People with high blood pressure or type 2 diabetes who are overweight or obese and want to shed some extra pounds may have more success using a combination of an online weight management program and one-on-one support from a health manager, according
to a study publishedin the Journal of the American Medical Association.
The trial compared weight loss after one year in patients who were randomized to one of three study groups: usual care, an online weight management program with meal plans and menus, and the online program plus additional support from a health manager
or coach. To take part in the trial, participants had to be overweight or obese (body mass index between 27 and 40), and have high blood pressure or type 2 diabetes.
In addition, they needed Internet access and a willingness to lose weight.
Participants in the usual care group (326) were mailed general information about weight management. Participants in the group that used only the online program (216) had access to nutritional and behavior change sessions, including meal plans, activity
trackers, and features to report progress. Those in the combined intervention group (298) took part in the online program and received additional support over the phone from non-clinical staff members. These health managers monitored participants’
progress and reached out to help and encourage them to use the online program regularly.
Of the 840 participants who were enrolled in the trial across 15 primary care practices associated with Brigham and Women’s Hospital between 2016 and 2019, 732 had a recorded weight in their electronic health record at 12 months. Participants were
60 years old on average, and 60% were female.
There was a significant difference in weight loss between participants who had access to the combined online program and support from health managers compared with either the usual care or the online program only. The average weight loss at 12 months
was 2.7 pounds in the usual care group, 4.2 pounds in the online program only group, and 6.8 pounds in the combined intervention group. Participants in the combined intervention group were able to reduce their body weight by an average of 3%, a statistically
significant difference from the 1.4% and 1.9% reductions in weight found in the usual care and online-only groups.
At 18 months, the mean weight change was 1.9 kg less in the usual care group, 1.1 kg less in the online program only group, and 2.8 kg less in the combined intervention group. Much of the weight loss in this group was maintained even though the intervention
ended after 12 months.
“Among [these] patients, combining population health management with an online program resulted in a small, but statistically significant greater weight loss at 12 months compared with usual care or the online program only,” the authors wrote.
The team was particularly interested to see whether tapping into existing population health managers—trained staff already working with people who could benefit from weight loss, such as patients with high blood pressure or type 2 diabetes—could
increase the effectiveness of the online program. It’s an important question given the many people who could benefit, especially at institutions already using population health management strategies for high-risk groups.
More than 2 out of 3 U.S. adults are overweight or obese, according to the Centers for Disease Control and Prevention, which can be harmful. Even losing a small amount of body weight— 3-5%—as was seen in this study can carry health benefits.
And while primary care providers are often a main source for information and counseling on how to lose weight, most do not have the time, training, or support to guide patients through a comprehensive weight loss program, according to the authors.
They said more research is needed to determine whether these findings hold true in larger and less educated groups of patients; if participants’ weight loss is sustained over time; and to determine how scalable or feasible it is for practices to
offer this type of combined approach to weight loss.
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