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Provider Counseling and Weight Loss Outcomes in a Primary Care-Based Digital Obesity Treatment

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McVay M, Steinberg D, Askew S, Bennett GG. Provider Counseling and Weight Loss Outcomes in a Primary Care-Based Digital Obesity Treatment. J Gen Intern Med. 2019 Mar 19. doi: 10.1007/s11606-019-04944-5.

Abstract

BACKGROUND:

Primary care-based digital health weight loss interventions offer promise for addressing obesity in underserved populations.

OBJECTIVES:

To determine if primary care providers’ weight counseling is associated with weight change during a weight loss intervention.

DESIGN:

This is a secondary analysis of a randomized clinical trial testing a 12-month primary care-based digital health weight loss intervention.

PARTICIPANTS:

Participants were community health center patients with body mass indexes of 30-44.9 kg/m2.

INTERVENTIONS:

The weight loss intervention included tailored behavioral goal setting; weekly goal monitoring via text messaging or interactive voice response calls; counseling calls; skills training material; and participant-tailored recommendations for provider counseling.

MAIN MEASURES:

At 6 and 12 months, participants’ weight was measured and they reported if their provider delivered weight counseling (general or intervention-specific) at their most recent visit and their perception of providers’ empathy. Providers’ documentation of weight counseling was extracted from health records.

KEY RESULTS:

Participants (n = 134-141) were predominantly female (70%) and African American (55%) with a mean age of 51 years and BMI of 36 kg/m2. Participant-reported provider weight counseling was not associated with weight change. However, participants whose providers documented intervention-specific counseling at any point during the intervention (n = 35) lost 3.1 kg (95% CI 0.4 to 5.7 kg) more than those whose providers documented only general weight counseling (n = 82) and 4.0 kg (95% CI 0.1 to 7.9 kg) more than those whose providers did not document weight counseling (n = 17). Perceptions of provider empathy were associated with greater weight loss from 6 to 12 months (0.8 kg per measure unit, 95% CI 0.07 to 1.5 kg, p = .03).

CONCLUSIONS:

Provider counseling that focuses specifically on engagement in a weight loss intervention may enhance weight loss outcomes relative to more general weight loss advice. Counseling that enhances patients’ perceptions of empathy may be most beneficial for patients’ weight loss.