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No, these sites are the most popular, meaning more people visit these online dating sites on a monthly basis. The internal email system makes online trans dating simple and low pressure, so you can chat up potential partners from the safety of your own home. AskMen may receive a portion of revenue if you click a link in this article and buy a product or service. Its 77 million users express who they are and their desires without fear of judgment.

Its members come from all across the globe, and its available in most major languages. Archived from on 2010-10-06. These simple sites safe and secure memberships niches that are constantly monitored for fake profiles and can effectively eliminate those unwanted just out to mess with people's lives.

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These aren't necessarily the , although many of them do show up on both lists. No, these sites are the most popular, meaning more people visit these online dating sites on a monthly basis. Although this list can change every few months, the biggest of the bunch usually stay the same. So if you're looking for an online dating site that offers the most active members, in all parts of the world with biggest features and most active forums, these are your best places to start. Continue to 2 of 8 below. The largest of the free dating sites, POF boasts an estimated 23 million unique members using the site every month. While owner Markus Frind has wiped the site of folks only looking for or an , I've found this has only increased the incidence of folks lying about their age or intentions. Still, it's a great site to get your feet wet in the online dating world, just to see what's out there and how the process works. Continue to 3 of 8 below. Zoosk hosts an estimated 11. Having said that, I've found a larger-than-average number of folks looking only for something casual here likely due to the lack of time investment needed to join , and I've yet to hear of any successful relationships come out of the site where readers tell me they've met The One, or something equally special, on the site. I freely admit that I'm biased when it comes to OkCupid, as it's taken my top spot on my list for years now. I still love it, and highly recommend it to all singles and polyamorous couples looking for love, friendship, or even something a bit more casual. With just over 10 million unique monthly users, it's not the largest of the dating sites although it is owned by Match. Continue to 5 of 8 below. With just over seven million unique monthly users, eHarmony is the largest dating site focused exclusively on heterosexual, long-term partnerships that hopefully lead to marriage. Their free hour-long test is fascinating to help you determine compatibility markers, however, there's zero way to tell if the person you're matched with also has an account, and therefore can reply to your questions. Christian Mingle Originally called Engage, Christian Mingle merged with the aforementioned site in 2009 after Spark Networks bought it out. Continue to 7 of 8 below. While I found the site cluttered and confusing to use, they're obviously doing something right with three million unique members visiting every month. People Media The only site specifically geared to the largest demographic group on the planet at this time 50+ , and the second niche site on this list, OurTime has a lot to offer senior singles.

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Premium membership enables activity reports, read receipts, extra beans. Continue to 3 of 8 below. She was north to have the support of her longtime girlfriend, who stayed with her throughout her transition — but not every trans person has a committed partner to give them love and acceptance regardless of gender identity. I am happy to provide the wonderful members of the site a much needed solo. They tied the knot last November. The dating site and app makes flirtatious fun more accessible for transgendered singles across the US.

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The use of personal counseling delivered by telephone allows individualized, personal interaction without the costs of transportation and facilities that accompany in-person programs. The app also delivers tailored and individualized feedback. Intervention for the Personal Coaching group began within 6 weeks of randomization.

When you see the green expert checkmark on a wikiHow article, you know that the article has received careful review by a qualified expert. Get back to it, even if you get off track for a day or two. The ePub format is best viewed in the iBooks reader. The delivery of the intervention occurs primarily through monthly coaching calls.

Lose weight, have fun, gain self-esteem! - Participants in the standard plus mobile group lost 3. Second,,many features included in the CITY app are only available to the Cell Phone Intervention group and not to the Personal Coaching group see for comparison of components available to each group.

We are experimenting with display styles that make it easier to read articles in PMC. The ePub format is best viewed in the iBooks reader. You may notice problems with the display of certain parts of an article in other eReaders. Generating an ePub file may take a long time, please be patient. This article has been corrected. See the correction in volume 39 on page 351. Weight loss intervention for young adults using mobile technology: design and rationale of a randomized controlled trial — Cell phone Intervention for You CITY Bryan C. Svetkey, MD, MHS Background The obesity epidemic has spread to young adults, leading to significant public health implications later in adulthood. Intervention in early adulthood may be an effective public health strategy for reducing the long-term health impact of the epidemic. Few weight loss trials have been conducted in young adults. It is unclear what weight loss strategies are beneficial in this population. Purpose To describe the design and rationale of the NHLBI-sponsored Cell Phone Intervention for You CITY study, which is a single center, randomized three-arm trial that compares the impact on weight loss of 1 a behavioral intervention that is delivered almost entirely via cell phone technology Cell Phone group ; and 2 a behavioral intervention delivered mainly through monthly personal coaching calls enhanced by self-monitoring via cell phone Personal Coaching group , each compared to; 3 a usual care, advice-only control condition. Study personnel assessing outcomes were blinded to group assignment. The primary outcome is weight change at 12 months. We hypothesize that each active intervention will cause more weight loss than the usual care condition. Study completion is anticipated in 2014. These data suggest that weight control i. These results suggest that intervention design or delivery may need to be tailored based on age and stage in life. The number of participants in the studies ranged between 16—67 and the period for intervention delivery ranged from 2 weeks to 52 weeks. Although the weight lost was comparable across interventions, the results may not be generalizable as the trials were small and of short duration and the attrition rates were high. More research is needed in order to design effective weight loss interventions for young adults. It may be speculated that relative to older adults, young adults relate less to future health problems associated with weight gain and may be more accustomed to immediate gratification, which may serve as barriers to weight loss. Other barriers to weight loss, which have been identified in qualitative studies, that are relevant to young adults include financial constraints making it difficult to meet the added costs of healthful behaviors i. It is worthwhile to consider new approaches to weight management in young adults that are designed to fit their lifestyles and circumstances. One such approach is use of mobile phone technology for delivery of a behavioral intervention. Two hundred forty-one adults with a mean age of 52. Although weight loss in the self-directed group was less than in the coach-led group, the resources needed to deliver the intervention were significantly less, making the potential reach and, therefore, impact of the intervention greater. Sixty-nine adults with a mean age of 57. Participants in the standard plus mobile group lost 3. Although the results of both studies above demonstrate that weight loss can be achieved and potentially augmented through use of technology as a mode intervention delivery, each only included middle aged and older adults The Cell Phone Intervention for You CITY study is a comparative effectiveness trial in which we test and compare the effect on weight loss of 1 a novel behavioral weight loss intervention that is delivered almost entirely via a mobile phone application; and 2 a behavioral intervention delivered through personal coaching calls enhanced by self-monitoring via cell phone, each compared to 3 a usual care, advice-only control group. We hypothesize that each behavioral intervention will be superior to control. Although we will compare the two behavioral interventions to each other, we make no a priori hypothesis about which will be superior. The results from the CITY study will provide an opportunity to 1 evaluate the impact of a personal coaching intervention on weight loss in young adults and 2 evaluate the impact of a behavioral weight loss intervention delivered via mobile phone in young adults. The result of this comparison has the potential to address whether human interaction is necessary for young adults to achieve weight loss. Ultimately, the results of the study will have implications for the design and implementation of future weight loss interventions in young adults. The CITY study was approved by the Institutional Review Board at Duke University, as well as an NIH-appointed Data and Safety Monitoring Board. The duration of the trial is 24 months. In this manuscript we report the design and rationale for the CITY trial. Overview The CITY study is conducted as part of the Early Adult Reduction of weight through LifestYle Intervention EARLY trials included in an NHLBI-sponsored cooperative agreement NIH 5U01HL096720. The first 15 months of the project were used to conduct formative work. The focus of the formative work was to gather information that would inform our recruitment and marketing strategy for the trial. Six focus group discussions were conducted. Health, social image, and factors such as emotions, self-esteem, and confidence were reported as reasons to pursue weight loss. Participants highlighted physical activity, dietary intake, social support, medical intervention, and taking control e. Further, participants listed the following reasons for participating in a weight loss intervention: incentives, positive outcomes, education, convenience, and social support. Lastly, ways to recruit young adults into a weight loss trial that were highlighted included incentives, advertisement, emphasizing benefits, and convenience. Following the formative phase, we finalized the protocol and began participant recruitment for the randomized trial. Recruitment Several methods were used for participant recruitment including on-line advertising using the Duke Clinical Trials website, clinicaltrials. Mass mailings proved to be the most successful method of recruitment. Use of social media Facebook did not prove to be a successful recruitment strategy. Study population and enrollment Enrollment began in December of 2010 and ended in February 2012. We enrolled and randomized 365 individuals. Individuals were excluded if they were taking weight loss medications, corticosteroids or had weight loss surgery. Other exclusion criteria were primarily related to safety. For example, individuals taking medication for diabetes were excluded because the extent of safety monitoring required due to the risk of weight-loss-induced hypoglycemia and the potential need for dosage adjustments is not feasible in the context of the current trial. Specific inclusion and exclusion criteria are summarized in. We targeted enrollment of men often under-represented in weight loss trials at 30%, and of African Americans at 30%. We initially targeted similar enrollment of Latinos, but reduced that goal to 6% because a large proportion of Latinos in the area were not proficient in English, which was a study inclusion criteria. Eligibility criteria Potential participants underwent a four question pre-screening assessment by telephone, Interactive Voice Response IVR , Short Message Service SMS , or by online survey. After determining initial eligibility, participants underwent a second screening by telephone to confirm eligibility and collect baseline measurements. Those who met criteria were scheduled for a face-to-face screening visit. The purpose of the face-to-face visit was to 1 obtain written consent, 2 confirm accuracy of self-reported information gathered during pre-screening assessments, 3 measure weight, height and blood pressure to confirm study eligibility, and 4 collect baseline data physical measures and survey data. The study visit lasted approximately 2 hours. Blood samples were obtained by venipuncture after an 8—14 hour overnight fast after the screening visit and up to the morning of the randomization visit. Randomization occurred at a separate face-to-face visit within 10 weeks of the screening visit. The post-randomization treatment period began at the randomization visit for both the Cell phone and usual care control groups. Intervention for the Personal Coaching group began within 6 weeks of randomization. Each treatment period lasts 24 months, with data collection at 6, 12, and 24 months post-randomization. The behavioral framework for both interventions is the same. However, the intervention delivery strategies differ for each group. Participants in both the Personal Coaching and Cell Phone groups receive an Android smartphone and a Bluetooth-enabled scale that transmits weights to the study research server through the cell phone. Because both active interventions require text and data plans on the phone, participants also receive fifty-three dollars in monthly reimbursement for these costs. They are expected to use the CITY phone as their primary cell phone and carry the phone as much as possible. Participants in the Personal Coaching and Cell Phone groups have access to the same self-monitoring tools to track weight, dietary intake and physical activity in the CITY app. However, there are two important differences between the Personal Coaching and the Cell Phone interventions. First, the Personal Coaching group does not receive prompting to use the self monitoring tools whereas the Cell Phone group does throughout the study. Second,,many features included in the CITY app are only available to the Cell Phone Intervention group and not to the Personal Coaching group see for comparison of components available to each group. The information recorded by the participants via the cell phone is available to the interventionists to monitor progress and review during each intervention encounter. An important difference between these interventions is the modality in which these lifestyle guidelines are promoted. Personal coaching intervention Participants randomized to the Personal Coaching intervention group initially attend a series of six weekly group sessions followed by a monthly one-on-one coaching call from an interventionist for the remainder of the 24 month intervention. The Intervention monitoring website embedded within the trial management website allows recording and monitoring of attendance and make-ups to group sessions and individual phone calls. The group sessions consisted of approximately 10 to 15 participants, were led by the study interventionists and lasted two hours each. Participants weighed in at the beginning of each session. The outline for the group sessions and monthly calls included the following framework: progress check; lifestyle behavior discussions; setting a personal goal and action planning around achieving the goal. During the lifestyle behavior discussion segment of the group sessions, specific topics were covered to set the foundation for the participants to initiate behavioral change toward weight loss. These topics included a review of lifestyle guidelines, self-monitoring, appetite awareness, goal setting, conscious eating, portion control, priority-setting, social eating, dealing with negative thoughts, stress management, meal planning, triggers and craving, and social support. Each of the coaching calls lasted approximately 20 minutes. In addition, participants in the Personal Coaching group are encouraged to perform self-monitoring through the apps provided on the study cell phone. The delivery of the intervention occurs primarily through monthly coaching calls. Cell phone intervention The Cell phone intervention is designed to incorporate into a cell phone application app many similar behavioral strategies that are stressed in the Personal Coaching group including self-monitoring, problem solving, relapse prevention, stimulus control, goal-setting, action-planning and progress-monitoring toward goals. The app also delivers tailored and individualized feedback. The goal of the intervention is to provide skill-training and build self-efficacy that will lead to lasting behavioral change. The cell phone app includes tutorials, tips and news, goal-setting activities, a buddy system, food and physical activity trackers, feedback and challenge games, and technical support. Each component of the app is introduced sequentially; some components are set up according to a pre-designated schedule so that participants are prompted to open a particular component at a certain time. MI principles are incorporated whenever possible. Control Group Participants assigned to the usual care control group are given health education materials at the time of randomization, but otherwise receive no active intervention. Like the Cell Phone and Personal Coaching groups they come to the clinic for data collection visits at 6, 12 and 24 months. After the 24-month data collection visit, control participants are offered a delayed intervention consisting of 6 weekly group sessions of behavioral coaching for weight loss. During the delayed intervention, participants will learn and practice proven strategies and skills in diet and physical activity monitoring and problem solving, and receive support from group members and the interventionist. Weight is measured in duplicate to the nearest 0. Height is measured in duplicate without shoes using a wall-mounted stadiometer, and recorded to the nearest 0. Waist circumference is measured in duplicate at the level of the upper iliac crest at the end of a normal exhalation, and the measurement is recorded to the nearest 0. Participants are asked to refrain from eating, exercising or smoking for at least 30 minutes prior to BP measurements. Prior to BP measurement, participants sit for 5 minutes in a quiet room free from activity. BP is measured in the right arm with participants in a seated position with the back supported, feet flat on the floor, and arm supported at heart level. Three measurements are obtained at 30 second intervals, and averaged. After an overnight fast 8—12 hours , blood is obtained by venipuncture. Serum is sent to a commercial clinical lab LabCorp, Research Triangle Park, NC for chemical analysis of glucose, insulin and lipid levels. Serum, plasma and buffy coat samples are banked for future analysis. Two diet recalls are completed by participants at each time dietary intake is assessed. Additional diet-related questions assess 1 consumption of sugar-sweetened beverages; 2 consumption of alcohol; 3 frequency of eating away from home; 4 daily meal patterns; and 5 weight management strategies. Additional physical activity questions measure 1 sedentary behavior; 2 sleep habits; and 3 physical environment. Additional questionnaires measure demographic information, medical history, smoking history and current medications. Last, a technology usage questionnaire measures types and frequency of use of communications and social networking technologies. Analysis plan The primary analysis will be based on intention-to-treat principles. The outcome for the two main study hypotheses Personal Coaching vs. Control and Cell Phone vs. Control is absolute weight change in kilograms at 12 months. The variables in the model will include dichotomous stratification factors overweight vs. Virtually all of the other study outcomes change in blood pressure, insulin resistance, lipids, nutritional intake, and psychosocial factors are continuous and longitudinal; therefore, they will be analyzed using the cLDA modeling approach described above. For analyses focusing on consistency of weight control across subgroups of interest e. The interaction term will be tested to determine if the treatment effect is consistent across the levels of the subgroup variable. To maintain an overall type I error rate of 0. All secondary and additional exploratory analyses will be evaluated at the standard 0. A common standard deviation of weight of 16. Calculations further reflected the assumption that the control group will gain approximately 1. With 120 participants randomized to each of the three intervention arms and a type I error rate alpha of 0. Discussion CITY is part of a consortium of 7 trials addressing weight control in 18 to 35 year olds. To date there are few large, randomized controlled weight loss interventions focused specifically on of young adults. If effective, implementation of the CITY interventions could mitigate the alarming rates of obesity in young adults. These criteria may be best met using mobile technologies. Mobile phones create novel healthcare opportunities because the phones can be used to deliver and gather tailored health-related information and to broadly disseminate interventions in free-living conditions. Although motivation, incentive, and uptake of different strategies may differ by age, the development of weight loss interventions for young adults could logically build on interventions that have been successful in older age groups. However, there is a lack of data regarding the design and delivery of weight loss interventions to young adults via mobile phone technology. The use of personal counseling delivered by telephone allows individualized, personal interaction without the costs of transportation and facilities that accompany in-person programs. However, this model for delivering behavioral intervention still relies on professional interventionists, and is therefore not sufficiently scalable to address the extensive obesity epidemic. The Cell Phone intervention has the potential to be disseminated very broadly among young adults, using technology with tremendous potential for economy of scale. The design of the CP intervention integrates the essential elements of a successful weight loss interventions into a cell phone application. The design also incorporates flexibility in the mode and timing of delivery of information and feedback. Challenges related to recruitment of diverse participants Our original goal was to include 30% African Americans and 10% Latinos in the study. In order to meet these goals we utilized investigator relationships with the community partners. In addition, we consulted geospatial mapping data in order to target mailings to areas that have a diverse population. Enrollment of 10% Latinos proved to be difficult therefore we revised our enrollment goal to include 6% Latinos. We also targeted recruitment in order to achieve enrollment of 30% men. In order to meet this goal we included male participants in public interviews about the study and targeted mailings to areas with a high prevalence of men. Challenges related to the personal coaching intervention In order to maximize attendance at group sessions we incorporated practical information and demonstrations during the sessions and were flexible about timing of the sessions. We recognized that participants might experience a lack of social support after the six in person group sessions were complete. Accordingly, we coordinated and encouraged group activities throughout the intervention and integrated video story sharing via a specific application among participants. Challenges related to the Cell Phone intervention One of the challenges we faced in development of the intervention was how to adapt the intervention over time. Our solution was to incorporate participant feedback in the development process. Another challenge we faced was how to keep participants engaged in the Cell Phone intervention and using the app. The literature regarding how often one needs to use a weight loss app to achieve successful weight loss is lacking. However, we sought to maximize opportunities for engagement of the Cell Phone group with the app. Accordingly, we developed algorithms to send prompts to the Cell phone group based on application use history. Further, we utilized campaigns and competitions amongst special groups to enhance engagement. Lastly, we built in alerts so that when the application is not used an automated message prompts the participant to resume use. Another challenge we encountered was related to frequent changes in cell phone models and software versions. The everchanging landscape of mobile technology has required us to adapt the study phone app to accommodate new phone models and upgrades in operating systems. Challenges related to the Usual Care Group The biggest challenge we anticipate with the usual care group is retention. Accordingly we built into the protocol incentives for data completion in order to maximize retention in this group. Overall, we anticipate the solutions we put in place to address the above challenges will lead to retention of study participants and sustained engagement in the intervention. Conclusions Addressing the obesity epidemic will require a range of strategies and interventions. One of these strategies involves a focus on young adults in order to establish weight control early in adult life and prevent CVD risk factors in later life. In this population, mobile technology may be particularly effective. Implications for more weight loss in the Cell Phone as compared to Personal Coaching group includes the possibility that the app provides individuals flexible and easy access to intervention components and feedback. Implications for more weight loss in the Personal Coaching as compared to Cell Phone group includes the possibility that human interaction and coaching led to more effective goal setting and action planning. The sample size; diversity of the study population with regard to age within the young-adult range , sex, and race; and duration of follow-up 24 months will permit reasonable generalization, with important implications for implementation. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Grambow reported that he currently receives consulting fees from Gilead Sciences for serving on multiple Data and Safety Monitoring Boards DSMBs. Although the relationship is not perceived to represent a conflict with the present work, it has been included in the spirit of full disclosure. Bosworth hCenter for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, 508 Fulton Street, Durham, NC 27705, USA iDepartment of Medicine, Division of General Internal Medicine, Duke University Medical Center, Box 3240, Durham, NC, 27710, USA jDepartment of Psychiatry, Duke University Medical Center, 2301 Erwin Road, Durham, NC 27710 Durham, NC, USA kDuke University School of Nursing, 307 Trent Drive, DUMC 3322, Durham, NC 27710, Durham, NC, USA Bryan C. Batch: ; Crystal Tyson: ; Jacqueline Bagwell: ; Leonor Corsino: ; Stephen Intille: ; Pao-Hwa Lin: ; Tony Lazenka: ; Gary Bennett: ; Hayden B. Bosworth: ; Corrine Voils: ; Steven Grambow: ; Aziza Sutton: ; Rachel Bordogna: ; Matthew Pangborn: ; Jenifer Schwager: ; Kate Pilewski: ; Carla Caccia: ; Jasmine Burroughs: ; Laura P. Kiang Liu, Daviglus Martha L, Loria Catherine M, Colangelo Laura A, Spring Bonnie, Moller Arlen C, Lloyd-Jones Donald M. Healthy Lifestyle through Young Adulthood and Presence of Low Cardiovascular Disease Risk Profile in Middle Age: The Coronary Artery Risk Development in Young Adults CARDIA Study. Live wallpaper tips, links, facts Skill building, visual reminder, Feedback CP A short message is presented periodically on the live wallpaper; the messages are related to tips for healthy living, health news relevant to weight loss, jokes or motivational quotes. Weighing Self- Monitoring, feedback CP with prompting and PC A feature to track weight. Physical activity PA tracking Self- Monitoring, feedback CP with prompting and PC A physical activity tracker encourages participants to track the type and minutes of each activity throughout the day. Buddy system random pairing every 4 weeks. Buddies can send pre-scripted messages or construct their own messages from a pool of keywords. Messages can be encouraging statements or advice and tips for overcoming certain lifestyle challenges. Buddies can also view a basic profile of each other without revealing their identity. Goal setting Goal setting, Action planning CP with prompting and PC A goal-setting feature that allows participants to set own or select from a list of pre-determined goalsand to track if goal is achieved. Countdown Goal setting, Action planning CP A goal-setting feature that allows participants to set a weight goal to achieve before the end of the study and to receive feedback on her or his progress toward that goal. Rewards Positive re- enforcement CP Rewards in the form of cartoons, video links or blog entries are sent to participants when they accomplish a certain level of tracking.

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For example, individuals taking medication for diabetes were excluded because the extent of safety monitoring required due to the file of weight-loss-induced hypoglycemia and the potential need for dosage adjustments is not feasible in the context of the current trial. Don't pretend you didn't have that extra scoop of ice cream after dinner. It may be speculated that relative to older adults, young adults relate less to u health problems associated with weight gain and may be more accustomed to immediate gratification, which may serve as barriers to weight loss. Our media culture, TV shows, and magazines are obsessed with thinness, and we often start dieting behavior when popular media make us feel badly about our own bodies. Being hungry makes it hard to concentrate, makes us irritable and tired, and also makes us more likely to crave high-fat and high-sugary foods and then overeat at the next meal. With the right diet, habits, and exercise, your weight can be controlled. Control and Note Phone vs.