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April 2014


Dear (Editor),
As you very well may know obesity is a growing epidemic in the United States. Many
Americans are trying to focus more on their health but meet many obstacles such as lack in
nutrition related knowledge, financial limitations, and time constraints. As interest and
recognition for the field of nutrition and dietetics increases Registered Dietitians (RDs) are
continuously trying to offer their services to a broader population.
To meet the needs of their patients and clients many RDs have decided to turn to
telehealth to offer a range of services. As many other professionals have begun
using technology to promote their services many RDs have begun doing the same to continue
to bring attention to the field of dietetics.
This study shows a positive correlation between telehealth and weight loss. Although the
study did not prove the initial hypothesis the outcomes suggests telehealth is definitely a viable
platform for RDs to provide their services with successful results.
This study was completed in accordance with the requirements for the ARAMARK
Distance Learning Dietetic Internship. The study was completed under the supervision of the
dietitians at Blessing Hospital in Quincy, Illinois as well an ARAMARK Dietetic Internship
Director. The study was approved by Blessing Hospital and their Director for the department of
Food and Nutrition. This study was conducted with the hopes of proving telehealth to be a viable
option to the dietitians of Blessing Hospital and thus to other dietitians in the nation.


Sincerely,


Priscilla E. Bloom, BS, Dietetics (Corresponding Author)
Dietetic Intern
ARAMARK Healthcare Distance Learning Dietetic Internship
303 S. 7th St
Quincy, IL 62301
Bloom-Priscilla@aramark.com


Amy Wampler DeMage, MS, RD, LD
Regional Director
ARAMARK Healthcare Distance Learning Dietetic Internship
Demage-Amy@aramark.com


Ami Froese RD, LDN
Clinical Nutrition Manager
Blessing Hospital
Froese.Ami@blessinghealthsystem.org
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Research Practice and Innovation
Overweight/obese, online, nutrition counseling
Word Count: 2687







Will overweight/obese patients who are provided with online nutrition counseling have
increased weight loss compared to patients enrolled in the Be Well for Life program?






Priscilla E. Bloom, BS, Dietetics (Corresponding Author)
Dietetic Intern
ARAMARK Healthcare Distance Learning Dietetic Internship
303 S. 7th St
Quincy, IL 62301
Bloom-Priscilla@aramark.com


Amy Wampler DeMage, MS, RD, LD
Regional Director
ARAMARK Healthcare Distance Learning Dietetic Internship
Demage-Amy@aramark.com


Ami Froese RD, LDN
Clinical Nutrition Manager
Blessing Hospital
Froese.Ami@blessinghealthsystem.org





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Will overweight/obese patients who are provided with online nutrition counseling have
increased weight loss compared to patients enrolled in the Be Well for Life program?
Abstract
Nutrition and dietetics are growing fields that can provide the population with immense
knowledge on how to better their health and improve their quality of life. Unfortunately in this day
and age the public is still not correctly informed on what a Registered Dietitian does and how
they can be utilized. Whether it be from little to no exposure, financial limitations, or limited
access Registered Dietitians are struggling to provide an essential service to their members of
the community. As a way to increase access to their services many dietitians are starting to use
technology to reach a broader population. This present study investigates the effectiveness of
telehealth and its influence on weight loss answering the question: will overweight/obese
patients who are provided with online nutrition counseling have increased weight loss compared
to patients enrolled in the Be Well for Life program? A total of six participants, five women and
one male, were involved with this three month long study. Each participant was allotted one hour
to meet with the researcher who provided general coaching sessions. During these sessions
participants would discuss their eating habits, what they struggled with, questions they may
have, and goals to work on before the next session. Participants provided an initial weight, a
weekly weight, and a final weight at the end of the study. Results were compared to Blessing
Hospitals Be Well For Life Program, a 16-week long program geared toward improving health
and lowering risk for chronic disease. At the end of the study participants lost an average of 7.2
pounds, however, those participating in the Be Well For Life program lost an average of 11.8
pounds, 4.6 pounds more than those in this study. Although this study does not support the
hypothesis that telehealth increases weight loss compared to the Be Well for Life program, the
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weight loss generated by this study is substantial enough for dietitians to continue to use this
platform to provide their services to patients and clients.
5
Will overweight/obese patients who are provided with online nutrition counseling have
increased weight loss compared to patients enrolled in the Be Well for Life program?

Introduction
The amount of overweight and obese adults in the United States is steadily increasing
year after year. As of 2010, 32% of US adults are obese with a BMI of 30 or greater, and 34% of
US adults are overweight with a BMI of 25 29.9
1
. This epidemic is already common knowledge
in many American households but the best target of action to decrease the number of obese
adults is still under extensive consideration. Many potential solutions have surfaced throughout
the years from medications to calorie restrictive diets. One of the solutions that has been
researched and confirmed beneficial in increasing weight loss is nutrition counseling. Studies
have confirmed that nutrition wellness coaching not only increases weight loss but it can reduce
intake of total fat, saturated fat, and cholesterol
2,3
. Further research also shows the benefits of
nutrition counseling versus a self-directed approach. An article found in ACP Journal Club
showed that behavioral weight loss interventions utilizing in-person individual and group
sessions or coaching by telephone resulted in a 5% weight loss amongst participants


4,1
. After 2
years these participants showed a greater amount of weight loss compared to the self-directed
control group. Nutrition counseling should be recommended by many working in the health care
field as a method for weight loss and maintenance.
Many patients look to their physicians for answers on how they can lose weight and
maintain their weight loss. In a study found in Preventative Medicine entitled Weight
management advice: What do doctors recommend to their patients? research found that
although many physicians are telling their patients they are overweight or obese only 5.2%
referred their patients to a formal diet program
5
. It is important to verbalize to the patient if they
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are obese or overweight but it is even more beneficial to consult the patient on the best methods
of losing weight and refer them to the appropriate programs. Many Americans get their nutrition
information from the internet, magazines, television, or friends advice; directing them to
appropriate programs will allow them to improve their eating habits and maintain their weight
loss.
Blessing Hospital in Quincy, Illinois offers a program to their patients and employees
called Be Well For Life. Be Well For Life is a 16-week programs focused on helping participants
improve their health. This is done through a variety of ways such health risk assessments,
wellness coaching sessions, individual nutrition consultations with a Registered Dietitian, yoga
classes, and many more health focused options
6
. This program has helped many participants
improve their health, stop tobacco use, and increase weight loss. Although participants in Be
Well For Life have the opportunity for nutrition counseling with an RD, they have not yet
incorporated technology into their programs. Many dietitians around the United States have
begun incorporating online nutrition counseling into the services they offer. Through the use of
the Internet and webcams dietitians can reach a wider variety of patients and clients.
Speaking with the dietitians at Blessing Hospital, online nutrition counseling is something
they feel they might want to incorporate as part of the many services they offer. By providing
online nutrition counseling for patients and clients that have webcam capabilities and reliable
Internet, the dietitians at Blessing can reach a greater variety of people in the Quincy area.
Amongst the different types of people living in Quincy and the variety of nutrition related
problems the dietitians deal with on a day-to-day basis, overweight and obese patients are one
of the most prevalent groups. Currently Quincys obese population has reached 25.7%, with the
diabetic population at 9.4%.
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These statistics are greater than the general state statistics for
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Illinois. If online nutrition counseling proves to be beneficial in increasing weight loss, the
dietitians at Blessing may find they can extend their services into the surrounding areas near
Quincy.
The purpose of this research is to see if there is significant weight loss amongst
participants who can consistently meet with a dietitian using online nutrition counseling via a
webcam. More specifically this research project will answer: will overweight/obese patients who
are provided online nutrition counseling have increased weight loss compared to patients
enrolled in the Be Well for Life program? By answering this question dietitians at Blessing
Hospital in Quincy, IL can decide if this is a service that can be beneficial for their patients and if
proven beneficial a service that can increase the scope of the dietetic practice. It is hypothesized
that online nutrition counseling will increase weight loss by 5% more than the Be Well For Life
program.
Methodology
The study was conducted using a quantitative casual comparative/quasi experimental
research design. The study had a total of 6 participants, 5 women and 1 man, all with a BMI over
25. Participants were chosen based on their BMI; participants must have a BMI of 25 of greater
classifying them as either overweight or obese. Neither race, gender, nor age were considered
in the inclusion criteria. The sessions were conducted over a span of 3 months and progress
was monitored with weekly weigh-ins, where participants had to submit their weight every
Monday via e-mail. Participants were provided with materials to read before the initial counseling
begins and counseling sessions occurred once a week for the first month and then gradually
decreased to sessions every other week as the sessions were less geared towards educating
and more focused on implementing what they have learned. Counseling sessions were
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conducted using a webcam and utilized Googles program Google Hangouts. Google
Hangouts allowed the researcher and the participant not only to communicate through their
webcams but it also allowed the researcher to share important documents with the participants
via the programs screen share. Sessions were very goal centered, with participants creating
weekly goals. Each participant allotted one hour for each session to focus on goals, food
behavior, and education. The comparative program, Be Well for Life, allows their dietitians to
choose any method of nutrition counseling they desire. For the purpose of this study and to
encourage an effective counseling session two methods of nutrition counseling were
implemented in order to effectively assist participants with their goals: motivation therapy and
cognitive behavioral therapy (CBT)
1,8
. Participants were asked to develop short and long term
goals that they worked on throughout the 3 months, following the motivational interviewing
method and creating goal orientated sessions. Each participant had a folder in which their
personal information, session notes, and emails were stored in order to monitor their progress
and easily access any information. The weekly weigh-ins were inserted into an excel
spreadsheet to determine if any weight had been lost. The spreadsheet recorded the total
weight loss, % weight loss, and average weight loss of each participant. Once the data was
collected the results were compared to the control group, Blessings Be Well for Life, to
understand if participants lost more weight.
The role of the researcher as the nutrition counselor was to change the way participants
view food and the limitations they have set on themselves, whether it be thinking they have no
time for a healthful diet or that a healthful diet is too restrictive. Sessions focused on how to
change attitudes and focused on goals already in place. Focusing on these two aspects
encouraged a more healthful diet and increased weight loss. It was initially estimated that there
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would be a 5% greater increase in weight loss compared to the Be Well for Life program already
in place at Blessing.
Results
Table 1.0 Participant Weight Loss
1
Weight
(lbs)
Beginning 175
End 175.4
Total Pounds Lost + 0.4
% body weight lost -




2
Weight
(lbs)
Beginning 245
End 237
Total Pounds Lost 8
% body weight lost 3.26




3
Weight
(lbs)
Beginning 185.6
End 182.8
Total Pounds Lost 2.8
% body weight lost 1.50




4
Weight
(lbs)
Beginning 365
End 352
Total Pounds Lost 13
% body weight lost 3.56




5
Weight
(lbs)
Beginning 157
End 147
Total Pounds Lost 10
% body weight lost 6.36




6
Weight
(lbs)
Beginning 234
End 224
Total Pounds Lost 10
% body weight lost 4.27
Average Total Weight loss
(lb) 7.23
Median 9
Mode 10


Table 2.0 Be Well For Life Participant Weight Loss
1
Weight
(lbs)
Beginning (2/13) 196.9
End (5/30/13) 190
Total Pounds Lost 6.9
% body weight lost 3.50




2
Weight
(lbs)
10
Beginning (2/13) 194
End (05/28/13) 184.5
Total Pounds Lost 9.5
% body weight lost 4.89




3
Weight
(lbs)
Beginning (2/13) 292.6
End (05/28/13) 274.3
Total Pounds Lost 18.3
% body weight lost 6.25




4
Weight
(lbs)
Beginning (2/13) 213.9
End (05/28/13) 200.8
Total Pounds Lost 13.1
% body weight lost 6.12




5
Weight
(lbs)
Beginning (2/13) 183.6
End (05/31/13) 173.3
Total Pounds Lost 10.3
% body weight lost 5.61




6
Weight
(lbs)
Beginning (2/13) 333.8
End (5/30/12) 351
Total Pounds Lost -17.2
% body weight lost -




7
Weight
(lbs)
Beginning (2/13) 217.2
End (05/28/13) 192.7
Total Pounds Lost 24.5
% body weight lost 11.27




8
Weight
(lbs)
Beginning (2/13) 273.4
End (05/30/13) 264.6
Total Pounds Lost 8.8
% body weight lost 3.21




9
Weight
(lbs)
Beginning (2/13) 208.8
End (05/28/13) 196.9
Total Pounds Lost 11.9
% body weight lost 5.69




10
Weight
(lbs)
Beginning (2/13) 231
End (5/29/13) 216.5
Total Pounds Lost 14.5
% body weight lost 6.27




11
Weight
(lbs)
Beginning (2/13) 251.3
End (05/30/13) 222
Total Pounds Lost 29.3
% body weight lost 11.65
Mean Weight lost (lb) 11.80
Median 11.9
Mode n/a


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Tables 1.0 and 2.0 are indicative of the weight loss results seen by both participants in
the research study and for the Blessing Hospitals Be Well For Life program. The Be Well For
Life program had an average of 11.8 pounds lost between all 11 participants. This research
study only had six participants and had a 7.2 pound average weight loss between them.
Comparing the two, the Be Well For Life participants lost an average of 4.6 pounds more than
the participants in the research study that only communicated using web base access.
The results obtained from Be Well For Life and for this research study only takes into
account weight loss. Weight loss or maintenance post program and new nutrition related
knowledge acquired as a result of the program was not taken into consideration when obtaining
the results.
Discussion
Upon analyzing the results it can be noted that the Be Well For Life patients lost an
average of 4.6 pounds more than the participants in this study that only had access to nutrition
counseling and coaching via online access. The purpose of this research study was to answer
the following questions: will overweight/obese patients who are provided online nutrition
counseling have increased weight loss compared to patients enrolled in the Be Well for Life
program? The Be Well For Life program has more participants than this research study, which
could have affected the averages, however, the results appear to suggest that online nutrition
counseling does not increase overall weight loss.
Although the participants in this research study did not lose more weight than those
enrolled in the program at Blessing Hospital the participants of this research study all had
positive things to say. Each one of the participants expressed that they had gained something
from this experience. Many of them believed they had received the right tools and resources to
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continue with their new lifestyle change. All of the participants expressed that the nutrition
counseling sessions they received allowed them to reprogram how they viewed food and
exercise.
There are, unfortunately, many limitations to this research study. Although this study was
made known to the public and there was high interest prior to the start date, only a small number
of participants actually decided to continue with the study. Other limitations include scale
discrepancies. All of the participants were told to use the same scale and to weigh themselves at
the same time and day with the same clothing on. Unfortunately this is very difficult to monitor
when the person is not physically present on the weigh in date. One final limitation that might
have prevented a greater weight loss is the absence of an incentive. The participants of the Be
Well for Life program had to pay to be a part of the program. Rules were also in place that
required the patients to complete certain things every week and not following the rules would
result in termination from the program. As this research study was designed simply to answer
the proposed question and involved participants to volunteer their time, participants felt freer to
miss a session or turn in their weights later than the designated day.
Conclusion
As recognition for dietitians continues to grow it is very important to provide the
population with more access to the multitude of services dietitians can provide. As the number of
obese people living in the United States continues to increase every year it is even more
important to provide nutrition information to those patients with a busy schedule, those living in a
rural area, or those who have limited access to transportation. Although this study did not agree
with the posed hypothesis, weight loss and behavior modification was still seen. The limitation of
no incentive may have decreased the potential weight loss for these participants, but the
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strength of the study comes from the lack of incentive. Participants in the program did not pay
for the service provided and termination was not a motivating factor in determining their
progression with the study. This indicates that, through the sessions, participants gained a lot of
knowledge that allowed them to make better food choices and encourage exercise. This is
reason enough for dietitians to provide this service to their clients and patients.



















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