Effect of Telehealth Extended Care for Maintenance of Weight Loss in Rural US Communities

Abstract

IMPORTANCE Lifestyle interventions for obesity produce reductions in body weight that can decrease risk for diabetes and cardiovascular disease but are limited by suboptimal maintenance of lost weight and inadequate dissemination in low-resource communities. OBJECTIVE To evaluate the effectiveness of extended care programs for obesity management delivered remotely in rural communities through the US Cooperative Extension System. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial was conducted from October 21, 2013, to December 21, 2018, in Cooperative Extension Service offices of 14 counties in Florida. A total of 851 individuals were screened for participation; 220 individuals did not meet eligibility criteria, and 103 individuals declined to participate. Of 528 individuals who initiated a 4-month lifestyle intervention, 445 qualified for randomization. Data were analyzed from August 22 to October 21, 2019. INTERVENTIONS Participants were randomly assigned to extended care delivered via individual or group telephone counseling or an education control program delivered via email. All participants received 18 modules with posttreatment recommendations for maintaining lost weight. In the telephone-based interventions, health coaches provided participants with 18 individual or group sessions focused on problem solving for obstacles to the maintenance of weight loss. MAIN OUTCOMES AND MEASURES The primary outcome was change in body weight from the conclusion of initial intervention (month 4) to final follow-up (month 22). An additional outcome was the proportion of participants achieving at least 10% body weight reduction at follow-up. RESULTS Among 445 participants (mean [SD] age, 55.4 [10.2] years; 368 [82.7%] women; 329 [73.9%] white), 149 participants (33.5%) were randomized to individual telephone counseling, 143 participants (32.1%) were randomized to group telephone counseling, and 153 participants (34.4%) were randomized to the email education control. Mean (SD) baseline weight was 99.9 (14.6) kg, and mean (SD) weight loss after the initial intervention was 8.3 (4.9) kg. Mean weight regains at follow-up were 2.3 (95% credible interval [CrI], 1.2-3.4) kg in the individual telephone counseling group, 2.8 (95% CrI, 1.4-4.2) kg for the group telephone counseling group, and 4.1 (95% CrI, 3.1-5.0) kg for the education control group, with a significantly smaller weight regain observed in the individual telephone counseling group vs control group (posterior probability >.99). A larger proportion of participants in the individual telephone counseling group achieved at least 10% weight reductions (31.5% [95% CrI, 24.1%-40.0%]) than in the control group (19.1% [95% CrI, 14.1%-24.9%]) (posterior probability >.99).

Benefits and Challenges of Using Virtual Primary Care During the COVID-19 Pandemic: From Key Lessons to a Framework for Implementation

“…[46]. Remote care has been promised to reduce inequities in access to care for decades, particularly in rural and geographically remote areas [47][48][49]. In line with previous literature, our results demonstrate the ability of remote care to overcome barriers for those who have physical limitations to attend a face-to-face meeting, but also highlight their potential to entrench existing inequities in access to care [50,51].…”

Rapid conversion to virtual obesity care in COVID‐19: Impact on patient care, interdisciplinary collaboration, and training

“…13 Virtual visits are a way to improve access to health care, creating the potential to increase engagement in weight management programs. 14 Digital weight loss interventions and telephone counseling have been shown to be effective at creating and maintaining clinically meaningful weight loss in socioeconomically disadvantaged patients 15 and rural patients 16 in particular, thus extending obesity care to those with limited access to in‐person programs. The COVID‐19 pandemic limited access to in‐person care for all patients.…”

Dietary adherence and program attrition during a severely energy-restricted diet among people with complex class III obesity: A qualitative exploration

“…For example, this may include providing participants with different product samples of brands and product lines to taste before commencement of the diet and asking the participants if there are any transport or logistical barriers to clinic attendance. Additional support can then be provided at low cost by the adoption of telehealth services to reduce barriers related to program accessibility [50] with the partial or complete substitution of in-person appointments to telehealth modes such as telephone calls [51], videoconferencing [52], website use [53], email [54] and mobile phone applications [55]. The combination of in-person and telehealth appointments appears to be a viable and effective form of weight loss service delivery [54][55][56].…”