Examining Theory-Based Behavior-Change Constructs,Social Interaction,and Sociability Features of the Weight Watchers’ Online Community

Abstract

Objective. To examine whether and to what extent relevant and meaningful discussions of weight loss occurred in the Weight Watchers’ online community, and whether and to what extent the online community is designed for fostering such discussions. Methods. A multimethod approach was used here. First, a quantitative content analysis was conducted on 320 posts from 64 threads sampled from WeightWatchers.com’s message boards between December 1, 2011, and January 31, 2012. The coding categories included constructs from the health belief model, the planned behavior theory, and the theory of self-efficacy. An acceptable level of intercoder reliability was reached; frequencies, cluster analysis, and t test were reported. Second, a conventional content analysis of the posts was conducted. The posts were examined for themes and patterns within the discussion. Finally, the researchers examined the sociability features of the message boards. The qualitative review followed established procedures and was conducted independently by four researchers. Results. Mastery experience occurred in 46% of the posts. Threads focusing on physical activities contained more perceived barriers, mastery experiences, and verbal persuasion than other types of threads. Posts focusing on diet included unanswered questions about dieting practices with certain medical conditions. Posts focusing on mastery experience celebrated any small step toward success. Posts irrelevant to weight loss mostly contained events and happenings in members’ lives. The sociability review revealed a lack of moderation. Conclusion. The Weight Watchers’ online community included much discussion about weight loss. Findings suggest that physical activities require more encouragement than dieting. Health educators have an opportunity to interject and moderate meaningful discussions. For example, dieting with certain medical conditions, opinions on various diets, and the relationship between dieting and being healthy are opportunities to facilitate learning. Discussion posts irrelevant to weight loss help build social relationships.

Keywords

health belief model online health community social cognitive theory theory of planned behavior weight loss

From 2009 to 2010, the age-adjusted prevalence of overweight and obesity (body mass index ≥ 25) was 68.8% among American adults (Flegal, Carroll, Kit, & Ogden, 2012). With such a high overweight and obesity rate, Americans are increasingly concerned about health. Statistics show that 72% of Americans have looked for health information online (Pew Internet & American Life Report, 2012). Eighty-four percent of American Internet users participate in some kind of online community, and roughly one third of these communities are related to health (Jones & Fox, 2009). Sixty percent of Americans have tracked their weight, diet, or exercise routine (Pew Internet & American Life Report, 2012). The Internet has become an important source and tool for Americans who want to lose weight.

Meanwhile, the Internet is also used by commercial weight loss brands to communicate with people who want to lose weight. CBS News identified Weight Watchers (WW) as the “titan” of the $61 billion diet industry (Picchi, 2014). The WW’s brand includes packaged food products, diet plans, and the “PointsPlus” calorie tracking system. To engage its consumers, WeightWatchers.com endorses an online weight loss community on its message boards. Compared with other online health interventions previously researched (Ferrer, Huedo-Medina, Johnson, Ryan, & Pescatello, 2011; Letourneau et al., 2012; Lorig et al., 2010; Solomon, Wagner, & Goes, 2012; van Genugten et al., 2012), the Weight Watchers’ (WW) online community has active participation. However, it is unclear whether and to what extent relevant and meaningful discussions of weight loss occur in peer-to-peer interaction, and whether and to what extent the online community is designed for fostering such discussions. To bridge this gap, the purpose of this study is to provide a comprehensive picture of theory-based behavior-change constructs, sociability features, and social interaction in WW’s online community.

First, this study examines the presence of theory-based behavior change constructs within the WW online community since health behavior moderates outcome (Glanz, Rimer, & Viswanath, 2008). Studies suggest that online communities have the potential to facilitate behavior change, such as colorectal cancer screening behavior (Yoo, Kwon, & Pfeiffer, 2013) and youth’s protest activity (Valenzuela, Arriagada, & Scherman, 2012). However, previous studies found that the use of health behavior theories was minimal on health-related websites (Doshi, Patrick, Sallis, & Calfas, 2003) and in smartphone applications (Cowan et al., 2012). Following these studies, the current study examines theory-based behavior-change constructs within the theory of planned behavior (TPB; Ajzen, 1985, 1991), the health belief model (HBM; Janz & Becker, 1984), and the theory of self-efficacy (Bandura, 1977). These models gather psychological variables that play a key role in predicting and explaining weight loss behaviors (Palmeira et al., 2007). TPB focuses on intentions to engage in weight loss and perceived control over weight loss (Palmeira et al., 2007). Self-efficacy is important to weigh loss because the more self-efficacy a person has, the stronger his or her belief that he or she has control over the behavior (Bandura, 2004). The HBM indicates that perceived severity and perceived susceptibility will motivate people to lose weight if perceived benefits of losing weight outweigh perceived barriers (Diane, 2007).

Second, this study examines social interaction in the WW online community since online social interaction serves as a rich source of social learning. Social interaction is a dynamic process of exchanging messages among participants (Preece, Abras, & Maloney-Krichmar, 2004). With the aid of technology, social interaction is documented for others to see. As a result, social interaction in an online community establishes a social learning environment in which previous behaviors set examples for following actions (Preece, et al., 2004). For instance, college students who use Facebook have learned how to conduct themselves on the social media site by observing how others behave online (Martey & Stromer-Galley, 2007). When users of Facebook observe friends contributing content, they will contribute more content as well (Burke, Marlow, & Lento, 2009). Moreover, examining social interaction in the WW online community reveals the wants, needs, concerns, and opinions of people who want to lose weight.

Third, this study examines the sociability features of the WW online community since sociability features shape participation and social interaction (Preece, 2001). Sociability features, including purposes, people, and policies, are design features to increase the sociability of a social media site (Preece, 2001). The purpose of a community is the most important design feature since it provides a reason for members to stay in the community (Preece, 2001). The extent to which the purpose of a community serves the purpose of weight loss determines whether its participants share an interest in weight-loss behavior. People refer to the roles of community members, such as moderators and opinion leaders (Preece, 2001). Several case studies showed that the role of the moderator could help keep the messages on topic and establish a respectful atmosphere in online political deliberation (Jensen, 2003; Wright & Street, 2007). Policies of a community are an important part of group norms (Preece, 2001). Previous studies found that online political discussion groups with explicit guidelines for discussion and preset discussion topics had more balanced, nuanced, and serious political discussion than those without these design features (Jensen, 2003). Thus, examining the sociability features of the WW online community can help us determine whether and to what extent the design of the message boards facilitates discussions on weight loss.

Method

Study Design

The design of the current study included a quantitative content analysis of theory-based behavior-change constructs, a conventional content analysis (Hsieh & Shannon, 2005) of themes occurring in social interaction, and a qualitative review of the online community’s sociability features.

Sampling

The message boards are predetermined by WeightWatchers.com and periodically change. Currently, 56 message boards are listed under two broad categories: “Make Conversation” and “Exchange Information.” The main topics of these messages boards are dieting, exercising, and social support. For example, some of these sampled forums are titled “Dietary Restrictions,” “Fitness Challenges,” “Lose for Good,” and “Maintenance.”

The sampling occurred between December 1, 2011, and January 31, 2012, a period when people worried about their weight due to major holidays, tried to diet, and made New Year’s resolutions to lose weight. The sampling procedure took “snap-shots” by selecting consecutive posts from randomly selected threads. As there were a large number of threads posted during the sampling period, three steps were applied to obtain a manageable and comparable sample. First, seven message boards were randomly selected using systematic random sampling. Systematic random sampling is a variation of simple random sampling (Davis, 2012). Using this method, this study sampled every fifth message boards. Message boards that did not have posts during the sampling period were dropped. Second, a random sampling of threads within each selected message board was conducted. Third, consecutive posts, starting with the most recent one, were collected from the threads. Six was set as the maximum number of consecutive posts from each thread based on the researchers’ judgment and the feasibility of the coding. Thus, if the thread had more than six posts in the sampled time frame, only the most recent six posts were selected. If the thread had fewer than six posts in the sampled time frame, all consecutive posts were selected. Screenshots of sampled posts were taken and saved as images. A unique number was assigned to a sampled thread. Depending on the chronic order of the posts in the thread, each post had an identifying integral number ranging from 1 to 6. Following this sampling procedure, the current study collected 320 posts from 64 threads. Each sampled thread had an average of five posts. The size of the sample is comparable to similar studies on online weight loss communities (Wang, Willis, & Rodgers, 2014).

Quantitative Content Analysis

Constructs of the TPB, the HBM, and theory of self-efficacy were defined and operationalized in a codebook, and then coded. TPB posits health behavior is governed not only by individual attitudes but also by social environments and a person’s sense of control (Ajzen, 1985). Thus, six construcs of the TPB that represent a person’s control over behavior were coded, including behavioral beliefs, normative beliefs, control beliefs, attitude toward the behavior, subjective norms, and perceived behavior control (Ajzen, 1991). The HBM has three assumptions: the feeling that a negative health condition can be avoided; the expectation that by taking action, the negative health condition will be avoided; and the belief that an individual is able to practice the healthy action (Rosenstock, 1974; Rosenstock, Strecher, & Becker, 1988). All four main constructs of the HBM were coded, including perceived severity, perceived susceptibility, perceived benefits, and perceived barriers. Self-efficacy refers to “the belief of one’s capabilities to organize and execute the courses of action required to manage prospective situations” (Bandura, 1995, p. 2). The present study coded the three most powerful sources of self-efficacy: mastery experience, vicarious experience, and verbal persuasion (Bandura, 1991). In addition, whether a post focused on dieting or physical activities was also coded.

The unit of analysis was each post. Theory-based behavior-change constructs were defined and operationalized in a codebook (see Appendix I, available online at heb.sagepub.com/supplemental). Two graduate students did the coding. Two rounds of coder training were conducted. Then, the coders coded 28% of the sampled posts (N = 90) independently to establish intercoder reliability, calculated by Cohen’s Kappa coefficient. The Kappa value ranged from .79 to 1, satisfying the minimum requirement of .75 (Tinsley & Weiss, 2000). Cohen’s Kappa was not calculated for normative beliefs, subjective norms, perceived behavior control, perceived susceptibility, and perceived severity since only the value of absence appeared in the coding results. However, the agreement between the two coders on these coding categories was 100%. When satisfactory level of intercoder reliability was reached, each coder coded half of the sampled posts using the same codebook. The coding results were entered into an Excel sheet, and then analyzed by SPSS v. 21.

Conventional Content Analysis of Social Interaction

All 320 posts in the sample were analyzed using an inductive approach. Based on findings from the quantitative content analysis, posts related to diet and exercise and posts irrelevant to weight loss were examined separately to identify themes. Without predetermined categories or a codebook, texts were examined several times; themes emerged during initial readings, and more readings were done to explore those themes (McKee, 2003). While coding themes and patterns, the researchers isolated something “(a) that happens a number of times and (b) that consistently happens in a specific way” (Miles & Huberman, 1994, p. 215). The researchers discussed reoccurring themes together in the context of the literature, and returned to the texts in order to glean “thick description” in regard to the purpose of the study (Geertz, 1977).

Qualitative Review of Sociability Features

The qualitative review of the WW online community’s sociability features followed Maloney-Krichmar and Preece’s (2005) practice. Two researchers and two graduate students independently reviewed WW’s message boards using the Neilsen’s heuristics (Maloney-Krichmar & Preece, 2005; Preece et al., 2004) and two key dimensions of sociability identified by Preece et al. (2004): the extent to which the community exists only virtually and the type of software environment that supports the community.

Results

The first purpose of this study is to examine theory-based behavior-change constructs. Table 1 shows the frequencies of theory-based behavior-change constructs and other coded variables.

Table 1.

Frequencies of Posts That Contained Theory-Based Behavior-Change Constructs.

Measurement	Frequencies
Posts not relevant to weight loss	163
Posts relevant to weight loss	157
Total	320
Posts primarily about physical activities	85
Posts primarily about diet	72
Total	157
The planned behavior theory
Behavioral beliefs	3
Normative beliefs	1
High control beliefs	8
Low control beliefs	2
Positive attitude toward the behavior	21
Negative attitude toward the behavior	0
Subjective norms	0
Perceived behavior control	0
The health belief model
Perceived susceptibility	0
Perceived severity	0
Perceived benefit	4
Perceived barriers	19
The theory of self-efficacy
Mastery experience	148
Vicarious experience	6
Verbal persuasion	41

The second purpose of this study is to examine the social interaction occurring in the WW online community. Frequencies showed that 14 threads did not contain any content related to weight loss. The remaining 50 threads were classified using two-step cluster analysis to determine the focus of the discussion. The cluster analysis was based on the density of posts that focused on diet or exercise in a thread. Density was the ratio between posts with a certain focal topic (diet or exercise) in a thread and the total sampled posts in a thread. For example, if there are 3 posts focusing on diet in a thread of 4 sampled posts, then the density of diet is 3/4 = 0.75 (see Table 2).

Table 2.

Variables Entered Into Cluster Analysis.

Variable	Mean	SD	Skewness	Kurtosis
Density of physical activities	0.31	0.37	0.75	−1.06
Density of diet	0.32	0.12	−1.71	2.63

The cluster analysis revealed three clusters of threads with a good classification quality (Silhouette = 0.6). Silhouette indicates whether the clusters are distinctive and clear-cut (Rousseeuw, 1987). The predictor importance of diet was 0.83 and that of exercise was 1 in classifying the threads. The predictor importance indicates the importance of each predictor in making a prediction (Kent, 2015). The cluster analysis identified 18 threads with a strong focus on diet, 18 threads with equal focus on diet and exercise, and 14 threads with a strong focus on exercise. Thus, all 64 threaded discussions were grouped into four categories based on the focal topic of the discussion (see Figure 1).

A comparison of theory-based behavior-change constructs in the threads is shown in Table 3. Discussion focusing on exercise had the most theoretical constructs in general. A one-way analysis of variance indicated that the presence of perceived barriers, mastery experience, and verbal persuasion significantly differed among the three types of threads. Specifically, discussion focusing on exercise had the most posts containing perceived barriers, mastery experience, and verbal persuasion.

Table 3.

Characteristics of Different Types of Discussion on Weight Loss.

The number of posts with a theoretical construct	Discussion focusing on diet		Discussion equally focusing on diet and exercise		Discussion focusing on exercise
The number of posts with a theoretical construct	Mean	SD	Mean	SD	Mean	SD
Exercise	0.28	0.57	1.06	1.21	4.43	0.85
Diet	2.89	1.23	0.72	0.57	0.29	0.61
Behavioral beliefs	0.06	0.24	0	0	0.14	0.54
High control beliefs	0	0	0.17	0.38	0.36	0.63
Positive attitude toward the behavior	0.39	0.78	0.17	0.38	0.79	0.80
Perceived benefits	0.11	0.32	0	0	0.14	0.36
Perceived barriers^a	0.22	0.73	0.22	0.43	0.71	0.61
Vicarious experience	0.28	0.58	0.06	0.24	0	0
Mastery experience^b	2.78	1.59	1.83	1.04	4.64	1.34
Verbal persuasion^c	0.44	1.04	0.72	0.96	1.57	1.40

F(2, 47) = 3.36, p = .043. ^bF(2, 47) = 17.48, p = .000. ^cF(2, 47) = 4.16, p = 0.022.

Thus, the quantitative content analysis revealed general patterns of the threads. Then, a conventional content analysis was conducted to provide a finer picture of the posts.

Themes of Posts That Focused on Diet (N = 72)

Controlling Food Intake in Face of Temptation

Resisting food temptation was a big issue for community members, especially during holidays. Parties, family gatherings, dining out, and so on were challenging situations for weight loss. Members of the WW message boards posted about their personal successes and failures of resisting food temptation, determination for getting in control of eating, and obstacles to dieting, such as social gatherings, stress, and busy lifestyles. One participant said that she had to postpone her diet plan because of Shabbos, a traditional Jewish day of rest. Another mentioned that it was hard to control eating when going out to a bar with friends. Participants also shared her/his experience with controlling eating at social gatherings. One member wrote,

When I’m having a house load of people and lots of food, I try to have lots of fruit and veggies available. As long as some of my favorites are on the table, I’m pretty good with it.

Exchanging Experiences and Information on Various Diets

WW’s point system is called “PointsPlus” in the United States and “Pro Points” in the United Kingdom. The point system assigns points to different foods, in order to help people keep track of their food intake. Because of its popularity, it was also a common topic on the message boards. Participants often shared the points contained in the food they ate, and discussed ways and strategies to maintain low points. For example, one participant wrote about a recipe that was of low points:

I season every step with some garlic, onion, sometimes ginger, gf [gluten-free] soy or teriyaki or peanut sauce. Comes out very tasty and you get a big bowl of low point food.

Eating gluten-free diet was considered by some participants as being part of a healthy eating style. They exchanged information on gluten-free food, vendors, and shared their experience of being gluten-free.

People with certain medical conditions were looking for dieting information. They posted questions about dieting with diabetes, irritable bowel syndrome, food allergies, and so on. Often the questions were left unanswered or the recommendations were inadequate. For example, one participant had type 2 diabetes, and asked about low-point food, and ways of getting enough protein. Another person asked about healthy alternatives for nuts because of allergy. Both questions received only one relevant recommendation.

Expressing Opinions of Different Diet Strategies

Participants also discussed their opinions and attitudes toward different diet strategies. One post pointed out that eating salad did not necessarily mean eating fewer calories or eating healthy. Others argued that eating traditional food was healthier than eating processed food, like WW packaged food. One simply needed to eat less; eating WW packaged food was unnecessary. Participants who agreed with this view described WW packaged food having “a weird texture,” “artificial ingredients,” and suggested that WW packaged food were not “real food.” Some others pointed out eating healthy might not mean losing weight. Some believed that organic food was a healthier way to diet:

I don’t like the really low fat or fat free of Weight Watchers either. I buy grass fed meats from the farmer.

Themes of Posts that Focused on Exercise (N = 85)

Sharing One’s Exercising Experiences

The message boards were a place for members to share feelings of happiness, perseverance, successes, and struggles they experienced while exercising. Various activities were mentioned, for example, snow shoveling, aerobics, exercise videos, running, hiking, marathon training, crunches, biking, and so on. The joy and the feeling of accomplishment prevailed in the online discussion. For example, a participant said, “Proud of myself for going to the gym to an interval class after work yesterday, to try to work out some of the stress.” Another said that he/she felt “virtuous” after exercising. People also reported their exercising routines in the community:

I did an old VHS tape today—Firm Tough Tape 2 which alternates weights and 2-3 sections of cardio for 3-5 minutes. I really sweat during this one and today was no exception.

Helping Others to Continue Exercising by Expressing Encouragement, Providing Incentives, and Stressing Accountability

Participants encouraged and praised each other. For example, one member posted: “I was so happy to read about the losers this week and all the exercise going on! Keep it up!” Accountability was stressed when a member missed a day of exercise. Some participants created virtual incentives to encourage one another:

Members who complete [30 minutes of activity] five days each week will be added to HALL OF FAME (which is updated on Sunday).

Themes of Posts That Addressed Mastery Experience (N = 148)

Successfully Controlling Food Intake and Maintaining a Healthy Diet

Resisting food temptation and controlling food intake was a big challenge, and participants liked to share with each other how they successfully resisted food consumption. For example, a participant celebrated: “Had only one portion of my light food-spaghetti and white clam sauce. I usually go back for fifths!” Additionally, participants also felt proud of eating a healthy diet. Some claimed that they were “GF (gluten-free) for 6 years” and felt improvement of health.

Successfully Maintaining an Exercise Routine

Successful experiences of exercising were exchanged often, for example, being able to go to the gym and exercise, finishing 100 crunches a day, walking or riding a certain number miles a day, and so on.

Successfully Losing Weight

Another way to share success was for community members to demonstrate the amount of weight loss he or she has lost. People shared their current weight and recent change of weight. For example, “This week it all paid off and I lost 4 pounds.”

Themes of Posts Irrelevant to Weight Loss (N = 157)

In these irrelevant posts, community members often kept up with events and happenings in other members’ lives, asked about vacations, birthdays, holidays, and so on. Several of the threads related to the community structure and roles among the members. For example, one thread listed the hosts for that week, or those members that started the daily conversation and “check in” (e.g., reporting weight) for other members. The members shared hosting responsibilities, acting as group moderators.

Occasionally, there were posts from “lurkers.” One thread in particular was from a “lurker” who decided to post to the message board:

I lurk here. And post occasionally. . . . I’m impressed at the way you respond to questions and problems here.

Lurking means that a community member may not post to the community or participate in the online discussion therein but simply observes the online community and its members.

The third purpose of this study is to examine the sociability features of the WW online community. Table 4 shows the qualitative review of Neilson’s heuristics and two of Preece’s key dimensions.

Table 4.

Key Sociability Features of WeightWatchers.com Message Boards.

Key sociability features	Evaluation of features
Statement of purpose	The purpose is stated on the page of the online community: “Exchange information; Make conversation.”
Statement identifying site administrator	The site administrator is identified as “the community team” in the netiquette. “The community team” can remove posts but “the community team” does not get involved in the discussion.
Statement of moderation policy	None
Guidelines for netiquette (online etiquette)	“General Community & Community Recipe Swap Ground Rules” (see Appendix II; available online at heb.sagepub.com/supplemental)
Registration policy	Registration policy is included in the user agreement upon registration. The user agreement covers copyright in the context of using copyright material, a person’s creation of copyrighted material by the act of making posts or contributing, and items and content that should not be used or posted on WW message boards.
The extent to which the community exists only virtually	In addition to posting online, the community members had offline meetings and socials, as revealed by the postings.
Type of software environment that supports the community	Message boards: registered users can start a new thread on any message board, and visitors can browse all message boards. Registered users can create a profile, which includes a picture, a user name, demographic information, an icon to indicate mood, a tracker to indicate start weight, current weight, and goal weight, and three icons to signify these three weights.

Discussion

The findings revealed that the presence of theory-based behavior-change constructs in the WW online community was largely weak. One exception was that nearly half of the sampled posts contained mastery experiences. According to Bandura’s (1991) hierarchy, mastery experience is the most powerful source of self-efficacy. The conventional content analysis showed that the participants celebrated three types of mastery experiences: success with exercise, success with dieting, and success with weight loss. In other words, people deem health outcomes as well as health behavior change as personal successes. Another feature of the shared success is that people posted not only great achievements, for example, being gluten-free for 6 years, but also any small steps toward success no matter how trivial, for example, eating less food at a social gathering. These small steps are also a way for other participants to get to know moments in other members’ lives, and thus a method of socializing.

Socializing also turns out to be a major function of irrelevant posts. Nearly half of the sampled posts had nothing to do with weight loss. These posts occurred in all sampled forums, ranging from 17% to 79% of the sampled posts. In those posts, community members kept up with events and happenings in other members’ lives, asking about vacations, birthdays, holidays, and so on. They also discussed and shared hosting responsibilities. By doing so, participants of online communities get to know each other, and build relationships. Thus, posts and threads irrelevant to weight loss are a healthy component of the online discussion. The content of these posts and threads helps build a social network that grows and maintains the community.

Among the threads that were relevant to weight loss, the findings showed that threads with a focus on exercise had stronger presence of several theory-based behavior-change constructs, including perceived barriers, mastery experience, and verbal persuasion. The conventional content analysis largely confirmed the general pattern revealed by the analysis of variance. The conventional content analysis suggests that in addition to sharing personal successes, participants encourage each other to maintain an exercise routine. These findings suggest that encouragement is more often needed in the case of exercise than dieting.

The themes about diet have uncovered unfilled informational needs and debatable topics. Information on diet options for people with certain medical conditions was limited in the WW community. Such knowledge involves professional medical training, and thus is scarcely available in an all-peer online community. As consumers often actively use the digital media to fulfill personal needs (Sundar & Limperos, 2013; Zhang & Zhang, 2012), this unfilled informational need presents an opportunity to educate online community members (and “lurkers”) about information sources of dieting with certain medical conditions and importance of consulting with their healthcare providers about these issues.

In addition, the online discussion also revealed people’s opinion on various diet strategies. They compared “real food,” “organic food,” and commercial diets. They also discussed the meaning of being healthy and losing weight. These debatable topics are an opportunity for health communicators to start engaging conversations and improve members’ health literacy related to weight loss.

The findings on sociability features of the online community revealed a lack of moderation. Professional moderation is often used in online health-related communities that are part of large intervention programs, for example, CHESS, Bosom Buddies, Student Bodies, and so on (Eysenbach, Powell, Englesakis, Rizo, & Stern, 2004). Moderators, as shown in several case studies in political communication, can help keep the messages on topic and create a respectful atmosphere (Wright & Street, 2007). Although the site mentions a “community team,” there was rarely any involvement from WeightWatchers.com administration unless to remove an inappropriate post. There were not professional facilitators or moderators within the community to guide the online discussion in any particular way; instead, the users of the community drove the discussion, including the topics discussed, opinions and experiences shared, products and services recommended, and so forth. The participants also tried to organize and moderate the discussion by themselves.

However, such grass-roots effort of moderation may not be adequate to address the needs of the community. As discussed above, there is an unfilled need for information about dieting with certain medical conditions. Helping consumers find answers to these questions from their health care providers require knowledge and training. Professional moderation can also facilitate a more meaningful and fruitful discussion about various diets and about what it means to be healthy. All these topics are sought and needed by the community, and present an opportunity for health educators to communicate about these issues and engage the public.

Conclusion

Discussion in the all-peer WW community was a mixture of content on diet, exercise, and posts irrelevant to weight loss. Findings from this study suggest that, content irrelevant to weight loss may help members get to know each other, build social relationships, and subsequently maintain and grow the community. Participants also socialize with each other by sharing any small personal successes of dieting, exercising, or losing weight. In terms of exercising, the findings also suggest that exercise requires more encouragement than dieting.

The examination of the design features of the WW online community revealed that the WW online community lacked professional health moderators. As a result, there were unfilled informational needs and doubts and questions about various dieting strategies and health in general. These unfilled needs are opportunities for health educators to engage the public in a conversation about weight loss and what it truly means to be healthy. As studies on strategic communication point out (Neiger et al., 2012), with consumer insights into people’s needs and wants, health education should be easy.

However, the present study is not without limitations. This study applied both qualitative and quantitative methods, but the generalizability of the quantitative content analysis is limited by the sampling period and the sample size. In addition, the present study focuses on one particular online community though it has a high frequency of activities. Future studies can extend the examination to other types of social media sites, like blogs, other weight loss message boards, or message boards about other conditions.

Footnotes

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Supplemental Material

Additional supporting information is available at .

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