Internet-Based Weight Loss Programs Effective for New Moms

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Internet-based weight loss programs effectively help new mothers return to their prepregnancy weight, a new study shows. Some experts suggest the low-intensity, flexible internet-based program may be more effective for new mothers than traditional high-intensity in-person programs.

Suzanne Phelan, PhD, from California Polytechnic State University, San Luis Obispo, and colleagues published the results of their cluster randomized trial online June 20 in JAMA.

“Among low-income postpartum women, an internet-based weight loss program in addition to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), compared with the WIC program alone, resulted in a statistically significant greater weight loss over 12 months,” the authors write.

Every year, 4 million women in the United States give birth, and many do not return to their prepregnancy weight.

Yet even relatively modest (≥1 kg) postpartum weight retention increases risk for obesity and diabetes in women, Dr Phelan and colleagues suggest. Low-income Hispanic women are also more likely to retain their pregnancy weight. However, few effective weight loss interventions are available for multicultural, low-income women.

Therefore, Dr Phelan and colleagues aimed to investigate whether an internet-based weight loss program in addition to the WIC program for low-income postpartum women could promote more weight loss than the WIC program alone (standard care) over the course of 12 months. The internet-based program was available in English and Spanish and included a website (providing weekly lessons, a web diary, instructional videos, computerized feedback, and text messages to notify participants about new content) and monthly group visits at the WIC clinics.

They conducted a predominantly web-based, cluster randomized, assessor-blind trial recruiting women from 12 clinics offering the WIC program.

They enrolled 371 women of mean age 28.1 years who were predominantly Hispanic (81.6%), a mean of 7.8 kg above prepregnancy weight, and a mean of 5.2 months postpartum.

Women were randomly assigned to receive either the WIC program (standard care group) or the WIC program plus the 12-month primarily internet-based weight loss program (intervention group).

Overall, 89.2% of participants completed the 12-month study.

Women in the intervention group achieved significantly greater mean 12-month weight loss than those in the standard care group (3.2 kg vs 0.9 kg; P < .001), which was the primary endpoint of the trial.

In addition, a larger proportion of women in the intervention group returned to their preconception weight by 12 months compared with those in the standard care group (32.8% vs 18.6%; P < .001).

“The intervention was effective across all demographic characteristics and among women who were breastfeeding and not breastfeeding,” the authors write.

However, the researchers found no significant differences between the groups in 12-month changes in moderate to vigorous physical activity (P = .76) or other activity parameters.

Although the authors emphasize that this long-term study was adequately powered, they also acknowledge its limitations, including restriction of the study sample to women in the WIC program. The study provided some women with internet access, they add, which could prove costly if expanded to a larger population. The program also did not include an app, which might have improved the program’s use.

The authors also suggest that the program’s effect on return to prepregnancy weight might be inaccurate because some women probably underreported their preconception weight.

“Further research is needed to determine program and cost-effectiveness as part of the WIC program,” Dr Phelan and colleagues conclude.

In an accompanying editorial, Adam Gilden Tsai, MD, MSCE, from Kaiser Permanente of Colorado, Denver, and Wanda K. Nicholson, MD, MPH, MBA, from the University of North Carolina School of Medicine, Chapel Hill, note that this trial is the first to show sustained weight loss after 1 year in a postpartum population. And despite the trial’s limitations, the researchers successfully recruited a high-risk population and achieved excellent retention in the trial.

Combined with data from earlier studies, the results of this trial suggest that remote methods of delivering weight-loss interventions may be more effective for postpartum women than interventions delivered in person, they add.

“This observation stands in sharp contrast to current obesity treatment guidelines that suggest high-intensity, in-person interventions as the gold standard for lifestyle modification.”

Noting that the postpartum period is one of the most challenging times in a woman’s life, Dr Tsai and Dr Nicholson hypothesize that new mothers may find internet-based weight loss programs more useful because these programs provide counseling and support in a way that better fits their demanding schedules. As such, the relatively low intervention intensity and its primarily remote delivery may have contributed to the favorable weight loss outcomes in this trial because the program was less intrusive and less demanding for new mothers, they write.

The results of this trial suggest that clinical guidelines may thus need to be adapted for individual patients or patient groups, the editorialists emphasize.

“This study by Phelan et al may serve as a first step for many postpartum women to effectively return to their prepregnancy weight,” they conclude.

This study was supported by grants from the National Institutes of Health. One author has reported being a member of the scientific advisory board and receiving consultant fees and a grant from Weight Watchers International. The remaining authors and editorialists have reported no financial conflicts of interest.

JAMA. Published online June 20, 2017. Article abstract, Editorial extract

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Internet-Based Weight Loss Programs Effective for New Moms

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