Looking to Lose Weight? Get a 'Coach'
TUESDAY Nov. 15, 2011 -- Dieters appear to do better if they have either a "coach" or intensive weight-loss counseling, two different studies suggest.
Even if that coach helps out by phone, with no face-to-face contact, it can translate to more weight loss, the experts found. Either approach results in more weight loss than going solo. The studies will be presented this week at the American Heart Association annual meeting in Orlando, Fla., and published online in the New England Journal of Medicine.
"The 'remote' intervention, to me, is very exciting," said Dr. Lawrence Appel, a professor of medicine and director of the Welch Center for Prevention, Epidemiology and Clinical Research at the Johns Hopkins University School of Medicine and Bloomberg School of Public Health. He led one of the studies.
Weight-loss support and education delivered over the phone or a website, he said, was effective. "We don't discourage in-person," Appel said. "Going in, we thought it would be the best intervention." The researchers found otherwise. "Given their druthers, the people said, 'I prefer not to come in,' 'I prefer to use the phone, the Internet.'"
In the study, Appel and his colleagues assigned 415 obese men and women, average age 54, all with at least one cardiovascular risk factor such as high blood pressure, to one of two programs. In one, patients got weight loss support remotely -- by phone, a website and email. In the second, they got in-person support during group and individual sessions, along with remote support.
The participants received monthly email messages summarizing their progress. If they didn't log on to the website, they got a nudge by email.
A third comparison group met with a weight-loss coach at the study start. They could also meet with the coach at the end. In between, they were on their own, referred to websites on weight loss and given brochures.
Those in the self-directed group lost less weight. On average, the self-directed group shed 1.7 pounds, the remote group lost 10.1 pounds, and the in-person group 11.2 pounds over the two-year study.
A higher proportion of those in the intervention groups lost 5 percent or more of their starting weight. That may not sound like much, but experts agree it is enough to make a difference to your health.
In the second study, Dr. Thomas Wadden, at the University of Pennsylvania, and his team assigned 390 obese adults to one of three types of programs. One group was termed ''usual care" and saw their doctors for weight-loss education and support every three months. One group received brief lifestyle counseling, including visits with their doctor every three months and monthly sessions with lifestyle coaches. One group received enhanced lifestyle counseling, which included everything the brief lifestyle counseling group got, along with being offered a choice of meal replacements or weight-loss medications.
The weight-loss medicines were either orlistat or sibutramine. Orlistat now carries a warning about potential liver damage. Sibutramine is not available in the United States now, after reports of an increased risk of heart attacks and strokes with its use. By the end of the study, most were using the meal replacements, not the medicines.
At the end of the two years, 86 percent were still participating. Those who received the enhanced lifestyle counseling lost the most: 10.1 pounds. Those in the usual care group lost just 3.7 pounds and those in the brief lifestyle counseling group lost 6.4 pounds.
Those in the enhanced lifestyle group were more likely to drop 5 percent of their starting weight, according to the report.
Both studies suggest a model using primary care doctors works, said Wadden, professor of psychology and psychiatry and director of the Center for Weight and Eating Disorders at the university. That model is recommended by the U.S. Preventive Services Task Force, which makes recommendations based on evidence of benefits and harms.
In an accompanying editorial, Dr. Susan Yanovski of the U.S. National Institutes of Health pointed out that the participants got the meal replacement and medicines at no cost. "Whether patients would be willing to pay for these therapies, or insurers would be willing to reimburse for them, is not known," she said.
Appel estimates his program would cost less than $500 for the two years and speculates that employers might pay. Wadden said his program would cost about $1,300 for the two years. He said employers or insurers might pay in the future.
One in three U.S. adults is obese. Both studies were funded by the U.S. National Heart, Lung, and Blood Institute. The study led by Appel was also supported by other sources, including Healthways, a disease-management company that has a consulting agreement with Johns Hopkins. One study author has received consulting fees from Bristol-Myers Squibb and Merck and royalties from Taylor & Francis Publishing.
For information about healthy food choices, visit the U.S. Department of Agriculture.
Posted: November 2011
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