Maintaining Activity and Nutrition through Technology-Assisted Innovation in Primary Care

Obesity is often a chronic lifelong condition and most individuals who reduce body weight through lifestyle interventions, such as diet and physical activity, regain weight. Sustained lifestyle support and consistent self-monitoring of behaviors and weight are key strategies for promoting successful maintenance of weight loss. Thus, self-monitoring interventions that leverage the long-term relationships that patients share with their primary care physicians (PCPs) for support in maintaining lifestyle changes could address this problem.

The research team conducted the Maintaining Activity and Nutrition through Technology-Assisted Innovation in Primary Care (MAINTAIN-pc) randomized controlled trial using an electronic health record (EHR)-based intervention to help patients successfully maintain recent intentional weight loss. The intervention provided health coaching to participants via a patient portal and progress reports to PCPs via the EHR. EHR-based delivery of the intervention is notable, as it facilitates real-time clinical updates coordinated with routine care. Participants were recruited through the University of Pittsburgh Medical Center, where PCPs approved patient enrollment into the study.

The specific aim of the project was as follows:

• Determine the efficacy of online coaching and electronic progress reports delivered through the portal to support weight maintenance after initial weight loss of at least 5 percent body weight. 

The trial enrolled 98 coaching intervention patients and 96 control patients. All participants received information on the EHR-based tracking tools, healthy eating, and safe physical activity; they also received weekly reminders to track weight, diet, and physical activity in the portal. Participants randomized to the intervention additionally received 2 years of personalized health coaching through the EHR patient portal, where coaches sent questionnaires and health promotion information, and answered questions. PCPs for the intervention group received real-time progress reports with counseling tips to help support patient weight loss, notification of weight change of greater than 10 pounds from enrollment weight, and annual progress reports at 12 and 24 months, all delivered via the EHR.

Outcomes were measured at baseline and 6, 12, and 24 months. Compared to the control participants, intervention participants regained less weight at each assessment. At 24 months, 65 percent of intervention and 49 percent of control patients had maintained the 5 percent weight loss. There were no differences, however, between groups in waist circumference, pedometer steps, or blood pressure. Findings indicate that EHRs can be adapted for weight maintenance coaching without excessive cost or programming requirements. Future research is needed to assess longer-term effectiveness, generalizability, and cost-effectiveness of the intervention.