December 5, 2011

Losing weight, keeping it off: Two programs that work

Research finds options for obese patients that lead to sustainable weight loss

Obese patients 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 for two years, according to new Johns Hopkins research. The program was just as effective as a weight-loss program that involved in-person coaching sessions.

A report on the research was published Nov. 15 in the New England Journal of Medicine.

Roughly 40 percent of obese patients enrolled in each of the two weight-loss programs lost at least 5 percent of their body weight, an amount associated with real health benefits such as lower blood pressure, lower cholesterol and better diabetes control, the researchers say.

“Until now, doctors had no proven strategy to help their patients lose weight and keep it off. Now, we have two programs that work,” said study leader Lawrence J. Appel, a professor of medicine and director of the Welch Center for Prevention, Epidemiology and Clinical Research at the Johns Hopkins University School of Medicine with a joint appointment in the Johns Hopkins Bloomberg School of Public Health.

Appel, who recently presented his team’s findings at the American Heart Association’s annual Scientific Sessions in Orlando, Fla., identified several possible reasons why the interventions were effective: frequent counseling (by phone or in person), physician support and an interactive website with tools to track weight and provide regular feedback by email. Patients were encouraged to sign in at least weekly to the program’s website to track their weight and to learn how to reduce it. Patients who didn’t log in for more than a week received automated reminders. If they were out of touch for too long, they got phone calls from their coaches and letters from their doctors.

For the study, the researchers recruited 415 obese people with an average body mass index of 36.6 and an average weight of 229 pounds. The group was diverse but predominantly middle-aged women. They were randomly split into three groups: The control group received information about weight loss but did not receive counseling; another group received counseling over the phone by a coach; and a third group was offered in-person counseling. Those in the control group lost an average of less than two pounds over the course of two years. Those who had telephone sessions or in-person coaching lost a similar amount of weight: an average of 10 pounds over two years.

According to Appel, in-person programs are the standard, and such programs do lead to weight loss. But he was surprised to see that those who had only telephone contact with coaches did just as well as those who had in-person one-on-one and group sessions. Also, he said that as the study progressed, the in-person group opted to trade in the face-to-face sessions for the convenience of using the telephone.

“In most weight-loss studies, there is a lot of emphasis on frequent in-person counseling sessions, but from a logistical perspective, it’s a disaster,” Appel said. “Patients start off strong but then stop attending in-person sessions. That’s why I like the telephone program. It is convenient to individuals and can be done anywhere. You could be living in rural South Dakota, and we could deliver this intervention. It removes some of the major logistical barriers.”

Obesity is an important and growing public health problem in the United States, where one in three adults is obese and thus at increased risk of mortality, especially from cardiovascular disease. Obesity by some estimates costs the United States more than $110 billion a year in health care and lost productivity costs.

As part of the new study, phone calls and in-person sessions were weekly for the first three months. For the next three months, the in-person program offered three monthly contacts (one group and two individual sessions) and then two monthly contacts for the rest of the two-year study. Those who were contacted by telephone were offered monthly calls from the end of the third month on.

Other Johns Hopkins researchers involved in the study are Jeanne M. Clark, Hsin-Chieh “Jessica” Yeh, Nae-Yun Wang, Janelle W. Coughlin, Gail Daumit, Edgar Miller, Arlene Dalcin, Gary Noronha, Thomas Pozefsky, Jeanne Charleston, Jeffrey B. Reynolds, Nowella Durkin, Richard Rubin, Thomas A. Louis and Frederick L. Brancati.

The primary sponsor of the study was the National Heart, Lung and Blood Institute. Healthways Inc. developed the data collection and intervention websites, provided the lifestyle coaches for the intervention arm where services were provided over the phone, and provided unrestricted funds in support of the trial. Under an institutional consulting agreement between The Johns Hopkins University and Healthways Inc., the university is entitled to fees for consulting services. Those faculty members who participate in the consulting services receive a portion of the university fees. The terms of this agreement are managed by The Johns Hopkins University in accordance with its conflict-of-interest policies.


Related websites

Lawrence Appel

Welch Center for Prevention, Epidemiology and Clinical Research

More on the weight-loss trials