Introduction
Obesity treatment is less successful for socioeconomically disadvantaged populations,
particularly when delivered in primary care. Digital health strategies can extend
the reach of clinical obesity treatments to care settings serving patients at highest
risk.
Methods
Track was an effectiveness RCT of a 12-month digital weight-loss intervention, embedded
within a community health center system. Participants were 351 adult patients (aged
21–65 years) with obesity and hypertension, diabetes, and hyperlipidemia. Patients
were randomized to usual care (n=175) or an intervention (n=176) comprising app-based self-monitoring of behavior change goals with tailored
feedback, a smart scale, dietitian-delivered counseling calls, and clinician counseling
informed by app-generated recommendations, delivered via electronic health record.
The primary outcome was 12-month weight change. Randomization began on June 18, 2013,
final assessments were completed on September 10, 2015. Data analysis was conducted
in 2016 and 2017. The trial retained 92% of usual care and 96% of intervention participants
at 12 months.
Results
The Track intervention produced larger weight losses relative to usual care at 6 months
(net effect: –4.4 kg, 95% CI= –5.5, –3.3, p<0.001) and 12 months (net effect: –3.8 kg, 95% CI= –5.0, –2.5, p<0.001). Intervention participants were more likely to lose ≥5% of their baseline
weight at 6 months (43% vs 6%, p<0.001) and 12 months (40% vs 17%, p<0.001). Intervention participants completing ≥80% of expected self-monitoring episodes
(–3.5 kg); counseling calls (–3.0 kg); or self-weighing days (–4.4 kg) lost significantly
more weight than less engaged intervention participants (all p<0.01).
Conclusions
A digital obesity treatment, integrated with health system resources, can produce
clinically meaningful weight-loss outcomes among socioeconomically disadvantaged primary
care patients with elevated cardiovascular disease risk.
Trial registration
This study is registered at www.clinicaltrials.gov NCT01827800.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of Preventive MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
REFERENCES
- Obesity and socioeconomic status in adults: United States, 2005–2008.NCHS Data Brief. 2010; : 1-8
- Trends in obesity among adults in the United States, 2005 to 2014.JAMA. 2016; 315: 2284-2291
- Obesity treatment in disadvantaged population groups: where do we stand and what can we do?.Prev Med. 2014; 68: 71-75
- Obesity treatment for socioeconomically disadvantaged patients in primary care practice.Arch Intern Med. 2012; 172: 565-574
- Behavioral treatment of obesity in patients encountered in primary care settings: a systematic review.JAMA. 2014; 312: 1779-1791
- How does physician advice influence patient behavior? Evidence for a priming effect.Arch Fam Med. 2000; 9: 426-433
- Physician practice patterns of obesity diagnosis and weight-related counseling.Patient Educ Couns. 2011; 82: 123-129
- The delivery of public health interventions via the Internet: actualizing their potential.Annu Rev Public Health. 2009; 30: 273-292
- eHealth interventions for the prevention and treatment of overweight and obesity in adults: a systematic review with meta-analysis.Obes Rev. 2015; 16: 376-392
- 2013 AHA/ACC/TOS Guideline for the management of overweight and obesity in adults.J Am Coll Cardiol. 2014; 63: 2985-3023
- Technology-assisted weight loss interventions in primary care: a systematic review.J Gen Intern Med. 2015; 30: 107-117
- Interventions employing mobile technology for overweight and obesity: an early systematic review of randomized controlled trials.Obes Rev. 2013; 14: 279-291
- Electronic health (eHealth) interventions for weight management among racial/ethnic minority adults: a systematic review.Obes Rev. 2014; 15: 146-158
- Track: a randomized controlled trial of a digital health obesity treatment intervention for medically vulnerable primary care patients.Contemp Clin Trials. 2016; 48: 12-20
- Behavioral treatment for weight gain prevention among black women in primary care practice: a randomized clinical trial.JAMA Intern Med. 2013; 173: 1770-1777
- Daily text messaging for weight control among racial and ethnic minority women: randomized controlled pilot study.J Med Internet Res. 2013; 15: e244.
- A text messaging-assisted randomized lifestyle weight loss clinical trial among overweight adults in Beijing.Obesity (Silver Spring). 2014; 22: E29-E37
- Health literacy and weight change in a digital health intervention for women: a randomized controlled trial in primary care practice.J Health Commun. 2016; 21: 34-42
- The efficacy of a daily self-weighing weight loss intervention using smart scales and e-mail.Obesity (Silver Spring). 2013; 21: 1789-1797
- Motivational Interviewing: Preparing People to Change Addictive Behavior.Guilford Press, New York, NY1991
- Comparative effectiveness of weight-loss interventions in clinical practice.N Engl J Med. 2011; 365: 1959-1968
- Satisfaction with primary care provider involvement is associated with greater weight loss: results from the practice-based POWER trial.Patient Educ Couns. 2015; 98: 1099-1105
- Current science on consumer use of mobile health for cardiovascular disease prevention.Circulation. 2015; 132: 1157-1213
- Adherence to self-monitoring via interactive voice response technology in an eHealth intervention targeting weight gain prevention among black women: randomized controlled trial.J Med Internet Res. 2014; 16: e114.
- Smartphone Internet access and use: extending the digital divide and usage gap.Mob Media Commun. 2017; 5: 239-255
- Change in percentages of adults with overweight or obesity trying to lose weight, 1988–2014.JAMA. 2017; 317: 971-973
- Weight gain prevention among black women in the rural community health center setting: the Shape Program.BMC Public Health. 2012; 12: 305.
Article Info
Publication History
Published online: October 22, 2018
Identification
Copyright
© 2018 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
