Preliminary evidence shows potential for a fully automated, online behavioral obesity treatment program to serve as a pragmatic resource in primary care, according to a new study in obesity log.
“Our research shows that primary care physicians can help their patients who want to lose weight by providing them with an automated online behavioral science program that is very inexpensive and doesn’t overload busy caregivers,” said J. Graham Thomas, Ph. D., professor in the division of psychiatry and human behavior at Brown University’s Warren Alpert Medical School and associate director of the Weight Control & Diabetes Research Center at Miriam Hospital, Providence, RI Thomas is the study’s corresponding author.
Experts note that primary care is often where obesity is first addressed, but primary care physicians often have few resources to provide weight loss patients. When weight loss resources are available, they are often expensive and can present other barriers that make them difficult to access, such as the need for frequent clinic visits. Previous studies of behavioral obesity treatment delivered in primary care have typically involved intensive investigator involvement in delivering treatment and/or maintaining participants’ involvement in the study. The current study is one of the first times that a fully automated obesity treatment program has been pragmatically tested in a large primary care network of clinicians responsible for identifying patients, providing the program and supporting its use.
As part of routine primary care, health care providers and 16 nursing care managers offered a free, online, obesity treatment program called Rx Weight Loss (RxWL) to 1,765 patients of the Rhode Island Primary Care Physicians Corp., a primary care practice organization that includes approximately 60 practices with 100 doctors. Eligible patients were 18 to 75 years old with a body mass index (BMI) of ≥ 25 kg/m22 and internet access. The majority of the 464 patients ultimately enrolled in the program and involved in treatment were white and female. Two percent of the sample identified as Hispanic or Latinx ethnicity, and Black/African American. The program included 12 weekly online sessions, a self-monitoring program and automated feedback.
The mean weight loss in 12 weeks was 5.10%. Researchers note that most e-health treatments for obesity report an average weight loss of 2.5% initial body weight after 12 or 24 weeks.
Patients who reported their weight at all 12 weeks achieved an estimated weight loss of 7.2%, compared to 3.4% in those who submitted less frequently. Patients who took all 12 video classes achieved an estimated weight loss of 8% compared to 4.2% for patients who took fewer classes. Neither BMI, gender, nor identification with a racial/ethnic minority group were associated with these measures of engagement, but age was associated with a greater number of lessons viewed.
The study by Thomas and colleagues “proposes a highly innovative model of behavioral weight management that may address several barriers found in primary care,” said Thomas A. Wadden, Ph.D., Center for Weight and Eating Disorders, Department of Psychiatry , Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, and Adam H. Gilden, MD, MSCE, Anschutz Health and Wellness Center and Department of Medicine, University of Colorado School of Medicine, Aurora, commenting on the program. Wadden and Gilden were not involved in the investigation.
The study authors note that further research will help determine whether the disproportionately small number of men and racial/ethnic minorities participating in this program is due to the characteristics of the patients seen in these practices, a bias on the part of the clinicians when referring patients to the program, or lack of interest in weight loss expressed by these patients. Efforts to increase initial engagement with the program will help determine the effectiveness of the program in patients who may be less motivated to lose weight.
Other authors of the study are Emily Panza, Hallie M. Espel-Huynh, Carly M. Goldstein, Kevin O’Leary and Rena R. Wing of the Weight Control & Diabetes Research Center, The Miriam Hospital and the Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI; Noah Benedict, Rhode Island Primary Care Physicians Corp., Cranston, RI; and Albert J. Puerini, Department of Family Medicine, Warren Alpert Medical School at Brown University and Rhode Island Primary Care Physicians Corp.
The study, titled “Pragmatic Implementation of a Fully Automated Online Treatment of Obesity in Primary Care,” will be published in the August 2022 print issue.
More children aged 8-17 trying to lose weight than a decade ago, including healthy weight children
Innovative online automated obesity treatment program shows weight loss results, obesity (2022). onlinelibrary.wiley.com/doi/10.1002/oby.23502
Provided by The Obesity Society
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