Provider Counseling and Weight Loss Outcomes in a Primary Care-Based Digital Obesity Treatment
Primary care-based digital health weight loss interventions offer promise for addressing obesity in underserved populations.
To determine if primary care providers’ weight counseling is associated with weight change during a weight loss intervention.
This is a secondary analysis of a randomized clinical trial testing a 12-month primary care-based digital health weight loss intervention.
Participants were community health center patients with body mass indexes of 30–44.9 kg/m2.
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.
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.
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).
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.
KEY WORDSweight loss primary health care obesity community health centers vulnerable populations
We wish to acknowledge the Track study participants and the health care providers for making this research possible. We also acknowledge the research assistants who assisted with data collection on EHR provider counseling data, Jacob Christy and Jasmine Burroughs.
This research is funded in part by the following grants: R01DK093829 to Dr. Gary Bennett; K23HL127334 to Dr. Megan McVay; K12HD043446 to Dr. Dori Steinberg.
Compliance with Ethical Standards
Conflict of Interest
Gary Bennett holds equity in Coeus Health, LLC, and serves on the scientific advisory board of Nutrisystem, is a member of the board of directors at Girl Trek, and is a past president and a member of the board of directors at the Society of Behavioral Medicine. All remaining authors declare that they do not have a conflict of interest.
- 1.LeBlanc E, O’Connor E, Whitlock EP, Patnode C, Kapka T. Screening for and Management of Obesity and Overweight in Adults. Rockville (MD): Agency for Healthcare Research and Quality (US); 2011.Google Scholar
- 7.Lake T. Do HMOs make a difference? Consumer assessments of health care. Inquiry. 1999; 36(4):411–8.Google Scholar
- 12.Mohr DC, Cuijpers P, Lehman K. Supportive Accountability: A Model for Providing Human Support to Enhance Adherence to eHealth Interventions. J Med Internet Res [Internet]. 2011 Mar 10 [cited 2018 May 4];13(1).Google Scholar
- 15.Bennett GG, Steinberg D, Askew S, Levine E, Foley P, Batch BC, Svetkey LP, Bosworth HB, Puleo EM, Brewer A, DeVries A. Effectiveness of an app and provider counseling for obesity treatment in primary care. Am J Prev Med. 2018.Google Scholar
- 19.Dennison L, Morrison L, Lloyd S, Phillips D, Stuart B, Williams S, et al. Does brief telephone support improve engagement with a web-based weight management intervention? Randomized controlled trial. J Med Internet Res. 2014 Mar 28.Google Scholar