Results

A total of 24 women enrolled in the study. Of those, 13 participated in the GoWoman program and attended at least half of the 16 weekly sessions. The women had a wide variety of disabling health conditions, such as multiple sclerosis and spinal cord injury. Most were middle-aged (average = 50 years old) and had been living with their disability for many years (average = 22 years).

Most importantly, we wanted to know if the women lost weight. To answer this question, we weighed the women before and after the 16 week program. We also measured their waist circumference before and after the program. Waist circumference is important because it gives us an estimate of abdominal fat – which is related to type 2 diabetes, hypertension, and other health conditions. These two measures were primary outcome measures.

Since weight loss depends on the balance between calories taken in and calories burned, we also asked the women about their eating patterns and their physical activity. We asked these questions before and after the program. The physical activity questionnaire was designed specifically for people with disabilities. The measure asked about a wide range of activities – not just exercise.

We also measured other things that can affect weight loss. These included support from friends and family, nutrition knowledge, and self-efficacy (or self-confidence) that they could eat healthy and exercise.

The 13 women who attended at least half of the GoWoman sessions in Second Life:

• Lost an average of 6 pounds or 3% of their body weight
• Lost an average of 1.4 inches in their waist
• Ate fewer calories (On average, they ate 243 fewer calories per day)
• Increased their physical activity
• Increased their confidence (self-efficacy) that they could control their eating behavior
• Increased their confidence (self-efficacy) that they could engage in healthy exercise
• Reported only small changes in social support from family and friends
• Did not show improved nutrition knowledge. Most already had high scores on our nutrition knowledge measure before the program.

We asked the women what they thought of the GoWoman program, what they thought about Second Life, and whether the program helped them meet their goals. Here is what we found:

• All 13 women rated the program as either "excellent" or "good."
• All 13 said they made positive changes in their diet; 12 said these were “important” changes.
• All 13 said they made positive changes in their physical activity; 10 said they made “important” changes.
• 5 women met or exceeded their weight loss goal; 5 said they made “good progress” toward their goal.
• All 13 felt supported by the group facilitators in Second Life; 11 felt “very supported.”
• 12 of the 13 women felt supported by their fellow group members in Second Life.
• Most women ranked Second Life as their 1st choice of program formats (from a list of 4 different format options). Face-to-face was the second highest ranked format.

We examined whether age and level of physical function affected how much weight people lost. We found that age had a small effect, with younger people losing a little more weight than older people. We also found that people with fewer physical limitations lost a little more weight than people with more limitations. However, far more important was how engaged they were in the GoWoman program. The women who were more active in the program (meaning they attended more sessions and more regularly recorded their diet and physical activity) lost more weight and more inches from their waist.

The results are promising. We were pleased that the women who participated in the program lost weight and showed improvements in other ways as well. We were also pleased that Second Life seems to be a useful way to offer group programs to women with mobility impairments. We look forward to testing more health promotion programs using Second Life.

This was a pilot study of only 13 women. The next step is to test the GoWoman program with a much larger sample of women with mobility impairments from various backgrounds. They will be randomly assigned to either a group that participates in the GoWoman program or a group that receives information by email. By comparing the amount of weight lost and other results for women in each group, we will be able to tell with more certainty if the GoWoman program is helpful.

Some improvements we will make in the GoWoman program are:

• Expand the program so it lasts more than 4 months. Participants will meet weekly for 16 weeks, then every other week, and finally once a month. This will help them keep up their progress without weekly support from the group.
• Follow participants longer after the program is over so we know how well they are able to keep the weight off. We would like to follow participants for at least a year after the GoWoman program has ended.
• Use better measures of body weight, body fat, and daily calories burned.

As we continue this research, we will gather information about what parts of the program are the most important for successful weight loss. We have applied for funding to expand our research on weight management and women with mobility impairments. Be sure to check back from time to time for updates on our progress.