Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2018 Dec;55(6):777-786.
doi: 10.1016/j.amepre.2018.07.005. Epub 2018 Oct 22.

Effectiveness of an App and Provider Counseling for Obesity Treatment in Primary Care

Gary G Bennett  1 , Dori Steinberg  2 , Sandy Askew  2 , Erica Levine  2 , Perry Foley  2 , Bryan C Batch  3 , Laura P Svetkey  4 , Hayden B Bosworth  5 , Elaine M Puleo  6 , Ashley Brewer  7 , Abigail DeVries  7 , Heather Miranda  8
Affiliations
Randomized Controlled Trial

Effectiveness of an App and Provider Counseling for Obesity Treatment in Primary Care

Gary G Bennett et al. Am J Prev Med. 2018 Dec.

Abstract

Introduction: Obesity treatment is less successful for socioeconomically disadvantaged populations, particularly when delivered in primary care. Digital health strategies can extend the reach of clinical obesity treatments to care settings serving patients at highest risk.

Methods: Track was an effectiveness RCT of a 12-month digital weight-loss intervention, embedded within a community health center system. Participants were 351 adult patients (aged 21-65 years) with obesity and hypertension, diabetes, and hyperlipidemia. Patients were randomized to usual care (n=175) or an intervention (n=176) comprising app-based self-monitoring of behavior change goals with tailored feedback, a smart scale, dietitian-delivered counseling calls, and clinician counseling informed by app-generated recommendations, delivered via electronic health record. The primary outcome was 12-month weight change. Randomization began on June 18, 2013, final assessments were completed on September 10, 2015. Data analysis was conducted in 2016 and 2017. The trial retained 92% of usual care and 96% of intervention participants at 12 months.

Results: The Track intervention produced larger weight losses relative to usual care at 6 months (net effect: -4.4 kg, 95% CI= -5.5, -3.3, p<0.001) and 12 months (net effect: -3.8 kg, 95% CI= -5.0, -2.5, p<0.001). Intervention participants were more likely to lose ≥5% of their baseline weight at 6 months (43% vs 6%, p<0.001) and 12 months (40% vs 17%, p<0.001). Intervention participants completing ≥80% of expected self-monitoring episodes (-3.5 kg); counseling calls (-3.0 kg); or self-weighing days (-4.4 kg) lost significantly more weight than less engaged intervention participants (all p<0.01).

Conclusions: A digital obesity treatment, integrated with health system resources, can produce clinically meaningful weight-loss outcomes among socioeconomically disadvantaged primary care patients with elevated cardiovascular disease risk.

Trial registration: This study is registered at www.clinicaltrials.gov NCT01827800.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
CONSORT 2010 flow diagram. SMS, text messaging.
Figure 2.
Figure 2.
Average weight change by treatment group.
See this image and copyright information in PMC

References

    1. Ogden CL, Lamb MM, Carroll MD, Flegal KM. Obesity and socioeconomic status in adults: United States, 2005−2008. NCHS Data Brief. 2010; 1–8. - PubMed
    1. Flegal KM, Kruszon-Moran D, Carroll MD, Fryar CD, Ogden CL. Trends in obesity among adults in the United States, 2005 to 2014. JAMA. 2016;315(21):2284–2291. 10.1001/jama.2016.6458. - DOI - PMC - PubMed
    1. Harvey JR, Ogden DE. Obesity treatment in disadvantaged population groups: where do we stand and what can we do? Prev Med. 2014;68:71–75. 10.1016/j.ypmed.2014.05.015. - DOI - PMC - PubMed
    1. Bennett GG, Warner ET, Glasgow RE, et al. Obesity treatment for socioeconomically disadvantaged patients in primary care practice. Arch Intern Med. 2012;172(7):565–574. 10.1001/archinternmed.2012.1. - DOI - PMC - PubMed
    1. Wadden TA, Butryn ML, Hong PS, Tsai AG. Behavioral treatment of obesity in patients encountered in primary care settings: a systematic review. JAMA. 2014;312(17):1779–1791. 10.1001/jama.2014.14173. - DOI - PMC - PubMed

Publication types

Associated data