E-learning may not effectively improve dietary behaviors

Oct 28 2011

With more people online and using smart phones, health applications or "apps" as they are popularly known are being promoted to help with everything from exercising to quitting smoking. A new review suggests that apps designed to change and improve eating habits may not make much of a difference.

Recent developments in communication technology have sparked a new way to present information, known as "e-learning." With e-learning, users can learn skills and receive professional advice on their own time and at their own pace through interactive programs delivered on the Internet, television, CD-ROMs as well as mobile telephones.

"E-learning is a relatively new development in self-management and we were very interested to see what its effect on dietary behaviors might be," said Phil Edwards, Ph.D., a senior lecturer in Statistics at the London School of Hygiene & Tropical Medicine and member of the team of British reviewers.

The systematic review, which appears in the current issue of Health Technology Assessment, looked at whether e-learning to improve dietary behaviors is effective compared with getting the same advice directly from a health care professional, or in some cases getting no advice at all.

The reviewers evaluated 43 research trials, most of which studied e-learning interventions that aimed to reduce participants' fat intake and increase their fruit and vegetable consumption. Other interventions focused on weight loss.

Of the 43 studies, 32 presented nutritional and healthy lifestyle information to the user, and 25 required entering what foods were consumed daily. The e-learning programs in 14 studies mostly aimed to change behavior by having the user set dietary goals and then provided feedback on performance and prompts on how to reach those goals.

For example, one study done at a community center in the U.S. had 1,071 participants use an online program once a week for 10-minute sessions over a 12-week period. The program gave goals with specific strategies, plus meal planning and general nutrition information.

The reviewers concluded that the e-learning interventions did not produce significant changes to dietary behaviors, except for a small increase in the intake of fruits and vegetables. Participants in all studies consumed an average of only 0.24 more servings of fruits and vegetables and 0.78 fewer grams of total fat per day.

The reviewers surmised that other outside factors might have a bigger role in influencing participants' eating habits. Factors such as the local availability of healthy foods at affordable prices, marketing of energy-dense foods by the food industry, as well as habits learned from family and peers can influence dietary and eating patterns, explained Edwards.

"These wider determinants of dietary behavior are unlikely to be changed by individually targeted interventions such as e-learning," he added.

Tom Baranowski, M.D., professor of pediatrics and specialist in behavioral nutrition at Baylor College of Medicine in Houston, Texas, said that while electronic interventions are not likely to work completely by themselves, it "seems premature to close off developing such interventions."

"We are just beginning to learn how to design electronic interventions and how best to use them," said Baranowski, who has done his own research in designing video games to promote diet and physical activity behavior change in children.

He added that primary care providers often "do not want to be bothered with dietary change, in part because they don't get reimbursed for it," but electronic interventions can be developed for use with patients to encourage behavior change.

Edwards and his team, however, concluded that further research is needed to explore whether there are particular groups of people who might benefit from these programs.

"E-learning may have potential as one approach within a package of interventions to tackle poor diet and obesity in the population," said Edwards.