Can DVDs and programs delivered by portable electronic devices help people lose weight and keep it off? Yes, indeed, two studies in this week's Archives of Internal Medicine conclude. That's really great news for the two-thirds of Americans and increasing numbers of people worldwide who are overweight or obese, Rick and I agree on PodMed, and it also helps beleaguered primary care practices to integrate technology into interventions that can be applied outside office visits or other time-sinks. What did these studies do?
One of the studies randomized sixty-nine overweight adults to either standard care, including biweekly sessions with a dietitian, physician or psychologist to cover weight loss goals, nutrition, physical activity and behavior change, as well as weigh-in, or the above plus a personal digital assistant programmed to record food intake, physical activity, and to update goals. This second group also received biweekly phone calls from a coach who provided individualized guidance based on the uploaded data.
The group who received the personal digital assistant plus the coaching in addition to standard care lost 3.1% more weight relative to the standard care group. One thing Rick really likes about this study is it was conducted in a Veteran's Administration population who were all self-admittedly technology-naive. Thus it establishes not just the upside of utilizing technology to augment other weight loss and maintenance efforts but to educate those who may not be technology geeks to use such devices. Now, of course, these would largely be smart phones rather than PDAs.
The second study had three arms and utilized the Diabetes Prevention Program lifestyle interventions to assist weight loss efforts. One arm was usual care, another used a coach-led approach to implementing the program, and participants in the third arm were given a DVD to use at home. At month 15 of follow-up the coach-led group had achieved a mean 2.2 reduction in body mass index (BMI), the home-based DVD viewers 1.6, and the usual care 0.9. A 7% weight loss goal was achieved by 37% of the folks in the coach-led group, just shy of 36% of those in the DVD group, and in 14.4% of those in the usual care group. Once again, the take home message is clearly that utilizing a multipronged approach to the problem of weight loss and maintenance results in more people meeting goals that translate immediately into improved cardiovascular risk.
Clearly neither of these studies reported a majority of subjects achieving goals and remaining there, so we have a long way to go to discern all the modifiable factors relative to overweight and obesity and to tailor interventions that are scalable, portable, inexpensive, and readily adopted by those who attempt them. But these studies offer hope that we're on the right track, and may allow us to utilize strategies other than bariatric surgery to get our obesity epidemic under control.
Other topics this week include outcomes related to chest compression only CPR in Circulation, the management of obstructive sleep apnea at higher altitudes in JAMA, and preventing adolescent smoking in Annals of Internal Medicine. Until next week, y'all live well.