Comparative Effectiveness of Weight-Loss Interventions in Clinical Practice

Published in The New England Journal of Medicine

Author(s): Lawrence J. Appel, MD, MPH; Jeanne M. Clark, MD, MPH; Hsin-Chieh Yeh, PhD; Nae-Yuh Wang, PhD; Janelle W. Coughlin, PhD;, Gail Daumit, MD, MHS; Edgar R. Miller, III, MD, PhD; Arlene Dalcin, RD, Gerald J. Jerome, PhD; Steven Geller, MD; Gary Noronha, MD; Thomas Pozefsky, MD; Jeanne Charleston, RN; Jeffrey B. Reynolds, MS; Nowella Durkin; Richard R. Rubin, PhD; Thomas A. Louis, PhD; and Frederick L. Brancati, MD, MHS

We conducted a randomized, controlled trial to examine the effects of two behavioral weight-loss interventions in 415 obese patients with at least one cardiovascular risk factor. Participants were recruited from six primary care practices; 63.6% were women, 41.0% were black, and the mean age was 54.0 years. One intervention provided patients with weight-loss support remotely — through the telephone, a study-specific Web site, and e-mail. The other intervention provided in-person support during group and individual sessions, along with the three remote means of support. There was also a control group in which weight loss was self-directed. Outcomes were compared between each intervention group and the control group and between the two intervention groups. For both interventions, primary care providers reinforced participation at routinely scheduled visits. The trial duration was 24 months.

At baseline, the mean body-mass index (the weight in kilograms divided by the square of the height in meters) for all participants was 36.6, and the mean weight was 103.8 kg. At 24 months, the mean change in weight from baseline was −0.8 kg in the control group, −4.6 kg in the group receiving remote support only (P<0.001 for the comparison with the control group), and −5.1 kg in the group receiving in-person support (P<0.001 for the comparison with the control group). The percentage of participants who lost 5% or more of their initial weight was 18.8% in the control group, 38.2% in the group receiving remote support only, and 41.4% in the group receiving in-person support. The change in weight from baseline did not differ significantly between the two intervention groups.

In two behavioral interventions, one delivered with in-person support and the other delivered remotely, without face-to-face contact between participants and weight-loss coaches, obese patients achieved and sustained clinically significant weight loss over a period of 24 months. (Funded by the National Heart, Lung, and Blood Institute and others; ClinicalTrials.gov number, NCT00783315.)

Key Takeaways

  • The remote support group, which received the Sharecare/Johns Hopkins telephonic and online program, had mean weight loss of 4.6 kg (10.1 lbs.) two years after starting the program.
  • 38.2% of remote-support participants achieved and maintained the goal weight loss of 5%.
  • Remote support performed equally well to the in-person support intervention. Both groups demonstrated significant weight loss relative to the comparison group over the 24-month
    study period.
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