**Effects of a Web-Based Weight Loss Program on the Healthy Eating Index-NVS in Adults with Overweight or Obesity and the Association with Dietary, Anthropometric and Cardiometabolic Variables: A Randomized Controlled Clinical Trial**

**Jan Kohl 1,\*, Judith Brame 1, Pascal Hauff 1, Ramona Wurst 1, Matthias Sehlbrede 2, Urs Alexander Fichtner 2, Christoph Armbruster 2, Iris Tinsel 2, Phillip Maiwald 2, Erik Farin-Glattacker 2, Reinhard Fuchs 1, Albert Gollhofer <sup>1</sup> and Daniel König 1,3,4**


**Citation:** Kohl, J.; Brame, J.; Hauff, P.; Wurst, R.; Sehlbrede, M.; Fichtner, U.A.; Armbruster, C.; Tinsel, I.; Maiwald, P.; Farin-Glattacker, E.; et al. Effects of a Web-Based Weight Loss Program on the Healthy Eating Index-NVS in Adults with Overweight or Obesity and the Association with Dietary, Anthropometric and Cardiometabolic Variables: A Randomized Controlled Clinical Trial. *Nutrients* **2023**, *15*, 7. https://doi.org/10.3390/ nu15010007

Academic Editor: Giuseppe Della Pepa

Received: 28 November 2022 Revised: 16 December 2022 Accepted: 16 December 2022 Published: 20 December 2022

**Copyright:** © 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).

**Abstract:** This randomized, controlled clinical trial examined the impact of a web-based weight loss intervention on diet quality. Furthermore, it was investigated whether corresponding changes in diet quality were associated with changes in measures of cardiovascular risk profile. Individuals with a body mass index (BMI) of 27.5 to 34.9 kg/m2 and an age of 18 to 65 y were assigned to either an interactive and fully automated web-based weight loss program focusing on dietary energy density (intervention) or a non-interactive web-based weight loss program (control). Examinations were performed at baseline (t0), after the 12-week web-based intervention (t1), and after an additional 6 (t2) and 12 months (t3). Based on a dietary record, the Healthy Eating Index-NVS (HEI-NVS) was calculated and analyzed using a robust linear mixed model. In addition, bootstrapped correlations were performed independently of study group to examine associations between change in HEI-NVS and change in dietary, anthropometric, and cardiometabolic variables. A total of *n* = 153 participants with a mean BMI of 30.71 kg/m2 (SD 2.13) and an average age of 48.92 y (SD 11.17) were included in the study. HEI-NVS improved significantly in the intervention group from baseline (t0) to t2 (*p* = 0.003) and to t3 (*p* = 0.037), whereby the course was significantly different up to t2 (*p* = 0.013) and not significantly different up to t3 (*p* = 0.054) compared to the control group. Independent of study group, there was a significant negative association between change in HEI-NVS and dietary energy density. A higher total score in HEI-NVS did not correlate with improvements in cardiovascular risk profile. The interactive and fully automated web-based weight loss program improved diet quality. Independent of study group, changes in HEI-NVS correlated with changes in energy density, but there was no association between improvements in HEI-NVS and improvements in cardiovascular risk profile.

**Keywords:** dietary quality; weight loss; cardiometabolic risk factors; body composition; dietary energy density; web-based intervention; fully automated; overweight; obesity
