Results Summary
What was the research about?
Patients who are above a healthy weight may benefit from weight loss support. But doctors have limited time during clinic visits to support weight management.
In this study, the research team compared three ways to help patients manage their weight outside the clinic:
- BMIQ. BMIQ is an online weight management program with meal plans, menus, and a weight tracker. It also includes 33 educational sessions on topics such as coping with food cravings and learning portion control. BMIQ is available in English and Spanish.
- BMIQ plus support from a health manager. The health manager checked patients’ progress with BMIQ, called patients monthly, and offered patients brief meetings with a dietitian. The health manager also reached out to patients if they didn’t watch educational sessions or track their weight on BMIQ.
- Usual care. Patients received written information about weight management by mail, including general advice about exercise and healthy eating.
What were the results?
After one year, patients using BMIQ plus support lost more weight than patients using BMIQ alone or those receiving usual care. On average, patients using BMIQ plus support lost about seven pounds. Patients using BMIQ alone lost about four pounds, and patients receiving usual care lost about three.
Compared with both usual care and BMIQ alone, BMIQ plus support also had greater increases in
- Percent weight change
- Proportion of patients who lost at least 5 percent of their weight
- Confidence in ability to lose weight
Patients in the three groups didn’t differ in changes in
- Quality of life related to their weight
- How healthy they felt
- Risk factors for heart disease, such as blood pressure or blood sugar levels
- The types of foods they ate or how often they exercised
After 18 months, changes were similar, except weight loss, which was greater in patients who received usual care than in those who received BMIQ alone.
Who was in the study?
The study included 840 patients with high blood pressure or type 2 diabetes who had overweight or obesity. Of these, 76 percent were white, 10 percent were black, and 5 percent reported another race; also, 6 percent were Hispanic. The average age was 59, and 60 percent were women. Patients received care at 1 of 24 primary care clinics in the Boston area.
What did the research team do?
The research team assigned clinics by chance to use BMIQ, BMIQ plus support, or usual care. Patients used the method assigned to their clinic. At the start of the study and again 6, 12, and 18 months later, the team looked at health records, and patients completed surveys.
Patients, caregivers, and healthcare professionals gave input on the study.
What were the limits of the study?
The study didn’t have enough patients to detect differences in some outcomes.
All patients in the study had high blood pressure or type 2 diabetes. Future studies could include patients with other health problems.
How can people use the results?
Clinics can use the results when considering ways to offer weight management support.
Professional Abstract
Objective
To compare the effectiveness of an online program alone, the online program plus population health management support, and usual care on improving patients’ weight management
Study Design
| Design Element | Description |
|---|---|
| Design | Cluster randomized trial |
| Population | 840 patients with hypertension or type 2 diabetes and BMI between 27 and 40 who received care at primary care clinics |
| Interventions/ Comparators |
|
| Outcomes |
Primary: change in body weight at 12 months Secondary: change in body weight at 6-month and 18-month follow-up; percent weight change; weight loss ≥5%; changes in cardiovascular risk factors; changes in patient-reported health, diet, physical activity, weight-related quality of life, and confidence in ability to lose weight |
| Timeframe | 1-year follow-up for primary outcome |
This pragmatic cluster randomized trial compared the effectiveness of an online weight management intervention called BMIQ, BMIQ plus population health management support, and usual care on reducing body weight. Researchers randomized 24 primary care clinics to one of three groups. Patients used the method assigned to their clinic.
- BMIQ alone. BMIQ included meal plans and menus; a tracking system for weight, diet, and physical activity; and 33 educational sessions delivered over one year on topics such as navigating food cravings and reinforcing portion control. BMIQ was available in English and Spanish.
- BMIQ plus population health management support. This combined intervention included a non-clinical population health manager who monitored patients’ progress with BMIQ, called patients monthly for support, and offered brief consultations with a registered dietitian. The population health manager also had access to patients’ BMIQ interface and reached out to patients if they fell behind with tasks such as viewing educational sessions or tracking their weight.
- Usual care. Patients received written information by mail about weight management, including general recommendations about diet and physical activity.
The study included 840 patients with hypertension or type 2 diabetes and a body mass index (BMI) between 27 and 40. Of these, 76% were white, 10% were black, and 5% reported another race; also, 6% were Hispanic. The average age was 59, and 60% were female. Patients received care at 1 of 24 primary care clinics in the Boston area.
Researchers collected data from electronic health records and patients completed surveys at baseline and again 6, 12, and 18 months later.
Patients, caregivers, and healthcare providers helped design the study and patient surveys.
Results
After one year, patients receiving the combined intervention lost more weight than patients receiving BMIQ alone (p=0.01) or usual care (p<0.001). Average weight loss was approximately seven pounds for patients receiving the combined intervention, four pounds for those receiving BMIQ alone, and three pounds for those receiving usual care.
Compared with both usual care and BMIQ alone, the combined intervention had greater increases in
- Percent weight change (p<0.001)
- Proportion of patients who had at least 5% weight loss (p<0.001)
- Confidence in ability to lose weight (p<0.001)
The three groups did not differ significantly in other secondary outcomes after one year.
At 18 months, changes in weight and other outcomes were similar, except weight loss, which was greater among patients who received usual care than among those who received BMIQ alone.
Limitations
The study may have been underpowered to detect meaningful differences in secondary outcomes. All patients had hypertension or type 2 diabetes. Findings may differ for patients with other health conditions.
Conclusions and Relevance
In this study, BMIQ plus population health management support resulted in more weight loss after one year than BMIQ alone or usual care.
Future Research Needs
Future research could include populations with other health conditions.
Final Research Report
View this project's final research report.
More to Explore...
Related PCORI Dissemination and Implementation Project
Journal Citations
Article Highlight: This study compared three types of weight loss management programs for people with high blood pressure or type 2 diabetes who also had overweight or obesity. The study compared outcomes of patients in three groups: an online weight management program with meal plans, menus, and a weight tracker; that same program plus support from a health manager; and usual care. As reported in JAMA, the group that used the online weight management program and had access to a health manager, on average, experienced a statistically significant greater weight loss after 12 months compared to the other two groups.
Results of This Project
Related Journal Citations
Peer-Review Summary
Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.
The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments.
Peer reviewers commented and the researchers made changes or provided responses. Those comments and responses included the following:
- The reviewers asked for more details about the role of the population health managers in conducting outreach and in monitoring patients’ progress on the online weight management program. Specifically, they asked whether records were kept of services that the population health managers delivered to study participants. The researchers said the study only collected the number of contacts the population health managers made with participants and no further information on the nature of those interactions. The researchers noted this as a limitation of the study.
- The reviewers asked about how much care was taken when collecting weight data for patients to ensure that the researchers measured weights accurately and consistently over time. The researchers said they did not perform any specific training on collecting weight data, but the primary care clinics used the same procedures to collect weight data for all visits. They noted that other studies have shown high agreement between weight data collected in clinic visits and weights that the researchers measured.
- The reviewers asked about subgroup analyses and recommended considering subgroups of patients with type 2 diabetes and hypertension for additional analyses. The reviewers noted that it would be helpful for clinicians to understand how these conditions could be affected by weight loss through this intervention. The researchers said they planned to conduct subgroup analyses by age, race, and education from the outset of their project. However, they did also add subgroup analyses for patients with type 2 diabetes and hypertension after collecting data.
- The reviewers noted that the researchers did not provide analyses to back up their assumptions regarding missing data in the sample. The researchers responded by conducting two different sensitivity analyses: one with only complete data and one using weighting to account for missing measurements. They also compared characteristics of patients with and without missing weight data and included all of these analyses as supplementary material for the report.