Tailored obesity intervention program offers hope for weight loss in underserved patients

Reviewed by Emily Henderson, B.Sc.Sep 5 2020

Low-income Louisiana patients enrolled in a tailored obesity intervention program lost much more weight than counterparts receiving usual care. Study results were published this week in The New England Journal of Medicine. This population, who traditionally face the most barriers to weight loss and the highest levels of obesity, found success in a coaching program delivered directly through their primary care clinics.

It's hard to lose weight for anyone. Adding any obstacle to treatment, especially poverty, makes that task much more difficult. We wanted to remove as many barriers as possible so we brought an effective program to people where they are, in the primary care clinics where they're comfortable, and it works."

Peter Katzmarzyk, Ph.D., Associate Executive Director of Population and Public Health Sciences at Pennington Biomedical Research Center

Over the past decade, several studies failed to achieve meaningful weight loss among people with obesity through lifestyle modification, or diet and exercise, Dr. Katzmarzyk said. The results from the Promoting Successful Weight Loss in Primary Care in Louisiana (PROPEL) study demonstrate the importance of making the program as convenient for the patient as possible.

The PROPEL study enrolled 803 patients from 18 primary care clinics in rural and urban parts of the state. The two-year program randomly divided the patients into two groups:

• 452 took part in an "intensive lifestyle intervention." For six months, patients had weekly in-person or phone sessions with a health coach. The coaches demonstrated appropriate portion sizes and identified portion-controlled foods such as fruits, soups and frozen entrees. The coaches also worked with patients on coping with stress and increasing physical activity. The patients were given electronic scales and encouraged to weigh themselves every day. For the remaining 18 months, the patients had monthly in-person or phone sessions.
• 351 patients received "usual care," routine primary care services and three newsletters per year with articles on the importance of being active, getting enough sleep, household money management, family coping skills, and not smoking.

The lifestyle group lost 5 percent of their body weight, compared to 0.5 percent in the usual care group.

Pennington Biomedical Executive Director John Kirwan, Ph.D., said the study has important health implications in the effort to slow the global obesity epidemic.

"The significance of this study cannot be overstated. Obesity has been linked to at least 13 deadly cancers and lies at the root of type 2 diabetes and heart disease and stroke. People with obesity who contract COVID-19 are at much greater risk for serious illness or death," Dr. Kirwan said. "A weight loss of 3 percent to 5 percent can generate significant health benefits."