Obesity treatment for socioeconomically disadvantaged patients in primary care practice

Abstract

Background: Few evidence-based weight loss treatment options exist for medically vulnerable patients in the primary care setting.

Methods: We conducted a 2-arm, 24-month randomized effectiveness trial in 3 Boston community health centers (from February 1, 2008, through May 2, 2011). Participants were 365 obese patients receiving hypertension treatment (71.2% black, 13.1% Hispanic, 68.5% female, and 32.9% with less than a high school educational level). We randomized participants to usual care or a behavioral intervention that promoted weight loss and hypertension self-management using eHealth components. The intervention included tailored behavior change goals, self-monitoring, and skills training, available via a website or interactive voice response; 18 telephone counseling calls; primary care provider endorsement; 12 optional group support sessions; and links with community resources.

Results: At 24 months, weight change in the intervention group compared with that in the usual care group was -1.03 kg (95% CI, -2.03 to -0.03 kg). Twenty-four-month change in body mass index (calculated as weight in kilograms divided by height in meters squared) in the intervention group compared with that in the usual care group was -0.38 (95% CI, -0.75 to -0.004). Intervention participants had larger mean weight losses during the 24 months compared with that in the usual care group (area under the receiver operating characteristic curve, -1.07 kg; 95% CI, -1.94 to -0.22). Mean systolic blood pressure was not significantly lower in the intervention arm compared with the usual care arm.

Conclusion: The intervention produced modest weight losses, improved blood pressure control, and slowed systolic blood pressure increases in this high-risk, socioeconomically disadvantaged patient population. Trial Registration clinicaltrials.gov Identifier: NCT00661817.

Figure 1

CONSORT flow diagram. BMI indicates body mass index (calculated as weight in kilograms divided by height in meters squared); EMR, electronic medical record; HTN, hypertension; PCP, primary care provider. ^aNon-English or non-Spanish speakers. ^bChronic use of medications likely to cause weight gain or prevent weight loss. ^cParticipants excluded due to a serious medical condition or psychiatric condition.

Figure 2

Effects of Be Fit, Be Well lifestyle intervention on (A) weight, (B) systolic and (C) diastolic blood pressure, and (D) blood pressure control. Error bars indicate 95% CIs.