Effect of an Online Weight Management Program Integrated With Population Health Management on Weight Change: A Randomized Clinical Trial.

Importance: Online programs may help with weight loss but have not been widely implemented in routine primary care. Objective: To compare the effectiveness of a combined intervention, including an online weight management program plus population health management, with the online program only and with usual care. Design, Setting, and Participants: Cluster randomized trial with enrollment from July 19, 2016, through August 10, 2017, at 15 primary care practices in the US. Eligible participants had a scheduled primary care visit and were aged 20 to 70 years, had a body mass index between 27 and less than 40, and had a diagnosis of hypertension or type 2 diabetes. Follow-up ended on May 8, 2019. Interventions: Participants in the usual care group (n = 326) were mailed general information about weight management. Participants in the online program only group (n = 216) and the combined intervention group (n = 298) were registered for the online program. The participants in the combined intervention group also received weight-related population health management, which included additional support from nonclinical staff who monitored their progress in the online program and conducted periodic outreach. Main Outcomes and Measures: The primary outcome was weight change at 12 months based on measured weights recorded in the electronic health record. Weight change at 18 months was a secondary outcome. Results: Among the 840 participants who enrolled (mean age, 59.3 years [SD, 8.6 years]; 60% female; 76.8% White), 732 (87.1%) had a recorded weight at 12 months and the missing weights for the remaining participants were imputed. There was a significant difference in weight change at 12 months by group with a mean weight change of -1.2 kg (95% CI, -2.1 to -0.3 kg) in the usual care group, -1.9 kg (95% CI, -2.6 to -1.1 kg) in the online program only group, and -3.1 kg (95% CI, -3.7 to -2.5 kg) in the combined intervention group (P < .001). The difference in weight change between the combined intervention group and the usual care group was -1.9 kg (97.5% CI, -2.9 to -0.9 kg; P < .001) and the difference between the combined intervention group and the online program only group was -1.2 kg (95% CI, -2.2 to -0.3 kg; P = .01). At 18 months, the mean weight change was -1.9 kg (95% CI, -2.8 to -1.0 kg) in the usual care group, -1.1 kg (95% CI, -2.0 to -0.3 kg) in the online program only group, and -2.8 kg (95% CI, -3.5 to -2.0 kg) in the combined intervention group (P < .001). Conclusions and Relevance: Among primary care patients with overweight or obesity and hypertension or type 2 diabetes, combining population health management with an online program resulted in a small but statistically significant greater weight loss at 12 months compared with usual care or the online program only. Further research is needed to understand the generalizability, scalability, and durability of these findings. Trial Registration: ClinicalTrials.gov Identifier: NCT02656693.

Integrating an online weight management program with population health management in primary care: Design, methods, and baseline data from the PROPS randomized controlled trial (Partnerships for Reducing Overweight and Obesity with Patient-centered Strategies).

BACKGROUND: Scalable, low-cost weight management strategies are needed in primary care. We conducted a pragmatic, cluster-randomized controlled trial to examine the effectiveness of an online weight management program integrated with population health management support. METHODS: We adapted an online weight management program and integrated it with population health management support in 15 primary care practices (24 clinics). We randomized the 24 clinics to usual care (UC), online program alone (OP), or combined intervention (CI). Eligible participants had to be ages 20 to 70 and have a recent primary care visit, body mass index (BMI) ≥ 27 and < 40 kg/m2, and a diagnosis of hypertension or type 2 diabetes. Participants attended routine visits and completed surveys over 18 months. The primary outcome is absolute weight change at 12 months (± 90 days) after enrollment, calculated from weights measured at primary care visits and recorded in the electronic health record. RESULTS: We enrolled 840 participants between July 2016 and August 2017 (326 UC, 216 OP, and 298 CI.) At enrollment, participants' mean age was 59.3 years, their mean weight was 203.1 pounds, and their mean BMI was 32.5 kg/m2; 60% of participants were female, 76.8% were white, 96.4% had hypertension, and 24.4% had type 2 diabetes. CONCLUSION: It is feasible to adapt an online weight management program and integrate it with population health management support in primary care. The results of this trial will provide valuable information about the effectiveness of these strategies in primary care settings. ClinicalTrials.govregistration number:NCT02656693.

Utility of BMIQ, a novel web-based weight management programme, at an academic weight management centre.

BACKGROUND: BMIQ is a customizable online platform used to deliver evidence-based behavioural management that complements office visits with healthcare providers. BMIQ offers educational materials, meal plans and tracking tools for patients, and remote monitoring and guidance for physicians. In this retrospective chart review, the implementation and utility of BMIQ was assessed in patients treated at the Comprehensive Weight Control Center (CWCC) at Weill Cornell Medicine. METHODS: The study included all new patients seen at the CWCC between 9/1/2016 and 6/1/2017 who enrolled in BMIQ. Use of BMIQ was assessed by the number of enrolled patients who activated their account and viewed BMIQ sessions. Demographics, comorbidities, medications, and weight change during 6-month follow-up were obtained from the electronic medical records. RESULTS: Of the 495 new patients enrolled in BMIQ, 217 met the inclusion criteria of 6-month follow-up. The mean age was 50.2 (±13.1) and 72% (n = 157) were female. Sixty-four percent (n = 138) activated their BMIQ account and viewed greater than or equal to 1 BMIQ session. The average number of physician and registered dietitian visits were 3.5 (±1.1) and 1.9 (±1.6), respectively. The average number of weight loss medications was 1.6 with metformin being the most commonly prescribed (76%). Mean weight loss at 6 months was 7.0 ± 5.9%; 59% achieved greater than or equal to 5% weight loss and 28% achieved greater than or equal to 10% weight loss. The total number of physician visits and weight-loss pharmacotherapies used were significant predictors of patients achieving greater than or equal to 5% weight loss. Regular BMIQ usage was an independent predictor of patients achieving both greater than or equal to 5% and greater than or equal to 10% weight loss at 6 months. CONCLUSION: Clinically significant weight loss was achieved in the majority of patients with limited in-clinic physician and registered dietitian follow-up in combination with BMIQ. This retrospective study demonstrates the utility of online behavioural therapy as part of a medical weight management intervention.