By Jill Pease
The COVID-19 pandemic has brought about an explosion in telehealth, but is it as effective as in-person treatment? A new University of Florida study published in JAMA Network Open found that rural residents who received individual telephone counseling for a year after participating in a weight loss program were able to maintain 100% of their weight loss.
This is significant considering many people will regain one-third to one-half of the weight they lost within a year after participating in a weight loss program.
“Providing extended care for the treatment of obesity can help solve one of the major problems that confronts obesity management: weight gain after treatment ends,” said Michael G. Perri, Ph.D., the study’s lead investigator and dean of the UF College of Public Health and Health Professions. “We’ve found that we can slow down and decrease the amount of weight regain people experience and we can do that effectively via telehealth. We can also significantly increase the proportion of people who are in a category of being very successful in managing their weight over the long run.”
The study targeted people living in rural areas where preventive health services are typically scarce. Participants received counseling from staff at Cooperative Extension Service offices. The U.S. Cooperative Extension System, operated through the nation’s land grant universities in partnership with local, state and federal governments, has offices in nearly every county in the U.S.
“The study is yet another example of the potential of telehealth interventions to improve the long-term management of chronic health conditions. Whether someone lives far from a doctor or is self-isolating because of the pandemic, telehealth can be a lifeline to high-quality care,” said David R. Nelson, M.D., senior vice president for health affairs at UF and president of UF Health.
“This research also shows how well the U.S. Cooperative Extension Service can help us confront the inattention to chronic conditions like obesity that occurs with devastating consequences in rural communities throughout Florida and the nation,” he added.
For the first phase of the UF study, which was funded by the National Heart, Lung, and Blood Institute, more than 500 adults in 14 northern Florida counties participated in a 16-week face-to-face weight loss program held at cooperative extension offices. Participants lost an average of 18.3 pounds. Afterward, participants were randomly assigned to one of three extended care groups that received 18 contacts for one year via individual phone counseling, group phone counseling or email education-only.
Participants who received individual phone counseling were more likely to maintain their weight than those in the email education group. At the end of the yearlong extended contact program, participants in the individual phone group maintained 100% of their initial weight losses, whereas those in the group phone program regained 14% of their initial losses and those in the email education group regained approximately one-third of their initial losses.
A key component of weight management extended care programs is encouraging participants to continue to self-monitor their calorie intake, Perri said.
“When you’re working one-on-one with a counselor, because you know that person is checking on you and helping you, you’re much more likely to stick with your goals,” he said. “We think the reason this model works is that it provides the individual with supportive accountability.”
For the third phase of the study, researchers weighed participants six months after the counseling phase ended. Those in the individual phone counseling group had the most success with maintaining their weight loss without counseling support, sustaining an average of 72% of their weight loss. Participants in that group were also more likely to achieve weight loss of 10% of their original body weight, which is associated with several health benefits, including diabetes prevention, lower blood pressure and better cholesterol levels.
Perri, who has long argued that obesity is a chronic condition, believes that weight management needs continuous care in the same way people with high blood pressure or diabetes receive long-term care for their condition.
“For somebody who has a problem with obesity, they probably need to be working on it for the rest of their lives,” he said. “Having a health care professional provide that long-term supportive accountability will enhance the chances they’ll be successful over the long run.”