Online Counseling to Enable Lifestyle-Focused Obesity Treatment in Primary Care

The United States Preventive Services Task Force (USPSTF) recommends that clinicians screen all adult patients for obesity and offer intensive counseling and behavioral interventions to those who are obese to promote sustained weight loss. Despite this guideline, fewer than half of physicians provide such counseling due to a lack of training, cost, and time constraints.

This study looked at the use of health information technology to facilitate clinical lifestyle counseling on weight loss, with the goal of integrating lifestyle issues into routine preventive medicine. The team looked at the effectiveness of delivering an online version of the Diabetes Prevention Program (DPP) intensive lifestyle curriculum. The DPP includes counseling on diet, physical activity, and behavior modification. DPP has been shown to be efficacious for promoting weight loss, and has led to improvements in diabetes- and weight-related co-morbidities. Automating the counseling process and delivering it via the Internet may reduce staffing costs and increase patient convenience.

The specific aims of this project were to:

• Use Internet technology to translate an evidence-based lifestyle intervention into diverse primary care settings in order to facilitate the delivery of evidence-based preventive counseling.
• Examine how different strategies of delivering a DPP-based online lifestyle intervention differ in weight loss and cost-effectiveness.

Obese primary care patients were enrolled in one of three randomized controlled trial arms. All participants received a lifestyle intervention consisting of an in-person lifestyle counseling session plus 1 year of access to one of the following: a comprehensive online intervention modelled on DPP with standard coaching (COI-S); a comprehensive online intervention modelled on DPP with modulated coaching (COI-M) in which coaching was provided only when a need was identified or; online lifestyle goals and resources without coaching (OGR). Coaches had access to an electronic tool that helped them identify participants in the COI-M group who were not meeting program goals and thus needed coaching sessions.

Patients in all three arms of the study lost weight at 6 months. Although there was not a statistically significant difference between the groups, point estimates suggested that the COI-S intervention had a greater clinically significant impact. At 12 months, weight loss was sustained in all study arms, with point estimates for weight further declining in the COI-M and OGR arms during the second half of the interventions. At each time point, there was no significant difference in weight loss between groups.

This research showed that online lifestyle support can be a more efficacious obesity intervention than a typical primary care visit.