POWER: Telephone coaching as effective for weight loss as in-person counseling

AHA Scientific Sessions 2011

ORLANDO, Fla. — Significant and sustained weight loss among participants in a remote telephone- and Web-based coaching intervention was on par with that experienced by those who also engaged in in-person counseling sessions, according to data from the POWER trial.

“Patients commonly ask physicians for advice on weight loss, yet we don’t have the evidence-based models to deliver it,” Lawrence J. Appel, MD, MPH, professor of medicine and director of the Welch Center for Prevention, Epidemiology and Clinical Research at The Johns Hopkins University, said at a press conference here.

Appel and colleagues conducted a comparative effectiveness trial that evaluated two practical behavior weight-loss interventions in obese patients with hypertension, hypercholesterolemia or diabetes. The results were published online in The New England Journal of Medicine.

Results

Participants at six primary care practices in Baltimore, Md., were randomly assigned to one of three groups: remote care via telephone, a study-specific website and email; in-person coaching in both individual and group settings in addition to remote care; and self-directed care. The researchers set a weight-loss goal of 5% and sought to reduce caloric intake; implement a healthy dietary pattern; promote at least 180 minutes of exercise per week; and encourage logging into the study website at least once a week. Of the 415 participants, 63.6% were women, 41% were black, mean age was 54 years, mean BMI was 37 and mean weight was 103 kg.

At 24 months, researchers obtained body weight measurements for 95% of the study cohort. Results indicated that the control group experienced a mean 0.8-kg reduction in body weight, Appel said, whereas the in-person coaching group and the remote support group demonstrated 5.1-kg and 4.6-kg reductions, respectively. Further, compared with 18.8% of participants in the control group, 38.2% in the remote support group and 41.4% in the in-person support group lost at least 5% of their body weight.

Noteworthy observations

“There were basically no differences [in outcomes] between the in-person and remote groups,” Appel said. “However, a very interesting aspect of our study was the number and patterns of contacts with the coaches.”

During the first 6 months, he reported, participants in the remote intervention made 14 of 15 recommended phone calls to coaches, whereas those in the in-person group only attended 6.5 of 12 recommended group coaching sessions and four of six individual sessions. This trend persisted throughout the next 18 months, Appel said, with participants in the remote support group making 16 of 18 recommended phone calls to coaches compared with only one of 18 recommended group sessions and one of six individual sessions in the in-person program. The number of log-ins to the website was weekly during the first 6 months and roughly bi-weekly during the next 18 months, with no difference between the remote and and in-person programs.

“With physician support, the remote intervention has the potential for widespread implementation and should be applicable to management of other chronic conditions,” Appel said.

These results may have positive clinical implications, Susan Z. Yanovski, MD, of the National Institute of Diabetes and Digestive Kidney Diseases, wrote in an accompanying editorial.

“Given that remotely delivered coaching resulted in weight-loss outcomes similar to those of in-person visits, the use of mobile technologies to deliver behavioral weight-loss treatment in primary care appears to be promising,” Yanovski wrote. “Such interventions may present fewer barriers to adherence than interventions delivered in person, since they allow for greater scheduling flexibility, decreased travel time and lower transportation costs.”

For more information:

• Appel LJ. LBCT.04. Presented at: American Heart Association Scientific Sessions 2011; Nov. 12-16, 2011; Orlando, Fla.
• Appel LJ. N Engl J Med. 2011;doi:10.1056/NEJMoa1108660.
• Yanovski SZ. N Engl J Med. 2011;doi:10.1056/NEJMe1111487.

Disclosure: Drs. Appel and Yanovski report no relevant financial disclosures.

We know that weight loss improves health for obese people, but it is not easy. Although a variety of diets have been tested, finding a ‘magic diet’ is not the answer. Instead, we need to consider developing approaches to retraining behaviors, such as eating and exercise patterns. The POWER study is a very important advance on this behavioral side. First, it showed that remote counseling is effective in producing 5% weight loss and then found that, if anything, remote counseling was a little better than traditional, in-person counseling. Data also showed that doctors’ offices help motivation, so the key is to engage the physician’s office on a regular basis. Secondly, there was no weight gain after 2 years, which is a remarkable achievement and could be considered something of a breakthrough in weight loss. Additionally, the remote intervention presents an economical way to do counseling, and that’s very important for us to think about.

– Frank Sacks, MD
Harvard School of Public Health

Disclosure: Dr. Sacks has received grant support from R3i Foundation, has been an expert witness for Abbott and a consultant or advisory board member for Amgen, Eli Lilly, Merck and Roche.

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