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- Title
Effect of Telehealth Extended Care for Maintenance of Weight Loss in Rural US Communities: A Randomized Clinical Trial.
- Authors
Perri, Michael G.; Shankar, Meena N.; Daniels, Michael J.; Durning, Patricia E.; Ross, Kathryn M.; Limacher, Marian C.; Janicke, David M.; Martin, A. Daniel; Dhara, Kumaresh; Bobroff, Linda B.; Radcliff, Tiffany A.; Befort, Christie A.
- Abstract
Key Points: Question: Does extended care for obesity management delivered remotely via individual or group telephone counseling in rural communities improve the maintenance of weight loss compared with an education program about weight gain prevention? Findings: In this randomized clinical trial of 445 participants who completed a lifestyle weight-loss intervention, extended care delivered remotely via individual telephone counseling decreased weight regain and increased the proportion of participants who achieved clinically meaningful weight losses compared with education alone. Meaning: These findings suggest that extended care delivered remotely via individual telephone counseling may reduce weight regain and increase the proportion of participants who achieve long-term weight reductions of at least 10%. This randomized clinical trial examines the efficacy of individual or group telephone counseling vs an educational control for weight loss maintenance among individuals in rural communities in the US. Importance: Lifestyle interventions for obesity produce reductions in body weight that can decrease risk for diabetes and cardiovascular disease but are limited by suboptimal maintenance of lost weight and inadequate dissemination in low-resource communities. Objective: To evaluate the effectiveness of extended care programs for obesity management delivered remotely in rural communities through the US Cooperative Extension System. Design, Setting, and Participants: This randomized clinical trial was conducted from October 21, 2013, to December 21, 2018, in Cooperative Extension Service offices of 14 counties in Florida. A total of 851 individuals were screened for participation; 220 individuals did not meet eligibility criteria, and 103 individuals declined to participate. Of 528 individuals who initiated a 4-month lifestyle intervention, 445 qualified for randomization. Data were analyzed from August 22 to October 21, 2019. Interventions: Participants were randomly assigned to extended care delivered via individual or group telephone counseling or an education control program delivered via email. All participants received 18 modules with posttreatment recommendations for maintaining lost weight. In the telephone-based interventions, health coaches provided participants with 18 individual or group sessions focused on problem solving for obstacles to the maintenance of weight loss. Main Outcomes and Measures: The primary outcome was change in body weight from the conclusion of initial intervention (month 4) to final follow-up (month 22). An additional outcome was the proportion of participants achieving at least 10% body weight reduction at follow-up. Results: Among 445 participants (mean [SD] age, 55.4 [10.2] years; 368 [82.7%] women; 329 [73.9%] white), 149 participants (33.5%) were randomized to individual telephone counseling, 143 participants (32.1%) were randomized to group telephone counseling, and 153 participants (34.4%) were randomized to the email education control. Mean (SD) baseline weight was 99.9 (14.6) kg, and mean (SD) weight loss after the initial intervention was 8.3 (4.9) kg. Mean weight regains at follow-up were 2.3 (95% credible interval [CrI], 1.2-3.4) kg in the individual telephone counseling group, 2.8 (95% CrI, 1.4-4.2) kg for the group telephone counseling group, and 4.1 (95% CrI, 3.1-5.0) kg for the education control group, with a significantly smaller weight regain observed in the individual telephone counseling group vs control group (posterior probability >.99). A larger proportion of participants in the individual telephone counseling group achieved at least 10% weight reductions (31.5% [95% CrI, 24.1%-40.0%]) than in the control group (19.1% [95% CrI, 14.1%-24.9%]) (posterior probability >.99). Conclusions and Relevance: This randomized clinical trial found that providing extended care for obesity management in rural communities via individual telephone counseling decreased weight regain and increased the proportion of participants who sustained clinically meaningful weight losses. Trial Registration: ClinicalTrials.gov Identifier: NCT02054624
- Subjects
FLORIDA; OBESITY treatment; BEHAVIOR modification; BODY weight; REGULATION of body weight; COUNSELING; HEALTH behavior; HEALTH promotion; INGESTION; RURAL population; STATISTICAL sampling; TELEMEDICINE; WEIGHT loss; RANDOMIZED controlled trials; TREATMENT effectiveness; EVALUATION of human services programs; DATA analysis software; DESCRIPTIVE statistics
- Publication
JAMA Network Open, 2020, Vol 3, Issue 6, pe206764
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2020.6764