Less Weight Regain in 'Unique' Study: Online Coaching Plus EHR

Becky McCall

November 13, 2019

Online coaching combined with the use of electronic health record (EHR)-based tracking tools resulted in less weight regain compared with use of EHR tools alone in adults, who had recently lost a significant amount of body weight, according to new results from a randomized controlled trial that explored how to optimize maintenance of intentional weight loss.

In fact, participants in the combination "coaching group" regained only half as much weight, at 2.1 kg (4.6 lbs), compared with those in the tracking tools only group who regained 4.9 kg over the 24 months of the study (P = .001 for the difference).

And at study end, 65% of participants in the coaching group and 50% in the tracking tools group maintained weight loss of at least 5%. Changes in body mass index (BMI) and waist circumference were also more favorable in the coaching group.

The researchers stress that most people who lose weight through lifestyle interventions will eventually regain it.

The study was published online November 12 in Annals of Internal Medicine.

"We are very encouraged by the fact that patients who received coaching were able to do a better job with weight maintenance than those who did not," lead author Molly Conroy, MD, told Medscape Medical News.

"Given that many people have ongoing issues with weight over their lifetime, it is important for us to develop treatment and support programs that can be used for weight maintenance, not just for weight loss," added Conroy, from the University of Utah, Salt Lake City.

She also emphasized that addressing weight as an ongoing health issue requires sustained treatment and support, rather than a one-time "cure" or diet.

"It is more consistent with the model we use to treat other chronic conditions such as diabetes and hypertension," she outlined.

In an accompanying editorial, Adam Gilden Tsai, MD, says the study is unique and "represents an important step forward in the integration of obesity treatment into routine medical care," including use of EHR.

"Participants were able to send secure messages to their weight loss coach, similar to how many health systems enable patients to message their physicians through online portals," noted Tsai, from Kaiser Permanente and the University of Colorado School of Medicine, Aurora.

Combining Approaches to Maximize Outcomes

Conroy and colleagues aimed to explore whether using personalized online coaching with primary care physician support, in addition to EHR tracking tools, would be more beneficial than tracking tools alone for weight loss maintenance.

All participants had previously experienced intentional weight loss of at least 5% in the 2 years prior to study start and had not undergone bariatric surgery in the previous 5 years. Mean age was 53.4 years, 74% were women, and 88% were white. The mean baseline weight of participants was 85.8 kg, and average BMI was 30.4 kg/m2.

A total of 194 adults were randomized 1:1 to the coaching group or tracking tools alone group. The EHR tools included weight, diet, and physical activity tracking flow sheets; surveys; and reminders. The coaching group also received 24 months of online personalized coaching, with 24 scheduled contacts.

All participants received a 1-hour orientation on the EHR-based tracking tools and advice on healthy eating and physical activity, as well as weekly reminders to enter information into the tracking tools.

The primary outcome was weight change at 24 months, and secondary outcomes included number of participants maintaining 5% weight loss as well as changes in BMI and waist circumference. 

At 24 months, 65% of 79 participants in the coaching group (n = 51) and 50% of 73 participants in the tracking group (n = 37) had maintained weight loss of at least 5%. However, there were no differences between groups in terms of changes in number of steps, health-related quality of life, physical function, or systolic or diastolic blood pressure.

BMI increased by 0.8 kg/m2 in the coaching group and by 1.8 kg/m2 in the tracking group (P = .002). Waist circumference was up 1.34 cm and 3.83 cm in the two groups, respectively. 

"The incremental addition of coaching and real-time progress reports to EHR-based tracking tools was more effective than EHR-based tracking tools alone in achieving desired weight outcomes at 24 months," the researchers note.

Routine Care Easily Adapted to This Approach for Moderate Obesity  

The improved weight loss maintenance in the coaching group is likely because of the personalized advice, Conroy notes.

In terms of demands on time, the coaching intervention averaged fewer than 8 minutes per patient per week over the course of the protocol.

Referring to this aspect of the study, editorialist Tsai writes: "It seems possible that one appropriately trained health coach armed with well-designed EHR tools could engage a sizable panel of patients."

Highlighting the uniqueness of the study, Conroy and colleagues observe: "[There] are relatively few weight maintenance trials with which to compare our results. Although our findings are similar to those of other trials overall, none of the previous trials involved use of the EHR to communicate with participants or primary care providers."

They also emphasize that their trial utilizes a platform already used in routine care.

"Our trial's EHR-based delivery is notable because it facilitates real-time clinical updates coordinated with routine care...The EHR that was leveraged is commonly used in primary care and could be adapted for weight maintenance counseling," the authors note.

Tsai points out that "the results suggest that the intervention is generally limited to socioeconomically advantaged participants and those with mild to moderate obesity (maximum BMI was approximately 35 kg/m2)."

"A technology-based coaching intervention of moderate intensity (just over one contact per month) worked well in this context, but socioeconomically disadvantaged persons and those with more severe obesity might respond differently," he stressed.

He adds that, despite the relatively low participation, 60% of those who qualified for the study declined to participate, suggesting not all patients want formal assistance with behavior change.  

Ann Intern Med. Published online November 12, 2019. Abstract, Editorial

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