The present report describes the examination of 26,658 individuals (79% women, BMI ≥25.0) participating in an online, behaviorally oriented, commercial weight loss program for company employees from various states within the United States. Companies contacted their employees regarding participation in the online weight loss program via emails and flyers placed at the worksites, and participation was voluntary. The focus of the current analyses is on the relationship between weight loss, categories of change in PA, and indices of QoL. The study was reviewed by an ethics committee (Chesapeake IRB, Columbia, MD). Because the research presented in the manuscript is secondary data analysis of de-identified data, the requirement to document informed consent was waived and the study was determined to be exempt from IRB oversight according to the tenets of the US Department of Health and Human Services regulations at 45 CFR 46.
All participants were enrolled in the online weight loss program (Wondr Health™, formerly Naturally Slim, Dallas, TX, USA) through their respective employers. The yearlong program is composed of 10 weekly classes, followed by seven bi-weekly and six monthly maintenance classes for a total of 52 weeks. Classes are based on Specific, Measurable, Attainable, Realistic, Time-based (SMART) behavioral goal-setting practices [20, 21], and the program curriculum focuses on specific elements found in standard behavioral weight management programs such as self-monitoring, goal setting, stimulus control, modification of eating habits, and problem-solving while concentrating on mindful healthy eating and understanding hunger signals. The focus of each of the weekly classes is as follows: (1) Mindful Eating and Portion Control, Stimulus Control, Medical Considerations & Weight Loss, (2) Stop Eating Cues, Introduction to PA, (3) Stress and Emotions, Mindless Eating, Goal Setting and Problem Solving, PA, (4) Hidden Sugar, Mindful Activities, Energy Balance, (5) Nutrition 101, Stress Management, PA & Weight Maintenance, (6) Weight Fluctuations, Food Cravings vs. Easily Accessible Food, Centers for Disease Control and Prevention (CDC) Exercise Recommendations, (7) Emotions and Eating, Importance of Self-Monitoring, Making Exercise A Habit, (8) Grocery Shopping and Meal-Planning, Metabolic Syndrome, Cognitive Behavioral Techniques, (9) Serving Sizes, Social Support, Dealing with Saboteurs and (10) Review of Eating Skills and Tools, Maintaining Motivation, and Long-Term Action Planning. An outline of all program objectives has been previously published . Participants are encouraged to reduce intake of carbohydrates and sugar, particularly refined sugars, and to maintain a protein intake of 25–30% of total calories. The program does not place a special focus on eliminating specific food groups or macronutrients from participants’ diets, however. Participants are further encouraged to engage in moderate-intensity PA, primarily walking, per the NIH consensus development panel on PA and cardiovascular health . Program classes are distributed via a web-based distance-learning platform, allowing participants to attend anywhere and anytime at their convenience, given access to the Internet.
All outcome data reported herein were obtained from participants’ self-report, recorded online, and stored in a central database.
Change in quality of life
At the 10th week of the program, changes in six indices of QoL (energy, mood, sleep, self-confidence, indigestion, and musculoskeletal pain) were assessed via questions asking, “How has your QoL index 1-6 changed compared to before starting the online weight loss program?” with response options being “very much improved”, “improved”, “no change”, and “worsened”.
Change in physical Activity
Similar to QoL, changes in PA were assessed upon completion of the program via a 5-point Likert scale (“quite a bit more”, “slightly more”, “no change”, “slightly less”, and “much less”).
Total weight change in kg and percent weight change was calculated based on the self-reported weights before the start and after completion of the program, as post-program weight – pre-program weight and (post-program weight – pre-program weight) / pre-program weight × 100.
The present analysis examines findings relative to participation in the weight loss program, and we included participants who attended ≥8 of the first 10 weekly classes (26,658 of 27,814 participants who completed the QoL survey; 96%). The primary outcomes were indices reflecting QoL defined as changes in (1) energy, (2) mood, (3) sleep, (4) self-confidence, and clinical QoL indices (5) indigestion and (6) musculoskeletal pain. The descriptive characteristics of the study sample were examined for all participants as well as by gender. Continuous data are presented as mean (standard deviation [SD]) and categorical data as N (%). Weight change (in kg and percent) is presented with corresponding 95% confidence intervals (CI).
Using logistic regression (proc logistic), change in QoL (binary) was regressed against percent weight loss (continuous) and change in PA category with adjustment for age and gender. To create the binary QoL variable, the four QoL categories were collapsed into the two categories “improved”, composed of “very much improved” and “improved”, and “not improved” composed of “no change” and “worsened”. Weight loss was categorized using the clinical cut-points < 3.0%, 3.0–4.9, and > 5.0%. For the change in PA category, due to the very small number of participants in the “slightly less” (1.4%) and “much less” (0.3%) PA categories, we collapsed these groups into the “no change” category, resulting in the three PA change categories “quite a bit more”, “slightly more”, and “no change”. Using a generalized linear model adjusted for age and gender, we examined the percentage of participants indicating improvements in the binary QoL category (“very much improved” or “improved”) for all nine combinations of weight loss category and change in PA category.
All analyses were performed with SAS version 9.4 (SAS Institute Inc., Cary, NC), and significance was accepted at p < 0.05.