University of Oulu

Teeriniemi A‐M, Salonurmi T, Jokelainen T, Vähänikkilä H, Alahäivälä T, Karppinen P, Enwald H, Huotari M‐L, Laitinen J, Oinas‐Kukkonen H, Savolainen MJ (University of Oulu, Oulu, Finland; Oulu University Hospital, Oulu, Finland; University of Oulu, Oulu, Finland; Kuopio University Hospital, Kuopio, Finland; Oulu University Hospital, Oulu, Finland; University of Oulu, Oulu, Finland; University of Oulu, Oulu, Finland; University of Oulu, Oulu, Finland; and Finnish Institute of Occupational Health, Helsinki, Finland). A randomized clinical trial of the effectiveness of a Web‐based health behaviour change support system and group lifestyle counselling on body weight loss in overweight and obese subjects: 2‐year outcomes. J Intern Med 2018; 284: 534–545.

A randomized clinical trial of the effectiveness of a web-based health behaviour change support system and group lifestyle counselling on body weight loss in overweight and obese subjects : 2-year outcomes

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Author: Teeriniemi, A.-M.1,2,3,4; Salonurmi, T.1,2,3; Jokelainen, T.5;
Organizations: 1Biocenter Oulu, Research Center for Internal Medicine, University of Oulu
2Department of Internal Medicine, Oulu University Hospital
3Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu
4Department of Medicine, Endocrinology and Clinical Nutrition, Kuopio University Hospital, Kuopio
5Unit of Medicine, Oulu University Hospital
6Research Unit of Oral Health Sciences
7Oulu Advanced Research on Service and Information Systems (OASIS), Faculty of Information Technology and Electrical Engineering
8Department of Information Studies, Faculty of Humanities, University of Oulu, Oulu
9Finnish Institute of Occupational Health, Helsinki, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 2.1 MB)
Persistent link:
Language: English
Published: John Wiley & Sons, 2018
Publish Date: 2018-07-05


Background: Weight loss can prevent and treat obesity‐related diseases. However, lost weight is usually regained, returning to the initial or even higher levels in the long term. New counselling methods for maintaining lifestyle changes are urgently needed.

Objectives: An information and communication technology‐based health behaviour change support system (HBCSS) that utilizes persuasive design and methods of cognitive behavioural therapy (CBT) was developed with the aim of helping individuals to maintain body weight. The purpose of this study was to assess whether CBT‐based group counselling combined with HBCSS or HBCSS alone helps to maintain improved lifestyle changes needed for weight loss compared to self‐help guidance or usual care


Methods: A randomized lifestyle intervention for overweight or obese persons (BMI 27–35 kg m−2 and age 20–60 years), recruited from the population registry in the city of Oulu, Finland, was conducted. This study comprised six randomly assigned study arms: CBT‐based group counselling (eight sessions led by a nutritionist), self‐help guidance‐based group counselling (SHG; two sessions led by a nurse) and control, each with or without HCBSS, for 52 weeks. Subjects visited the study centre for anthropometric measurements, blood sample collection and to complete questionnaires at baseline, 12 and 24 months. The main outcome was weight change from baseline to 12 months and from baseline to 24 months.

Results: Of the 1065 volunteers screened for the study, 532 subjects (51% men) met the inclusion criteria and were enrolled. The retention rate was 80% at 12 months and 70% at 24 months. CBT‐based counselling with HBCSS produced the largest weight reduction without any significant weight gain during follow‐up. The mean weight change in this arm was 4.1% [95% confidence interval (CI), −5.4 to −2.8, P < 0.001) at 12 months and 3.4% (95% CI, −4.8 to −2.0, P < 0.001) at 24 months. HBCSS even without any group counselling reduced the mean weight by 1.6% (95% CI, −2.9 to −0.3, P = 0.015) at 24 months.

Conclusion: The combination of CBT‐based group counselling and HBCSS‐based weight management is feasible for overweight or obese individuals. Moreover, HBCSS alone could be disseminated to the population at large as an effective means of treating obesity.

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Series: Journal of internal medicine
ISSN: 0954-6820
ISSN-E: 1365-2796
ISSN-L: 0954-6820
Volume: 284
Issue: 5
Pages: 534 - 545
DOI: 10.1111/joim.12802
Type of Publication: A1 Journal article – refereed
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
113 Computer and information sciences
616 Other humanities
3142 Public health care science, environmental and occupational health
Funding: This study was supported by grants from the Ministry of Social Affairs and Health, Finland, the Academy of Finland, the Sigrid Jusélius Foundation, the Juho Vainio Foundation, the Finnish Foundation for Cardiovascular Research and the Diabetes Research Foundation. The city of Oulu, Finland, has provided funding for the clinical laboratory analysis of the study samples. We thank all the study subjects recruited from the city of Oulu for their participation. We also thank the laboratory staff from the laboratory of Internal Medicine at the University Hospital of Oulu and University of Oulu for their considerable contribution to this project both in the laboratory and during the recruitment process and study visits. Many thanks also to the rest of the PrevMetSyn study team. Finally, we especially thank Tuija Huusko, PhD, for her contribution to the randomization process. The funders had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; or the decision to submit the manuscript for publication.
Copyright information: © 2018 The Authors. Journal of Internal Medicine published by John Wiley & Sons Ltd on behalf of Association for Publication of The Journal of Internal Medicine. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.