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Adding extra telephone coaching may help patients with obesity who did not respond well to initial online weight loss programs lose weight and keep it off.
Additional coaching after a suboptimal response to a weight-loss intervention program was cost-effective and effective in helping patients lose weight, according to findings published in JAMA Network Open.
“While intensive behavioral programs can produce clinically significant weight loss and improvements in cardiometabolic risk factors, they are limited in reach due to geographical constraints, availability of programs, cost, and time-related barriers,” Jessica L. Unick, PhD, and colleagues wrote.
“Conversely, fully automated online behavioral weight-loss programs can reduce costs and reach more individuals; however, weight loss produced via these programs is less than traditional behavioral therapy, and large variability is observed. One potential strategy to improve the effectiveness of online weight-loss programs is via an adaptive intervention approach.”
Adapting Existing Interventions
The researchers conducted a randomized clinical trial of 437 adults with overweight or obesity. To be eligible, patients needed daily internet access. The patients were an average of 58 years old (range, 18-70) and had an average BMI of 34.6 kg/mm2 (range, 25-45). More than two-thirds (69.8%) were women.
All patients underwent a 4-month, online automated weight-loss program followed by an 8-month maintenance program that included self-monitoring, personalized feedback, and video lessons. The researchers randomly assigned patients with a suboptimal response, defined as losing less than 4% of their body weight in one month, to receive one of three adaptive interventions: no additional coaching (control group); brief telephone coaching consisting of three calls occurring between weeks 5 and 8 of the study; or more extensive telephone coaching, which consisted of 12 calls between weeks 5 and 16.
At the beginning of the study, the control group included 146 patients, the brief coaching group had 143 patients, and the extensive coaching group had 148 patients.
The study’s primary outcomes were patients’ total weight change and the proportion of patients who lost more than 5% of their baseline weight. Secondary outcomes examined the weight loss cost per kilogram and patients’ engagement with the program.
Additional Coaching Aids Weight Loss
Dr. Unick and colleagues reported that more than three-quarters of patients (79.2%, n=346) had a suboptimal response to the program.
At the 4-month mark, both the brief and extensive coaching groups lost more weight than those in the control group. The brief coaching group lost an average of 6.2% of their starting weight (SD, 4.7%), and the extensive coaching group lost an average of 7% (SD, 5.1%), whereas patients in the control group lost an average of 4.5% (SD, 4.7%, P<0.001 for all).
Furthermore, greater proportions of patients in the intervention groups lost at least 5% of their body weight compared with those of the control group: 65.9% of the extensive coaching group reached this benchmark (n=89), compared with 58.5% (n=77) of the brief coaching group and 36.5% of the control group (n=46, P<0.001).
The same was true at the 1-year mark. Nearly half (48.1%) of the extensive coaching group had lost 5% or more of their body weight by 12 months, compared with 45.9% of the brief coaching group and 32.8% of the control group (P=0.03).
Patients assigned to extensive coaching lost a greater percentage of their baseline weight compared with those in the control group (mean change, −5.5% [SD, 6.7%] vs −3.9% [SD, 7.4%], P=0.03). However, according to the findings, there was no significant difference between the brief coaching and control groups.
Cost and Feasibility
Beyond the initial cost of the study and the control group, brief coaching cost an additional $50.09 per kilogram of weight lost, whereas extensive coaching cost an additional $92.65. They also noted that such an intervention could be scaled up for use in further-reaching programs.
“The findings of this study suggest that providing coaching for individuals with suboptimal response within online obesity treatment improves weight loss and program engagement. This adaptive intervention model is a cost-effective and scalable treatment alternative to traditional obesity management,” Dr. Unick and colleagues concluded.
“Future pragmatic trials are needed to test this treatment approach within a clinical setting, and continued research should examine how to optimize coaching efforts within an automated weight loss program. Emphasis should also be placed on recruitment of more diverse and representative samples of adults with obesity.”
