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.