Members of a large Internet weight loss community exchange social support in the form of encouragement and motivation, information, and shared experiences. The support is similar to face-to-face social support, but also offers the unique aspects of convenience, anonymity, and non-judgmental interactions. Our findings have implications for the potential role of Internet weight loss communities as a resource for clinicians to recommend to patients.
A strength of this study was the use of multiple data sources. Studies of online social support in other health domains analyzed forum postings [4
] or conducted surveys of members [14
]. We evaluated forum postings, surveys, and interviews. We also employed a context-specific, inductive approach to explore social support as described by members of the online community [3
], rather than constraining the evaluation to previous definitions of social support developed in other contexts. To our knowledge, this is the first description of social support among members of a public Internet weight loss community.
The study also had several limitations. First, findings may not generalize to other weight loss communities, although the specific communication avenues (e.g. forums, email, and blogs) are not likely to vary widely between online communities. Second, survey and interview participants were mostly white women. However, the predominance of white women is consistent with the general SparkPeople membership, other online health communities [14
], and, to a lesser extent, US internet users [29
]. Third, we could not calculate all possible response rates for the survey. We do not know how many members viewed the study announcement on the forums. Nor do we know how many of the 3000 members invited by email would have participated if there was no cap of 250. The response rates using known denominators were acceptable (). Fourth, selection bias likely occurred, such that survey respondents may have been more active in the SparkPeople community or had more positive social support interactions compared to nonrespondents. However, survey respondents were similar in age and gender to the general membership. We also analyzed discussion forum messages from a broader sample of members to corroborate findings from the survey and interviews. Fifth, questions about interactions with other SparkPeople members () were worded positively, which might have led to social desirability bias in how respondents answered the questions. However, the response scale was balanced, with two positive and two negative choices flanking a neutral middle choice. Nevertheless, the possibility of these biases suggests that our findings depict social support benefits of active participants in an Internet weight loss community, rather than a definitive summation of experiences. Accessing people who quit due to negative experiences or explicitly asking current participants about negative experiences would yield additional information about these communities. Lastly, we did not explore the use of other community features which may also aid weight management, such as nutrition and physical activity tracking tools.
Consistent with descriptions of face-to-face social support [1
], the major types of online social support for weight loss in this study are encouragement and motivation, information, and shared experiences. These themes are not mutually exclusive. Because of their shared experience of trying to lose weight, SparkPeople members share day-to-day encouragement/motivation and information frequently not available from “offline” contacts. These types of support are also shaped by unique characteristics of convenience, anonymity, and non-judgment.
For example, the prominence of encouragement and motivational support, similar to emotional and appraisal support, is appropriate considering the chronic behavioral modifications necessary for weight loss. Reading testimonies from peers who have lost weight may be particularly helpful, since weight loss is correlated with the weight loss success of peer supporters [8
]. Online peers may be more accessible and helpful than clinicians or offline friends who are not experiencing the same challenges. SparkPeople members value the ability to receive such support conveniently and without fear of judgment.
The importance of informational support to our participants is consistent with our previous work [30
] and other descriptions of online and traditional social support [1
]. Not only has the Internet supplanted clinicians as the primary source of health information for the American public [33
], but the primacy of read-only Web resources created by a central core of experts (“Web 1.0”) is giving way to online communities which offer the collective wisdom of peers (“Web 2.0”) [13
The shared experiences aspect of online support for weight loss is akin to the concept of network support [4
]. The sense of unity among SparkPeople members is forged not by geographic proximity, but by the common endeavor to lose weight. Our findings resonate with a previous depiction of Internet health communities as “weak tie” networks, characterized by relatively low time commitment, emotional intensity, and intimacy [17
]. The SparkPeople community offers benefits of weak tie networks, such as diverse sources of support and a safe environment to disclose information without judgment or stigmatization, which lead to integration within the community [17
As traditionally defined, instrumental (tangible) support was not a major type of support described by SparkPeople members. However, this dimension is growing. SparkPeople members occasionally meet in their local communities for group exercise sessions. There were also two national conventions for members in 2009. Furthermore, if instrumental support is that which helps a person lose weight (rather than just cope with being overweight), then many interactions among SparkPeople members might be cast as instrumental support. For example, members reported that advice, encouragement, accountability, and friendly competition empowered them to perform behaviors which directly led to weight loss.
In this aspect, the benefits of online support for weight loss may surpass the benefits of support for other health conditions, although this hypothesis would be difficult to test. For example, online social support for psoriasis [14
], infertility [15
], Huntington’s disease [4
], and HIV [5
] can help an individual cope with the psychosocial stressors associated with the health condition, make informed health decisions, and find healthcare providers. In this study, members of the Internet weight loss community reported similar benefits, but also reported that the support actually helped them lose weight.
This online weight loss community, by providing a venue for social support, functions as a valuable weight loss resource for active participants. As the obesity epidemic overwhelms the capacity of clinicians to provide weight loss counseling [35
], it is unrealistic to expect clinicians to create and maintain venues for social support. Instead, they could refer patients to sustainable social support resources, such as SparkPeople.com and other similar online communities. Ideally, these communities would provide social support as an adjunct to structured counseling. While concerns exist about the accuracy of online health information, we have previously shown that weight loss advice in this community (and others) is generally accurate compared to clinical guidelines [30
However, several questions remain unanswered. First, which types of people will join and participate in these communities when referred by clinicians? Current SparkPeople members are primarily white women, but a more sophisticated understanding of psychosocial, socioeconomic, and clinical predictors of community participation is needed. Second, can modifications to these communities increase participation of men and ethnic minorities, or are other interventions needed? Most importantly, what is the objective effect of online social support via these communities in terms of weight loss and other patient-valued outcomes? These questions require prospective studies.
In conclusion, this Internet weight loss community plays a prominent role in participants’ weight loss efforts—roles which might not be adequately filled by clinicians or offline family and friends. Internet-mediated support provides similar benefits as face-to-face support, with unique convenience, anonymity, and lack of judgment. Participants report that the support from this Internet community helps them lose weight as well as cope with being overweight. Internet weight loss communities merit further evaluation as a potential resource for clinicians to recommend to patients, especially communities which are free and open to the public.
What was already known:
- Face-to-face peer social support facilitates weight loss efforts.
- Internet health communities allow individuals to interact with peers who share similar health issues and concerns.
What this study adds:
- Online social support interactions play a prominent role in the weight loss efforts of members of a large, public Internet weight loss community.
- The support is manifested as encouragement and motivation, information, and shared experiences and it is characterized as convenient, anonymous (if desired), and non-judgmental.
- Community members report that the social support helps them cope with being overweight and helps them lose extra weight.