Feasibility, effectiveness, and perceptions of an Internet-and incentive-based behavioral weight loss intervention for overweight and obese college freshmen: A mixed methods approach


Challenges inherent with the transition to college are often accompanied by weight gain among college freshmen. Weight gain and duration of obesity increase metabolic syndrome and cardiovascular disease risk in young adulthood, which supports the need for weight loss interventions tailored to college students. The purpose of this investigation was to conduct a mixed methods pilot trial to determine the efficacy and acceptability of a semester long Internet-and incentive-based weight loss intervention for overweight/obese college freshmen. Participants (n = 27, aged >18 yrs, BMI >25) were randomly assigned to a 12-week social cognitive theory (SCT)-based intervention (Fit Freshmen [FF]) or a health information control group. The FF intervention also included modest financial incentives for weight loss. Primary outcomes included body weight/composition, dietary and physical activity (PA) behaviors, and psychosocial measures (i.e. self-efficacy, self-regulation) associated with diet, PA, and weight loss. Students in the FF intervention participated in focus groups to provide qualitative feedback on program structure and design. FF participants demonstrated significant reductions (all group differences p < 0.10) in body weight (﹣1.2 kg), fat mass (﹣0.6 kg), dietary energy (﹣673 kcal/d), fat (﹣37 g/d) and added sugar intake (﹣41 g/d), and increases in diet and PA-related self-regulatory skills at week 12 compared to control participants (+1.0 kg, +1.1 kg, ﹣334 kcal/d, ﹣15 g/d, ﹣13 g/d, respectively). No changes in PA were noted, but FF participants demonstrated increases in self-efficacy to overcome barriers to PA relative to control participants. Themes for content improvement from focus groups included reducing email contact and increasing in-person interacttions. Program characteristics that were positively evaluated included incentives for weight loss and access to an onsite weigh station kiosk. Overall, this efficacious SCT Internet-and incentive-based weight loss intervention was well received and can be adapted for larger-scale use in the college population.

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Davy, B. , Potter, K. , Dennis Parker, E. , Harden, S. , Hill, J. , Halliday, T. and Estabrooks, P. (2013) Feasibility, effectiveness, and perceptions of an Internet-and incentive-based behavioral weight loss intervention for overweight and obese college freshmen: A mixed methods approach. Open Journal of Preventive Medicine, 3, 429-440. doi: 10.4236/ojpm.2013.37058.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] McTigue, K.M., Garrett, J.M. and Popkin, B.M. (2002) The natural history of the development of obesity in a cohort of young US adults between 1981 and 1998. Annals of Internal Medicine, 136, 857-864.
[2] Lewis, C.E., Jacobs Jr., D.R., McCreath, H., Kiefe, C.I., Schreiner, P.J., Smith, D.E., et al. (2000) Weight gain continues in the 1990s: 10-year trends in weight and overweight from the CARDIA study. Coronary Artery Risk Development in Young Adults. American Journal of Epidemiology, 151, 1172-1181.
[3] Anderson, E.S., Wojcik, J.R., Winett, R.A. and Williams, D.M. (2006) Social-cognitive determinants of physical activity: The influence of social support, self-efficacy, outcome expectations, and self-regulation among participants in a church-based health promotion study. Health Psychology: Official Journal of the Division of Health Psychology, American Psychological Association, 25, 510-520.
[4] Racette, S.B., Deusinger, S.S., Strube, M.J., Highstein, G.R. and Deusinger, R.H. (2005) Weight changes, exercise, and dietary patterns during freshman and sophomore years of college. Journal of American College Health: Journal of ACH, 53, 245-251.
[5] Holm-Denoma, J.M., Joiner, T.E., Vohs, K.D. and Heatherton, T.F. (2008) The “freshman fifteen” (the “freshman five” actually): Predictors and possible explanations. Health Psychology: Official Journal of the Division of Health Psychology, American Psychological Association, 27, S3-9.
[6] Hovell, M.F., Mewborn, C.R., Randle, Y. and FowlerJohnson, S. (1985) Risk of excess weight gain in university women: A three-year community controlled analysis. Addictive Behaviors, 10, 15-28.
[7] Lloyd-Jones, D.M., Liu, K., Colangelo, L.A., Yan, L.L., Klein, L., Loria, C.M., et al. (2007) Consistently stable or decreased body mass index in young adulthood and longitudinal changes in metabolic syndrome components: the Coronary Artery Risk Development in Young Adults Study. Circulation, 115, 1004-1011.
[8] Anderson, L.M., Quinn, T.A., Glanz, K., Ramirez, G., Kahwati, L.C., Johnson, D.B., et al. (2009) The effectiveness of worksite nutrition and physical activity interventions for controlling employee overweight and obesity: A systematic review. American Journal of Preventive Medicine, 37, 340-357.
[9] Gokee-LaRose, J., Gorin, A.A., Raynor, H.A., Laska, M.N., Jeffery, R.W., Levy, R.L., et al. (2009) Are standard behavioral weight loss programs effective for young adults? International Journal of Obesity, 33, 1374-1380.
[10] Walsh, J.R., White, A.A. and Greaney, M.L. (2009) Using focus groups to identify factors affecting healthy weight maintenance in college men. Nutrition Research (New York, NY), 29, 371-378.
[11] Wang, Y. (2008) Tai Chi exercise and the improvement of mental and physical health among college students. Medicine and Sport Science, 52, 135-145.
[12] Liu, K., Daviglus, M.L., Loria, C.M., Colangelo, L.A., Spring, B., Moller, A.C., et al. (2012) Healthy lifestyle through young adulthood and the presence of low cardiovascular disease risk profile in middle age: the Coronary Artery Risk Development in (Young) Adults (CAR-DIA) study. Circulation, 125, 996-1004.
[13] Anding, J.D., Suminski, R.R. and Boss, L. (2001) Dietary intake, body mass index, exercise, and alcohol: Are college women following the dietary guidelines for Americans? Journal of American College Health: Journal of ACH, 49, 167-171.
[14] Edmonds, M.J., Ferreira, K.J., Nikiforuk, E.A., Finnie, A.K., Leavey, S.H., Duncan, A.M., et al. (2008) Body weight and percent body fat increase during the transition from high school to university in females. Journal of the American Dietetic Association, 108, 1033-1037.
[15] Strong, K.A., Parks, S.L., Anderson, E., Winett, R. and Davy, B.M. (2008) Weight gain prevention: Identifying theory-based targets for health behavior change in young adults. Journal of the American Dietetic Association, 108, 1708-1715. http://dx.doi.org/10.1016/j.jada.2008.07.007
[16] Greaney, M.L., Less, F.D., White, A.A., Dayton, S.F., Riebe, D., Blissmer, B., et al. (2009) College students’ barriers and enablers for healthful weight management: A qualitative study. Journal of Nutrition Education and Behavior, 41, 281-286.
[17] Calfas, K.J., Sallis, J.F., Nichols, J.F., Sarkin, J.A., Johnson, M.F., Caparosa, S., et al. (2000) Project GRAD: Two-year outcomes of a randomized controlled physical activity intervention among young adults. Graduate Ready for Activity Daily. American Journal of Preventive Medicine, 18, 28-37.
[18] Kelly, N.R., Mazzeo, S.E. and Bean, M.K. (2013) Systematic review of dietary interventions with college students: Directions for future research and practice. Journal of Nutrition Education and Behavior, 45, 304-313.
[19] Dennis, E.A., Potter, K.L., Estabrooks, P.A. and Davy, B.M. (2012) Weight gain prevention for college freshmen: Comparing two social cognitive theory-based interventions with and without explicit self-regulation training. Journal of obesity, 2012, 803769.
[20] Greene, G.W., White, A.A., Hoerr, S.L., Lohse, B., Schembre, S.M., Riebe, D., et al. (2012) Impact of an online healthful eating and physical activity program for college students. American Journal of Health Promotion: AJHP, 27, e47-58.
[21] Dour, C.A., Horacek, T.M., Schembre, S.M., Lohse, B., Hoerr, S., Kattelmann, K., et al. (2013) Process evaluation of Project WebHealth: A nondieting web-based intervention for obesity prevention in college students. Journal of Nutrition Education and Behavior, 45, 288-295. http://dx.doi.org/10.1016/j.jneb.2012.10.001
[22] Hivert, M.F., Langlois, M.F., Berard, P., Cuerrier, J.P. and Carpentier, A.C. (2007) Prevention of weight gain in young adults through a seminar-based intervention program. International Journal of Obesity, 31, 1262-1269.
[23] Von Ah, D., Ebert, S., Ngamvitroj, A., Park, N. and Kang, D.H. (2004) Predictors of health behaviours in college students. Journal of advanced nursing, 48, 463-474.
[24] Escoffery, C., Miner, K.R., Adame, D.D., Butler, S., McCormick, L. and Mendell, E. (2005) Internet use for health information among college students. Journal of American College Health: Journal of ACH, 53, 183-188.
[25] Park, A., Nitzke, S., Kritsch, K., Kattelmann, K., White, A., Boeckner, L., et al. (2008) Internet-based interventions have potential to affect short-term mediators and indicators of dietary behavior of young adults. Journal of Nutrition Education and Behavior, 40, 288-297.
[26] An, J.Y., Hayman, L.L., Park, Y.S., Dusaj, T.K. and Ayres, C.G. (2009) Web-based weight management programs for children and adolescents: a systematic review of randomized controlled trial studies. ANS Advances in Nursing Science, 32, 222-240.
[27] Stevens, V.J., Funk, K.L., Brantley, P.J., Erlinger, T.P., Myers, V.H., Champagne, C.M., et al. (2008) Design and implementation of an interactive website to support longterm maintenance of weight loss. Journal of Medical Internet Research, 10, e1.
[28] Neuhauser, L. and Kreps, G.L. (2003) Rethinking communication in the E-health era. Journal of Health Psychology, 8, 7-23.
[29] Abrantes, A.M., Lee, C.S., MacPherson, L., Strong, D.R., Borrelli, B. and Brown, R.A. (2009) Health risk behaviors in relation to making a smoking quit attempt among adolescents. Journal of Behavioral Medicine, 32, 142-149.
[30] Couper, M. (2000) Web surveys: A review of issues and approaches. Public Opinion Quarterly, 64, 464-494.
[31] American Dietetic Association (2007) Adult weight management toolkit. American Dietetic Association, Chicago.
[32] Mendlinger, S. and Cwikel, J. (2008) Spiraling between qualitative and quantitative data on women’s health behaviors: A double helix model for mixed methods. Qualitative Health Research, 18, 280-293.
[33] Garner, D.M., Olmsted, M.P., Bohr, Y. and Garfinkel, P.E. (1982) The eating attitudes test: Psychometric features and clinical correlates. Psychological Medicine, 12, 871-878. http://dx.doi.org/10.1017/S0033291700049163
[34] Courneya, K.S., Jones, L.W., Rhodes, R.E. and Blanchard, C.M. (2004) Effects of different combinations of intensity categories on self-reported exercise. Research Quarterly for Exercise and Sport, 75, 429-433.
[35] Pereira, M.A., Fitzer Gerald, S.J., Gregg, E.W., Joswiak, M.L., Ryan, W.J., Suminski, R.R., et al. (1997) A collection of Physical Activity Questionnaires for health-related research. Medicine and Science in Sports and Exercise, 29, S1-205.
[36] Gionet, N.J. and Godin, G. (1989) Self-reported exercise behavior of employees: A validity study. Journal of Occupational Medicine, 31, 969-973.
[37] Godin, G., Jobin, J. and Bouillon, J. (1986) Assessment of leisure time exercise behavior by self-report: A concurrent validity study. Canadian Journal of Public Health= Revue canadienne de sante publique, 77, 359-362.
[38] Winett, R.A., Anderson, E.S., Wojcik, J.R., Winett, S.G. and Bowden, T. (2007) Guide to health: Nutrition and physical activity outcomes of a group-randomized trial of an Internet-based intervention in churches. Annals of Behavioral Medicine, 33, 251-261.
[39] Bandura, A. (2001) Social cognitive theory: An agentic perspective. Annual Review of Psychology, 52, 1-26.
[40] Anderson, E.S., Winett, R.A. and Wojcik, J.R. (2000) Social-cognitive determinants of nutrition behavior among supermarket food shoppers: A structural equation analysis. Health psychology, 19, 479-486.
[41] Krueger, R. (2000) Focus groups: A practical guide for applied research. 3rd Edition, Sage, Thousand Oaks.
[42] Patton, M. (1990) Qualitative evaluation and research. 2nd edition, Sage, Thousand Oaks.
[43] Pope, C., Ziebland, S. and Mays, N. (2000) Qualitative research in health care. Analysing qualitative data. British Medical Journal, 320, 114-116.
[44] US Department of Health and Human Services (2005) Dietary guidelines for Americans.
[45] Raynor, H.A., Jeffery, R.W., Phelan, S., Hill, J.O. and Wing, R.R. (2005) Amount of food group variety consumed in the diet and long-term weight loss maintenance. Obesity Research, 13, 883-890.
[46] Bandura, A. (1997) Self efficacy: The exercise of control. W.H. Freeman and Co., New York.
[47] Bandura, A. (2004) Health promotion by social cognitive means. Health Education & Behavior, 31, 143-164.
[48] Neutens, J.J. and Robinson, L. (2002) Research techniques for the health sciences. Benjamin Cummings, San Francisco.
[49] Johnson, R.K., Appel, L.J., Brands, M., Howard, B.V., Lefevre, M., Lustig, R.H., et al. (2009) Dietary sugars intake and cardiovascular health: A scientific statement from the American Heart Association. Circulation, 120, 1011-1020. http://dx.doi.org/10.1161/CIRCULATIONAHA.109.192627
[50] Myers, E.F., Khoo, C.S., Murphy, W., Steiber, A. and Agarwal, S. (2013) A critical assessment of research needs identified by the dietary guidelines committees from 1980 to 2010. Journal of the Academy of Nutrition and Dietetics, 113, 957-971 e951.
[51] Ambrosini, G.L., Oddy, W.H., Huang, R.C., Mori, T.A., Beilin, L.J. and Jebb, S.A. (2013) Prospective associations between sugar-sweetened beverage intakes and cardiometabolic risk factors in adolescents. The American journal of clinical nutrition, 98, 327-334.
[52] Bachman, J.L. and Raynor, H.A. (2012) Effects of manipulating eating frequency during a behavioral weight loss intervention: A pilot randomized controlled trial. Obesity, 20, 985-992.
[53] Butryn, M.L., Phelan, S., Hill, J.O. and Wing, R.R. (2007) Consistent self-monitoring of weight: A key component of successful weight loss maintenance. Obesity, 15, 3091-3096.

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