Automated online behavioral program resulted in weight loss, less regain in patients with obesity

A pragmatic, automated, online behavioral obesity treatment program that included an active maintenance phase resulted in clinically significant weight loss at 12 and 24 months, a study found.

To determine whether the program was effective for long-term weight loss and the most effective delivery schedule, researchers conducted a clinical trial of 540 patients ages 18 to 75 years with overweight or obesity who were enrolled from 2018 to 2020. All were treated actively for three months with an automated, online behavioral obesity treatment program (Rx Weight Loss [RxWL]) and then randomized to nine months of maintenance with three different strategies: control (monthly online newsletters), monthly intervention (nine monthly video lessons and one week of self-monitoring per month), or refresher intervention (an introductory session and two four-week periods of lessons and self-monitoring at seven and 10 months).

The noncommercial RxWL program offered 12 weekly interactive 15-minute video lessons teaching evidence-based behavior change strategies for weight loss, such as goal setting and problem solving. Patients submitted self-monitoring data including daily weight, minutes of moderate to vigorous physical activity (MVPA), and energy intake and received weekly automated tailored feedback. Program goals included weight loss of 0.5 to 1 kg each week, a calorie prescription of 1,200 to 1,800 kcal/d tailored to patients' starting weight, and an MVPA goal that gradually increased to 150 or more minutes per week. The primary outcome was weight change at 12 months using height and weight data collected from electronic medical records. Results were published online March 11 by JAMA Internal Medicine.

Participants lost a mean of 3.6 kg on average, and those in the two active maintenance groups regained less weight at 12 and 24 months than those in the control group. At the 12-month primary end point, the amount of weight regained was 0.37 kg (95% CI, −0.06 to 0.81 kg) in the monthly intervention group and 0.45 kg (95% CI, 0.27 to 0.87 kg) in the refresher group compared to 1.28 kg (95% CI, 0.85 to 1.71 kg) in the control group (P=0.004). The difference in weight regain between the monthly and refresher maintenance groups was not statistically significant. This pattern persisted at 24 months.

"These findings underscore the importance of providing ongoing maintenance intervention to prevent weight regain and suggest that a maintenance intervention can be offered successfully with different schedules of contact," the authors concluded.