Directors of InCHIP's Weight Management Research Group Tricia Leahey and Amy Gorin's latest study published in JAMA Internal Medicine underscores the power of patient-provided care for weight loss maintenance
For the majority of people who lose weight, keeping the weight off can be challenging.
Research has shown biological, behavioral, and environmental factors may undermine weight loss maintenance. Within 2 to 3 years, most individuals will regain nearly all the weight they lost. As a result, the U.S. National Institutes of Health (NIH) has identified weight-loss maintenance as the next major challenge in obesity treatment.
Tricia Leahey, professor of allied health sciences and director of the UConn Institute for Collaboration on Health, Intervention, and Policy (InCHIP), and, Amy Gorin, professor of psychological sciences and vice provost for health sciences and interdisciplinary initiatives, have led a new study that underscores the power of patient-delivered care for weight loss maintenance.
Leahey and Gorin also direct InCHIP's Weight Management Research Group, which develops and assesses weight management interventions for the treatment of obesity and reduction of chronic disease.
The study, which was recently published in the prestigious, peer-reviewed academic journal, JAMA Internal Medicine, found that patient-delivered care may be more effective than care delivered by professional staff.
"Patient-delivered care holds great potential, but how patients promote health behavior change has not been investigated extensively. Our goal with this study was to better understand how patient care providers support weight loss maintenance and improve cardiovascular disease risk, and whether this model would be sustainable long-term," says Leahey, who is the study's lead author.
Leahey is a clinical health psychologist who has extensive experience developing and evaluating lifestyle interventions for obesity treatment. Her recent work has explored how patient-provided care influences short-term weight loss outcomes.
Overweight and obesity are complex health conditions that can increase one's risk of hypertension, type 2 diabetes, heart disease, stroke, and more. In addition, adults with obesity can pay up to $2,505 in additional medical expenses per year. From 2001 to 2016, total direct medical costs relating to obesity doubled from $124 billion to $260.6 billion.
Obesity impacts about 40% of U.S. adults, according to data from the U.S. Centers for Disease Control and Prevention. Obesity treatment, whether lifestyle, pharmaceutical, or surgery, produces significant weight loss and reduces the risk of diabetes and cardiovascular disease. However, these risks may return if weight is regained.
Traditionally, treatment for sustaining weight loss is delivered regularly over the course of 18 months by professional staff who have a master's degree and training in behavioral weight loss maintenance. While this approach is effective, it can be costly and difficult to maintain. Research has also demonstrated that weight regain occurs after treatment ends.
Insights into patient-provided care
Patient-delivered care may be a more cost-effective option that could be sustainable indefinitely. This model employs two types of patient providers: mentors and peers. Mentors are patients who have successfully altered their health behaviors and coach incoming patients on lifestyle change. Peers are incoming patients who support and coach one another. Typically, patient-delivered care employs a hybrid approach that incorporates patients and professional staff.
The research evidence supporting the efficacy of patient-provided care has been mixed. Studies have shown this model can enhance quality of life and survival rates for cancer patients. It has also been shown to improve short-term blood sugar levels in individuals with diabetes and weight loss outcomes when used in conjunction with professionally delivered treatment.
Other studies suggest the effectiveness of patient-provided support is limited when used for managing depression or pain.
Despite these varied outcomes, patient care providers may offer a unique sense of empathy and motivation not replicated by professional caregivers. Fellow patients may also provide ongoing weekly support over an extended period, and possibly when patients need it the most - again, not possible with professional providers.
Leahey and Gorin's study addressed these research gaps. It is the first study to examine the efficacy of a treatment intervention fully delivered by patient-providers and compare it to professionally delivered treatment. The study is also the first to train patient providers to provide all components of the treatment intervention, include both types of patient providers, and determine whether patients continue to coach one another after the treatment period ends.
"This study offers insights into how patient providers may support weight loss maintenance over the long-term. By including both mentors and peers in the treatment intervention, we leveraged the strengths of both to provide a more effective treatment program," says Leahey.
Required: ongoing support and intervention
The National Institute of Diabetes and Digestive and Kidney Disease funded the study (PI: Leahey; Co-I: Gorin), which employed a two-phase weight loss maintenance design considered the gold standard for weight loss maintenance trials.
Phase one was a weight loss intervention where all study participants engaged in a 4-month online obesity treatment program based on the U.S. Centers for Disease Control and Prevention's National Diabetes Prevention Program (DPP). This evidence-based lifestyle change program provides education on eating healthy, physical activity and behavior change strategies to support weight loss.
Phase one participants who lost more than 5% of their body weight were eligible to participate in the study's second phase, the weight loss maintenance trial.
Phase two participants were randomly assigned to participate in one of two weight loss maintenance interventions - patient-delivered treatment or standard of care delivered by a professional.
The authors found that study participants in the patient-delivered intervention group had superior weight loss maintenance compared to those in professional care.
Additionally, the patient-delivered treatment group had significantly lower diastolic blood pressure and resting heart rate and this group engaged in more lifestyle activity and less sedentary behavior during the weight loss maintenance program.
These results are meaningful and demonstrate the potential of patient-delivered care in behavioral medicine where health behavior maintenance remains a significant challenge, whether weight loss, smoking cessation, physical activity, or other behavior.
"Sustaining health behaviors, including weight loss, requires ongoing intervention and support. Patient-provided treatment eliminates the need of costly professional care and promotes ongoing support and excellent maintenance outcomes," says Leahey.
Leahey and Gorin's study indicates that patient-provided care for weight loss maintenance is just as effective as the gold-standard, professionally delivered treatment, potentially shifting the obesity treatment paradigm for long-term weight loss maintenance.
