Online weight loss intervention improves asthma control, quality of life
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An online weight loss intervention for people with obesity and asthma significantly improved asthma control and quality of life, according to a study published in The Journal of Allergy and Clinical Immunology: In Practice.
Additionally, this intervention has the potential to meet FDA guidance for product evaluation, which requires 5% weight loss among 35% of its participants, Olivia Johnson, MS, RDN, a research specialist at Larner College of Medicine in Burlington, Vermont, and colleagues reported in the study.
The researchers recruited 43 participants (median age, 48 years; interquartile range [IQR], 41-59; 85% women; median BMI, 40.3 kg/m2; IQR, 34.7-46.8) from specialty clinics at University of Vermont and University of Arizona — which are part of the American Lung Association-Airway Clinical Centers Network — and from community advertising.
Participants had a history of physician diagnosis of asthma and had been on regular prescribed controller therapy for at least 3 months. Their asthma onset typically occurred during adulthood.
During two in-person study visits, participants were assessed for asthma and learned about how to use the MyFitnessPal website, on which they entered data about their diet, weight and exercise. They completed a phone visit 2 weeks after the intervention started, followed by in-person visits to assess weight and asthma, including via spirometry, at 6, 12, 18 and 24 weeks. They also accessed online meetings and lessons and recorded daily asthma symptoms and peak flow on the study’s website.
The program introduced individualized calorie and fat intake goals. A weight loss facilitator who also was a registered dietician led weekly group meetings via real-time chat. The facilitator emphasized diets high in fruits, vegetables and whole grains and low in fat, sugar and alcohol while providing weekly feedback to reinforce or shape new behaviors.
Participants also were encouraged to incrementally work toward completing a weekly minimum of 200 minutes of moderate exercise by week 9 of the program.
Overall, 10 participants (23%; 95% CI, 12-39) achieved at least 5% weight loss by the end of the study, crossing the threshold to overcome futility with a 95% CI that exceeded 35%. Although only 33 participants completed the study, two of those who dropped out met the 5% weight loss threshold before they left the program.
Participants who lost at least 5% of their weight lost a median of 7.4 kg (IQR, –12.5 to –5.3), whereas those who did not lost a median of 0.4 kg (IQR, –2.4 to 1.2). The participants who lost weight also were slightly older than those who did not.
Additionally, the participants who lost at least 5% of their weight had significantly higher rates of attending weekly group chat room meetings, completing the daily food diary, meeting their calorie goals and recoding their daily weight.
All of the participants reduced their calorie intakes, but those who lost at least 5% of their weight saw qualitatively greater reductions in total caloric intake, significant increases from baseline in the percentage of protein in their diets and significant decreases in total fat and carbohydrate intake.
Although there was no difference in lung function between those who did and did not meet the 5% goal, participants who lost at least 5% of their weight experienced clinically and statistically significant improvements in asthma control (P < .05), in addition to significant improvements in asthma quality of life (P = .008) and health-related quality of life (P = .014), with numeric improvements in Asthma Symptom Utility Index scores.
Overall, participants had positive feedback for the intervention, although they were less favorable of the online chat room, which did not have any video capability. Also, many participants indicated they thought they would have benefitted from an activity monitor.
Noting that only a small proportion of participants achieved their exercise goals, the researchers said that including an exercise physiologist in the program and tailoring exercise for people with asthma could be helpful in future studies.
Perspective
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Priya J. Bansal, MD, FAAAAI, FACAAI
I am not surprised by the results. Quality-of-life parameters improved as the 5% weight loss target was achieved for asthma and general quality of life. Because they feel better, people can do more, and then that reinforces their changes.
Patients are more apt these days to use technology to help with counseling and diet for their weight loss. Those who lose weight and increase activity tend to have better quality-of-life markers.
Doctors can use these findings to spread awareness of nontraditional home methods to assist patients in weight loss. They can monitor asthma quality-of-life measures via the Asthma Control Test questionnaire to assess for improvement. This will help the doctor and the patient communicate better and help make further shared decisions about their health care.
Based upon the results, further expansion to the Spanish speaking group is important as well as increasing the number of those in the study. Adding a video arm for all the chats may improve results.
Also, considering expansion to software or apps that include counseling services may increase the positive results because mindset and dietary changes are both important. Adding a placebo group will evaluate for the placebo effect. Finally, adding activity monitoring may increase positive feedback for those in the study.
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