Study Shows Incorporating Online Programs Facilitates Greater Weight Loss

Heater Baer, ScD

Results from a study of primary care patients from a network of Brigham and Women’s primary care practices are shedding light on the potential benefits of combining population health management and online programs in weight management programs.

A cluster-randomized, 3-group trial, results suggest combing population health management with an online program contributed to statistically significant weight loss differences among a population of more than 800 patients from 15 primary care practices.

"Population health managers are already doing outreach to people who would benefit from weight loss, such as patients with hypertension or type 2 diabetes," said corresponding author Heather Baer, ScD, an associate epidemiologist in the Division of General Internal Medicine and Primary Care at the Brigham, in a statement. "The idea was to leverage population health management, which is a strategy that's been implemented at the Brigham and in other institutions, to see if it could be integrated with an online weight loss program and be sustainable over time."

With the prevalence and societal burden of obesity continuing to grow, a greater emphasis has been placed on identifying effective interventions for weight loss. With this in mind, investigators designed the current trial to evaluate the effect of pairing an online program with a phone- and email-based population health management program.

Using patients in the Brigham and Women’s Primary Care Center of Excellence, which includes 15 practices, investigators enrolled a cohort of 840 patients between July 19, 2016-August 10, 2017. Patients were considered eligible for the trial if they were between the ages of 20-70 years, had a BMI between 27-39, and had a diagnosis of hypertension or type 2 diabetes. The mean age of the 840 participants was 59.3 (SD, 8.6) years, 60% were female, and 76.8% were white. Of these, 732 had a recorded weight at 12 months.

Of the 840 included in the trial, 326 were randomized to usual care, 216 were randomized to the online program only, and 298 were randomized to the combined intervention group. Those randomized to usual care received a 1-time mailing with information related to weight management that included recommendations on diet and physical activity. The online program included 33 nutritional and behavioral change sessions in written and video format released weekly for 16 weeks and then every other week.

For the primary outcome, investigators chose weight change at 12 months (±90 days) after enrollment. Secondary outcomes for the trial included weight change at 18 months after enrollment.

Upon analysis, results indicated significant differences in weight change at 12 months with a mean weight change of -1.2 kg (95% CI, -2.1 to -0.3 kg) in the usual care group, -1.9 kg (95% CI, -2.6 to -1.1 kg) in the online program only group, and -3.1 kg (95% CI, -3.7 to -2.5 kg) in the combined treatment group (P <.001). Results also indicated a between-group difference in mean weight change of -1.9 kg (97.5% CI, -2.9 to -0.9 kg) in the combined group versus the usual care group and -1.2 kg (95% CI, -2.2 to -0.3 kg; P=.01).

In 18 month analyses, the mean weight change was -1.9 kg (95% CI, -2.8 to -1.0 kg) in the usual care group, -1.1 kg (95% CI, -2.0 to -0.3 kg) in the online only group, and -2.8 kg (95% CI, -3.5 to -2.0 kg) in the combined intervention group (P <.001).

“We knew that online weight loss programs can be more convenient, accessible, and cheaper for patients, but now both physicians and patients have become more comfortable with the idea of care being delivered virtually," Baer added. "Virtual care is going to stay with us post-pandemic, and this study provides more evidence that even pre-pandemic, virtual care for some conditions is working."

This study, “Effect of an Online Weight Management Program Integrated With Population Health Management on Weight Change,” was published in JAMA.