medwireNews: People who are trying to maintain weight loss with the help of electronic health records (EHR)-based tracking tools do significantly better if they are given access to an online coach, shows a randomized trial.
The 194 people enrolled to the study had lost 5% of their baseline bodyweight during the preceding 2 years. Their average BMI was around 30 kg/m2, with an average past maximum of approximately 34 kg/m2. Around one in five participants had prediabetes or diabetes.
As reported in the Annals of Internal Medicine, all study participants were given access to EHR-based tracking tools for weight, diet, and physical activity. Over the 24 months of follow-up, they received weekly reminders to keep these tracking tools up to date.
Molly Conroy (University of Utah, Salt Lake City, USA) and co-researchers found that use of the tools declined during this period, “perhaps reflecting decreased novelty or because new technologies for tracking are continuously being developed and released.”
By 24 months, 21 of the 96 people randomly assigned to use the EHR tracking tools only had dropped out of the study, and the weight of the remaining 77 had risen by an average of 4.93 kg from a baseline of 81.4 kg.
The other 98 people received 2 years of access to a health coach, to offer them a personalized online service via the EHR patient portal. Eighteen of this group dropped out, and the weight of the remaining 80 participants rose by 2.07 kg from a baseline of 87.9 kg, with the 2.86 kg difference versus the EHR tracking tool-only group being statistically significant.
There were also significant differences in favor of coaching for BMI (1.0 kg/m2) and waist circumference (2.49 cm), but not for physical activity (steps per day), health-related quality of life, or blood pressure. Nor was there any difference in diet score, in an exploratory analysis, but the team notes that the trial was not powered to detect differences in these secondary and exploratory outcomes.
Another exploratory analysis, following up 142 participants for an additional 6 months, suggested that the positive effects of coaching persisted after it ended, with the former coaching group regaining 3.21 kg less weight than the former EHR tools-only group by month 30.
The researchers say that other weight maintenance trials are scarce, but note that their results for online coaching were as good as those previously reported for a trial of a face-to-face intervention.
They report that the coaches spent, on average, less than 8 minutes on each patient per week, prompting editorialist Adam Tsai (University of Colorado School of Medicine, Aurora, USA) to suggest in a linked article that “one appropriately trained health coach armed with well-designed EHR tools could engage a sizable panel of patients.”
He says: “This study is unique in its integration of obesity treatment into the EHR, which allowed the intervention to become part of routine care,” adding that “[i]t is easy to imagine the development of analogous EHR-based tools for other interventions relevant to primary care, such as for smoking cessation, hypertension management, medication adherence, and possibly even pain management.”
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Ann Intern Med 2019; doi:10.7326/M18-3337
Ann Intern Med 2019; doi:10.7326/M19-2988