Objective: Behavioral treatment is recommended as the first line of intervention for the prevention of health problems pertaining to obesity. Internet-based programs are used to provide cognitive behavioral therapy for psychiatric disorders and systemic diseases to a large number of patients at low cost. The aim of this study is to develop the first Turkish obesity behavioral therapy program and test its short-term effectiveness.
Method: A Turkish web-based behavioral therapy program based on the behavioral strategies employed in the Diabetes Prevention Program was developed. In order to test the effectiveness of this internet-based program developed in nearly two years, with the cooperation of experts from the fields of psychiatry, endocrinology, nutrition and sports science, a randomized study was conducted for eight weeks. A total of 101 overweight participants with body mass index in the 25-40 range were randomly assigned to an eight-week weight loss program using either the Internet behavioral therapy (IBT, n = 51) or e-mail education (EE, n = 50). The participants in the IBT group were provided access to an Internet program that provided videos teaching behavioral weight-loss skills as well as a self-monitoring platform to calculate the daily calorie balance. The participants in the EE group received weekly e-mails with information on healthy eating, physical exercises and weight loss for eight weeks. The primary outcome measure was the observed weight change at the end of the 8 weeks.
Results: In the analyses wherein baseline weight was carried forward for missing data, the IBT produced significantly larger mean weight loss in comparison to the EE at the end of the 8 weeks [2.28 kg (2.11) vs. 0.74 kg (1.57), p = 0.001]. The participants in the IBT group, when compared to the EE group, were also more likely to achieve a clinically significant weight loss of 5% of their initial body weight at the end of the 8-week study period (17.6% vs. 2%, p = 0.016).
Conclusion: The participants who received a structured Internet behavioral therapy intervention lost significantly more weight after two months, compared to those who received weekly informational emails regarding weight loss. Hence, it can be observed that Internet-based behavioral therapy programs may have the potential to serve as a low-cost alternative that physicians can recommend to their obese patients.