Thomas reports receiving personal fees from Lumme Health Inc. Please see the study for all other authors’ relevant financial disclosures.
A fully automated weight loss program that was implemented in primary care settings produced encouraging results, but the magnitude of benefits varied based on patient engagement, according to a study published in Obesity.
Primary care is where obesity is typically addressed first, but primary care physicians often lack resources to help patients lose weight, according to a press release from The Obesity Society. The resources that are available are often expensive and difficult to access, requiring more frequent clinic visits and adding strain on health care workers.
However, researchers recently found that the Rx Weight Loss (RxWL) program — an online intervention that can be implemented into the routine primary care workflow with no additional in-person counseling — produced an average weight loss of 5.1% — a finding that the researchers deemed “clinically meaningful.”
“Our study shows that primary care clinicians can help their patients seeking to lose weight by providing them with an automated online program based in behavioral science that is very low-cost and does not overburden busy providers,” J. Graham Thomas, PhD, a professor in the department of psychiatry and human behavior at Brown University, said in the release.
For the clinical trial, 16 nurse care managers offered the RxWL program during routine primary care visits to patients aged 18 to 75 years with a BMI of 25 kg/m2 or greater. The program includes three core components: submission of self-monitored weight, activity data and energy intake; 12 weekly online lessons; and automated, personalized feedback.
Patients who were interested in the program received a referral code for the online platform. The final analysis included 464 participants. Among them, 70% were women and 94% were white.
Thomas and colleagues found that patients who took part in the program lost an estimated mean of 5.1% of their initial body weight — much more effective than other e-health obesity treatments, which usually produce a 2.5% loss, according to the researchers. This finding aligns with previous clinical trials evaluating RxWL, in which the program helped 154 primary care patients achieve mean weight losses of 5.8%.
The results are clinically significant because “weight loss of 3% to 5% is recommended to improve cardiovascular risk factors among individuals with obesity,” Thomas and colleagues wrote. If widely implemented, they added, “the public health impact of such an effective, low-cost, easily scalable program could be considerable.”
“These weight-loss findings are particularly notable because RxWL is a fully automated program that was pragmatically implemented in primary care, and the weight loss observed here was largely the result of patients’ independent efforts,” the researchers wrote.
Notably, the participants who most actively participated in the program had better outcomes. Participants who consistently submitted their data for all 12 weeks — about 37% — lost more weight than those who submitted infrequently; the former lost about 7.2%, while the latter lost 3.4%. In a similar vein, participants who accessed all 12 online lessons saw nearly double the weight loss of those who did not: 8% vs. 4.2%
Because “greater program engagement was associated with greater weight loss,” the researchers wrote that “efforts are needed to understand barriers to engagement.”
Other benefits of the program, they wrote, is that it “demonstrates good patient acceptability and engagement,” and “is more cost-effective than in-person treatment.”
“Furthermore, whereas many available treatments require regular clinician contact and coaching, the full automation of RxWL substantially reduces burden on the medical team and thereby maximizes scalability in routine care settings,” the researchers wrote.
Although the trial only showed outcomes through 12 weeks, Thomas told Healio that the research team is currently preparing a second article to report on the program’s outcomes through 2 years, “so we’ll soon know more about longer term effectiveness.”
“Regarding the feasibility of implementation at other practices, an important goal of this study was to learn about how to implement a program like this in a large practice network,” Thomas said. “While the program is currently still only available to our research partners, we have learned a lot about clinical integration, and we will be pursuing broader implementation in the future.”