Electronic health record-based weight maintenance coaching

1. This randomized controlled trial showed a mean weight difference of -2.86 kg at 24 months and -3.21 kg at 30 months in participants that received personalized online health coaching in comparison to electronic health record (HER) tracking alone.

2. Participants that received a personalized coach had higher satisfaction with the program and entered their weight into the EHR more frequently than those that did not receive a coach.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Obesity is a persistent problem in America and poses many health risks. Many patients struggle with keeping the weight off and eventually regain it. A randomized controlled trial affiliated with the University of Pittsburg Medical Center evaluated weight maintenance interventions using electronic health record (EHR) tools alone versus EHR plus personalized online health coaching for 24 months. This study examined weight change at 24-months, as well as at 30-months after the intervention ended. Participants that received coaching has less weight regain at each follow-up assessment with a mean difference of -2.86 kg at 24 months and -3.21 kg at 30 months. In addition, the coaching group participants had greater satisfaction with the program and entered their weight into the EHR more frequently than participants receiving only EHR tools.

This study had several limitations including that it was a single-site trial and most participants were female and white, meaning that these results may not be generalizable to other populations. In addition, the participants and study staff were not blinded to trial groups and there was missing data that could have introduced potential bias during analysis.

Overall this study showed that personalized online health coaching helped participants keep their weight off better than just EHR tracking alone. Further research is needed to assess longer-term effectiveness and generalizability of the results.

Click to read the study in Annals of Internal Medicine

Relevant Reading: Web-based intervention to promote weight-loss maintenance using an activity monitor: A randomized controlled trial

In-Depth [randomized controlled trial]: This study was a randomized controlled trial conducted with practices affiliated with the University of Pittsburgh Medical Center. Participants were recruited between October 2013 and February 2015, with follow-up completed in March 2017. Patients between the ages of 18 to 75 years with intentional weight loss of at least 5% in the previous 2 years were included in this study. Patients were excluded if there was a medical explanation for weight loss, preparation for or participation in bariatric surgery, and pregnancy. Participants were split into 2 groups – a coaching group and a tracking group. The coaching group received a personalized online health coach that answered questions, discussed barriers, and provided feedback to the participant. The tracking group recorded outcomes in the EHR with no personalized feedback.

The primary outcome measured was weight change at 24-months and an exploratory 30-month weight outcome after the intervention ended. Other outcomes explored were BMI, maintenance of at least 5% weight loss, waist circumference, number of steps per day, health-related quality of life, physical function, blood pressure, and patient satisfaction. Participants that received coaching had less weight regain at each follow-up assessment. There was a significant difference in weight change between the 2 groups at 24 months (-2.86 kg [95% CI, -4.60 to -1.11 kg]). At 30 months, there was a mean difference of -3.21 kg ([CI, -5.17 to -1.25 kg]). In addition, the coaching group participants had greater satisfaction with the program than participants receiving only EHR tools (mean difference, 0.29 [CI, 0.07 to 0.52]; P=0.012). It was also noted that on average the coaching group entered tracking information more frequently that the other group. Neither group reported any serious adverse events.

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