background obesity is an extremely common problem ~ 1/3 of adult americans are obese patients...
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BackgroundObesity is an extremely common problem
~ 1/3 of adult Americans are obese
Patients commonly ask physicians for advice on weight loss, yet evidence is sparse
NHLBI issued a request for grant applications to test weight loss interventions in the setting of routine medical care
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ObjectiveConduct a comparative
effectiveness trial that tested two practical behavioral weight loss interventions in obese medical outpatients with cardiovascular risk factors
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Design
Control
Remote
In-Person
Randomization
= Measured weights and other outcomes
Baseline 6 Mo 12 Mo 24 Mo
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Intervention GroupsRemote In-Person
Mode of counseling Telephone only Group meetingsIndividual meetings
Telephone
Coach Healthways Hopkins
Website/Internet Educational modules Self monitoring tools
Tailored emails
Physician Roles SupportiveReview weight progress reports
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Weight Progress Report
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Intervention Goals and Behaviors
Weight loss goal 5% weight loss
Behaviors Reduce caloric intake Consume healthy dietary pattern, DASH diet Exercise > 180 min/week Self-monitor weight, calorie intake and exercise Log-in study website at least weekly
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ParticipantsObese individuals with hypertension,
hypercholesterolemia, or diabetes
Other major inclusion criteria Patient at one of six primary care practices Internet access at least 4 days per week Ability to use internet and email
Approach to enrollment Minimize barriers and exclusion criteria to
increase generalizability
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Characteristics (n=415)
Age 54 yrsWomen 64%White 56%Black 41%Weight 103 kgBody Mass Index 37 kg/m2
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Characteristics
Hypertension 76%Hypercholesterolemia 68%Diabetes 23%Metabolic Syndrome 33%
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Follow-up
Measured weight88% of participants at 6 months86% of participants at 12 months95% of participants at 24 months
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Mean Weight Change (kg): Remote vs Control
-3.8 kg P<0.001
0 6 12 24-8
-6
-4
-2
0
2
Control Remote
Months after Randomization
We
igh
t ch
an
ge
, kg
-4.6
-0.8-1.4
-6.1
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Mean Weight Change (kg): In-Person vs Control
0 6 12 24-8
-6
-4
-2
0
2
Control In-Person
Months after Randomization
We
igh
t ch
an
ge
, kg
-5.1
-0.8-1.4
-5.8
-4.3 kgP<0.001
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Mean Weight Change (kg): In-Person vs Remote
0 6 12 24-8
-6
-4
-2
0
2
Remote In-Person
Months after Randomization
We
igh
t ch
an
ge
, kg
-5.1
-4.6-0.5 kg P=0.63
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Percent of Participants at Various Weight Thresholds at 24 months
Control Remote In-Person
< Baseline weight 52% 77%** 74%**
> 5% Weight loss (goal) 19% 38%** 41%**
> 10% Weight loss 9% 18%* 20%*
*P <0.05 (vs control), **P <0.001 (vs control)
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Coach Contacts
*Actual = Median
First 6 Months* Next 18 Months
Recommended Actual Recommended Actual
Remote Intervention
Phone 15 14 18 16
In-Person Intervention
Group 12 6.5 18 1
Individual 6 4 6 1
Phone 3 4 12 11
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Web and PCP Contacts
*Actual = Median
First 6 Months* Next 18 Months
Recommended Actual Recommended Actual
Remote Intervention
Web Log-In 26 23 72 35
PCP Visit 1 1
In-Person Intervention
Web Log-In 26 20.5 72 35
PCP Visit 1 1
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Conclusions
Two behavioral interventions achieved and sustained clinically significant weight loss over 24 months in obese medical patients
The Remote and In-Person interventions were similarly effective
In this comparative effectiveness trial,
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ImplicationThe Remote intervention that consists of:
phone counseling interactive website physician support
has the potential for widespread implementation and should be applicable to management of other chronic conditions
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AcknowledgementsParticipantsPhysicians and staff at six medical practices Investigative teamPrimary sponsor
National Heart, Lung and Blood InstituteSupport and advice
Healthways National Center for Research Resources National Institute for Diabetes, Digestive and Kidney Diseases Colleagues from U. Penn and Harvard
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For More InformationPOWER Website: www.powertrials.orgOnline publication: www.nejm.org