More weight lost with automated internet program vs usual primary care
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Primary care provider referral to an automated weight-loss program resulted in significantly increased weight loss at 6 and 12 months vs. usual care, according to study findings published in Obesity.
In addition, biweekly emails from providers to internet participants was not associated with more weight loss vs. internet participation alone.
“Although there are several effective online programs for obesity, more research is needed to determine whether automated online programs can be effective when integrated into primary care, and whether outcomes and engagement are enhanced by provider involvement via email,” Deborah F. Tate, PhD, professor in the departments of health behavior and nutrition at the Gillings School of Global Public Health, University of North Carolina at Chapel Hill, and colleagues wrote. “Counseling and involvement by PCPs have been associated with weight loss, and research suggests that patients would like providers to be more engaged in their weight-management efforts.”
This three-arm cluster randomized controlled trial included 550 adults with overweight or obesity (mean age, 51.4 years; 72% women; mean BMI, 35.1 kg/m2) from August 2013 to November 2015 who were enrolled through 31 primary care providers. Each provider was randomly assigned to refer their patients to a 12-month internet weight-loss intervention (n = 181), the intervention plus semiautomated feedback from their provider (n = 182) or usual care (n = 187). Researchers recorded each participant’s weight at baseline and 3, 6 and 12 months.
A total of 25 participants in the internet weight-loss intervention, 38 in the intervention plus feedback and 31 in the usual care arm did not complete the 12-month visit.
The internet weight loss intervention included self-monitoring via diary entries, prompts for daily weight recording, weekly algorithm-tailored feedback based on individual progress, 18 behavioral weight-loss lessons, message boards, topic articles and individual progress charts. The intervention plus feedback arm also included biweekly emails from the PCP based on individual progress and in-person review of progress if there was an office visit scheduled.
At 12 months, researchers observed a weight change of –0.92 kg among participants in the usual care arm, –3.68 kg in the internet weight-loss intervention arm and –3.58 kg in the intervention plus feedback arm. Weight loss was significantly different among participants in both intervention groups compared with the usual care group (P < .001). Weight loss was similar for participants in the intervention groups regardless of provider feedback.
“Interventions that are effective in clinical populations but do not qualify for reimbursement have historically been difficult to disseminate,” the researchers wrote. “Having just experienced a time during COVID-19 when most nonacute health care services required remote delivery, there may be greater opportunity to disseminate automated remote interventions.”
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