Frequent counseling, physician support and interactive website help obese patients lose weight

Obese patients enrolled in a weight-loss program delivered over the phone by health coaches and with website and physician support lost weight and kept it off for two years, according to new Johns Hopkins research. The program was just as effective as another weight-loss program that involved in-person coaching sessions.

A report on the research was published today in the New England Journal of Medicine.

Roughly 40 percent of obese patients enrolled in each of the two weight-loss programs lost at least five percent of their body weight, an amount associated with real health benefits such as lower blood pressure, lower cholesterol and better diabetes control, the researchers say.

"Until now, doctors had no proven strategy to help their patients lose weight and keep it off. Now, we have two programs that work," says study leader Lawrence J. Appel, M.D., M.P.H., a professor of medicine and director of the Welch Center for Prevention, Epidemiology and Clinical Research at the Johns Hopkins University School of Medicine and the Bloomberg School of Public Health.

Appel, who is scheduled to present his team's findings at the American Heart Association's annual Scientific Sessions in Orlando, identified several possible reasons why the interventions were effective: frequent counseling (by phone or in person), physician support and an interactive website with tools to track weight and provide regular feedback by email. Patients were encouraged to sign in at least weekly to the program's website to track their weight and to learn how to reduce it. If patients didn't log in for more than a week, they got automated reminders. If they were out of touch for too long, patients got phone calls from their coaches and letters from their doctors.

For the study, the researchers recruited 415 obese people with an average body mass index (BMI) of 36.6 and an average weight of 229 pounds. The group was diverse, but predominantly middle-aged women. They were randomly split into three groups: the control group received information about weight loss but did not receive counseling; another group received counseling over the phone with a coach; and a third group was offered in-person and phone counseling. Those in the control group lost an average of less than two pounds over the course of two years. Those who had telephone sessions or in-person coaching lost a similar amount of weight — an average of 10 pounds over two years.

According to Appel, in-person programs are the standard, and such programs do lead to weight loss. But he was surprised to see that those who only had telephone contact with coaches did just as well as those who had in-person one-on-one and group sessions. He says that as the study progressed, the in-person group opted to trade in the face-to-face sessions for the convenience of using the telephone.

"In most weight loss studies, there is a lot of emphasis on frequent, in-person counseling sessions, but from a logistical perspective, it's a disaster," Appel says. "Patients start off strong but then stop attending in-person sessions. That's why I like the telephone program. It is convenient to individuals and can be done anywhere. You could be living in rural South Dakota, and we could deliver this intervention. It removes some of the major logistical barriers."

Obesity is an important and growing public health problem in the United States, where one in three adults is obese and thus at increased risk of mortality, especially from cardiovascular disease. Obesity by some estimates costs the U.S. more than $110 billion a year in health care and lost productivity costs.

As part of the new study, phone calls and in-person sessions were weekly for the first three months. For the next three months, the in-person program offered three monthly contacts (one group and two individual sessions), and then two monthly contacts for the rest of the two year study. Those who were contacted by telephone were offered monthly calls from the end of the third month on.