A new Northwestern Medicine remote weight-loss programme, called Opt-IN, provides maximum weight loss for the lowest cost and with much less hassle than the gold-standard National Diabetes Prevention Program (DPP), according to the outcomes from a clinical trial. The DPP is claimed to be the most successful behavioural non-drug treatment currently available. Outcomes from the Opt-IN programme show that participants in a clinical trial lose 11 to 13lbs, which is equivalent to the DPP's success rate. The study findings, ‘A Factorial Experiment to Optimize Remotely Delivered Behavioral Treatment for Obesity: Results of the Opt‐IN Study’, were published in the journal Obesity.
"This matches the gold standard, so it's as good as it gets," said senior study author, Dr Bonnie Spring, director of the Institute for Public Health and Medicine's Center for Behavior and Health at Northwestern University Feinberg School of Medicine. "What's novel is how participants get there."
Compared to the DPP treatment, a year-long programme costing around $1,500 that requires weekly 90-minute in-person meetings with highly trained and paid medical professionals, the Opt-IN programme is cheaper and much less burdensome, fully remote and costs participants between US$324 and US$427, depending on their package.
Spring said while there has been a lot of effort made in the US to try to make the DPP treatment more accessible and affordable, uptake has been minimal. She cited reasons such as users having a hard time getting to the in-person meetings because of childcare or transportation challenges.
"All these traditional treatments have not been scalable because they're not accessible," said Spring, who also is the chief of behavioral medicine in the department of preventive medicine at Feinberg. "And they're expensive and burdensome. The direction we've gone in with Opt-IN is to meet people where they are, and these days - especially during the COVID-19 pandemic - that means in their homes. To tackle the obesity behemoth, we are going to need to make obesity treatment much more accessible and affordable. The Opt-IN study demonstrates how we could do that."
For the Optimization of Remotely Delivered Intensive Lifestyle Treatment for Obesity (Opt‐IN) study, the researcher applied the Multiphase Optimization Strategy to develop an entirely remotely delivered, technology‐supported weight‐loss package to maximize the amount of weight loss attainable for ≤US$500.
In total, 562 Chicago-area adult participants who were overweight or with obese begin a bare-minimum ‘core’ programme to achieve weight loss: goals, online lessons and a custom-designed weight-loss intervention app. Similar to commercial weight-loss apps on the market, this app helps users predetermine how many calories are in a food before they eat it and helps track their caloric intake and exercise throughout the day. Unlike other apps, however, this one sends the user's data directly to their coach, which Spring said helps keep users accountable.
Spring and her team then layered on and tested other treatment components added to the basic core programme. The most cost-effective treatment package included 12 health-coaching calls, progress reports sent to the person's primary care physician and a ‘buddy’ who was trained to help support weight loss.
The study tested more expensive treatment components, like 24 coaching calls instead of 12 and meal replacement products, but they were left out of the final Opt-IN programme, because results showed that they did not increase weight loss.
About 84.3% of participants completed the final assessment. The treatment package yielding maximum weight loss for ≤US$500 included 12 coaching calls, buddy training, and primary care provider progress reports; produced average weight loss of 6.1kg, with 57.1% losing ≥5% and 51.8% losing ≥7%; and cost US$427 per person. The comparable DPP treatment also produces weight loss of 7% of initial body weight in 50% of enrolees, but at a much greater burden and cost.
A cheaper treatment package for US$324 that includes only the core app and online lessons plus 12 coaching calls resulted in an estimated 11.5lbs average weight loss or at least 5% weight loss for more than 50% of participants over six months.
"Not fixing our national obesity problem invites the oncoming tsunami of diabetes, heart disease, some cancers and other chronic diseases for which obesity heightens risk, yet preventive services, including obesity treatment, are woefully lacking from our current health care delivery system," added Spring. "We hope our study helps to convince payers to cover, employers to offer and individuals to engage in preventive care."
To access this paper, please click here