• Molly B Conroy, Kathleen M McTigue, Cindy L Bryce, Dana Tudorascu, Gibbs Bethany Barone BB University of Pittsburgh, Pittsburgh, Pennsylvania (K.M.M., C.L.B., D.T., B.B.G., J.A., D.C., K.H., L.R.S., G.S.F.)., Jonathan Arnold, Diane Comer, Rachel Hess, Kimberly Huber, Laurey R Simkin-Silverman, and Gary S Fischer.
• University of Utah, Salt Lake City, Utah (M.B.C., R.H.).
• Ann. Intern. Med. 2019 Dec 3; 171 (11): 777-784.

BackgroundWeight regain after intentional loss is common. Most evidence-based weight management programs focus on short-term loss rather than long-term maintenance.ObjectiveTo evaluate the benefit of coaching in an electronic health record (EHR)-based weight maintenance intervention.DesignRandomized controlled trial. (ClinicalTrials.gov: NCT01946191).SettingPractices affiliated with an academic medical center.ParticipantsAdult outpatients with body mass index (BMI) of 25 kg/m2 or higher, intentional weight loss of at least 5% in the previous 2 years, and no bariatric procedures in the previous 5 years.InterventionParticipants were randomly assigned to EHR tools (tracking group) versus EHR tools plus coaching (coaching group). The EHR tools included weight, diet, and physical activity tracking flow sheets; standardized surveys; and reminders. The coaching group received 24 months of personalized coaching through the EHR patient portal, with 24 scheduled contacts.MeasurementsThe primary outcome was weight change at 24 months. Secondary outcomes included 5% weight loss maintenance and changes in BMI, waist circumference, number of steps per day, health-related quality of life, physical function, blood pressure, and satisfaction.ResultsAmong 194 randomly assigned participants (mean age, 53.4 years [SD, 12.2]; 143 [74%] women; 171 [88%] white), 157 (81%) completed the trial. Mean baseline weight and BMI were 85.8 kg (SD, 19.1) and 30.4 kg/m2 (SD, 5.9). At 24 months, mean weight regain (± SE) was 2.1 ± 0.62 kg and 4.9 ± 0.63 kg in the coaching and tracking groups, respectively. The between-group difference in weight change at 24 months was significant (-2.86 kg [95% CI, -4.60 to -1.11 kg]) in the linear mixed model. At 24 months, 65% of participants in the coaching group and 50% in the tracking group maintained weight loss of at least 5%.LimitationSingle-site trial, which limits generalizability.ConclusionAmong adults with intentional weight loss of at least 5%, use of EHR tools plus coaching resulted in less weight regain than EHR tools alone.Primary Funding SourceAgency for Healthcare Research and Quality and National Institutes of Health.

24 keywords...

hide…