Online Weight Loss Program Helps Overweight and Obese Individuals With HIV Lose Weight
Overweight or obese HIV-positive people randomized to an internet behavioral weight-loss program lost significantly more weight than those randomized to an internet educational program. The behavioral program worked despite participants' low socioeconomic status and high comorbidity rate.
Researchers from Brown University and Miriam Hospital in Providence note that overweight and obesity are becoming more prevalent in people with HIV and contributing to cardiovascular risk. A prior study at the Miriam Hospital linked obesity to tripled odds of diabetes and doubled odds of hypertension in people with HIV.
The behavioral intervention trial enrolled 40 overweight or obese adults with HIV and randomized 20 of them to a 12-week automated internet-delivered behavioral weight-loss program (WT LOSS) and 20 to an internet education program. WT LOSS includes 12 weekly lessons, a self-report system to monitor changes and feedback tailored to individual participants. WT LOSS videos focus on diet, exercise and behavioral modification including daily weighing, self-monitoring of diet and physical activity. All enrollees had an undetectable viral load and a CD4 count above 200 cells/mm3 (average 743 cells/mm3).
Twenty-one participants (52.5%) were men, 27 (67.5%) white, six (15%) Hispanic and five (12.5%) African American. While 24 participants (60%) had an annual household income below $20,000, 27 (67.5%) had a history of depression, 13 (32.5%) had a substance abuse history and 10 (25%) had an alcohol abuse history. Participants took an average 4.3 medications daily in addition to antiretrovirals. Body mass index averaged 34.2 kg/m2. The WT LOSS group was younger than the control group (average 46.3 versus 53.6 years, P = .01), but none of the other just-reported variables differed significantly between groups.
Most participants (92%) completed the trial. Participants viewed an average seven lessons and submitted data for an average eight of 12 study weeks. Both measures correlated positively with weight loss (r = 0.61 and r = 0.63, P < .01). Intention-to-treat analysis determined that weight loss after 12 weeks averaged 4.4 kg in the WT LOSS group and 1.0 kg in the control group (P = .02). WT LOSS participants reported greater use of weight control strategies than controls and a significantly higher proportion in the intervention group reported improvements in health-related quality of life (59% versus 21%, P < .05). Changes in cardiovascular risk factors did not differ significantly between study groups.
The researchers note these HIV-positive trial participants lost as much weight as HIV-negative people enrolled elsewhere in the same program. They stress that WT LOSS is completely automated and easily disseminated.