Online Obesity Program Helped Primary Care Patients Lose Weight

Pragmatic implementation of an automated online behavioral obesity treatment program that included 9 months of active maintenance helped people with overweight or obesity lose a clinically significant amount of weight by 12 and 24 months, a randomized trial showed.

In the intention-to-treat analysis, after a mean estimated weight loss of 3.6 kg (95% CI -4.3 to -2.9), or 7.9 lb, following a 3-month weight loss program among primary care patients, the amount of weight regained at 12 months in the two maintenance groups that involved additional patient engagement was significantly less compared with the control maintenance group (P=0.004):

• Monthly intervention group (nine monthly video lessons and 1 week of self-monitoring per month): 0.37 kg (95% CI -0.06 to 0.81)
• Refresher intervention group (an introductory session and two 4-week periods of lessons and self-monitoring at 7 and 10 months): 0.45 kg (95% CI 0.27-0.87)
• Control maintenance group (monthly online newsletters): 1.28 kg (95% CI 0.85-1.71)

This pattern persisted at 24 months, reported J. Graham Thomas, PhD, of the Weight Control and Diabetes Research Center in Providence, Rhode Island, and colleagues in JAMA Internal Medicine.

“This study shows that a fully automated online obesity treatment program can produce beneficial results for many patients in real-world primary care settings,” Thomas told MedPage Today. “We were encouraged to find that the online weight-loss program performed just as well in real-world primary care practices as it does in our previous highly controlled clinical trials.”

These patients lost weight “at rates comparable” to those seen in studies in which the researchers were completely hands-on in every aspect of the program, he added.

Because the treatment program is online and fully automated, Thomas said it is quite practical for widespread implementation across primary care practices. “The data show that the primary care clinicians were able to implement the program independently, and patients were able to use it successfully.”

Across all maintenance groups, age, sex, and race/ethnicity were not linked with the rate of weight regain, while greater self-monitoring and patient engagement with lessons were associated with significantly less weight regain. For example, patients who viewed at least four lessons had less weight regain at 12 months relative to those who were less engaged — 0.46 kg versus 1.51 kg (1.01 lb vs 3.33 lb; P=0.004).

“Treatment outcomes were highly associated with program engagement,” said Thomas. “Many patients did not engage with the program in a meaningful way and were less likely to lose weight. On the other hand, patients who engaged at a high level tended to achieve very good outcomes.”

Because of this, he pointed out that “there is likely an important role for doctors in encouraging and supporting their use of a program like this to produce the best outcomes.”

For this study, the researchers recruited patients from a Rhode Island primary care network with about 60 practices and 100 physicians. Eligible participants were ages 18 to 75 with overweight or obesity who were referred by their nurse care manager and enrolled from 2018 to 2020.

Thomas and team included 540 patients in the intention-to-treat analysis. Mean age was 52.8, 71.1% were women, 94.3% were white, and mean body mass index was 36.

The Rx Weight Loss program consisted of 12 weekly interactive 15-minute video lessons teaching evidence-based behavior-change strategies for weight loss like goal setting and problem solving. Patients submitted self-monitoring data including daily weight, minutes of moderate to vigorous physical activity, and energy intake, and received weekly automated tailored feedback.

Goals of the program were a weight loss of 0.5 to 1 kg (1.1-2.2 lb) per week, a calorie intake of 1,200 to 1,800 kcal per day tailored to their starting weight, and an activity goal that gradually increased to 150 minutes or more per week.

Weight was monitored from electronic medical records through 24 months.

In a per-protocol analysis of 253 participants who engaged with a maintenance intervention, mean weight loss at the end of the initial 3-month intervention was 6.19 kg (95% CI -7.25 to -5.13), or 13.6 lb. At 12 months, there was less weight regain in the monthly (0.61 kg [1.3 lb]) and refresher (0.96 kg [2.1 lb]) maintenance groups than in the control maintenance group (1.86 kg [4.1 lb]).

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