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Two-pronged strategy population health management and online programme reports improved weight loss

Thu, 11/05/2020 - 09:33
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Researchers from Brigham and Women's Hospital who paired an online weight loss programme with a phone- and email-based population health management programme (two-pronged strategy), have found that patients in the combined programme had greater weight loss over 12 months than patients in the other two groups. Findings are published in the JAMA.

The study, ‘Effect of an Online Weight Management Program Integrated With Population Health Management on Weight Change - A Randomized Clinical Trial’, published in JAMA, sought to compare the effectiveness of a combined intervention, including an online weight management programme plus population health management, with the online programme only and with usual care.

"Population health managers are already doing outreach to people who would benefit from weight loss, such as patients with hypertension or type 2 diabetes," said corresponding author, Dr Heather Baer, an associate epidemiologist in the Division of General Internal Medicine and Primary Care at the Brigham. "The idea was to leverage population health management, which is a strategy that's been implemented at the Brigham and in other institutions, to see if it could be integrated with an online weight loss program and be sustainable over time."

The study followed 840 patients in the Brigham's Primary Care Center of Excellence, a network of 15 practices, between 2016 and 2019. Participants, all of whom either had overweight or obesity and hypertension or type 2 diabetes, were divided into three study groups. The "usual care" group (n=326) received general information about weight management in the mail; the "online only" group (n=216) participated in an online weight-loss programme, which included meal plans, activity trackers, and progress reporting features; and the "combined intervention" group (n=298) participated in the online program while receiving additional outreach and support from non-clinical staff members monitoring their progress.

Over the course of 12 months, the usual care, online only, and combined intervention groups lost an average of 2.7lbs, 4.1lbs and 6.9lbs, respectively. The researchers found that the combined intervention produced a small but statistically significant increase in weight loss compared to the other two methods. Moreover, participants in the combined intervention group decreased their body weight by an average of 3 percent, a statistically significant difference from the 1.4 and 1.9 percent decreases found in the usual care and online only groups.

The researchers acknowledge that while the amount of weight loss is fairly low, clinically significant health benefits are associated with a 3-5 percent decrease in weight among individuals with overweight or obesity. Approximately one third of participants in the combined intervention group lost 5 percent or more of their weight, compared to only 14.9 and 20.8 percent of participants in the usual care and online only groups, respectively. Moreover, the weight loss in the combined intervention group was also found to be maintained at 18 months, in spite of the fact that active interventions ceased after 12 months.

"Our findings suggest that the combined intervention facilitates potentially sustainable weight loss in the long term," added Baer. She notes that the generalisability of the team's findings is limited, given that the majority of participants were white, well-educated and English-speaking. Nevertheless, the combined intervention approach may offer an effective form of weight management that is more easily available to some patients who may face barriers in accessing traditional in-person care.

The results are especially notable as health care increasingly shifts to virtual forms amidst the COVID-19 pandemic.

"We knew that online weight loss programmes can be more convenient, accessible, and cheaper for patients, but now both physicians and patients have become more comfortable with the idea of care being delivered virtually," she said. "Virtual care is going to stay with us post-pandemic and this study provides more evidence that even pre-pandemic, virtual care for some conditions is working."