More Affordable Remote Weight Loss Program as Effective as Traditional Approach

By Linda Carroll

July 15, 2020

(Reuters Health) - A remote, low-cost weight-loss program may work just as well as the gold-standard National Diabetes Prevention Program, a new study suggests.

In an analysis of data from more than 500 overweight and obese adults participating in an optimization trial of the remote program, researchers found that 57% of participants lost at least 5% of their starting weight and 51% lost at least 7% of their starting weight, according to the report published in Obesity.

"The main takeaway is that we have found a way to deliver a weight-loss treatment that gives as good an outcome as the gold standard, which is a much more expensive and burdensome treatment," said the study's lead author, Bonnie Spring, a professor of preventive medicine, psychology and psychiatry and director of the Center for Behavior and Health in the Institute for Public Health and Medicine at Northwestern University's Feinberg School of Medicine in Chicago.

"That treatment requires participants to do in-person visits, which is especially a problem for folks who can't get to visits because of job responsibilities, the need for childcare or transportation issues," Spring said.

The new treatment coupled an online smartphone app with coaching and support via phone calls. The coach was kept informed of the participant's dietary choices, Spring said. "If the coach doesn't know what you were eating or the amount of physical activity, then they'd be flying blind," she added. "This is like having the coach on your shoulders walking around with you."

To assess the effectiveness of individual components and combinations of components in a remotely delivered behavioral treatments for overweight and obesity intervention, Spring and her colleagues recruited 562 adults with a BMI of at least 25 who were randomly assigned to conditions in a factorial experiment crossing five dichotomous treatment components set to either high/low (for example, 12 versus 24 coaching calls) or off/on (for example, primary care provider reports, text messaging, meal replacements and buddy training.

The treatment package yielding maximum weight loss for $500 or less included 12 coaching calls, buddy training, and primary care provider progress reports. It resulted in an average weight loss of 6.1 kg (13.4 pounds) at a cost of $427 per person. For comparison, the National Diabetes Prevention Program costs $1,500.

In the trial, the most expensive treatment, which included 24 coaching calls was no more effective than the one with 12 calls.

That was a surprise to Spring.

"I was certain that the one with 24 coaching calls would be better than the one with 12," she said. "But 12 was as good, if not marginally better, than the 24. That tells me people acquired the self-regulating skills they needed from 12. And the coaching is the most expensive part. So being able to cut the cost of 12 additional coaching sessions is huge."

Dori Arad welcomed the new study.

"It's great in that they looked at the different components of weight loss programs," said Arad, a nutrition and human metabolism expert and director of The Mount Sinai Physiolab in New York City. "They broke down the components to see which was effective and which was not."

Clinicians shouldn't make the mistake of being too literal about which components to use, Arad said.

"What might work for one person might not work for another," he explained. "You have to look at this as a toolbox. You want to use the tools that best fit a client's lifestyle and goals."

One important point, Arad said, is that even a 5% weight loss can make a big difference to health. "It can bring significant changes, especially for people who are very large, in terms of inflammation and their metabolic profile," he said.

SOURCE: Obesity, online July 12, 2020.