Behavior change has become a central objective of public health interventions over the last half decade, as the influence of prevention within the health services has increased. Many health conditions are caused by risk behaviors, such as problem drinking, substance use, smoking, and overeating. The key question in health behavior research is how to modify the adoption and maintenance of health behaviors, which will produce the positive effects on change that is desired. Health behavior change refers to the motivational, volitional, and actional processes of abandoning such health-compromising behaviors in favor of adopting and maintaining health-enhancing behaviors (1). Behavior change programs, which have evolved over time, encompass a broad range of activities and approaches, which focus on the individual, community, and environmental influences on behavior.
Over the last decade with the widespread growth, advancement, and use of computer and Internet technologies,it has increasingly been studied in its effect on assisting in behavioral change for both dietary and weight loss interventions. Research has shown that 74% of all U.S. adults use the Internet, and 61% have looked for health or medical information on the Web (2). Additionally, 49% have accessed a website that provides information about a specific medical condition or problem (2). Internet resources provide increasing opportunities for individuals seeking or in need of some form of health/medical guidance or assistance.
One of the most common areas of behavioral change interventions examined by researchers that utilize Internet technology, involves the country’s current epidemic of obesity, and substantial rise in both diabetes and prediabetes cases. Obesity rates in the US have escalated to 33.8%, and the number of states with an obesity prevalence of 30% or more has increased to 12 states (3). Similarly diabetes is the 7th leading cause of death in the US and a major cause of heart disease, stroke, kidney failure and new cases of blindness among adults (3). Estimated medical costs of both obesity and diabetes total an estimated $170 billion in the U.S. each year.
The fundamental cause of obesity and overweight is an energy imbalance between calories consumed and calories expended. Globally, there has been an increased intake of energy-dense foods that are high in fat, salt and sugars but low in vitamins, minerals and other micronutrients. Therefore, current effective intervention strategies for weight loss and management of diabetes focus on patient education and an adoption of new dietary/lifestyle habits. Utilizing Internet technologies allows for a more efficient and effective medium with which healthcare professionals can provide dietary counseling or support, and has been shown to be more effective than traditional professional counseling or self-education by the patient (4).
Researchers have examined several key parameters with regards to healthcare professionals utilizing Internet technology to deliver an effective dietary intervention that is conducive to a positive behavioral change & weight loss. Internet-tailored nutrition education provides respondents with individualized feedback about their dietary behaviors, motivations, attitudes, norms and skills and mimics the process of “person-to-person” dietary counseling (6). The available evidence indicates that this technological form of nutrition education is more effective in motivating people to make dietary changes than general nutrition information, either self-taught or provided by a healthcare professional. The effectiveness of professionally-guided Internet tailoring has been attributed to the fact that individualized feedback commands greater attention, is processed more intensely, contains less redundant information, and is appreciated better than more general intervention materials, which overall leads to better patient compliance (6). It is this compliance factor that is a major determinant of whether a credible dietary intervention can be effective.
Several studies have examined whether a structured Internet behavioral weight loss program produces greater weight loss and changes in waist circumference than a weight loss education site, or traditional face-to-face patient counseling. Specific studies compared participants who were given a structured online dietary treatment program with weekly contact by a qualified dietary professional, to participants given links to educational web sites/resources and other traditional materials (7,8). Measurements were taken at 3 and 6 months. Patients utilizing the online counseling with weekly contact had better weight loss and loss of waist circumference compared to the control group (4.0 kg & 4.1 kg versus 1.7 kg & 1.6 kg, at 3 and 6 months) (8). This is evidence of the short term effectiveness of online behavioral weight loss programs managed by qualified healthcare professionals.
Behavioral weight loss interventions markedly reduce the risk of developing diabetes, and recent studies suggest that new approaches to education and interventions are both needed and desired. Consumers desire alternatives to face-to-face treatments, creating a need for effective behavioral interventions for patients with diabetes. The Internet provides this opportunity, and has been used for diabetes education and self-management, with favorable results shown using the Internet to deliver these interventions. Specific research has examined the effects of an Internet weight loss program alone versus the addition of online behavioral and dietary counseling for 1 year to individuals at risk of type 2 diabetes. The results of the study showed that an Internet-based weight loss program with professional guidance produced an average weight loss of 4.4 kg after 1 year among adults at risk of type 2 diabetes (9). The major strength of this study is that it was a randomized trial with objective health measurements after 12 months in an at-risk population. This supports the need for greater involvement and use of current online resources by healthcare professionals in the treatment of not only weight loss, but the appropriate treatment and care for those at-risk populations.
The general consensus of available research shows utilizing Internet technology favors better interaction, less time between screening and feedback, increased exercise time, increased knowledge of nutritional status, increased participation in healthcare, a slower decline in health, and an overall greater compliance by the patient. In a comprehensive review of the effectiveness of nutrition education (10), researchers concluded that nutrition education and compliance was more likely to lead to healthier diets if more of the following prerequisites were met: (1) Nutrition education should be tailored to motivators and rein forcers that are personally relevant to the people in the target group; (2) Nutrition education should apply personalized self-evaluation and self-assessment techniques; (3) People in the target group should be able to participate actively in the nutrition education intervention. All of which favor the promising future for further research and application in the use of Internet technologies in patient care for dietary and weight loss or management interventions. Download Paper
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