Digital Obesity Treatment in Primary Care May Help Disadvantaged Patients

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Eligible participants with clinically significant obesity and hypertension, diabetes, and hyperlipidemia were included in the study.
Eligible participants with clinically significant obesity and hypertension, diabetes, and hyperlipidemia were included in the study.

Socioeconomically disadvantaged primary care patients with obesity and elevated cardiovascular risk may benefit from digital obesity treatment combined with health system resources, according to a study published in the American Journal of Preventive Medicine.

A team of researchers participating in the New Media Obesity Treatment in Community Health Centers study (ClinicalTrials.gov Identifier: NCT01827800) invited 351 adults (aged 21-65 y; 68% women) with obesity, hypertension, diabetes, and hyperlipidemia to participate in the randomized controlled trial.   Participants were identified from a health system service area in which the majority of patients are impoverished and either uninsured or receiving public insurance.

The primary outcome measured was change in weight over 12 months.

Individuals were randomly assigned to usual primary care (n=175) or to a 12-month digital weight loss intervention (n=176) within a community health center system. The intervention was defined as an “app-based self-monitoring of behavioral change goals with tailored feedback, a smart scare, dietitian-delivered counseling calls, and clinician counseling informed by app-generated recommendations.” This information was transcribed through an electronic health record system.

Of the 351 participants, 337 completed the study; 8 members from the control group and 6 members from the intervention group did not complete the study. In 12 months, the median number of healthcare provider visits was 3 among the participants who completed the study; 81% and 73% of intervention and control-group participants, respectively, reported being counseled about their weight.

Compared with members in the control group, members in the intervention group lost more weight within 6 months (net effect, -4.4 kg) and 12 months (net effect, -3.8 kg). The investigators noted that individuals in the intervention group were more likely to lose ≥5% of weight from baseline to 6 months (43% vs 6%) and 12 months (40% vs 17%) compared with participants in the usual-care group.

In addition, individuals in the intervention group who completed ≥80% of their self-monitoring episodes, counseling calls, or self-weighing days reported significantly more weight loss than those who were less engaged.

“These findings demonstrate that clinically meaningful weight loss can be achieved among patients in medically vulnerable circumstances and with heightened cardiovascular risk — a group in which such outcomes have been rarely demonstrated,” the authors wrote. “With rapidly increasing uptake of digital technologies, these approaches might have beneficial health impacts for patients, including those who have been historically challenging for the health system to reach and treat.”

Reference

 

Bennett GG, Steinberg D, Askew S, et al. Effectiveness of an app and provider counseling for obesity treatment in primary care [published online October 22, 2018]. Am J Prev Med. doi: 10.1016/j.amepre.2018.07.005
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