EHR-based coaching helps patients maintain weight loss
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Patients with obesity who received personalized electronic health record-based coaching in addition to using EHR tools to track their physical activity and diet maintained weight loss better that those who used EHR tools alone, according to a study published in the Annals of Internal Medicine.
Molly B. Conroy, MD, MPH, chief of the division of general internal medicine at the University of Utah School of Medicine, told Healio Primary Care that the findings show that “even though maintaining weight loss is challenging, patients can be more successful when they receive supportive coaching.”
In the study, supportive EHR coaching was provided to patients through EHRs that were accessible on a computer. Coaches — health care professionals with backgrounds in nursing, nutrition and exercise physiology who were trained to used EHRs — messaged patients on the EHR portal with personalized feedback and weight management advice based on questionnaire responses and daily weight, diet and activity logs.
Researchers conducted a randomized control trial of obese patients with at least a 5% weight loss in the last 2 years. All patients were assigned to use EHR tools to log their daily weight, diet and exercise on a computer, but half of the patients also received personalized EHR-based coaching. Coaches contacted patients on a set schedule over the 2-year study period.
Of the 194 patients (mean age, 53.4 years), 81% completed the 2-year trial. At baseline, the mean weight was 85.8 kg and the mean baseline BMI was 30.4 kg/m2.
At the end of the study period, mean weight regain was 2.1 ± 0.62 kg in the group that received coaching and 4.9 ± 0.63 kg in the group that did not.
After adjusting their analysis for sex, hypertension, clinic type and maximum percentage of weight lost, researchers found that there was a significant between-group difference in weight change at the end of the study period (–2.86 kg; 95% CI, –4.6 to –1.11).
Of the group that received coaching, 65% of patients maintained a weight loss of at least 5%, compared with 50% of those that used EHR tools alone.
While both groups reported moderate satisfaction with their program at the end of the study period, the coaching group reported greater satisfaction.
Researchers said there were limitations to the study, including the fact that participants had mild to moderate obesity and were socioeconomically advantaged. In addition, many patients who initially qualified for the trial chose not to participate. Conroy explained that this may be due to patients not wanting to take on responsibility of being in a research study or underestimating the need for ongoing support after weigh loss.
“Unfortunately, much of the conversation around weight still tends to focus on the initial weight loss, rather than longer-term maintenance,” Conroy told Healio Primary Care. “Physicians can help patients by celebrating their initial success, and then having concrete conversations about what types of support and tools might be needed for maintenance.”
Conroy explained that primary care physicians should make investments to ensure that EHR tools are accessible in more health care systems and to train staff to be coaches. These are achievable goals, she said.
In an editorial accompanying the study, Adam Gilden Tsai, MD, MSCE, associate professor of internal medicine at the University of Colorado School of Medicine, explained that while Conroy and colleagues’ findings show progress toward integrating obesity treatment into regular care, there are additional issues that need to be addressed.
“First, treatments must be adequately reimbursed, whether they comprise intensive behavioral intervention or pharmacotherapy,” he said. “Second, physicians must improve their knowledge of evidence-based treatment of obesity. Only then will the full benet of behavioral interventions, such as the one tested in this study, be available to the patients who need them most.” – by Erin Michael
Disclosures: Conroy reports grants from the Agency for Healthcare Research and Quality during the conduct of the study. Please see study for all other authors’ relevant financial disclosures. Tsai reports no relevant financial disclosures.