Help Calls: Two Weight-Loss Trials Support a Role for the Humble Telephone

Shelley Wood

June 22, 2013

CHICAGO, IL — Conference calls may be the bane of white-collar workers, but a new randomized controlled trial has shown that group telephone calls may be better than a one-to-one approach for weight loss [1]. The Support, Health Information, Nutrition, and Exercise (SHINE) randomized trial results were presented here on the opening day of the American Diabetes Association 2013 Scientific Sessions .

The idea, explained Dr Paula M Trief (University Hospital, Syracuse, NY), was to see whether something as "low-tech" as a telephone-based education session could be used to translate the "gold-standard" advice from the Diabetes Prevention Program (DPP) for diet and lifestyle changes to a wider, more diverse group of patients, and if so, to determine what worked better, a person-to-person phone call or a conference call with a group of overweight subjects, hosted by primary-care staff and DPP coaches.

The study included subjects from five primary-care sites in upstate New York, including several rural areas.

"We hypothesized that telephone transmission of the DPP delivered by primary-care staff would be effective and cost-effective," Trief said. "We also thought that we'd challenge the assumption that group interventions enhance weight loss more than individual support."

Going It Alone, or With a Group

In the study, 257 adults with metabolic syndrome but no diabetes were randomized to either solo sessions or group sessions instructing them in DPP lifestyle changes. For both study groups, primary-care staff delivered a series of DPP "lessons" with input from dietician coaches over the course of a year.

Mean weight at the study onset was 107 kg, and mean body-mass index (BMI) was 39.3 kg/m2. Waist circumference was 118.4 cm.

At both one and two years, weight loss was greater in the conference-call subjects than in the solo-session subjects. Importantly, while the solo-session subjects regained approximately half of the weight loss of year 1, the group-session patients actually shed some additional pounds in year 2.

Weight Loss at One and Two Years, by Group

End point Solo patients Group p
1 y 4.6 kg 5.5 kg N/A
2 y 2.6 kg 6.4 kg N/A
Mean weight loss at 2 y 3% 6.6% 0.01
Subjects who loss more than 10% of baseline weight 12.7% 26.1% 0.05

"Thus, while solo participants had overall improvement but regained some weight, group participants had further weight loss," Trief concluded.

"Telephones are low-tech but, we think, a highly effective way to expand and increase the reach of the DPP," she said.

Just why the group sessions were more effective than the solo sessions is unclear, Trief said, although having listened to hours of recorded tapes of the sessions, she said she had some insights.

One possibility is that some subjects got better, more useful advice from their peers than they did from the coaches and clinicians, including tips on food or exercise. "They also may have been more likely to accept the advice of their peers," she said. Finally, group subjects may have also felt more accountable to the group, which was facing the same challenges as they were, than to a healthcare worked they'd never met face-to-face.

Trief et al are continuing to analyze other differences between groups, including blood pressure, cholesterol, and other cardiovascular risk factors. They are also conducting an extension analysis out to three years, looking at weight-loss sustainability. In year 3, participants have the option to call the coaches and primary-care facilitators for advice, but there are no organized calls.

The Telephone and the Machine

In another study also presented at the ADA meeting yesterday, German investigators conducted a randomized, controlled trial looking at whether regular phone calls on top of a "telemedicine" (TM) weight-loss strategy could improve weight loss in a 12-week period [2]. The study randomized 180 subjects to one of three study groups. One was a TM-only arm, in which patients received a scale and a step counter that automatically transmitted their weight and daily steps to the nurse coaches. Another group of subjects were randomized to the TM devices plus a coach (TMC) who called subjects once a week to discuss the weight and activity data obtained remotely from the telemedicine devices. A third group received regular care.

Dr Stephan Martin (Deutsche Diabetes-Klinik, Dusseldorf Germany), presenting the results, said that while both the TMC and TM groups lost weight (and the control group did not), the weight loss was significantly greater in the TMC group. So, too, were BMI, waist circumference, total cholesterol, triglycerides, and systolic and diastolic blood pressure in the TMC arm only.

"This study shows that machines are not all--we should never forget to talk to the patients, because we can reduce CV risk parameters that much more. It's good to have machines, but don't forget to talk to the people."

The subjects, Martin added, all of whom were overweight and a mean age of 45, "really opened up and talked [to the nurses] about so many things they would never talk about with their physicians. We think it was a motivational tool--just giving people the ability to talk, the time to talk."

He added that the nurses were not specially trained to provide motivational coaching; they were primarily just a listening ear, armed with data from the telemedicine devices.

"Perhaps if we had had more motivational training, we could have increased the weight loss even more," he noted.

-SW

Trief disclosed having no conflicts. Martin disclosed research funding and other payments from Boehringer Ingelheim, Novartis, Almased Wellness, and other companies, including HMM Holding, the company which supplied the telemedicine devices in the study.

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