People lost a “clinically meaningful” percentage of body weight 12 weeks after starting a fully automated online program developed by researchers at Brown University.
Primary care doctors offered the free obesity treatment program during routine care. Each week, people reported weight changes and activity and calorie consumption; attended online lessons; and received personalized feedback.
The 464 people who took part for at least 1 week lost an average of 5% of their body weight. And those who followed the plan all 12 weeks lost an average of 7%.
The researchers point out this short-term weight loss was achieved without any face-to-face counseling, which can limit weight management in busy primary care settings.
“Obesity is a highly stigmatized condition,” says lead investigator J. Graham Thomas, PhD.
People take part in the Rx Weight Loss program in the privacy of their own homes. He says this not only makes it more convenient but could be an advantage for people who feel uncomfortable managing their weight around others.
Ideally, health care providers could offer the online program as an opportunity to patients “as opposed to something punitive,” says Thomas, a researcher at the Weight Control and Diabetes Research Center at the Miriam Hospital in Providence, RI.
The study was published online July 27 in the journal Obesity.
In three previous controlled clinical trials led by the same research team, the weight loss program was linked to average weight losses of 4.2% to 5.8%. In the current study, the researchers were not directly involved, and Thomas says he was encouraged that the doctor-led initiative led to similar results.
About 11 Pounds Lost
Patients were offered the program during routine care by doctors in the Rhode Island Primary Care Physicians Corporation, which includes 100 doctors at 60 sites. To be eligible, people had to be 18 to 75 years old, have internet access, be fluent in English, and have a body mass index (BMI) of 25 kilograms per square meter (kg/m2) or greater.
The average age of the people in the study was 53, 70% were women, and the average BMI was 36.2.
A BMI of 25 or above means you are overweight, while those with a BMI of 30 or higher are considered obese.
The average 5.1% decrease in body weight at 12 weeks translated to just more than 11 pounds of average weight loss.
The results of the study are “very encouraging,” says Gareth R. Dutton, PhD, who was not affiliated with the study.
Previous strategies had limits, he says.
“Fully automated interventions that have no staff contact with participants often achieve modest weight loss,” says Dutton, a professor of medicine and investigator in the Nutrition Obesity Research Center at the University of Alabama at Birmingham.
Weight loss programs recommended by primary care doctors have often performed even worse, he says.
“Weight loss interventions delivered through primary care are challenging because of many barriers, including limited resources and time,” says Dutton, who is also lead investigator of a study that aims to enroll 400 primary care patients to compare daily self-weighing with standard care.
Letting doctors and their staff refer patients to an evidence-based weight loss program has great potential, he says.
Looking to Improve Uptake
The Rx Weight Loss program was offered to 1,721 primary care patients overall.
When asked why only 26% of people offered the program agreed to participate, Thomas replied, “No matter how good the program is, It’s just never going to be the right time for a lot of people to add this to their lives, particularly given the last couple of years where folks are experiencing a lot of challenges and a lot of stressors.”
“Even though it’s an online program, addressing obesity always involves making substantial changes to eating and activity patterns,” he said.
The investigators plan to look into ways to get more people to take part in the program.
It is not yet available for widespread use by others, but that’s the goal. Thomas said they learned ways during the study to make the fully automated, online program easier for others to adopt.
Measuring any effect on weight loss at 1 year is the primary aim of the study. “I think we expect to find something similar to what we see in previous studies, which is that a certain amount of weight regain will be the norm” at 1 year, Thomas said.
“But a certain amount of weight loss and associated health benefits will persist, making it worthwhile even if, on average, some gradual regain occurs.”
Obesity: “Pragmatic implementation of a fully automated online obesity treatment in primary care.”
J. Graham Thomas, PhD, researcher, Weight Control and Diabetes Research Center, Miriam Hospital, Providence, RI.
Gareth R. Dutton, PhD, professor of medicine and investigator, Nutrition Obesity Research Center, University of Alabama at Birmingham.
Contemporary Clinical Trials: “The daily Self-Weighing for Obesity Management in Primary Care Study: Rationale, design and methodology.”
The study was funded by multiple National Institute of Health grants. Thomas reports receiving personal fees from Lumme Health Inc. and co-author Rena Wing from Noom Inc. outside the current study. Dutton had no relevant financial disclosures.
Damian McNamara is a staff journalist based in Miami. He covers a wide range of medical specialties, including infectious diseases, gastroenterology, and critical care. Follow Damian on Twitter: @MedReporter.