Final-SLR-MARKO-PAPUCKOVSKI

Marko Papuckovski 4074610
Does the use of Technological Interventions and Social Media platforms affect weight-
loss in overweight populations - a systematic review of current literature
Abstract
Background: With obesity becoming a worldwide epidemic, revolutionary technological
interventions and support through social media may prove to be an effective way in
treating and reversing the current epidemic.
Aim: To evaluate the effectiveness of technological intervention programs aimed at
reducing obesity and increasing weight loss in overweight populations.
Methods: A systematic literature review using data from databases; PubMed, Cochrane
and Web Of Science. The inclusion criteria stated that the article must be published
after the year 2004 and that subjects included are free from disease states that are
unassociated with obesity.
Results: The data showed that intervention programs through technology such as social
media prove to be effective in increasing weight loss, reducing BMI measurements,
increasing physical activity levels and educating subjects on healthy eating habits.
However, results proved to be short term and eventually started to plateau in the longer
interventions.
Conclusion: Technological interventions show promise in the treatment of obesity;
interventions are cost effective, efficient and attainable to anybody with internet
access. However, further research needs to be done in order to make the results more
consistent and clinically applicable; follow up studies and longer interventions are
necessary.
Keywords: obesity, technology, social media, intervention
Introduction
“Obesity worldwide has more than doubled since 1980, in 2014, more than 1.9 billion
adults aged over the age of 18 were overweight, of which these 600 million were obese.
Furthermore, 42 million children under the age of 5 were overweight or obese in
2013.” (WHO - World Health Organization 2015). Obesity is a worldwide epidemic, in
Australia, the NHMRC (National Health and Medical Research Council) has found that
roughly 25% of children aged 2-16 years of age were overweight or obese. The NHMRC
estimates that at current rates, over two thirds of Australia's population will be
overweight by the year 2025 and a third will develop type 2 diabetes in their lifetime, a
lifestyle related disease. The world’s favorite chef, Jamie Oliver once said that “diet

related disease is the biggest killer in the United States, with England and Australia right
behind - we need a revolution and now is the time!”
Changing eating habits is a result of changing ones environment, when removing
unhealthy options, nutritious foods become plan A and plan B. In the WHO factsheet on
obesity and overweight diseases, it is stated that “supportive environments and
communities are fundamental in shaping people’s choices, making healthier choice of
foods and regular physical activity more prominent.”
Our environment is becoming exponentially embedded with technology and social
media, young adults in particular are more likely than any other age group to spend time
on social media platforms such as; Facebook, Twitter, Instagram, Youtube, Blogs,
Podcasts and other websites. Technology and the internet is so prevalent that the term
‘internet addiction’ has become a social norm of the current culture. Recent studies
performed in China and Korea show that roughly 18% of teenagers in Korea and 19% of
adolescents in China are classified as having internet addiction. (Li, L et al. 2015)
These figures provide an insight of how deeply rooted internet usage is in the current
generation and its culture. However, there are many advantages to social media
platforms provided by technological advances, these platforms now provide a new
environment - not physical, but virtual. Health intervention through this virtual
environment may prove to be a revolutionary and effective means of treating obesity in
current, and future populations.
Leveraging exponentially low cost technologies are affecting the way we look at health.
Leveraging technology to our advantage has provided us with ‘apps’ that can go as far as
analyzing ones genetic makeup, some apps are so extreme that you can self diagnose for
an STD, others include glucose meters to measure blood glucose and potentially send
this to your physician for examination. Moore’s Law states that computer technology is
exponentially improving, therefore it may be accurate to predict that we are moving to
a paradigm of biomedicine incorporated with information technology and wireless
communication.
A comprehensive Systematic Literature Review (SLR) was undertaken to determine
whether multidisciplinary interventions via technology and social media platforms are
effective in health interventions within overweight subjects. This review will provide an

insight in current interventions and the modifications necessary to make these
interventions more effective in increasing weight loss in overweight subjects. The SLR
will aim to determine the predisposition of future studies by reducing limitations of
current literature, save costs on research that is unnecessary or unreliable and finally it
will aim to eliminate possible bias within the research topic, offering a more precise
method for future research. It is hypothesized that health interventions via
technological platforms such as social media will provide further support and affect
weight loss in obese or overweight subjects in a positive manner. The studies will
provide an insight of behavioral tendencies associated with obesity and internet usage.
Method
A systematic literature search was performed using the following databases; PubMed,
Scopus, ScienceDirect, Cochrane and Web Of Science. The studies were limited to
intervention studies between the years of 2004 - 2015. The inclusion criteria accepted
randomized controlled trials, prospective and retrospective cohort studies, pilot studies
and time series studies. The studies must include internet based interventions on
overweight subjects over a pre-determined amount of time; this can provide measurable
parameters. The intervention must contain comparisons and show an improvement of at
least one of the following biomarkers: body weight, BMI, motivation, self efficacy, waist
circumference, physical activity, dietary changes such as reduced fat and sugar intake
and increased fruit and vegetable intake. Because technology and social media were the
core of the study, digital parameters such as ‘facebook intensity scales’, the amount of
likes, comments and shares will be used in the same sense as biomarkers to provide an
insight of active use within an intervention program. The studies included must indicate
a measurable biomarker/parameter pre intervention and post intervention. Studies that
include only social media platforms to provide a supportive environment were included.
Studies were excluded if they were published prior to 2004. The exclusion criteria also
excluded any studies in which the subject group suffered from diseases other than those
that are obesity related such as genetic predispositions to diabetes or eating disorders
such as anorexia or bulimia. The exclusion criteria were also effective in any studies
that did not include technology or social media within their intervention programs.
Systematic Literature Reviews and Meta-Analysis studies were also excluded.

A pilot search was undertaken using the mesh terms ‘obesity AND technolog* AND
intervention’, this initial search provided 408 articles in the Web Of Sciences database.
When categorizing the 408 articles and refining the search to only include research
articles and exclude ‘review’,‘book chapter,’ or ‘proceeding paper’, the results were
narrowed down to 309 articles. The use of Boolean search terms also further narrowed
down the results to more specific findings. These included,‘obesity prevention AND
social media’,‘overweight AND technolog* AND intervention’,‘obesity AND lifestyle
intervention studies’.
Although Systematic Literature Reviews do not require ethical approval, ethics within
the studies included should be addressed; this will be done by using the Quality Criteria
Checklist (Appendix 1) and ensuring that ethical conduct is considered within all of the
studies that were included in the review. These studies ensured that the subjects
involved had provided consent for their date and statements to be used in analysis and
discussion. The studies will be assessed on their quality based on the levels of evidence
developed by the National Health and Medical Research Council (NHMRC). Studies are
judged on their level of evidence and categorized into level I, II, III-1, III-2, III-3 or IV.
The top two highest quality studies are I - A systematic review of level II studies and II -
A randomized controlled trial in which an “independent, blinded comparison with a valid
reference standard” was performed. (NHMRC, levels of evidence, 2009, pp.6)
Furthermore, each study was assessed using the Quality Rating Checklist from the
Evidence Analysis Manual by the Academy of Nutrition and Dietetics 2012. This criterion
assessed whether the studies included had clearly addressed the issues of the inclusion
and exclusion criteria, bias, generalizability, and data collection analysis. (Appendix 1.1)
Following analysis and quality rating, each study was then collated into a summary
table. The summary table categorized the articles by
‘Author’,‘Location’,‘Year’,‘Design’,‘Level of Evidence Rating,’,Sample
Size’,‘Intervention’,‘Results/Comments’. (Appendix 1.2)
Results
A thorough database search resulted in 32 articles being tested for inclusion criteria, of
which only 17 were eligible for this review. The final articles chosen included 1 pilot
study and 16 randomised controlled trials, this proved to be a sufficient amount of
evidence to draw a conclusion regarding technological interventions and their effects on
weight loss.

Table 1: PRISMA flowchart
Results within the articles included were categorized into 3 sections;
1. Measurable biomarkers such as changes in BMI, changes in body fat and changes in
overall body weight.
2. Changes in levels of physical activity; the studies had to show either an increase or
decrease in physical activity levels in subject via minutes measure by ‘apps’ or
accelerometers, or by surveys and questionnaires.
3. Education/Motivation; articles had to indicate a change in eating patterns in the
subjects, either an increased intake of fruit and vegetables or a decreased intake of

saturated fats, processed sugars and snacks. Motivation levels to continue with an
intervention must also be shown via surveys or questionnaires.
The following summary table provides a breakdown of the articles included from oldest
to most recent.
Table 2: Summary table of articles included

Referen
ce
Locati
on
Yr Design Level
of
Evid
ence
Ratin
g
Sample
Size
Intervention Results/
Comments
Williams
on, D,
A,. et al.
United
States
2006 Random
ized
Controll
ed Trial
II 57
overweig
ht girls
African
American
girls were
randomly
assigned to
one of two
intervention
s;
1. Behavioral
internet
program
2. Internet
health
education
program
BMI, body
weight and
boy
compositions
measuremen
ts were
performed
at 6 month
intervals and
at the
completion
of the 2
years.
The internet
intervention
group lost more
body fat and the
internet
education
program group
lost more mean
body weight.
The weight loss
occurred in the
first 6 months -
at the
completion of
the study, results
at 2 years
showed no
difference in
weight loss
between the two
intervention
groups.

Hurling,
R,. et al.
United
Kingdo
m
2007 Random
ized
Controll
ed Trial
II 77 47
participants
were
randomized
to a test
group that
had access
to an
internet and
mobile
phone based
activity
program and
30
participants
were
assigned to
a control
group that
had no
support.
The test group
showed a greater
increase over
the baseline
than the control
group for
perceived
control and
intention to
exercise. Leisure
data indicated
that the test
group had a
greater level of
moderate
physical activity
and lost more
body fat.
Referen
ce
Locati
on
Yr Design Level
of
Evid
ence
Ratin
g
Sample
Size
Comments

Gow, R,
W,. et al
United
States
2009 Random
ized
Controll
ed Trial
II 170 An internet
intervention
of first year
college
students
that were
randomly
assigned to
1 of 4
groups:
1. no
treatment
2. 6 week
online
interventi
on
3. 6 week
weight
and
caloric
feedback
- only via
email
4. 6 week
combine
feedback
& online
interventi
on
The combined
intervention
group showed
the lowest BMI
at the
completion of
the intervention.
Referen
ce
Locati
on
Yr Design Level
of
Evid
ence
Ratin
g
Sample
Size
Comments

Liebreic
h, T et
al.
Portug
al
2009 Pilot
Study
II 49 12 week
website an
email linked
counselling
intervention
on physical
activity
behaviour
change in
individuals
with type 2
diabetes.
The intervention
group showed an
improvement in
vigorous activity.
Increased
minutes spent on
moderate
physical activity.
Pilot study shows
potential for a
larger RCT.
Referen
ce
Locati
on
Yr Design Level
of
Evid
ence
Ratin
g
Sample
Size
Comments

McGrievy
, T,. et
al
United
States
2009 Random
ized
Controll
ed Trial
II 78 A 12 week
intervention
in which
subjects
were
separated
into two
groups that
both
received a
different
version of a
weight loss
podcast:
1. Weight
loss
podcast
(control)
2. Weight
loss
podcast
based on
social
cognitive
theory
(enhanced
)
The enhanced
group had
greater weight
loss then the
control group
and also showed
an increase in
weight loss
related
knowledge.
Referen
ce
Locati
on
Yr Design Level
of
Evid
ence
Ratin
g
Sample
Size
Comments

Webber,
K, H,. et
al
United
States
2010 Random
ized
Controll
ed Trial
II 66 Initial face
to face
motivation
sessions
followed by
a 16 week
internet
program.
Motivation
increased
initially and
remained high
for those with 5%
weight loss,
however by 4
weeks,
motivation
decreased by
those who had
not seen a 5%
decrease in
weight loss.
Referen
ce
Locati
on
Yr Design Level
of
Evid
ence
Ratin
g
Sample
Size
Comments

Cavallo,
D.N. et
al
United
States
2012 Random
ized
Controll
ed Trial
II 134 12 week
physical
activity
social
support
network to
increase
support for
physical
activity.
67 subjects
assigned to
online social
network plus
self
monitoring
and the
other 67
assigned to
education
only.
The use of an
online social
network plus self
monitoring did
not produce
greater
perception of
social support
for physical
activity when
compared to the
education only
group. The
‘Facebook
Intensity Scale’
was used to
measure overall
engagement in
intervention
group - a better
parameter of
measure may
provide greater
detail regarding
results.
Referen
ce
Locati
on
Yr Design Level
of
Evid
ence
Ratin
g
Sample
Size
Comments

Taylor,
C, B,. et
al.
United
States
2012 Random
ized
Controll
ed Trial
II 118
normal
weight
subjects
& 64
overweig
ht/obese
subjects
Subjects
over their
85th
percentile of
BMI for their
age were
assigned to
the
StayingFit
program;
the program
provides
cognitive
behavioral
principles,
adolescent
weight loss
intervention
s, satiety &
hunger
awareness
skills, self
monitoring
skills, goal
setting &
emotion
regulation
skills.
Results showed
that BMI slightly
increased in the
general group
from 20.3 to
20.7 and
decreased
slightly in the
weight
maintanence
group from 27.5
to 26.6. Students
reported in
consuming more
fruit and
vegetables.
Referen
ce
Locati
on
Yr Design Level
of
Evid
ence
Ratin
g
Sample
Size
Comments

Brindad,
E,. et al
Austra
lia
2012 Random
ized
Controll
ed Trial
II 8112 A 12 week
web based
weight loss
intervention
. 7 sites
were used,
subjects
were
separated
into 3
groups.
1. Informatio
n based
n=183
2. Supportiv
e based
n=3994
3. Personal
supportive
n=3935
Dietary
information
provided
was based
on ‘The
Wellbeing
Diet’.
Attrition was
high in the study
with 40% of
subjects
dropping out in
the first week.
Retention of
subjects was
higher in the two
support based
groups. At the
completion of
the study, 435
subjects
provided valid
weight
measurements.
The average
weight loss
overall was
2.76% with no
significant
difference in
weight loss
between the
intervention
groups.
Referen
ce
Locati
on
Yr Design Level
of
Evid
ence
Ratin
g
Sample
Size
Comments

LaChauss
e, R, G,.
et al.
United
States
2012 Random
ized
Controll
ed Trial
II 320 Undergradua
te students
were
randomly
assigned to
3 separate
intervention
groups;
1. MSB
nutrition
program
2. On-
campus
weight
managem
ent
program
3. Compariso
n group
Students
performed
surveys
regarding
nutrition,
physical
activity,
stress,
attitude and
body
The MSB
nutrition group
showed an
increase in fruit
and vegetable
consumption, a
reduction in
stress levels and
increased self
efficacy -
however they
showed no
significant
change in
physical activity
or weight loss
when compared
to the other
intervention
groups.
Referen
ce
Locati
on
Yr Design Level
of
Evid
ence
Ratin
g
Sample
Size
Comments

Genugte
n, L,. et
al.
Nether
lands
2012 Random
ized
Controll
ed Trial
II 539 A tailored
intervention
via a generic
information
website.
Anthropome
tric
measuremen
ts were
taken at
baseline and
at
completion
of the
intervention
at 6 months.
No statistically
significant
difference
between the
study groups.
Similar results
shown for waist
circumference
and skin fold
thickness.
However, the
physical activity
increased in the
intervention
group and the
intake of fatty
and sugary
snacks
decreased. The
online
intervention
resulted in
changes in the
desired
direction.
Referen
ce
Locati
on
Yr Design Level
of
Evid
ence
Ratin
g
Sample
Size
Comments

Carr, L,
J,. et al.
United
States
2013 Random
ized
Controll
ed Trial
II 53 An internet
based
intervention
with an
Enhanced
Internet
group versus
a Standard
Internet
group. Five
internet
features
were
included to
increase
physical
activity;
1. PA
tracking/
logging
2. Georgraph
ic
mapping
tool
3. Discussion
forum for
social
support
4. Exercise
The Enhanced
Internet Group
showed an
increase in
physical activity
within the first 3
months when
compared to the
Standard
Internet group.
The EI group also
maintained the
increase PA over
6 months.
Referen
ce
Locati
on
Yr Design Level
of
Evid
ence
Ratin
g
Sample
Size
Comments

Napolita
no, M,
A,. et al.
United
States
2013 Random
ized
Controll
ed Trial
II 52 Subjects
were
assigned to
one of three
groups:
1. Facebook
group
n=17
2. Facebook
plus text
group
n=18
3. Control
group
n=17
The
intervention
lasted 8
weeks.
At the
completion of
the intervention
the Facebook
plus group had
significantly
greater weight
loss than both
the Facebook
only group and
the control
group.
Referen
ce
Locati
on
Yr Design Level
of
Evid
ence
Ratin
g
Sample
Size
Comments

Patrick,
K et al.
United
States
2014 Random
ized
Control
Trial
II 404 A 2 year
clinical trial
deployed via
Facebook,
Smart Phone
Apps, SMS &
other
Internet
platforms to
provide an
engaging
weight loss
program
incorporatin
g the SMART
strategy
program.
Measurements
will occur at 6,
12, 18 and 24
months. The
primary goal of
the intervention
is a 5-10% weight
loss at the
completion of
the 24 months.
Referen
ce
Locati
on
Yr Design Level
of
Evid
ence
Ratin
g
Sample
Size
Comments

Dennison
, L et al.
Unite
Kingdo
m
2014 Random
ized
Controll
ed Trial
II 786 The
intervention
included the
POWeR Web
Based
weight
management
program.
POWeR
consisted of
weekly
online
sessions that
included self
monitoring,
goal setting
and
cognitive/
behavioral
strategies.
4. POWeR
only group
5. POWeR
plus
coaching
group
6. waiting lis
group
Participants in
the POWeR plus
coaching group
persisted with
the intervention
for longer and
were 1.61 times
more likely to
complete
sessions then
those in the
POWeR only
group. Both
intervention
groups showed
greater weight
loss than the
waiting list
control group -
the weight loss
in the POWeR
plus coaching
group was
slightly higher
then that in the
POWeR only
group.
Referen
ce
Locati
on
Yr Design Level
of
Evid
ence
Ratin
g
Sample
Size
Comments

Blomfiel
d, R,. et
al
Austra
lia
2014 Random
ized
Control
Trial
II 3 separate
intervention
groups
1. Gender
tailored
weight
loss
resources
2. Online
resources
plus
website
feedback
3. Control
group
Total energy,
total fat,
saturated fat
and
carbohydrate
intake decreased
in online
intervention
group - there
was also an
increase in
percentage of
‘core’ foods.
Referen
ce
Locati
on
Yr Design Level
of
Evid
ence
Ratin
g
Sample
Size
Comments

Li, W,.
et al.
Englan
d
2015 Random
ized
Controll
ed Trial
II 260 The
intervention
aimed to
analyze the
structural
and
functional
information
and the
neural
mechanism
underlying
internet
addiction in
healthy
young
adults.
The results
showed that
internet
addiction results
were directly
correlated with
reduced function
of inhibitory
control.
Referen
ce
Locati
on
Yr Design Level
of
Evid
ence
Ratin
g
Sample
Size
Comments

Biomarkers
Of the 16 randomised controlled trials included, 9 showed changes in measurable
biomarkers. The results consistently showed that the intervention groups had greater
weight loss, great body fat loss and a reduction in BMI.
Dennison, L,. et al performed an intervention based on weekly online sessions of self
monitoring, goal setting and cognitive/behavioral strategies. The articles were published
in 2014 and the intervention was labelled as the POWeR program. Participants were
separated into two groups, POWeR only, POWeR plus coaching and a control group. At
the completion of the study both POWeR intervention groups reported greater weight
loss than the control group. The mean difference between the POWeR plus group and
the control group was 1.97kg, and the POWeR only group 1.70kg.
Taylor, C, B,. et al studied the effects of a 10 week internet based intervention program,
118 high school students were allocated to the healthy weight regulation program and
64 to the weight maintenance program. BMI showed a decrease in the healthy weight
regulation group from 20.7 (s.d. = 2.4) to 26.6 (s.d. = 5.7).
Williamson, D, A,. et al performed an RCT to test the “efficacy of an internet-based
lifestyle behavior modification program for African-American girls over a 2 year
intervention.” A DXA scan was used to estimate the percentage of body fat lost and a
questionnaire was used to measure changes in weight loss behavior. In the first 6 months
the adolescents of the intervention group lost more body fat and the adults lost more
body weight compared to the control group. The changes in BMI and body fat were
statistically significant at 6 months (p < 0.05) but were not significant at 18 and 24
months (p > 0.05).
Brindad, E,. et al performed a large RCT with 8112 subjects. A 12 week web base
intervention was assessed. Attrition was high at 40% in the first week. 435 subjects
provided valid measurements and showed that there were no statistically significant
differences in body weight loss between the 3 intervention groups (P = .42). The overall
average weight-loss was 2.76%.
Similarly, Go, R, et al., found that a 6 week online intervention program with feedback
resulted in the lowest BMI measurement at the completion of the intervention when
compared to a control group, and an intervention only group with no feedback.

Furthermore, Nopolitano, M, et., McGrievy, T, et al., and Webber, K.H., et al., all
showed that an enhanced intervention via the internet platforms that also provided
feedback resulted in the greatest amount of weight loss when compared to control
groups.
Physical Activity
Hurling, R, et al., Genugten, L, et al., and Carr, L,J, et al., all showed that intervention
groups all showed an increase in the amount of time spent performing physical activity
when compared to a control group. The groups showed a greater intention to exercise
and a reduction in stress levels associated with exercise. Conclusively, these same
groups lost the most amount of body weight and body fat.
Education
Blomfield, R, et al., showed that over all energy intake decreased along with total
saturated fat and total carbohydrate intake also decreasing. An increase in the
percentage of ‘core’ foods resulted.
McGrievy, T, et al., performed surveys which showed that weight loss related knowledge
increased by the end of the intervention.
Discussion
The 16 randomised controlled trials all showed positive results through their
interventions. The participants enrolled in the studies were free from any genetic or
unrelated disease states and ethics were considered in the interventions. The subjects in
the studies varied from both healthy populations and overweight populations - providing
an insight on the effectiveness of the technological interventions in extreme cases and
mild cases of obesity. The wide range of subjects emphasizes the importance of
continuing study in this field and improving technological interventions that are
applicable to the majority of the population; the majority being anybody who has access
to the internet and a smart phone. However, the results from the intervention programs
plateau over time; this discredits their effectiveness, a follow up period of the studies is
necessary to determine the definite outcomes of the interventions.
Research by Morgan, J.P., et al., studied the effects of a weight loss program for
overweight and obese men. The primary aim of the study was “to evaluate the efficacy
of two relatively low intensity weight loss programs developed specifically for men (p.

2).” Biomarkers of 159 overweight and obese men were measured at baseline, 3 months
and 6 months of the study. The outcomes were measured by assessors blinded to group
allocation - removing any possible bias. The following parameters were compared: body
weight, % body fat, waist circumference, blood pressure, resting heart rate, physical
activity levels, self reported dietary intake and perceived sexually healthy. The results
showed that the online group saw a decrease in energy intake, total fat intake and
carbohydrate intake (P < 0.05) - but no significant difference was seen in the control
group (P > 0.05). This is a fairly long intervention lasting half a year, the results show to
be consistent, evidence based and applicable to obese or overweight men. The study
provides strong evidence that online interventions can be effective long term. Follow
up, post intervention research will strengthen the validity of the results. This study rates
as a B on the body of evidence matrix (Table 3). A similar study by Carr, L.J, et al.,
tested the efficacy of internet intervention programs in sedentary adults (41.7 +- 10.4
years of age). After 3 month of the intervention the results showed that physical activity
increased in the intervention group when compared to the control group, however these
figures plateaud and by 6 months there was little difference between the two groups
(186.0 vs 176.8 min/wk). This study was evidence based and applicable but showed no
clinical impact and the results proved to be inconsistent, the study rates as D on the
body of evidence matrix (Table 3).
Liebreich, T, et al., analysed the effects of a 12 week website and email linked
intervention on physical activity behavior change in individuals with type 2 diabetes.
Despite being a pilot study, the intervention included 49 subjects with type 2 diabetes,
this is a significant number of subjects for a pilot study. The subjects were separated
into two groups with one receiving information based on the Social Cognitive Theory and
with one group only being provided information from the general diabetes guidelines.
The more interactive and personal approach of the intervention group resulted in an
improvement in total vigorous activity and minutes spent performing moderate physical
activity (p = 0.05). Despite only being a pilot study, the subjects were randomly assigned
to their intervention groups, removing possible bias. The results were evidence based,
applicable and showed clinical impact. When adjusted for BMI, MET minutes per week
showed a significance of (p = 0.043) and moderate to vigorous activity showed a
significance of (p = 0.010).

In younger populations such as high school and college students, results are not as
significant. Cavallo, D.N, et al., claims that the “use of an online social networking
group plus self - monitoring did not produce greater perceptions of social support or
physical activity.” LaChausse, R.B, et al., also studied the impact of intervention groups
in younger adults - specifically college students. The intervention group showed an
increase in fruit and vegetable intake and a decrease in saturated fat, sugar and total
energy intake. However, there was no significant difference seen in physical activity or
body weight between the intervention group and the control group. Similarly a study by
Taylor, C.B, et al., also saw a significant increase in fruit and vegetable intake in high
school students (p = 0.001) - but with no effect on BMI in the overweight/obese groups.
However, a study performed by Williamson, D. A, et al., showed that an internet
intervention program that included behavioral support resulted in a decrease in body fat
in adolescent subjects (- 1.12 +- 0.47% vs 0.43 +- 0.47%, p < 0.05). Parents involved in
the study also saw a significant reduction in body weight when compared to the control
group (- 2.43 +- 0.66 vs. - 0.35 +- 0.64 kg, p < 0.05). Despite the positive results in the
initial stages of the intervention, a follow up study showed that after 2 years, there was
no statistically significant difference between weight and body fat in both the
adolescents and parents in the subject and intervention groups. This demonstrates that
online interventions show promising results in early stages, but consistency needs to be
addressed.
Online interventions are also at higher risk of attrition, this is shown in a study
performed by Brindal, E, et al,. where attrition was as high as 40% in the first week. The
intervention lasted 12 weeks, and of the 8112 initial participants, only 435 provided a
valid final weight at the end of the intervention. “On average, participants lost 2.76% of
their initial body weight, with no statistically significant difference in weight loss
between groups.” (p. 2)
Despite attrition and inconsistency being a risk factor, the potential of online
interventions is demonstrated in a ranomised controlled trial performed by Dennison, L,
et al. This study addressed attrition by including a intervention plus coaching group,”
the POWeR plus coaching group was 1.61 times more likely to complete sessions than the
other two groups”. (p. 2)
Table 3: Body of evidence rating

Conclusion
Despite showing
promising initial
results, addressing
obesity and overweight issues via technological interventions, including social media
platforms has proven to be challenging and needs to be refined. Programs are effective
in positively impacting biomarkers such as BMI, body weight and body fat percentage,
but these results are short lived and inconsistent. Longer interventions and follow up
studies are necessary to validate the positive results shown in the initial stages of the
interventions.
NHMRC 2009 – Levels of Evidence p. 15

References
Academy of Nutrition and Dietetics (2012),"Evidence Analysis Manual: Steps in the
Evidence Analysis Process" Appendix 10 - pg96.
https://www.andeal.org/vault/2440/web/files/2012_Aug_EA_Manual.pdf
Brindal, E., Freyne, J., Saunders, I., Berkovsky, S., Smith, G., Noakes, M., (2012).
“Features Predicting Weight Loss in Overweight or Obese Participants in a Web Based
Intervention: Randomized Trial”, Journal of Medical Internet Research, vol. 14, no.6, pp.
173.
Carr, L.J., Lewis, B, Hartman, S, Dominick, G, Dunsiger, S.I., Ciccolo, J.T., Bock, B,
Bock, B, Marcus, B.H. (2012). “Randomized Controlled Trial Testing and Internet Physical
Activity Intervention for Sedentary Adults”, Health Psychology, vol. 32, no. 3, pp. 328 -
336.
Cavallo, D.N., Tate, D.F., Ries, A.V., Brown, J.D., DeVellis, R.F., Ammerman, A.S.,
(2012). “A Social Media-Based Physical Activity Intervention - A Randomized Controlled
Trial”, American Journal of Preventative Medicine, vol. 43, no. 5, pp. 527-532
Genugten, L, Empelen, P, Boon, B, Borsboom, G, Visscher, T, Oenema, A. (2012). “Results
from an Online Computer - Tailored Weight Management Intervention for Overweight
Adults: Randomized Controlled Trial”, Journal of Medical Internet Research, vol. 14, no.
2, pp. 44

Gow RW, Trace SE, Mazzeo SE. (2010). “Preventing weight gain in first year college
students: an online intervention to prevent the “freshman fifteen”. Eating Behaviors,
vol. 11, no. 9, pp. 33
Herring, S.J., Cruice, J.F., Bennett, G.G., Davey, A, Foster, G.D., (2014). “Using
Technology to Promote Postpartum Weight Loss in Urban, Low-Income Mothers: A Pilot
Randomized Controlled Trial”, Journal of Nutrition Education and Behaviour, vol. 46, no.
6
Hurling, R, Catt, M, Boni, M, Fairley, B.W., Hurst, T, Murray, P, Richardson, A, Sodhi, J.S.
(2007). “Using Internet and Mobile Phone Technology to Deliver an Automated Physical
Activity Program: Randomized Controlled Trial”, Journal of Medical Internet Research,
vol. 9, no. 2, pp. 7
LaChausse, R.G., (2015). “My Student Body: Effects of an Internet-Based Prevention
Porgram to Decrease Obesity Among College Students”, Journal of American College
Health, vol. 60, no.4, pp. 324 - 330
Li, J.S., Barnett, A, Goodman, E, Wasserman, R.C., Kemper, A.R., (2013). “Approaches
to the Prevention and Management of Childhood Obesity: The Role of Social Networks
and the Use of Social Media and Related Electronic Technologies”, AHA Scientific
Statement, vol. 127, pp. 260 - 267
Li, W., et al. (2015). "Brain structures and functional connectivity associated with
individual differences in Internet tendency in healthy young adults." Neuropsychologia
70: 134-144.
Liebreich, T., Plotnikoff, R.C., Courneya, K.S., Boule, N., (2009). “Diabetes NetPLAY: A
physical activity website and linked email counseling randomized intervention for
individuals with type 2 diabetes”, International Journal of Behavioral Nutrition and
Physical Activity, vol. 6, no. 18, pp. 1479 - 1496.
Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred
Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS
Med 6(6): e1000097. doi:10.1371/journal.pmed1000097

Morgan, P.J., Collins, C.E., Plotnikoff, R.C., McElduff, P, Burrows, T, Warren, J.M.,
Young, M.D., Berry, N, Saunders, K.L., Aguiar, E.J., Calliste, R, (2010). “The SHED-IT
communitry trial study protocol: a randomised controlled trial of weight loss programs
for overweight and obese men”, BioMed Central Public Health, vol. 10, no. 701
Napolitano, M. A., et al. (2013). "Using facebook and text messaging to deliver a weight
loss program to college students." Obesity 21(1): 25-31.
NHMRC. levels of evidence and grades for recommendations for developers of guidelines.
2009. http://www.nhmrc.gov.au/_files_nhmrc/file/guidelines/
stage_2_consultation_levels_and_grades.pdf
Patrick, K., Marshall, S.J., Davilla, E.P., Kolodziejczyk, J.K., Fowler, J.H., Calfas, K, J.,
Huang, J.S., Rock, C.L., Griswold, W.G., Gupta, A., Merchant, G., Norman, G.J., Raab,
F., Donohue, M.C., Fogg, B.J., Robinson, T.N., (2013). “Design and implementation of a
randomized controlled social and mobile weight loss trial for young adults (project
MSART)”, Contemporary Clinical Trials, vol.37, pp.12-18.
Taylor, C.B., Taylor, K, Jones, M, Shorter, A, Yee, M, Genkin, B, Burrows, A, Kass, A.E.,
Rizk, M, Redman, M, Romer, P, Williams, J, Wilfley, D.E. (2012). “Obesity prevention in
defined (high school) populations”, International Journal of Obesity Supplements, vol. 2,
pp. 30 - 32
Turner-McGrievy, G. M., et al. (2009). "Pounds Off Digitally Study. A Randomized
Podcasting Weight-Loss Intervention." American Journal of Preventive Medicine 37(4):
263-269.
WHO. Obesity and Overweight. Secondary Obesity and Overweight. 2013. http://
www.who.int/mediacentre/factsheets/fs311/en/index.html
Wilfley, D.E., Vannucci, A, White, E.K. (2010). “Early Intervention of Eating and Weight
Related Problems”, Journal of Clinical Psychology Medicine, vol. 17, no. 4, pp. 285 - 300
Williamson, D.A., Walden, H.M., White, M.A., Crowe, M.Y., Newton, R.L., Alfonso, A,
Gordon, S, Ryan, D. (2006). “Two-Year Internet-Based Randomized Controlled trial for
Weight Loss in African-American Girls”, Obesity, vol. 14, no. 7, pp. 1231 - 1243

Appendix 1.0 Quality Rating Table based on ADA checklist

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