Obesity Treatment for Socioeconomically Disadvantaged Patients in Primary Care Practice

Abstract

Background Few evidence-based weight loss treatment options exist for medically vulnerable patients in the primary care setting. Methods We conducted a 2-arm, 24-month randomized effectiveness trial in 3 Boston community health centers (from February 1, 2008, through May 2, 2011). Participants were 365 obese patients receiving hypertension treatment (71.2% black, 13.1% Hispanic, 68.5% female, and 32.9% with less than a high school educational level). We randomized participants to usual care or a behavioral intervention that promoted weight loss and hypertension self-management using eHealth components. The intervention included tailored behavior change goals, self-monitoring, and skills training, available via a website or interactive voice response; 18 telephone counseling calls; primary care provider endorsement; 12 optional group support sessions; and links with community resources. Results At 24 months, weight change in the intervention group compared with that in the usual care group was −1.03 kg (95% CI, −2.03 to −0.03 kg). Twenty-four-month change in body mass index (calculated as weight in kilograms divided by height in meters squared) in the intervention group compared with that in the usual care group was −0.38 (95% CI, −0.75 to −0.004). Intervention participants had larger mean weight losses during the 24 months compared with that in the usual care group (area under the receiver operating characteristic curve, −1.07 kg; 95% CI, −1.94 to −0.22). Mean systolic blood pressure was not significantly lower in the intervention arm compared with the usual care arm. Conclusion The intervention produced modest weight losses, improved blood pressure control, and slowed systolic blood pressure increases in this high-risk, socioeconomically disadvantaged patient population.

Current Science on Consumer Use of Mobile Health for Cardiovascular Disease Prevention

“…With few exceptions, 72 most interventions have used a single, predetermined technology and did not give participants the option of choosing between a single or multiple forms of technology simultaneously (which has become commonplace for commercial applications). Most technologies have been created in research settings, although at least 1 published study used a commercially available app.…”

“…Indeed, across a large number of studies, weight loss outcomes have been shown to be dependent largely on the level of participant engagement. 63,72 Unfortunately, declining engagement and attrition (often as high as 40%-50%) are characteristic of digital health interventions. 87 Mobile interventions developed in research settings might benefit from leveraging the iterative design and testing conventions that are commonly used in the commercial market to promote user engagement.…”

Effectiveness of behavioural weight loss interventions delivered in a primary care setting: a systematic review and meta-analysis

“…However, other studies in the review reported similar use of evidence from theory with a lesser effect (20,31–33). This study also had the highest number of participant–interventionist contacts which may have enabled stronger reinforcement of the behavioural components, and increased participant motivation to lose weight.…”

Sustained weight loss one year after group telephone intervention: 3-Year results from the SHINE study

“…The DPP group assessed weight at >3 years, but the intervention continued during those years. Other trials of comparable interventions also intervened until the final assessment [11, 12]. Others who have specifically studied weight loss maintenance performed assessments after continued intervention [13, 14].…”