Background - Intranet da SBC

Background - Intranet da SBC

Background Obesity is an extremely common problem ~ 1/3 of adult Americans are obese Patients commonly ask physicians for advice on weight loss, yet evidence is sparse NHLBI issued a request for grant applications to test weight loss interventions in the setting of routine medical care Objective Conduct a comparative effectiveness trial that tested two practical behavioral weight loss interventions in obese medical outpatients with cardiovascular risk factors Design Randomization

Control Remote In-Person Baseline 6 Mo 12 Mo = Measured weights and other outcomes 24 Mo Intervention Groups Remote Mode of counseling Coach Website/Internet

Physician Roles Telephone only In-Person Group meetings Individual meetings Telephone Healthways Hopkins Educational modules Self monitoring tools Tailored emails Supportive Review weight progress reports Weight Progress Report

Intervention Goals and Behaviors Weight loss goal 5% weight loss Behaviors Reduce caloric intake Consume healthy dietary pattern, DASH diet Exercise > 180 min/week Self-monitor weight, calorie intake and exercise Log-in study website at least weekly Participants Obese individuals with hypertension, hypercholesterolemia, or diabetes Other major inclusion criteria Patient at one of six primary care practices Internet access at least 4 days per week Ability to use internet and email Approach to enrollment

Minimize barriers and exclusion criteria to increase generalizability Characteristics (n=415) Age Women White Black Weight Body Mass Index 54 yrs 64% 56% 41% 103 kg 37 kg/m2 Characteristics

Hypertension Hypercholesterolemia Diabetes Metabolic Syndrome 76% 68% 23% 33% Follow-up Measured weight 88% of participants at 6 months 86% of participants at 12 months 95% of participants at 24 months W e ig h t c h a n g e , k g Mean Weight Change (kg):

Remote vs Control -3.8 kg P<0.001 2 0 -0.8 -1.4 -2 -4 -6 -8 -4.6 -6.1

0 6 12 24 Months after Randomization Control Remote #REF! W e ig h t c h a n g e , k g Mean Weight Change (kg): In-Person vs Control

-4.3 kg P<0.001 2 0 -2 -0.8 -1.4 -4 -6 -8 -5.1 -5.8 0

6 12 24 Months after Randomization Control #REF! In-Person W e ig h t c h a n g e , k g Mean Weight Change (kg): In-Person vs Remote

2 -0.5 kg P=0.63 0 -2 -4.6 -4 -5.1 -6 -8 0

6 12 24 Months after Randomization Remote #REF! In-Person Percent of Participants at Various Weight Thresholds at 24 months Control Remote In-Person

< Baseline weight 52% 77%** 74%** > 5% Weight loss (goal) 19% 38%** 41%** > 10% Weight loss

9% 18%* 20%* *P <0.05 (vs control), **P <0.001 (vs control) Coach Contacts First 6 Months* Next 18 Months Recommended Actual Recommended Actual Remote Intervention Phone 15 14 18

16 In-Person Intervention Group 12 Individual 6 Phone 3 6.5 4 4 18 6 12

1 1 11 *Actual = Median Web and PCP Contacts First 6 Months* Next 18 Months Recommended Actual Recommended Actual Remote Intervention Web Log-In 26 PCP Visit 23 1 72

35 1 In-Person Intervention Web Log-In 26 PCP Visit 20.5 1 72 35 1 *Actual = Median

Conclusions In this comparative effectiveness trial, Two behavioral interventions achieved and sustained clinically significant weight loss over 24 months in obese medical patients The Remote and In-Person interventions were similarly effective Implication The Remote intervention that consists of: phone counseling interactive website physician support has the potential for widespread implementation and should be applicable to management of other chronic conditions Acknowledgements

Participants Physicians and staff at six medical practices Investigative team Primary sponsor National Heart, Lung and Blood Institute Support and advice Healthways National Center for Research Resources National Institute for Diabetes, Digestive and Kidney Diseases Colleagues from U. Penn and Harvard For More Information POWER Website: www.powertrials.org

Online publication: www.nejm.org

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