Effect of Electronic Health Record-Based Coaching on Weight Maintenance: A Randomized Trial

Ann Intern Med. 2019 Dec 3;171(11):777-784. doi: 10.7326/M18-3337. Epub 2019 Nov 12.


Background: Weight regain after intentional loss is common. Most evidence-based weight management programs focus on short-term loss rather than long-term maintenance.

Objective: To evaluate the benefit of coaching in an electronic health record (EHR)-based weight maintenance intervention.

Design: Randomized controlled trial. (ClinicalTrials.gov: NCT01946191).

Setting: Practices affiliated with an academic medical center.

Participants: 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.

Intervention: 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.

Measurements: 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.

Results: 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%.

Limitation: Single-site trial, which limits generalizability.

Conclusion: 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.

Primary funding source: Agency for Healthcare Research and Quality and National Institutes of Health.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Blood Pressure / physiology
  • Body Mass Index
  • Body Weight Maintenance*
  • Diet
  • Electronic Health Records*
  • Exercise
  • Female
  • Fitness Trackers
  • Humans
  • Male
  • Mentoring*
  • Middle Aged
  • Personal Satisfaction
  • Primary Health Care / methods*
  • Quality of Life
  • Social Support
  • Weight Loss

Associated data

  • ClinicalTrials.gov/NCT01946191