What Matters

Decision support for weight loss


Perhaps like many primary care clinicians, I perseverate on diseases most prevalent or problematic. Overweight and obesity are both. So, at the risk of sounding like we’ve dedicated this column exclusively to this condition, let’s focus on new data about an intervention that can help people lose weight and maintain weight loss.

Technology as applied to clinical medicine is a complex phenomenon. For managing massive amounts of patient data accumulating over time, it is essential. But many of us have, and continue to hold onto, expectations that it will increase our clinical "batting average" by improving things like diabetes control, hypertension, and weight.

Sadly, successes in this arena have been few. Human behavior seems to undo all the well-laid plans for improving medical conditions by altering human behavior.

But this is the season of hope.

Bonnie Spring, Ph.D., and her colleagues published results from a randomized clinical trial evaluating the use of mobile technology (via a personal digital assistant, or PDA) to track food intake, weight, and physical activity, and then facilitate intervention based on the data (Arch. Intern. Med. 2012 [doi:10.1001/jamainternmed.2013.1221]).

Sixty-nine adults took part, 85.5% of whom were male, with a mean age of 57.7 years. Inclusion criteria included a body mass index between 25 and 40 kg/m2, weight less than 181.4 kg, and the ability to participate in moderate-intensity physical activity. Patients were randomized to either a control group following the standard of care, or to an intervention group following the standard of care plus mobile technology and telephone coaching.

Participants were given a 5%-10% weight loss goal. The study had two phases: a weight loss phase (months 0-6) and a weight maintenance phase (months 7-12).

All patients received the standard intervention composed of the MOVE! group weight loss program offered at all Veterans Affairs medical centers. In the first 6 months, both arms of the study attended biweekly MOVE! sessions facilitated by dieticians, psychologists, or physicians. Each session lasted approximately 90 minutes, incorporating teachings on nutrition, physical activity, and behavior change.

The intervention group recorded daily food intake and used the PDA as a decision-support tool to assist in personal decisions about energy balance. The resulting data were used to guide a physical activity intervention, and a lifestyle coach provided telephone support every 2 weeks to review data and assist in data management issues. Physical activity recommendations and calorie intake were tailored to achieve weight loss goals. During the weight maintenance phase, data were collected but no behavioral counseling was provided.

The mobile technology group lost 3.9 kg more than the control group (95% CI: 2.2-5.5 kg). The mobile technology group members had significantly greater odds of losing 5% of their body weight.

The study shows that remote lifestyle coaching providing intervention based on data collected through mobile technology can be effective. The appeal of the intervention is the ability to use transmitted data to enhance the intervention without the need for face-to-face interactions. However, the MOVE! intervention used by both groups is itself an intense, resource-intensive intervention with 12 group sessions during a 6-month period.

We obviously need to accept the cold reality of clinical medicine and life: You get out what you put in. The more intense the intervention, the better patients will do. But this study definitely moves us closer to the vision of leveraging existing medical infrastructure and medical technology to remotely treat our patients and improve their lives by supporting them in weight loss.

Dr. Ebbert is professor of medicine and primary care clinician at the Mayo Clinic in Rochester, Minn. The opinions expressed are solely those of the author.

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