A Cluster-Randomized Study of Technology-Assisted Health Coaching for Weight Management in Primary Care.

IF 4.4 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Melanie R Jay, Sandra Wittleder, Sarvenaz Vandyousefi, Nicholas Illenberger, Andrew Nicholson, Victoria Sweat, Paul Meissner, Gina Angelotti, Andrea Ruan, Laura Wong, Adrian D Aguilar, Stephanie L Orstad, Scott Sherman, Evelyn Armijos, Hayley Belli, Judith Wylie-Rosett
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Abstract

Purpose: We undertook a trial to test the efficacy of a technology-assisted health coaching intervention for weight management, called Goals for Eating and Moving (GEM), within primary care.

Methods: This cluster-randomized controlled trial enrolled 19 primary care teams with 63 clinicians; 9 teams were randomized to GEM and 10 to enhanced usual care (EUC). The GEM intervention included 1 in-person and up to 12 telephone-delivered coaching sessions. Coaches supported goal setting and engagement with weight management programs, facilitated by a software tool. Patients in the EUC arm received educational handouts. We enrolled patients who spoke English or Spanish, were aged 18 to 69 years, and either were overweight (body mass index 25-29 kg/m2) with a weight-related comorbidity or had obesity (body mass index ≥30 kg/m2). The primary outcome (weight change at 12 months) and exploratory outcomes (eg, program attendance, diet, physical activity) were analyzed according to intention to treat.

Results: We enrolled 489 patients (220 in the GEM arm, 269 in the EUC arm). Their mean (SD) age was 49.8 (12.1) years; 44% were male, 41% Hispanic, and 44% non-Hispanic Black. At 12 months, the mean adjusted weight change (standard error) was -1.4 (0.8) kg in the GEM arm vs -0.8 (1.6) kg in the EUC arm, a nonsignificant difference (P = .48). There were no statistically significant differences in secondary outcomes. Exploratory analyses showed that the GEM arm had a greater change than the EUC arm in mean number of weekly minutes of moderate to vigorous physical activity other than walking, a finding that may warrant further exploration.

Conclusions: The GEM intervention did not achieve clinically important weight loss in primary care. Although this was a negative study possibly affected by health system resource limitations and disruptions, its findings can guide the development of similar interventions. Future studies could explore the efficacy of higher-intensity interventions and interventions that include medication and bariatric surgery options, in addition to lifestyle modification.

在基层医疗机构开展体重管理技术辅助健康指导的分组随机研究。
目的:我们开展了一项试验,以测试在初级保健中采用名为 "饮食与运动目标"(GEM)的技术辅助健康指导干预措施进行体重管理的效果:这项分组随机对照试验招募了 19 个初级保健团队的 63 名临床医生;其中 9 个团队被随机分配到 GEM,10 个团队被随机分配到增强型常规护理(EUC)。GEM干预包括1次面对面辅导和最多12次电话辅导。在软件工具的协助下,教练帮助患者设定目标并参与体重管理计划。EUC组的患者会收到教育手册。我们招募了讲英语或西班牙语、年龄在 18 岁至 69 岁之间、体重超重(体重指数为 25-29 kg/m2)并伴有体重相关并发症或肥胖(体重指数≥30 kg/m2)的患者。主要结果(12 个月时的体重变化)和探索性结果(如项目出席率、饮食、体育锻炼)根据治疗意向进行分析:我们共招募了 489 名患者(220 名在 GEM 治疗组,269 名在 EUC 治疗组)。他们的平均(标清)年龄为 49.8 (12.1) 岁;44% 为男性,41% 为西班牙裔,44% 为非西班牙裔黑人。12 个月后,GEM 治疗组的平均调整体重变化(标准误差)为-1.4 (0.8) kg,而 EUC 治疗组为-0.8 (1.6) kg,差异不显著(P = .48)。次要结果的差异无统计学意义。探索性分析表明,在除步行以外的每周中等强度至剧烈运动的平均分钟数方面,GEM组比EUC组有更大的变化,这一结果可能值得进一步探讨:结论:在基层医疗机构中,GEM干预并未达到临床上重要的减肥效果。虽然这是一项消极的研究,可能受到医疗系统资源限制和干扰的影响,但研究结果可以为类似干预措施的开发提供指导。未来的研究可以探索强度更高的干预措施以及除改变生活方式外还包括药物治疗和减肥手术的干预措施的效果。
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来源期刊
Annals of Family Medicine
Annals of Family Medicine 医学-医学:内科
CiteScore
3.70
自引率
4.50%
发文量
142
审稿时长
6-12 weeks
期刊介绍: The Annals of Family Medicine is a peer-reviewed research journal to meet the needs of scientists, practitioners, policymakers, and the patients and communities they serve.
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