Effect of Electronic Health Record–Based Coaching on Weight Maintenance

Conroy, Molly B.; McTigue, Kathleen M.; Bryce, Cindy L.; Tudorascu, Dana L.; Gibbs, Bethany Barone; Arnold, Jonathan; Comer, Diane; Hess, Rachel; Huber, Kimberly; Simkin‐Silverman, Laurey R.; Fischer, Gary S.

doi:10.7326/m18-3337

Cited by 16 publications

(32 citation statements)

References 24 publications

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“…Remote lifestyle interventions have found that coaching support results in better outcomes for weight management, regardless of delivery strategy [2, 4–9], and that in‐person coaching may not be necessary for positive outcomes [4, 5, 7, 10]. These studies have investigated successful remote delivery coaching methods, including e‐mail, calls, texts, chat rooms, online meetings, telemedicine, or a combination of these [2, 4–7, 9, 11, 12]. Our study adds to the weight‐management literature that coaching delivered exclusively via EHR provides successful weight‐maintenance outcomes and confirms that in‐person coaching may not be necessary [2, 4, 5, 7, 10] but is still desired for some participants struggling with weight regain.…”

Section: Discussionsupporting

confidence: 67%

Section: Discussionmentioning

confidence: 99%

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Impact of electronic health record‐coaching features in weight change: A secondary analysis from the MAINTAIN‐pc randomized trial

Cedillo

Kukhareva

Larsen

et al. 2022

Obesity

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Objective: This study aimed to evaluate whether coaching features were successfully transmitted via electronic health record (EHR) communication and to evaluate their relationship with weight change in a previously tested EHR-based coaching intervention. Methods: A secondary analysis from the Maintaining Activity and Nutrition through Technology-Assisted Innovation in Primary Care (MAINTAIN-pc) study randomized clinical trial was conducted in nine primary care practices and one specialty practice (endocrinology) affiliated with the University of Pittsburgh Medical Center. Eligibility included age 18 to 75 years, intentional 5% weight loss in the previous 2 years, access to an internet-connected computer, and receipt of care from a University of Pittsburgh Medical Center primary care provider. Survey data were collected during the randomized clinical trial. Results: Participants content with intervention delivery via the EHR and those who felt a strong connection to their coach had significantly less weight regain (p = 0.013 and p < 0.01, respectively). Participants who had needs unmet by the intervention (e.g., "in-person" support in a group setting or individual settings) regained more weight (p < 0.01). Conclusions: The data suggest heterogeneity in the patient population regarding preference for in-person versus EHR-based coaching formats. Such heterogeneity might result in the differential success of EHR-based interventions.

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Section: Discussionsupporting

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Impact of electronic health record‐coaching features in weight change: A secondary analysis from the MAINTAIN‐pc randomized trial

Cedillo

Kukhareva

Larsen

et al. 2022

Obesity

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“…A systematic review of PC-based interventions for obesity showed that several interventions delivered both in-person and remotely by interdisciplinary team members were more effective than usual care [ 112 •]. Few trials of weight maintenance interventions have been conducted in primary care settings, but both telephone- and EHR-based supportive coaching have been shown to help prevent weight regain after intentional weight loss [ 113 , 114 ]. When available, PCPs can also consider utilizing “e-consults” for brief discussions with a weight management specialist.…”

Section: A Review On Current Treatments For Obesitymentioning

confidence: 99%

The Most Undertreated Chronic Disease: Addressing Obesity in Primary Care Settings

et al. 2021

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Purpose of Review While obesity-related comorbidities are frequently addressed and treated in primary care (PC), obesity itself is undertreated. We review the current treatments for obesity and provide potential provider and system-level strategies for integrating weight management and improving longer term obesity care within PC settings. Recent Findings We now understand that the body develops multiple mechanisms to resist weight loss and promote weight regain, making both weight loss and weight loss maintenance challenging. Therefore, weight management often requires medically supervised interventions and should be treated on a long-term basis. However, there are multiple barriers to improving obesity care within PC settings. Summary Clinically, utilizing strategies such as a shared decision-making approach and the 5As to discuss treatment options can facilitate formulating an obesity treatment plan. Utilizing telehealth, a team-based approach, and community partnering can increase patient access to intensive behavioral interventions. Future studies should evaluate other cost-effective methods to implement obesity care into the PC setting.

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“…This analysis used longitudinal data (baseline, 6-months follow-up, and 24-months follow-up) from the MAINTAIN-pc trial that was conducted in Pittsburgh, PA (from 2013 to 2017). As previously described, 14,16 this trial randomized adult primary care patients with recent, intentional weight loss of ≥ 5% into one of two 24-month intervention arms. All participants received access to study-developed, electronic health record-based lifestyle tracking tools and basic healthy lifestyle education for the 24-month study period.…”

Section: Participants and Settingmentioning

confidence: 99%

“…Recently, the MAINTAIN-pc study reported that adding enhanced online coaching and communication with the primary care provider to tracking tools delivered through an electronic health record among primary care patients resulted in less weight regain at 24 months (− 2.86 kg, p < 0.001). 14 This study leveraged communication with coaches through the existing electronic patient portal and the primary care provider-patient relationships to encourage maintenance of weight loss through sustained healthy lifestyle behaviors (e.g., diet and physical activity). We have previously reported that certain lifestyle habits were associated with greater recent, intentional weight loss in MAINTAIN-pc participants at study enrollment.…”

Section: Introductionmentioning

confidence: 99%

Lifestyle Habits Associated with Weight Regain After Intentional Loss in Primary Care Patients Participating in a Randomized Trial

et al. 2020

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BACKGROUND: Though long-term weight loss maintenance is the treatment goal for obesity, weight regain is typical and few studies have evaluated lifestyle habits associated with weight regain. OBJECTIVE: To identify dietary and physical activity habits associated with 6-and 24-month weight regain among participants in a weight loss maintenance clinical trial. DESIGN: Secondary analysis of randomized clinical trial data. PARTICIPANTS: Adult primary care patients with recent, intentional weight loss of at least 5%. MAIN MEASURES: Lifestyle habits included consumption of low-fat foods, fish, desserts, sugary beverages, fruits, and vegetables and eating at restaurants from the Connor Diet Habit Survey; moderate-vigorous physical activity by self-report; steps recorded by a pedometer; and sedentary behavior by self-report. The outcome variable was weight change at 6 and 24 months. Linear regression models estimated adjusted associations between changes in weight and changes in dietary and physical activity habits. KEY RESULTS: Overall, participants (mean (SD): 53.4 (12.2) years old; 26% male; 88% white) maintained weight loss at 6 months (n = 178, mean (SD): − 0.02 (5.70)% change) but began to regain weight by 24 months (n = 157, mean (SD): 4.22 (9.15)% increase). When considered all together, more eating at restaurants, reduced fish consumption, and less physical activity were most consistently associated with weight regain in fully adjusted models at both 6 and 24 months of follow-up. In addition, more sedentary behavior was associated with weight regain at 6 months while reduced consumption of low-fat foods, and more desserts and sugary beverages were associated with weight regain at 24 months. CONCLUSIONS: Consuming less fish, fewer steps per day, and more frequent restaurant eating were most consistently associated with weight regain in primary care patients. Primary care providers may consider addressing specific lifestyle behaviors when counseling patients after successful weight loss. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01946191

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Effect of Electronic Health Record–Based Coaching on Weight Maintenance

Cited by 16 publications

References 24 publications

Impact of electronic health record‐coaching features in weight change: A secondary analysis from the MAINTAIN‐pc randomized trial

Impact of electronic health record‐coaching features in weight change: A secondary analysis from the MAINTAIN‐pc randomized trial

The Most Undertreated Chronic Disease: Addressing Obesity in Primary Care Settings

Lifestyle Habits Associated with Weight Regain After Intentional Loss in Primary Care Patients Participating in a Randomized Trial

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