3:31 AM
indigo
Today’s Managing Health Care Costs Indicator is 38.2%
Obesity isn’t easy to treat.
We all know that even people who reduce their caloric intake by 30,000 calories often don’t lose 10 pounds, and recent research shows that hormonal changes subvert our efforts to become svelte (or even to become non-obese).
Two studies published in the Thanksgiving New England Journal of Medicine show surprising efficacy of lifestyle coaching to help patients lose weight. In both studies the interventions were built around the primary care practice (not the insurance company), and both studies were part of an ambitious 24-month three center study funded by the National Heart Lung and Blood Institute.
The NEJM published the Johns Hopkins study, done in collaboration with Healthways. This study showed losses of 0.8kg (control group), 4.6kg (telephonic coaching only), and 5.1kg (in-person coaching). A striking 38.2% of people in the telephonic coaching group lost more than 5% of body weight. That number was 41.4% in the in-person group, even though participants only attended a small fraction of the recommended in-person sessions. Persistance with the web portal was also high.
NEJM also published the University of Pennsylvania study, which compared usual care with brief and enhanced brief lifestyle coaching. Enhanced included treatment with medications and free provided low calorie meals. The UPenn study showed weight loss of 1.7kg (usual care), 2.9 kg (brief coaching), and 4.6kg (enhanced coaching). Again, a striking portion of the participants lost more than 5% of their body weight (usual 21.5%, brief 26%, enhanced 34.9%).
These are impressive studies. They were difficult to carry out, although they were well funded. Both studies had low dropout rates. It will be important that the researchers also publish the results of the third study – to see if the results are consistent. Even so, this reporting is much less subject to publication bias than most of what we see in the wellness literature. The studies are also small – only about 400 people in each three-arm study, so under 150 in each of the treatment groups. It’s also striking that the participants in usual care lost so much weight, since this is quite contrary to the usual practice experience.
Obesity is clearly one of the major causes of future preventable death and adverse health care outcomes – and it’s heartening to see credible evidence of efficacy of the coaching intervention.
