By Luzia Valentini
Cardiovascular diseases, such as stroke and myocardial infarct, are the main cause of death in the Western World. In Europe they account for 42% of all deaths in the total population. Prevention, delay in onset and reversal of cardiovascular diseases, therefore, can benefit a large segment of the population and the health system in general. Obesity due to poor nutrition and low physical activity is the main underlying cause for cardiovascular diseases. Effective, low-cost and broadly available tools to reduce weight by improving lifestyle are thus dearly wanted.
Conventional in-person weight loss programs can be powerful tools, but due to availability, inconvenience and costs, these programs cannot offer access to the masses. As over 75% of Americans and Europeans have Internet access, the Web has emerged as a promising way to offer self-help options for non-medical weight loss treatments through conventional PCs, tablet PCs and smartphones that are cost-effective, save time, and are easily integrated into everyday life. Electronic approaches can offer the flexibility needed to handle individual nutritional approaches to self-reliantly empower humans to very specifically improve their dietary intake.
First Generation of Simple Weight Loss Platforms
Typical features of first generation self-help platforms are made up of static information like weight loss information, information on physical activity, recipes, menu planners, caloric information on food items, diaries for recording food consumption (without automatic calculation of energy intake), bulletin boards to offer support, shopping lists of healthy foods, motivational tips, exercise expenditure counters, portion size charts, and dining out guides. The platforms provide mainly static information with minimal interaction.
Commercial weight loss Web sites are widespread, and most of them belong to the first generation category; the effectiveness of very few of these platforms has been validated. Previous investigations showed that under study conditions first generation platforms produce at best half the weight loss achieved with a structured face-to-face weight loss program. These results are promising but not enough to be recognized as serious intervention tools by health professionals. The same evaluations revealed that dynamic self-monitoring “feedback factors” like visual display of goal progress, immediate evaluation of eating behaviors and physiological calculators are pivotal for effectiveness. Motivators are also important.
Second Generation of More Sophisticated and Technically Advanced Platforms
The second generation of weight loss Web sites are highly interactive and provide information beyond the potential of in-person face-to-face support, such as immediate analysis of food intake.
Our working group started with a first generation platform. After evaluating the feedback of our study participants, we screened the German speaking online weight loss programs and identified one platform, KiloCoachTM (www.kilocoach.at), that was distinctively different from the other platforms. This platform was more interactive and highly resembled the vision of our study participants for future platforms. We started to incorporate this platform in our research and are now about to test its efficacy in a prospective clinical trial. We expect to receive results above the 5% weight loss achieved with previous weight loss platforms.
One key feedback and teaching tool of this platform is the immediate analysis of dietary intake taking into account the amount of physical activity (not only sports, but also physical activity integrated into everyday life) needed to achieve the target energy intake needed to lose 0.5 kg of weight a week. This means that dietary intake must be precisely entered by users who are not nutritional professionals, and an immediate feedback has to be provided to the user, otherwise he cannot counteract (through physical activity) a possible excess of caloric intake within an appropriate time interval. By familiarizing themselves in detail with their own dietary habits, individuals automatically learn the nutritional facts of the food products they consume, become confident judging portion sizes and evaluating the adequacy of their nutritional intake.
Such high quality platforms require immense investments in comprehensive food and nutrient databases. Currently, the database of this respective platform contains over 30,000 food items, and is updated daily. This database allows users to quickly find exact food products by name so that entering a full food diary averages only 10 minutes a day and is very precise. The platform is well accepted on the market and is currently used daily by 2,000-3,000 subscribers; if proven effective, the program may be a starting point for future weight loss platforms.
In summary, the Internet offers unique opportunities for weight loss interventions paralleled with general improvements in lifestyle habits. Future public Internet interventions will utilize high-quality, dynamic Web sites with a high volume of automatic feedback. Such platforms, however, are work intensive and require scientifically sound specifications. This poses a large responsibility to the platform provider. Future models to use such platforms can comprise pure self-help techniques and cooperation with primary physicians.
Luzia Valentini Charité-Universitätsmedizin Berlin luzia.valentini@charite.de
About Brenda Wiederhold
President of Virtual Reality Medical Institute (VRMI) in Brussels, Belgium.
Executive VP Virtual Reality Medical Center (VRMC), based in San Diego and Los Angeles, California.
CEO of Interactive Media Institute a 501c3 non-profit
Clinical Instructor in Department of Psychiatry at UCSD
Founder of CyberPsychology, CyberTherapy, & Social Networking Conference
Visiting Professor at Catholic University Milan.