No-Cost, Fully Automated Weight Loss Programs Show Promise in Primary Care Setting

J. Graham Thomas, PhD

A weight loss trial assessing the use of a fully automated, online obesity treatment program in primary care settings has returned promising results.

Results of the 12-week weight loss trial, which assessed the effect of the no-cost, online education program called the Rx Weight Loss (RxWL) program in more than 450 patients, found those who participated in the program achieved a mean reduction in body weight of 5.1% by the end of the trial period, with greater levels of participation associated with increased efficacy.

“Our study shows that primary care clinicians can help their patients seeking to lose weight by providing them with an automated online program based in behavioral science that is very low-cost and does not overburden busy providers,” said study investigator J. Graham Thomas, PhD, professor in the Department of Psychiatry and Human Behavior at the Warren Alpert Medical School of Brown University and associate director of the Weight Control & Diabetes Research Center of The Miriam Hospital, in a statement.

As the obesity pandemic worsens, identification and implementation of low-cost, but effective weight loss interventions in primary care settings, particularly those that focus on patient education, has become a main focal point for many in healthcare. With funding from the National Institute of Diabetes and Digestive and Kidney Diseases, the program and study were designed and conducted by investigators within the Rhode Island Primary Care Physicians Corporation, which is a primary care practice organization that includes approximately 60 practices and 100 clinicians.

Designed based on the interventions from the Diabetes Prevention Program and in the Look AHEAD study, the RxWL program included 3 core components aimed at improving healthy eating, physical activity, and behavioral skills for promoting weight change. These components consisted of weekly online lessons, self-reporting of data, including body weight, energy intake, and activity, and providing personalized, automated feedback. As part of the trial, participants were asked to weigh themselves at least once weekly, with daily measurements preferred, and to submit these weights into the online portal each week. To encourage healthy lifestyle behaviors, the programs assigned goals for weight loss and energy intake as well as options to lower energy intake and support Mediterranean-style eating plans.

Initially, 1765 patients were referred for participation in the program. Of these, 721 were assessed for eligibility, 654 began treatment, and 464 had at least 1 reported body weight within the program. The final analytical cohort of 464 patients had a mean age of 52.6 (SD, 13.2) years, a mean BMI of 36.2 (SD, 6.9) kg/m2, 70% were female, and 94% were White. At weeks 4, 8, and 12 of the program, data was submitted by 331, 268, and 210 participants, respectively.

Upon conclusion of the 12-week program, the estimated mean weight change was -5.1% (SE, 0.2), which corresponded with a change of -5.1 kg (SE, 0.02). No significant effects were observed for age, BMI, sex, or racial/ethnic background on weight loss observed in the study (P >.18). Results indicated the mean number of weeks with an entry during participation in the program was 7.8 (SD, 0.3), with 37% of participants reporting weight on all 12 weeks. Results also indicated the mean number of lessons viewed among participants was 6.5 (SD, 4.1), with 20% of participants accessing all 12 lessons.

Further analysis demonstrated those who reported their weight in all 12 weeks achieved a greater degree of weight loss than their counterparts who reported their weight in fewer than 12 weeks, with estimated mean weight loss of 7.2% (SE, 0.3%) and 3.4% (SE, 0.3%), respectively (P <.0001). A similar trend was observed when assessing access to sessions, with those accessing all 12 sessions achieving a greater degree of weight loss (8.0%; SE, 0.4%) than their counterparts who accessed fewer lessons (4.2%; SE, 0.2%)(P <.0001).

“Pragmatic implementation of an established, fully automated, online behavioral obesity treatment in a large primary care practice network produced a mean weight loss of 5% of initial body weight at the end of the initial 12-week treatment period. This is consistent with national guidelines for minimum clinically significant weight loss for first-line treatment,” wrote investigators.

This study, “Pragmatic implementation of a fully automated online obesity treatment in primary care,” was published in Obesity.