Online obesity treatment program effective, researchers find

Key takeaways:

• Participants lost a mean 3.6 kg during the 3-month weight loss phase of the program.
• Two maintenance interventions then resulted in lower weight regain vs. a control intervention.

An online obesity treatment and maintenance program resulted in significant weight loss among primary care patients, according to findings from a randomized study published in JAMA Internal Medicine.

“For over 10 years, we have been refining and testing a fully automated online behavioral obesity treatment program for use in primary care,” Graham Thomas, PhD, a professor of psychiatry and human behavior at Brown University, told Healio. “We felt it was time to move forward with dissemination and implementation of the program in real-world clinical settings.”

According to Thomas and colleagues, most online obesity treatments in primary care “require supplemental clinician coaching, which enhances weight loss outcomes, but adds cost and reduces scalability.”

“Thus, we developed Rx Weight Loss (RxWL), an automated online program that requires no clinician contact and produces weight loss of approximately 5 kg at 3 months,” they wrote.

The trial of RxWL included 540 adults (mean age, 52 years; 71.1% women) with overweight or obesity enrolled between 2018 and 2020 from across 60 practices in a Rhode Island primary care network.

All participants were offered the same 3-month online weight loss program but were then randomly assigned to one of three 9-month maintenance interventions:

• a control intervention involving weekly newsletters;
• a monthly intervention involving video lessons and 1 week of self-monitoring per month; and
• a refresher intervention involving two 4-week periods of lessons, along with self-monitoring at 7 and 10 months.

“The program explains the potential health benefits associated with improving dietary quality, increasing physical activity, and losing weight,” Thomas explained. “It then guides patients in setting appropriate goals and making gradual improvements to weight-related health behaviors. Patients track their progress and receive algorithm-generated feedback with encouragement and support for problem-solving.”

All participants were included in the intention-to-treat analysis, but only those who engaged in the maintenance phase (n = 253) were included in the per-protocol analysis.

The primary end point in the study was weight loss at 12 and 24 months.

Participants had a mean 3-month weight loss of 3.6 kg (95% CI, 4.32 to 2.88) in the intention-to-treat analysis. At 12 months, the amount of weight regained in the monthly (0.37 kg; 95% CI,0.06 to 0.81) and refresher (0.45 kg; 95% CI, 0.27-0.87) maintenance groups was substantially less than that in the control group (1.28 kg; 95% CI, 0.85-1.71).

“This pattern persisted through 24 months,” the researchers noted.

Among participants in the per-protocol analysis, the mean weight loss at 3 months was 6.19 kg (95% CI, 7.25 to 5.13). At 12 months, there was also less weight regain among these participants in the monthly (0.61 kg) and refresher (0.96 kg) interventions vs. the newsletter intervention (1.86 kg).

Thomas and colleagues noted that 14.3% of participants never started the RxWL program when offered it and 38.9% never started the maintenance program.

“Research is needed to understand the reasons for low enrollment in weight loss and maintenance programs so researchers can develop strategies to address these barriers,” they wrote.

There were also some limitations in the study — for example, some participants could not be included because of a lack of weight information in the electronic medical record, and participants were mostly white and non-Hispanic.

Ultimately, the study “is a positive indication that fully automated online programs that capitalize on science-based behavior change strategies can produce health benefit in real-world clinical settings at low cost to patients and providers,” Thomas said. “There is a clear role for providers to connect patients with effective programs and support their use.”