Photo Credit: Svitlana Hulko
An online program designed for patients with overweight and obesity resulted in significant weight loss with minimal clinician involvement.
Most online obesity treatments implemented in clinical settings require supplemental clinician involvement. This adds costs and limits the intervention’s scalability, J.G. Thomas, PhD, and coauthors wrote for a study published in JAMA Internal Medicine.
To address these concerns, Dr. Thomas and his team created Rx Weight Loss, an automated obesity program that does not require clinician oversight. Researchers tested Rx Weight Loss’s long-term effectiveness when implemented into a statewide primary care network in Rhode Island.
“Historically, [Rx Weight Loss] has been tested with substantial researcher involvement (e.g., participation incentives and researcher interaction), which may improve patient engagement and outcomes,” Dr. Thomas and colleagues explained. “Conducting a pragmatic trial with minimal researcher involvement is an important next step for assessing the clinical effectiveness of such programs.”
Program Design and Implementation
A nurse care manager at each clinic enrolled patients with overweight and obesity in the program during 2018-2020. Patients were eligible to participate if they were 18-75 years of age, had a BMI of 25 kg/m2 or greater, and had a device connected to the Internet.
The study included 540 predominantly female patients (71.1%) with an average age of 52.8 (SD, 13.4) years.
Participants attended the weight loss program for 3 months. The researchers then randomly assigned participants to one of three groups for various 9-month maintenance interventions. The control group received monthly online newsletters, the monthly group received a monthly video lesson, and the refresher group received an introductory session followed by two 4-week lessons at 7 and 10 months.
“Lessons reinforced initial program goals and focused on successful behavioral maintenance strategies, such as coping with boredom and connecting goals with personal values,” the researchers explained. “Participants were instructed to use an evidence-based self-regulation approach involving strategies tailored to their weight trajectory (ie, no weight regain, small regain, large regain), and to continue increasing MVPA to 200 or more minutes per week. One week of self-monitoring and automated feedback, as occurred in the initial 3-month treatment, accompanied each lesson.”
To determine the efficacy of each maintenance intervention, Dr. Thomas and colleagues evaluated participants’ weight change at 12 months.
Meaningful Weight Loss
The intention-to-treat analysis showed that the average estimated weight loss at 3 months was 3.60 kg (95% CI, -4.32 to -2.88). At 12 months, the monthly and refresher groups regained significantly less weight than the newsletter group, with recorded measurements of 0.37 kg (95% CI, −0.06 to 0.81), 0.45 kg (95% CI, 0.27 to 0.87), and 1.28 kg (95% CI, 0.85 to 1.71) (P=0.004), respectively.
“The difference in weight regain between the monthly and refresher maintenance groups was not statistically significant,” Dr. Thomas and colleagues noted.
Researchers reported that this pattern between the groups persisted at 24 months.
The per-protocol analysis, which involved data from 253 participants, showed that patients lost an average of 6.19 kg (95% CI, -7.25 to -5.13) at the end of the initial 3-month intervention. The monthly and refresher groups had respective weight regains of 0.61 kg and 0.96 kg at the end of 12 months, compared with 1.86 kg in the newsletter group.
“This randomized clinical trial shows that a fully automated weight loss program can be pragmatically implemented and delivered in a large primary care system and can produce meaningful weight losses that are sustained at 2 years,” Dr. Thomas and colleagues concluded.
The study had several limitations. Body weight measurements in the EMR were not standardized and did not occur at predetermined intervals. The researchers also could not determine whether any weight patients lost was due to illness. In addition, the participants were largely White and non-Hispanic; Dr. Thomas and colleagues called for future studies to incorporate more diverse patients.
Nevertheless, they concluded their findings “underscore the importance of providing ongoing maintenance intervention to prevent weight regain and suggest that a maintenance intervention can be offered successfully with different schedules of contact.”
