greenland P et al. (2004) The escalating pandemics of obesity and sedentary lifestyle. A call to action for clinicians. Arch Intern Med 164, 249258.
30. Libby P (2005) The forgotten majority: unfinished business in cardiovascular risk reduction. J Am Coll Cardiol 46, 12251228.
31. Scott JG, Cohen D, DiCicco-Bloom B et al. (2004) Speaking of weight: how patients and primary care clinicians initiate weight loss counseling. Prev Med 38, 819827.
32. Ruser CB, Sanders L, Brescia GR et al. (2005) Identification and management of overweight and obesity by internal medicine residents. J Gen Intern Med 20, 11391141.
33. Simkin-Silverman LR, Gleason KA, King WC et al. (2005) Predictors of weight control advice in primary care practices: patient health and psychosocial characteristics. Prev Med 40, 7182.
34. Wee CC, McCarthy EP, Davis RB et al. (1999) Physician counseling about exercise. JAMA 282, 15831588.
35. Potter MB, Vu JD & Croughan-Minihane M (2001) Weight management: what patients want from their primary care physicians. J Fam Pract 50, 513518.
36. White MA, Martin PD, Newton RL et al. (2004) Mediators of weight loss in a family-based intervention presented over the internet. Obes Res 12, 10501059.
37. Tate DF, Wing RR & Winett RA (2001) Using Internet technology to deliver a behavioral weight loss program. JAMA 285, 11721177.
38. Harvey-Berino J, West D, Krukowski R et al. (2010) Internet delivered behavioral obesity treatment. Prev Med 51, 123128.
39. Miles J, Petrie C & Steel M (2000) Slimming on the Internet. J R Soc Med 93, 254257.
40. Winett RA, Tate DF, Anderson ES et al. (2005) Long-term weight gain prevention: a theoretically based Internet approach. Prev Med 41, 629641.
41. Tate DF, Jackvony EH & Wing RR (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: http://www.americanheart.org/presenter.jhtml?identifier=3006728. Accessed November 2002.
42. Harvey-Berino J, Pintauro S, Buzzell P et al. (2004) Effect of internet support on the long-term maintenance of weight loss. Obes Res 12, 320329.
43. Wing RR, Tate DF, Gorin AA et al. (2006) A self-regulation program for maintenance of weight loss. N Engl J Med 355, 15631571.
44. Appel LJ, Clark JM, Yeh HC et al. (2011) Comparative effectiveness of weight-loss interventions in clinical practice. N Engl J Med 365, 19591968.
45. Bennett GG, Warner ET, Glasgow RE et al. (2012) Obesity treatment for socioeconomically disadvantaged patients in primary care practice. Arch Intern Med 172, 565574.
46. Winett RA, Anderson ES, Wojcik JR et al. (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. McConnon A, Kirk SF, Cockroft JE et al. . (2007) The Internet for weight control in an obese sample: results of a randomised controlled trial. BMC Health Serv Res 7, 206.
48. Micco N, Gold B, Buzzell P et al. (2007) Minimal in-person support as an adjunct to internet obesity treatment. Ann Behav Med 33, 4956.
49. Morgan PJ, Lubans DR, Collins CE et al. (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.
50. Turnin MC, Bourgeois O, Cathelineau G et al. (2001) Multicenter randomized evaluation of a nutritional education software in obese patients. Diabetes Metab 27, 139147.
51. Womble LG, Wadden TA, McGuckin BG et al. (2004) A randomized controlled trial of a commercial internet weight loss program. Obes Res 12, 10111018.
52. Wylie-Rosett J, Swencionis C, Ginsberg M et al. . (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. Bennett GG, Herring SJ, Puleo E et al. (2010) Web-based weight loss in primary care: a randomized controlled trial. Obesity (Silver Spring) 18, 308313.
54. Rothert K, Strecher VJ, Doyle LA et al. (2006) Web-based weight management programs in an integrated health care setting: a randomized, controlled trial. Obesity (Silver Spring) 14, 266272.
55. Svetkey LP, Stevens VJ, Brantley PJ et al. (2008) Comparison of strategies for sustaining weight loss: the weight loss maintenance randomized controlled trial. JAMA 299, 11391148.
56. Funk KL, Stevens VJ, Appel LJ et al. . (2010) Associations of internet website use with weight change in a long-term weight loss maintenance program. J Med Internet Res 12, e29.
57. Cussler EC, Teixeira PJ, Going SB et al. (2008) Maintenance of weight loss in overweight middle-aged women through the Internet. Obesity (Silver Spring) 16, 10521060.
58. Gold BC, Burke S, Pintauro S et al. (2007) Weight loss on the web: A pilot study comparing a structured behavioral intervention to a commercial program. Obesity (Silver Spring) 15, 155164.
59. Harvey-Berino J, Pintauro SJ & Gold EC (2002) The feasibility of using Internet support for the maintenance of weight loss. Behav Modif 26, 103116.
60. Krukowski RA, Harvey-Berino J, Ashikaga T et al. (2008) Internet-based weight control: the relationship between web features and weight loss. Telemed J E Health 14, 775782.
61. Foster GD, Wadden TA, Makris AP et al. (2003) Primary care physicians' attitudes about obesity and its treatment. Obes Res 11, 11681177.
62. Hebert ET, Caughy MO & Shuval K (2012) Primary care providers' perceptions of physical activity counselling in a clinical setting: a systematic review. Br J Sports Med 46, 625631.
63. Melin I, Karlstrom B, Berglund L et al. (2005) Education and supervision of health care professionals to initiate, implement and improve management of obesity. Patient Educ Couns 58, 127136.
64. Treyzon L (2005) Assessment of obesity management in medical examination. Nutr J 4, 10.
65. Williams R, Rapport F, Elwyn G et al. (2004) The prevention of type 2 diabetes: general practitioner and practice nurse opinions. Br J Gen Pract 54, 531535.
66. Wee CC, Hamel MB, Davis RB et al. (2004) Assessing the value of weight loss among primary care patients. J Gen Intern Med 19, 12061211.
67. Wadden TA, Anderson DA, Foster GD et al. (2000) Obese women's perceptions of their physicians’ weight management attitudes and practices. Arch Fam Med 9, 854860.
68. McTigue KM, Hess R, Bryce CL et al. . (2006) Perception of “healthy” body weight by patients with diabetes. Diabetes Care 29, 695697.
69. Katz S, Feigenbaum A, Pasternak S et al. (2005) An interactive course to enhance self-efficacy of family practitioners to treat obesity. BMC Med Educ 5, 4.
70. Yarnall KS, Pollak KI, Ostbye T et al. (2003) Primary care: is there enough time for prevention? Am J Public Health 93, 635641.
71. Getz L, Sigurdsson JA & Hetlevik I (2003) Is opportunistic disease prevention in the consultation ethically justifiable? Br Med J 327, 498500.
72. Flocke SA, Frank SH & Wenger DA (2001) Addressing multiple problems in the family practice office visit. J Fam Pract 50, 211216.
73. Tsai AG, Asch DA & Wadden TA (2006) Insurance coverage for obesity treatment. J Am Diet Assoc 106, 16511655.
74. Ahern DK, Phalen JM & Mockenhaupt RE (2003) Science and the advancement of eHealth: a call to action. Am J Prev Med 24, 108109.
75. Hwang KO, Stuckey HL, Chen MC et al. . (2012) Primary care providers’ perspectives on online weight-loss programs: a big wish list. J Med Internet Res 14, e16.
76. McTigue KM, Conroy MB, Bigi L et al. (2009) Weight loss through living well: translating an effective lifestyle intervention into clinical practice. Diabetes Educ 35, 199204, 208.
77. McTigue KM, Conroy MB, Hess R et al. (2009) Using the internet to translate an evidence-based lifestyle intervention into practice. Telemed JE Health 15, 851858.
78. McTigue KM, Bhargava T, Bryce CL et al. (2011) Patient perspectives on the integration of an intensive online behavioral weight loss intervention into primary care. Patient Educ Couns 83, 261264.
79. Eurostat Press Office (2011) Internet access and use in 2011: almost a quarter of persons aged 16–74 in the EU27 have never used the internet. Eorostat News Release. http://europa.eu/rapid/pressReleasesAction.do?reference=STAT/11/188&type=. Accessed August 2012.
80. Pew Internet and American Life Project (2009) Internet, broadband, and cell phone statistics. http://www.pewinternet.org/Reports/2010/Internet-broadband-and-cell-phone-statistics.aspx?r=1. (accessed 15 June 2010).
81. Horrigan J (2009) Home Broadband Adoption 2009. Pew Internet and American Life Project http://pewinternet.org/Reports/2009/10-Home-Broadband-Adoption-2009.aspx (accessed 14 June 2010 ).
82. Nielsen/NetRatings (2002) Hispanics are the fastest growing ethnic group online, according to Nielsen/netratings. New York 16 July 2002. http://www.nielsen-online.com/pr/pr_020716.pdf. Accessed February 2008 .
83. Smith A (2010) Home Broadband 2010. Pew Internet and American Life Project 2010. http://pewinternet.org/Reports/2010/Home-Broadband-2010.aspx
84. Nielsen Wire (2008). An Overview of Home Internet Access in the U.S. December 2008. http://blog.nielsen.com/nielsenwire/online_mobile/home-internet-access-continuing-to-grow-but-big-differences-among-demographics/ (accessed 14 April 2009 ).
85. Nielsen Wire (2011). What you think you know vs. what you need to know about U.S. Hispanics and Media. http://blog.nielsen.com/nielsenwire/media_entertainment/what-you-think-you-know-vs-what-you-need-to-know-about-u-=s-hispanics-and-media/
86. Bleakley A, Merzel CR, VanDevanter NL et al. (2004) Computer access and Internet use among urban youths. Am J Public Health 94, 744746.
87. Kind T, Huang ZJ, Farr D et al. (2005) Internet and computer access and use for health information in an underserved community. Ambul Pediatr 5, 117121.
88. Mandl KD, Feit S, Pena BM et al. (2000) Growth and determinants of access in patient e-mail and Internet use. Arch Pediatr Adolesc Med 154, 508511.
89. Hess R, Santucci A, McTigue K et al. (2008) Patient difficulty using tablet computers to screen in primary care. J Gen Intern Med 23, 476480.
90. Barnett JE (2005) Online counseling: new entity, new challenges. Counsel Psychol 33, 872880.
91. Ensher EA, Heun C & Blanchard A (2003) Online mentoring and computer-mediated communication: New directions in research. J Voc Behav 63, 264288.
92. Rochlen AB, Zack JS & Speyer C (2004) Online therapy: Review of relevant definitions, debates, and current empirical support. J Clin Psychol 60, 269283.
93. Mallen MJ, Vogel DL & Rochlen AB (2005) The practical aspects of Online counseling: Ethics, training, technology, and competency. Couns Psychol 33, 776818.
94. Simkin-Silverman LR, Conroy MB, Bhargava T et al. (2011) Development of an online diabetes prevention lifestyle intervention coaching protocol for use in primary care practice. Diabetes Educ 37, 263268.
95. Bahr DB, Browning RC, Wyatt HR et al. (2009) Exploiting social networks to mitigate the obesity epidemic. Obesity (Silver Spring) 17, 723728.
96. Hwang KO, Ottenbacher AJ, Green AP et al. (2010) Social support in an Internet weight loss community. Int J Med Inform 79, 513.
97. Reed VA, Schifferdecker KE, Rezaee ME et al. (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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