Shorter communication A randomized comparison of two motivationally enhanced Internet behavioral weight loss programs Kelly H. Webber a, * , Deborah F. Tate b, c , J. Michael Bowling c a Department of Nutrition and Food Science, University of Kentucky, Lexington, KY, USA b Department of Nutrition, School of Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA c Department of Health Behavior and Health Education, School of Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA article info Article history: Received 6 March 2008 Received in revised form 15 May 2008 Accepted 3 June 2008 Keywords: Weight loss Internet Self-monitoring Motivation Obesity abstract Purpose: Sixty-six women participated in this study, which compared two 16-week motivationally enhanced weight loss interventions. Both intervention groups, which are entitled ‘‘Minimal’’ and ‘‘En- hanced’’ throughout the description that follows, received a motivationally enhanced initial face-to-face weight loss session. The initial session was followed by a 16-week Internet behavioral weight loss program, which included a study website with weekly lessons, an online self-monitoring diary form, web links to related sites, and separate message boards. The Enhanced group also received weekly moderated online chat group sessions led using motivational techniques. Results: Both groups lost weight over time (p < 0.001), however the group by time interaction was non- significant (p ¼ 0.19). The Minimal group lost 5.22  4.72 kg and the Enhanced group lost 3.71  4.46 kg. In the Enhanced group, online chat session attendance averaged 8.0 of the 16 chats offered. Greater program utilization was associated with greater weight loss in both groups. Conclusions: The addition of weekly motivationally enhanced online chats did not increase weight loss in this study. Further research is needed on the type and frequency of group support that is most desirable and beneficial in Internet weight loss interventions and could also explore building motivation for program utilization. Ó 2008 Elsevier Ltd. All rights reserved. Objectives The Internet has shown great potential for public health use in many areas of health behavior including weight loss (Gold, Burke, Pintauro, Buzzell, & Harvey-Berino, 2007; Rothert et al., 2006; Tate, Jackvony, & Wing, 2003; Tate, Jackvony, & Wing, 2006; Tate, Wing, & Winett, 2001) and weight maintenance (Harvey-Berino, Pintauro, Buzzell, & Gold, 2004; Wing, Tate, Gorin, Raynor, & Fava, 2006). A recent review of randomized Internet weight loss interventions concluded that structured behaviorally based programs with some form of counselor feedback were efficacious in producing signifi- cant weight loss (Saperstein, Atkinson, & Gold, 2007). Previous Internet interventions in weight loss and maintenance have used individual e-mails (Tate et al., 2001, 2003, 2006) or online group sessions as a means of treatment support (Gold et al., 2007; Har- vey-Berino, Pintauro, & Gold, 2002; Wing et al., 2006). These studies have demonstrated that adding ongoing support or guid- ance from a counselor is superior to self-directed programs (Tate et al., 2001, 2003, 2006) and to computer-automated counseling (Tate et al., 2006). While these previous Internet programs have produced signif- icant weight loss, they have not achieved weight losses equivalent to face-to-face behavioral programs (Wadden & Foster, 2000). One possible way to increase the efficacy of Internet interventions is by incorporating strategies to enhance motivation for weight loss. Building motivation might promote ongoing adherence to program procedures and attendance at online group sessions. This could be important because, although it is unclear what the optimal pattern of usage for an online treatment program is, it has been reported that continued program usage in the form of logins to the study website and completion of online self-monitoring diaries is asso- ciated with greater weight loss (Tate et al., 2001, 2003). Opportu- nities for incorporating motivational techniques into Internet programs include the initial face-to-face session of the program, which has been used in previous interventions to discuss safe weight loss practices, program goals, and website usage (Tate et al., 2001, 2003, 2006; Wing et al., 2006), and online programs might also build motivation by using motivational techniques during the ongoing counselor support. One promising technique for building motivation for both individuals and groups is motivational interviewing (MI). MI is an * Corresponding author. 212A Funkhouser Bldg., University of Kentucky, Lex- ington, KY 40506-0054, USA. Tel.: þ1 859 257 4351; fax: þ1 859 257 3707. E-mail address: kelly.webber@uky.edu (K.H. Webber). Contents lists available at ScienceDirect Behaviour Research and Therapy journal homepage: www.elsevier.com/locate/brat 0005-7967/$ – see front matter Ó 2008 Elsevier Ltd. All rights reserved. doi:10.1016/j.brat.2008.06.008 Behaviour Research and Therapy 46 (2008) 1090–1095