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Kukhareva PV, Weir CR, Cedillo M, Taft T, Butler JM, Rudd EA, Zepeda J, Zheutlin E, Kiraly B, Flynn M, Conroy MB, Kawamoto K. Design and implementation of electronic health record-based tools to support a weight management program in primary care. JAMIA Open 2024; 7:ooae038. [PMID: 38745592 PMCID: PMC11091423 DOI: 10.1093/jamiaopen/ooae038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 01/17/2024] [Accepted: 04/18/2024] [Indexed: 05/16/2024] Open
Abstract
Objectives This paper reports on a mixed methods formative evaluation to support the design and implementation of information technology (IT) tools for a primary care weight management intervention delivered through the patient portal using primary care staff as coaches. Methods We performed a qualitative needs assessment, designed the IT tools to support the weight management program, and developed implementation tracking metrics. Implementation tracking metrics were designed to use real world electronic health record (EHR) data. Results The needs assessment revealed IT requirements as well as barriers and facilitators to implementation of EHR-based weight management interventions in primary care. We developed implementation metrics for the IT tools. These metrics were used in weekly project team calls to make sure that project resources were allocated to areas of need. Conclusion This study identifies the important role of IT in supporting weight management through patient identification, weight and activity tracking in the patient portal, and the use of the EHR as a population management tool. An intensive multi-level implementation approach is required for successful primary care-based weight management interventions including well-designed IT tools, comprehensive involvement of clinic leadership, and implementation tracking metrics to guide the process of workflow integration. This study helps to bridge the gap between informatics and implementation by using socio-technical formative evaluation methods early in order to support the implementation of IT tools. Trial registration clinicaltrials.gov, NCT04420936. Registered June 9, 2020.
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Affiliation(s)
- Polina V Kukhareva
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT 84108, United States
| | - Charlene R Weir
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT 84108, United States
| | - Maribel Cedillo
- Department of Internal Medicine, University of Utah, Salt Lake City, UT 84132, United States
| | - Teresa Taft
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT 84108, United States
| | - Jorie M Butler
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT 84108, United States
- Department of Internal Medicine, University of Utah, Salt Lake City, UT 84132, United States
- George E. Wahlen Department of Veterans Affairs Medical Center, Geriatrics Research and Education Center (GRECC), Salt Lake City, UT 84148, United States
| | - Elizabeth A Rudd
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT 84108, United States
| | - Jesell Zepeda
- Department of Internal Medicine, University of Utah, Salt Lake City, UT 84132, United States
| | - Emily Zheutlin
- Department of Internal Medicine, University of Utah, Salt Lake City, UT 84132, United States
| | - Bernadette Kiraly
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT 84108, United States
| | - Michael Flynn
- Department of Internal Medicine, University of Utah, Salt Lake City, UT 84132, United States
- Department of Pediatrics, University of Utah, Salt Lake City, UT 84108, United States
- Community Physicians Group, University of Utah Health, Salt Lake City, UT 84102, United States
| | - Molly B Conroy
- Department of Internal Medicine, University of Utah, Salt Lake City, UT 84132, United States
| | - Kensaku Kawamoto
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT 84108, United States
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Conroy MB, Cedillo M, Jordanova K, Zepeda J, Kiraly B, Flynn M, Wu C, Kukhareva PV, Butler JM, Hess R, Greene T, Kawamoto K. Implementing weight maintenance with existing staff and electronic health record tools in a primary care setting: Baseline results from the MAINTAIN PRIME trial. Contemp Clin Trials 2024; 141:107520. [PMID: 38552870 DOI: 10.1016/j.cct.2024.107520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 03/18/2024] [Accepted: 03/26/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND There is need for interventions that can assist with long-term maintenance of healthy body weight and be sustainably integrated into existing primary care teams. The goal of MAINTAIN PRIME (Promoting Real (World) IMplEmentation) is to evaluate whether a successful electronic health record (EHR)-based weight maintenance intervention can be adapted to a new clinical setting with primary care staff serving as coaches. METHODS EHR tools include tracking tools, standardized surveys, and standardized "SmartPhrases" for coaching. Inclusion criteria were age 18-75 years, voluntary 5% weight loss in the past 2 years with prior BMI ≥ 25 kg/m2, and no bariatric procedures in past 2 years. Participants were randomized 1:1 to tailored online coaching with EHR tracking tools (coaching) or EHR tracking tools alone (tracking). RESULTS We screened 405 individuals between September 2021 and April 2023; 269 participants enrolled (134 coaching; 135 tracking). The most common reason for not enrolling was ineligibility (55%). At baseline, participants were 50.3 (SD 15.02) years old, 66.4% female, and 84% White; 83.7% reported moderate physical activity. Average weight and BMI at baseline were 205.0 (SD 48.9) lbs. and 33.2 (6.8) kg/m2, respectively. Participants lost an average of 10.7% (SD 5.2) of their body weight before enrolling. We recruited 39 primary care coaches over the same period. Conclusion The study successfully identified and recruited primary care patients with recent intentional weight loss for participation in a weight maintenance program that uses EHR-based tools. We also successfully recruited and trained primary care staff as coaches.
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Affiliation(s)
- Molly B Conroy
- Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA; Department of Population Health Science, University of Utah, Salt Lake City, UT, USA.
| | - Maribel Cedillo
- Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA.
| | - Kayla Jordanova
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA.
| | - Jesell Zepeda
- Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA.
| | - Bernadette Kiraly
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA.
| | - Michael Flynn
- Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA; Department of Pediatrics, University of Utah, Salt Lake City, UT, USA; Community Physicians Group, University of Utah Health, Salt Lake City, UT, USA.
| | - Chaorong Wu
- Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA.
| | - Polina V Kukhareva
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA.
| | - Jorie M Butler
- Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA; Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA; Geriatrics Research and Education Center (GRECC) George E. Wahlen, Department of Veterans Affairs Medical Center, Salt Lake City, UT, USA.
| | - Rachel Hess
- Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA; Department of Population Health Science, University of Utah, Salt Lake City, UT, USA.
| | - Tom Greene
- Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA; Department of Population Health Science, University of Utah, Salt Lake City, UT, USA.
| | - Kensaku Kawamoto
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA.
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Thomas JG, Panza E, Goldstein CM, Hayes JF, Benedict N, O’Leary K, Wing RR. Pragmatic Implementation of Online Obesity Treatment and Maintenance Interventions in Primary Care: A Randomized Clinical Trial. JAMA Intern Med 2024; 184:502-509. [PMID: 38466266 PMCID: PMC10928540 DOI: 10.1001/jamainternmed.2023.8438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/18/2023] [Indexed: 03/12/2024]
Abstract
Importance Behavioral weight loss interventions have achieved success in primary care; however, to our knowledge, pragmatic implementation of a fully automated treatment that requires little researcher oversight has not been tested. Moreover, weight loss maintenance remains a challenge. Objective To evaluate the long-term effectiveness of an automated, online, behavioral obesity treatment program (Rx Weight Loss [RxWL]) at 12 months (primary end point) and 24 months when delivered pragmatically in primary care and to compare the effectiveness of 3 weight loss maintenance approaches. Design, Setting, and Participants This randomized clinical trial of RxWL, an online weight loss program, recruited patients from a Rhode Island primary care network with approximately 60 practices and 100 physicians. Eligible participants were primary care patients aged 18 to 75 years with overweight or obesity who were referred by their nurse care manager and enrolled between 2018 and 2020. All participants were included in the intention-to-treat analysis, whereas only those who engaged with maintenance intervention were included in the per-protocol analysis. Data were analyzed from August 2022 to September 2023. Interventions All participants were offered the same 3-month weight loss program, with randomization to one of three 9-month maintenance programs: control intervention (monthly online newsletters), monthly intervention (9 monthly video lessons and 1 week of self-monitoring per month), or refresher intervention (an introductory session and two 4-week periods of lessons and self-monitoring at 7 and 10 months). Main Outcomes and Measures The primary outcome was weight change at 12 months using height and weight data collected from electronic medical records through 24 months. Results Among the 540 participants (mean [SD] age, 52.8 [13.4] years; 384 females [71.1%]) in the intention-to-treat analysis, mean estimated 3-month weight loss was 3.60 (95% CI, -4.32 to -2.88) kg. At the 12-month primary end point, the amount of weight regained in the monthly (0.37 [95% CI, -0.06 to 0.81] kg) and refresher (0.45 [95% CI, 0.27 to 0.87] kg) maintenance groups was significantly less than that in the newsletter control maintenance group (1.28 [95% CI, 0.85 to 1.71] kg; P = .004). The difference in weight regain between the monthly and refresher maintenance groups was not statistically significant. This pattern persisted at 24 months. In the per-protocol analysis of 253 participants, mean weight loss at the end of the initial 3-month intervention was 6.19 (95% CI, -7.25 to -5.13) kg. Similarly, at 12 months there was less weight regain in the monthly (0.61 kg) and refresher (0.96 kg) maintenance groups than in the newsletter control maintenance group (1.86 kg). Conclusions and Relevance Results of this randomized clinical trial indicate that pragmatic implementation of a 12-month automated, online, behavioral obesity treatment that includes 9 months of active maintenance produces clinically significant weight loss over 2 years in primary care patients with overweight or obesity. These findings underscore the importance of providing ongoing maintenance intervention to prevent weight regain. Trial Registration ClinicalTrials.gov Identifier: NCT03488212.
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Affiliation(s)
- J. Graham Thomas
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, Rhode Island
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Emily Panza
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, Rhode Island
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Carly M. Goldstein
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, Rhode Island
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Jacqueline F. Hayes
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, Rhode Island
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Noah Benedict
- Rhode Island Primary Care Physicians Corporation, Cranston
| | - Kevin O’Leary
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, Rhode Island
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Rena R. Wing
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, Rhode Island
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Suminski RR, Leonard T, Obrusnikova I, Kelly K. The Impact of Health Coaching on Weight and Physical Activity in Obese Adults: A Randomized Control Trial. Am J Lifestyle Med 2024; 18:233-242. [PMID: 38559788 PMCID: PMC10979733 DOI: 10.1177/15598276221114047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Health Coaching (HC) is an evidence-based, patient-centered approach to assisting individuals in achieving their health-related goals. Studies have generally shown positive effects of HC on weight loss in obese adults. However, limitations do exist, that if addressed would further clarify HC's viability as a clinical, obesity treatment approach. To examine the effects of HC on weight loss, moderate-to-vigorous physical activity (MVPA), and psychosocial constructs in obese adults. A randomized control trial with 44 [Mean body mass index (BMI) 36.5] middle-aged, White adults. Participants were randomly assigned to HC (n = 22) or control (n = 22) groups. A certified health coach provided bi-weekly, in-person and telehealth HC for 12 weeks. Percent excess weight loss was 15.7% in HC vs. 2.5% in controls (p< .001). The change in MVPA was significantly greater in HC (+50.3 min/wk) vs controls (+7.1 min/wk). Psychosocial constructs also changed more favorably in HC than controls. Health coaching is an effective approach for weight loss in obese adults. The results of this study support the consideration of HC as a treatment option for obese adults looking to lose weight.
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Affiliation(s)
- Richard R. Suminski
- Department of Behavioral Health and Nutrition, University of Delaware, Newark, DE, USA
| | - Tara Leonard
- Department of Behavioral Health and Nutrition, University of Delaware, Newark, DE, USA
| | - Iva Obrusnikova
- Department of Behavioral Health and Nutrition, University of Delaware, Newark, DE, USA
| | - Kristin Kelly
- Department of Behavioral Health and Nutrition, University of Delaware, Newark, DE, USA
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Halliday TM, McFadden M, Cedillo M, Barone Gibbs B, Hess R, Bryce C, Fischer GS, Huber K, McTigue KM, Conroy MB. Lifestyle strategies after intentional weight loss: results from the MAINTAIN-pc randomized trial. TRANSLATIONAL JOURNAL OF THE AMERICAN COLLEGE OF SPORTS MEDICINE 2023; 8:e000220. [PMID: 37458000 PMCID: PMC10348773 DOI: 10.1249/tjx.0000000000000220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Introduction/Purpose Weight maintenance following intentional weight loss is challenging and often unsuccessful. Physical activity and self-monitoring are strategies associated with successful weight loss maintenance. However, less is known about the type and number of lifestyle strategies used following intentional weight loss. The purpose of this study was to determine the types and amounts of strategies associated with successful long-term weight loss maintenance. Methods Data from the 24-month Maintaining Activity and Nutrition Through Technology-Assisted Innovation in Primary Care (MAINTAIN-pc) trial were analyzed. MAINTAIN-pc recruited adults (n=194; 53.4±12.2 years of age, body mass index (BMI): 30.4±5.9 kg/m2, 74% female) with recent intentional weight loss of ≥5%, randomized to tracking tools plus coaching (i.e., coaching group) or tracking tools without coaching (i.e., tracking-only group). At baseline, 6, 12, and 24 months, participants reported lifestyle strategies used in the past 6 months, including self-monitoring, group support, behavioral skills, and professional support. General linear models evaluated changes in the number of strategies over time between groups and the consistency of strategies used over the 24-month intervention. Results At baseline, 100% used behavioral skills, 73% used group support, 69% used self-monitoring, and 68% used professional support in the past 6 months; at 24 months, these rates were 98%, 60%, 75%, and 61%, respectively. While the number of participants utilizing individual strategies did not change significantly over time, the overall number of strategies participants reported decreased. More strategies were used at baseline and 6 months compared to 12- and 24-month follow-ups. The coaching group used more strategies at months 6 and 12 than the tracking-only group. Consistent use of professional support strategies over the 24-month study period was associated with less weight regain. Conclusion Weight loss maintenance interventions that incorporate continued follow-up and support from healthcare professionals are likely to prevent weight regain after intentional weight loss.
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Affiliation(s)
- Tanya M. Halliday
- Department of Health and Kinesiology, College of Health, University of Utah, Salt Lake City, UT, USA
| | - Molly McFadden
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Maribel Cedillo
- Division of General Internal Medicine, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Bethany Barone Gibbs
- Department of Health and Human Development, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rachel Hess
- Division of Health System Innovation and Research, Departments of Population Health Sciences and Internal Medicine, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Cindy Bryce
- Department of Health Policy & Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh PA, USA
| | - Gary S. Fischer
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Kimberly Huber
- Department of Health and Human Development, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kathleen M. McTigue
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Molly B. Conroy
- Division of General Internal Medicine, School of Medicine, University of Utah, Salt Lake City, UT, USA
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Cedillo M, Kukhareva PV, Larsen SM, McTigue KM, Bryce CL, Barone Gibbs B, Hess R, Huber K, Conroy MB. Impact of electronic health record-coaching features in weight change: A secondary analysis from the MAINTAIN-pc randomized trial. Obesity (Silver Spring) 2023; 31:31-36. [PMID: 36479831 DOI: 10.1002/oby.23595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/11/2022] [Accepted: 09/11/2022] [Indexed: 12/12/2022]
Abstract
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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Affiliation(s)
| | | | | | | | - Cindy L Bryce
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Rachel Hess
- University of Utah, Salt Lake City, Utah, USA
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7
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Tucker S, Bramante C, Conroy M, Fitch A, Gilden A, Wittleder S, Jay M. The Most Undertreated Chronic Disease: Addressing Obesity in Primary Care Settings. Curr Obes Rep 2021; 10:396-408. [PMID: 34297343 PMCID: PMC8300078 DOI: 10.1007/s13679-021-00444-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2021] [Indexed: 12/26/2022]
Abstract
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. 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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Affiliation(s)
- Shanna Tucker
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Carolyn Bramante
- Division of General Internal Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
- Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Molly Conroy
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Angela Fitch
- Departments of Medicine and Surgery, Massachusetts General Hospital Weight Center, Harvard Medical School, Boston, MA, USA
| | - Adam Gilden
- Kaiser Permanente Colorado, Denver, CO, USA
- University of Colorado School of Medicine, Aurora, CO, USA
| | - Sandra Wittleder
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Melanie Jay
- Departments of Medicine and Population Health, NYU Grossman School of Medicine, New York, NY, USA.
- New York Harbor Veterans Affairs, New York, NY, USA.
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8
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Gibbs BB, Tudorascu D, Bryce CL, Comer D, Fischer GS, Hess R, Huber KA, McTigue KM, Simkin-Silverman LR, Conroy MB. Lifestyle Habits Associated with Weight Regain After Intentional Loss in Primary Care Patients Participating in a Randomized Trial. J Gen Intern Med 2020; 35:3227-3233. [PMID: 32808209 PMCID: PMC7661615 DOI: 10.1007/s11606-020-06056-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 04/12/2020] [Accepted: 07/13/2020] [Indexed: 01/25/2023]
Abstract
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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Affiliation(s)
| | - Dana Tudorascu
- University of Pittsburgh, 32 Oak Hill Court, Pittsburgh, PA, USA
| | - Cindy L Bryce
- University of Pittsburgh, 32 Oak Hill Court, Pittsburgh, PA, USA
| | - Diane Comer
- University of Pittsburgh, 32 Oak Hill Court, Pittsburgh, PA, USA
| | - Gary S Fischer
- University of Pittsburgh, 32 Oak Hill Court, Pittsburgh, PA, USA
| | | | - Kimberly A Huber
- University of Pittsburgh, 32 Oak Hill Court, Pittsburgh, PA, USA
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9
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Razavi AC, Gingras V, Michos ED, Navar AM, Brown S, Delker E, Foti K, Harrison S, Lu Y, Nierenberg JL, Scott J, Tang O, Thomas AG, Turkson‐Ocran R, Wallace A, Zhang M, Lancaster KJ, Lutsey PL, Selvin E. American Heart Association EPI|Lifestyle Scientific Sessions: 2020 Meeting Highlights. J Am Heart Assoc 2020; 9:e017252. [PMID: 32476542 PMCID: PMC7429023 DOI: 10.1161/jaha.120.017252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Alexander C. Razavi
- Department of EpidemiologyTulane University School of Public Health and Tropical MedicineNew OrleansLA
- Department of MedicineTulane University School of MedicineNew OrleansLA
| | - Véronique Gingras
- Department of Population MedicineHarvard Medical School and Harvard Pilgrim Health Care InstituteBostonMA
| | - Erin D. Michos
- Ciccarone Center for the Prevention of Cardiovascular DiseaseJohns Hopkins University School of MedicineBaltimoreMD
| | | | - Sherry‐Ann Brown
- Cardio‐Oncology ProgramDivision of CardiologyMedical College of WisconsinMilwaukeeWI
| | - Erin Delker
- Department of PediatricsSchool of MedicineUniversity of CaliforniaSan DiegoCA
| | - Kathryn Foti
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical ResearchJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | - Stéphanie Harrison
- School of NutritionUniversité LavalQuebecCanada
- Centre NutritionSanté et SociétéInstitute of Nutrition and Functional FoodsUniversité LavalQuebecCanada
| | - Yifei Lu
- Department of EpidemiologyGillings School of Global Public HealthUniversity of North Carolina at Chapel HillDurhamNC
| | - Jovia L. Nierenberg
- Department of EpidemiologyTulane University School of Public Health and Tropical MedicineNew OrleansLA
| | | | - Olive Tang
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical ResearchJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | - Alvin G. Thomas
- Department of EpidemiologyGillings School of Global Public HealthUniversity of North Carolina at Chapel HillDurhamNC
| | - Ruth‐Alma Turkson‐Ocran
- American Heart Association Strategically Focused Obesity Research NetworkJohns Hopkins University School of MedicineBaltimoreMD
| | - Amelia Wallace
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical ResearchJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | - Mingyu Zhang
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical ResearchJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | - Kristie J. Lancaster
- Department of Nutrition and Food StudiesSteinhardt School of Culture, Education, and Human DevelopmentNew York UniversityNew YorkNY
| | - Pamela L. Lutsey
- Division of Epidemiology and Community HealthUniversity of Minnesota School of Public HealthMinneapolisMN
| | - Elizabeth Selvin
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical ResearchJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
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10
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Tsai AG. Integrating Obesity Treatment Into Routine Primary Care. Ann Intern Med 2019; 171:847-848. [PMID: 31711100 DOI: 10.7326/m19-2988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Adam Gilden Tsai
- University of Colorado School of Medicine, Aurora, Colorado (A.G.T.)
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