Adaptive Telephone Coaching Shows Promise in Online Weight Loss Program in Obese: Study Finds

The findings, published in JAMA Network Open, suggest that adopting an online obesity treatment program by coaching individuals with suboptimal responses could be a cost-effective approach to remote obesity treatment. The researchers suggest further evaluating this treatment model in other settings and patient populations.

The 3-group randomized clinical trial of 437 participants revealed that providing 3 or 12 weeks of telephone coaching to individuals with suboptimal weight loss at one month improved weight loss outcomes and engagement with the online program than those not receiving coaching.

The adaptive coaching intervention involved tailored phone sessions delivered by trained health coaches. These sessions provide personalized encouragement, support, and goal-setting strategies based on the participant's progress and challenges identified through the online platform.

Weight loss (WL) during the first month of a behavioral program is associated with longer-term WL. There is a need to test translatable and adaptive obesity programs. Jessica L. Unick, Warren Alpert Medical School at Brown University, Providence, Rhode Island, and colleagues aimed to compare brief, extended, and no telephone coaching for individuals with a suboptimal response (i.e., 1-month WL <4%) within an online WL program.

For this purpose, the researchers conducted a randomized clinical trial with enrollment between 2019 and 2022 at an academic research center in the US. Eligible participants were adults aged 18 to 70 years having daily internet access and a body mass index (BMI) between 25 and 45.

All participants received an automated online WL program for four months and a WL maintenance program for eight months), comprising self-monitoring, video lessons, and personalized feedback.

Participants were randomized, such that individuals with suboptimal response received either extended telephone coaching (12 calls during weeks 5-16), brief telephone coaching (3 calls during weeks 5-8), or no coaching (control). Coaching included goal setting,problem-solving, education, and promoting engagement with the online program.

The primary outcomes included percent weight change and proportion of participants achieving 5% or greater WL at 4 and 12 months.

The study included 437 participants who reported WL at 1 month (mean age, 50.8 years; mean BMI, 34.6; 69.8% females and 30.2% males) with 148 randomized to extended coaching, 143 assigned to brief coaching, and 146 assigned to control group.

The study led to the following findings:

• Of all participants, 79.2% were considered to have a suboptimal response. WL at 4 months was significantly greater in the extended coaching group (mean WL, −7.0%) and brief coaching group (mean WL, −6.2%) vs the control group (mean WL, −4.5%).
• The proportion of participants achieving 5% or greater WL at 4 months was greater in the extended coaching group (65.9%) and brief coaching group (58.5% participants) vs the control group (36.5% participants).
• At 12 months, there was a similar pattern for achievement of 5% WL or greater (extended coaching, 48.1% participants; brief coaching, 45.9% participants; control, 38 participants).
• Percent WL at 12 months was significantly higher in extended coaching versus control (mean WL for extended coaching, −5.5%; mean WL for control, −3.9%) but not for brief coaching (mean WL, −4.9%).
• The brief and extended coaching groups watched more lessons and self-monitored on more days than the control group.
• The cost per additional kilogram of WL, beyond that of the control group, was $50.09 for brief coaching and $92.65 for extended coaching.

"In the study testing an adaptive intervention, providing coaching for individuals with suboptimal response improved weight loss and was cost-effective; further testing in clinical settings (eg, health care systems) is warranted," the researchers concluded.

Reference:

Unick JL, Pellegrini CA, Dunsiger SI, et al. An Adaptive Telephone Coaching Intervention for Patients in an Online Weight Loss Program: A Randomized Clinical Trial. JAMA Netw Open. 2024;7(6):e2414587. doi:10.1001/jamanetworkopen.2024.14587