Automated Online Weight Loss Program Could Significantly Expand Primary Care Intervention

A fully automated, online behavioral obesity treatment program, integrated into the routine workflow of primary care practice, resulted in mean participant weight loss of 5.1% over a 12-week study period. Further, according to study authors, participants who more fully engaged with the free program lost more weight.

Primary care is the clinical setting where overweight and obesity are most often addressed first and also the setting with the fewest resources to offer patients who want to lose weight, including lack of clinician time to engage in intensive counseling and patient education, inadequate training to provide those services, and issues of reimbursement.

Referrals by primary care clinicians for intensive weight management treatment remain historically low despite an obesity rate in the US of 40%, the authors write in the journal Obesity.

Referrals by primary care clinicians for intensive weight management treatment remain historically low despite an obesity rate in the US of 40%.

The researchers also point out that trials of behavioral obesity treatment delivered in primary care settings typically involve intensive researcher involvement both to deliver treatment and to maintain participant engagement.

The research team from the Department of Psychiatry and Human Behavior at the Warren Alpert Medical School of Brown University developed Rx Weight Loss (RxWL), an automated 12-week online lifestyle intervention that can be offered by clinical teams to a wide range of patients who then engage with the program remotely, requiring no clinician involvement.

Investigators conducted the study at Rhode Island Primary Care Physicians Corporation, a primary care practice organization that includes approximately 60 practices and 100 clinicians. Nurse case managers described the weight loss program to those they believed to be eligible and those interested received a “prescription for weight loss” with a referral code to access the online study platform.

RxWL follows the intervention strategy used in the Diabetes Prevention Program and in the Look AHEAD study and includes 3 core components that target healthy eating, physical activity, and behavioral skills to help promote weight change:

• Weekly online lessons
• Submission of self-monitored body weight, energy intake, and activity data
• Personalized, automated feedback

Patients receive goals for weight loss, daily caloric intake, and for gradually increasing physical activity. Daily they record their progress toward each goal, weigh themselves once weekly, and submit the self-monitored data within the RxWL portal once weekly. Automated, individualized feedback based on the data submitted is provided weekly including encouragement and praise for meeting goals.

FINDINGS

An initial 1765 patients were referred for RxWL participation. Of these, 721 were assessed for eligibility, 654 began treatment, and 464 had at least 1 reported body weight after baseline, and so were included in the final analysis. This final cohort numbered 464, had a mean age of 52.6 (SD, 13.2) years and a mean BMI of 36.2 (SD, 6.9) kg/m²; 70% were women and 94% were White. Data were submitted at week 4 by 331 participants, at week8 by 268 participants, and at week 12 by 210 participants.

At the end of 12 weeks, the research team reports, the estimated marginal mean weight change was -5.1% (standard error [SE] 0.2), corresponding to a change of -5.1 kg (SE, 0.02). Investigators observed no significant effects for age, BMI, sex, or racial/ethnic background on weight loss (P >.18). They report that participants entered a weight into the RxWL portal on an average of 7.8 (SD, 0.3) weeks out of the 12, with more than one-third (37%) reporting weight on all 12 weeks. Approximately 20% of the cohort watched all 12 online video lessons, while others accessed only 1 (n = 53; 12%) or 2 (n = 47; 10%) lessons. The average number of lessons viewed by all participants was 6.5 (SD, 4.1).

The researchers found that engagement with the program proved to be associated with increased weight loss, with an estimated average loss of 7.2% (SE, 0.3%) for those self-reporting weight in the portal for all 12 weeks compared with 3.4% (SE = 0.3%) for those who submitted their weight on fewer than 12 weeks (P <.001). The trend for greater weight loss was similar among participants who accessed all 12 online lessons (8.0%; SE, 0.4%) vs those who engaged with fewer lessons (4.2%; SE, 0.2%) (P <.001).

The researchers found that engagement with the program proved to be associated with increased weight loss, with an estimated average loss of 7.2% for those self-reporting weight in the portal for all 12 weeks compared with 3.4% for those who submitted their weight on fewer than 12 weeks (P<.001).

“Pragmatic implementation of an established, fully automated, online behavioral obesity treatment in a large primary care practice network produced a mean weight loss of 5% of initial body weight at the end of the initial 12-week treatment period,” the authors wrote. “This is consistent with national guidelines for minimum clinically significant weight loss for first-line treatment” and provides important preliminary evidence for the potential of such programs as a resource to help primary care practices address the US epidemic of obesity, they add.

Reference: Thomas JG, Panza E, Espel-Huynh HM, et al. Pragmatic implementation of a fully automated online obesity treatment in primary care. Obesity. 2022;30:1621-1628. doi: 10.1002/oby.23502