Feasibility and acceptability of a technology-based, rural weight management intervention in older adults with obesity

Abstract

Background: Older adults with obesity residing in rural areas have reduced access to weight management programs. We determined the feasibility, acceptability and preliminary outcomes of an integrated technology-based health promotion intervention in rural-living, older adults using remote monitoring and synchronous video-based technology.

Methods: A 6-month, non-randomized, non-blinded, single-arm study was conducted from October 2018 to May 2020 at a community-based aging center of adults aged ≥65 years with a body mass index (BMI) ≥30 kg/m². Weekly dietitian visits focusing on behavior therapy and caloric restriction and twice-weekly physical therapist-led group strength, flexibility and balance training classes were delivered using video-conferencing to participants in their homes. Participants used a Fitbit Alta HR for remote monitoring with data feedback provided by the interventionists. An aerobic activity prescription was provided and monitored.

Results: Mean age was 72.9±3.9 years (82% female). Baseline anthropometric measures of weight, BMI, and waist circumference were 97.8±16.3 kg, 36.5±5.2 kg/m², and 115.5±13.0 cm, respectively. A total of 142 participants were screened (n=27 ineligible), and 53 consented. There were nine dropouts (17%). Overall satisfaction with the trial (4.7+ 0.6, scale: 1 (low) to 5 (high)) and with Fitbit (4.2+ 0.9) were high. Fitbit was worn an average of 81.7±19.3% of intervention days. In completers, mean weight loss was 4.6±3.5 kg or 4.7±3.5% (p< 0.001). Physical function measures of 30-s sit-to-stand repetitions increased from 13.5±5.7 to 16.7±5.9 (p< 0.001), 6-min walk improved by 42.0±77.3 m (p=0.005) but no differences were observed in gait speed or grip strength. Subjective measures of late-life function improved (3.4±4.7 points, p< 0.001).

Conclusions: A technology-based obesity intervention is feasible and acceptable to older adults with obesity and may lead to weight loss and improved physical function.

Clinical trial registration: Registered on Clinicaltrials.gov # NCT03104205 . Registered on April 7, 2017. First participant enrolled on October 1st, 2018.

Keywords: Disparities; Telehealth; Weight.

Fig. 1

Schematic of the Components of the Technology-Based Intervention

Fig. 2

Change in Measures over 6-month intervention. Box-plots representing longitudinal changes in weight (a), 30-s sit-to-stand test (b), 6-min walk test (c) and total function component of Late-life function and disability index (d) in a Technology-Based Weight Loss Intervention in Older Adults

Fig. 3

Changes in Key Measures in Participants with and without 5% Weight Loss. Box-plots representing longitudinal changes in 30-s sit-to-stand test (a), 6-min walk test (b) and function component of Late-life function and disability index (c) and grip strength (d) in a Technology-Based Weight Loss Intervention in Older Adults with and without 5% weight loss