Molly B. Conroy, MD, MPH; Kathleen M. McTigue, MD, MS, MPH; Cindy L. Bryce, PhD; Dana Tudorascu, PhD; Bethany Barone Gibbs, PhD; Jonathan Arnold, MD, MSE; Diane Comer, BA; Rachel Hess, MD, MS; Kimberly Huber, MPH; Laurey R. Simkin-Silverman, PhD; Gary S. Fischer, MD
Presented in part at the 2018 Society of General Internal Medicine Annual Meeting, Denver, Colorado, 11–14 April 2018.
Note: Drs. Conroy and Tudorascu had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the analysis.
Acknowledgment: The authors acknowledge the contributions of the trial coaches (Lacey Funair, MS; Cindy Murphy, RN [University of Pittsburgh]; and Sharon Stover, RN). Ms. Funair was also involved in the development of the intervention questionnaires. The authors also acknowledge the contributions of research assistants Tracey Murray, BS (University of Pittsburgh), and Janice Thieret, BA (University of Pittsburgh). Finally, the authors acknowledge the assistance of Maribel Cedillo, MS, RD (University of Utah) in the preparation of the final manuscript. Ms. Funair, Ms. Murphy, and Ms. Stover were compensated for their work as health coaches. Ms. Murray, Ms. Thieret, and Ms. Cedillo did not receive compensation for their contributions apart from their employment at their respective institutions.
Grant Support: By the Agency for Healthcare Research and Quality (R18HS021162-02) and the National Institutes of Health (grant UL1TR000005 to the University of Pittsburgh Clinical and Translational Science Institute to provide research registry support).
Disclosures: Dr. McTigue reports a patent (V3562 D993 P1) with royalties paid. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-3337.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Catharine B. Stack, PhD, MS, Deputy Editor, Statistics, reports that she has stock holdings in Pfizer, Johnson & Johnson, and Colgate-Palmolive. Christina C. Wee, MD, MPH, Deputy Editor, reports employment with Beth Israel Deaconess Medical Center. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Yu-Xiao Yang, MD, MSCE, Deputy Editor, reports that he has no financial relationships or interest to disclose.
Data Sharing Statement: Data available to interested readers by contacting Dr. Conroy at molly.conroy@hsc.utah.edu.
Corresponding Author: Molly B. Conroy, MD, MPH, University of Utah, 30 North 1900 East, Room 5R218, Salt Lake City, UT 84132; e-mail, molly.conroy@hsc.utah.edu.
Current Author Addresses: Dr. Conroy: Division of General Internal Medicine, University of Utah School of Medicine, 50 North Medical Drive, 5R218, Salt Lake City, UT 84132.
Drs. McTigue and Arnold: University of Pittsburgh, 230 McKee Place, Suite 600, Pittsburgh, PA 15213.
Dr. Bryce: Graduate School of Public Health, University of Pittsburgh, A612 Crabtree Hall, 130 DeSoto Street, Pittsburgh, PA 15261.
Dr. Tudorascu and Ms. Comer: University of Pittsburgh, 3501 Forbes Avenue, Suite 830, Pittsburgh, PA 15261.
Dr. Barone Gibbs: University of Pittsburgh, 32 Oak Hill, Room 220, Pittsburgh, PA 15261.
Dr. Hess: University of Utah, Williams Building, Room 1N492, 295 Chipeta Way, Salt Lake City, UT 84108.
Ms. Huber: Physical Activity and Weight Management Research Center, University of Pittsburgh, 32 Oak Hill Court, Room 224, Pittsburgh, PA 15261.
Dr. Simkin-Silverman: 154 James Place, Pittsburgh, PA 15228.
Dr. Fischer: University of Pittsburgh School of Medicine, MUH E925, 200 Lothrop Street, Pittsburgh, PA 15213.
Author Contributions: Conception and design: M.B. Conroy, K.M. McTigue, C.L. Bryce, D. Tudorascu, R. Hess, L.R. Simkin-Silverman, G.S. Fischer.
Analysis and interpretation of the data: M.B. Conroy, K.M. McTigue, D. Tudorascu, B. Barone Gibbs, J. Arnold, D. Comer, R. Hess, G.S. Fischer.
Drafting of the article: M.B. Conroy, C.L. Bryce, D. Tudorascu, K. Huber, G.S. Fischer.
Critical revision of the article for important intellectual content: M.B. Conroy, K.M. McTigue, C.L. Bryce, B. Barone Gibbs, R. Hess, L.R. Simkin-Silverman, G.S. Fischer.
Final approval of the article: M.B. Conroy, K.M. McTigue, C.L. Bryce, D. Tudorascu, B. Barone Gibbs, J. Arnold, D. Comer, R. Hess, K. Huber, L.R. Simkin-Silverman, G.S. Fischer.
Provision of study materials or patients: M.B. Conroy, K.M. McTigue.
Statistical expertise: D. Tudorascu.
Obtaining of funding: M.B. Conroy.
Administrative, technical, or logistic support: M.B. Conroy, K.M. McTigue, J. Arnold, K. Huber, G.S. Fischer.
Collection and assembly of data: M.B. Conroy, K.M. McTigue, J. Arnold, K. Huber.
Weight regain after intentional loss is common. Most evidence-based weight management programs focus on short-term loss rather than long-term maintenance.
To evaluate the benefit of coaching in an electronic health record (EHR)–based weight maintenance intervention.
Randomized controlled trial. (ClinicalTrials.gov: NCT01946191)
Practices affiliated with an academic medical center.
Adult outpatients with body mass index (BMI) of 25 kg/m2 or higher, intentional weight loss of at least 5% in the previous 2 years, and no bariatric procedures in the previous 5 years.
Participants were randomly assigned to EHR tools (tracking group) versus EHR tools plus coaching (coaching group). The EHR tools included weight, diet, and physical activity tracking flow sheets; standardized surveys; and reminders. The coaching group received 24 months of personalized coaching through the EHR patient portal, with 24 scheduled contacts.
The primary outcome was weight change at 24 months. Secondary outcomes included 5% weight loss maintenance and changes in BMI, waist circumference, number of steps per day, health-related quality of life, physical function, blood pressure, and satisfaction.
Among 194 randomly assigned participants (mean age, 53.4 years [SD, 12.2]; 143 [74%] women; 171 [88%] white), 157 (81%) completed the trial. Mean baseline weight and BMI were 85.8 kg (SD, 19.1) and 30.4 kg/m2 (SD, 5.9). At 24 months, mean weight regain (± SE) was 2.1 ± 0.62 kg and 4.9 ± 0.63 kg in the coaching and tracking groups, respectively. The between-group difference in weight change at 24 months was significant (−2.86 kg [95% CI, −4.60 to −1.11 kg]) in the linear mixed model. At 24 months, 65% of participants in the coaching group and 50% in the tracking group maintained weight loss of at least 5%.
Single-site trial, which limits generalizability.
Among adults with intentional weight loss of at least 5%, use of EHR tools plus coaching resulted in less weight regain than EHR tools alone.
Agency for Healthcare Research and Quality and National Institutes of Health.
Conroy MB, McTigue KM, Bryce CL, et al. Effect of Electronic Health Record–Based Coaching on Weight Maintenance: A Randomized Trial. Ann Intern Med. 2019;171:777–784. [Epub ahead of print 12 November 2019]. doi: https://doi.org/10.7326/M18-3337
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© 2020
Published: Ann Intern Med. 2019;171(11):777-784.
DOI: 10.7326/M18-3337
Published at www.annals.org on 12 November 2019
Infectious Disease, Obesity, Pneumonia, Pulmonary/Critical Care.
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