Group Behavioral Telehealth Program May Lead to Weight Loss

Group behavioral telehealth weight loss programs may help people with MS and obesity lose weight, results of a study suggest.

“Two thirds of the group lost clinically meaningful weight—5% or more—over 6 months. Evidence from this pilot study provides a promising approach for promoting healthy lifestyle behavior changes and weight loss in people with MS,” says lead study author Julia S. Cozart, MA, of the University of Missouri-Kansas City. “The present research provides evidence that this behavioral weightloss program can successfully help people with MS lose weight.”

In what the authors write in Preventive Medicine Reports “is the first behavioral weight loss intervention delivered to people with MS and obesity,” Cozart and colleagues enrolled seven women and one man with relapsing-remitting MS causing mild disability (mean Patient Determined Disease Steps [PDDS)]=1.1) in a 24- week weight loss program. All participants were patients at one academic MS specialty clinic.

Study participants ranged from 40 to 70 years of age with BMI between 29 and 50. The patients had MS for a mean of 16.7 years, and all were White. None had or planned bariatric surgery, had food allergy, needed a special diet, were on concurrent pharmacologic or behavioral weight-loss interventions, or had an eating disorder.

Tech Helped Participants Lose Weight

With the goal of losing 1 to 2 pounds of weight per week, participants received a 1-year subscription to the Lose It! phone application, a FitBit activity tracker, a FitBit Aria Smart Scale, and a study binder with MS-specific educational materials for each weekly group session.

The sessions involved self-monitoring, motivation and goal setting, mindset and stress management, exercise and physical activity, nutrition and diet, understanding food labels and health claims, personal meal planning, and the need for social support. Participants ate between 1,200 and 1,800 calories a day, and the study team encouraged participants to eat five servings of fruits and vegetables daily.

Participants purchased their own food and logged daily food and beverage consumption in the LoseIt! application. Between weeks 1 and 10, researchers encouraged increasing moderately intense physical activity, such as walking, from 45 to 150 minutes per week. Participants logged their daily steps and physical activity on their FitBit application and logged weight at least weekly on the FitBit Aria Smart Scale.

Over 6 months, study leaders invited participants to two individual Zoom calls and weekly one-hour weekly Zoom calls with the program leaders, who also messaged participants weekly in the in the Lose It! platform.

At baseline and 6 months, anthropometric measurements were recorded, and participants completed self-reported questionnaires about the kinds of food they ate.

All participants attended both individual calls and completed the program. They attended a median of 20.50 of the 24 sessions. At 6 months, the median percent weight loss was 10.54%, and six participants achieved clinically meaningful weight loss (≥5%). Those who adhered more closely to the self-monitoring guidelines (r=0.81; P=0.02), and those who averaged more minutes of activity per week (r=0.91; P=0.002) had higher percentages of weight loss.

The number of group meetings attended was not significantly linked with weight loss, and the overall consumption of fruits and vegetables did not significantly change.

Participants also reported that the program provided accountability and social support and that it improved their sense of physical wellbeing and self-esteem.

Further Research Is Needed and Underway

The authors acknowledge that the study is limited by its small sample size and short duration, and by not being a randomized controlled trial. They recommend larger, longer studies that include more diverse cohorts and a maintenance phase to investigate whether weight loss is maintained over time.

“This very small pilot study funded by the National Multiple Sclerosis Society marks the first step in understanding how weight loss impacts people with MS, and it lays the groundwork for future experimental studies and larger randomized controlled trials, including in people with more advanced disability,” Cozart says. To that end, she and her colleagues have completed a randomized controlled trial of this program in a larger population, and they look forward to disseminating their results.

“Adhering to a healthy lifestyle and maintaining a healthy weight is beneficial for all people, but specifically in individuals with MS, it may generate improved health outcomes and a sense of control over their well-being,” she notes.