Telephone Intervention Can Help Obese Patients Lose Weight

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ORLANDO—A weight loss program delivered by telephone can be just as effective in obese patients with at least one cardiovascular risk factor as a weight loss program delivered with in-person support, researchers reported at the American Heart Association Scientific Sessions 2011.

The results, also published simultaneously online in the New England Journal of Medicine, showed that patients who enrolled in a weight loss program delivered over the phone by health coaches and with website and physician support lost weight and kept it off just as well as patients who participated in a program involving in-person coaching sessions.

Patients assigned to both active interventions did better than a control group of patients who received only brief advice.

“Perhaps most impressive was the high percentage of patients who lost 5% or more of their initial body weight—about 40% in both the group receiving remote support only and in the group receiving in–person support versus about 20% in the control group,”

principal investigator Lawrence J. Appel, MD, Professor of Medicine at Johns Hopkins University in Baltimore, told Renal & Urology News. “A weight loss of 5% or more has been shown to produce multiple health benefits, including improved control of diabetes and hypertension, a reduced risk of these conditions, and a decrease in cardiovascular risk factors.”

In addition, although the magnitude of weight loss with the active interventions is essentially the same as that in several early efficacy studies, this study differs from most earlier ones in that patients sustained the weight loss until the end of the two-year study.

The study included 415 patients—mostly middle-aged women—with a mean body mass index of 36.6 kg/m2 and a mean weight of 103.8 kg who were randomized to the two active interventions or controls. Study participants were drawn from six local primary care practices.

At 24 months, the mean weight loss was 4.6 kg in the group receiving remote support only, 5.1 kg in the group receiving in-person support, and 0.8 kg in the control group.

Dr. Appel cautioned that a possible study limitation is its short duration of only two years. Nonetheless, the study duration was than that of many weight loss trials. In fact, as far as he is aware, the study is one of the longest to examine a remote intervention. 

Moreover, it is difficult to determine the relative contribution of each component of the intervention, including personalized counseling, reinforcement by primary care practitioners, and Web-based support. 

To date, few weight loss trials have investigated the effect of behavioral interventions in clinical practice, and results have been highly variable, Dr. Appel observed.  Thus, practicing physicians have not had effective, evidence-based tools to draw upon in assisting their obese patients in achieving and sustaining weight loss.

Remote weight loss support has particular appeal, he said, because it offers patients flexibility and may also help primary care doctors better manage obesity and related cardiovascular disease.

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