Obesity Treatment for Socioeconomically Disadvantaged Patients in Primary Care Practice

Abstract

Few evidence-based weight loss treatment options exist for medically vulnerable patients in the primary care setting. 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. 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. The intervention produced modest weight losses, improved blood pressure control, and slowed systolic blood pressure increases in this high-risk, socioeconomically disadvantaged patient population.