Effect of Telehealth Delivery of Weight Management by (Allied) Health Professionals in Rural Areas

• Published in: Obesity (Silver Spring, Md.) Vol. 30; p. 165
• Main Authors: Gorczyca, Anna, Washburn, Richard, Ptomey, Lauren, Mayo, Matthew, Krebill, Ron, Sullivan, Debra, Gibson, Cheryl, Stolte, Sarah, Donnelly, Joseph
• Format: Journal Article
• Language: English
• Published: Silver Spring Blackwell Publishing Ltd 01.11.2022
• Subjects: Intervention; Medical personnel; Overweight; Rural areas; Telemedicine; Weight control
• ISSN: 1930-7381; 1930-739X

Background: Weight management delivered by university affiliated interventionists has shown clinically relevant weight loss in rural adults; however, this approach is unsustainable. Thus, we evaluated a telehealth weight loss intervention delivered by personnel associated with rural health clinics, e.g., nurses, registered dietitians, or allied health professionals trained by members of our weight management research team to adults with overweight/obesity. Methods: Personnel (n=6) were trained to deliver weight management (6-mos. weight loss, 12 mos. maintenance) that included education/behavioral counseling, reduced energy diet and increased physical activity. Interventionists were provided training with a detailed intervention notebook, a 1-day on-site session at each clinic and 4 one-hour sessions delivered via Zoom®. Rural adults (BMI= 35 kg/m2, 82% female) were randomized (2:2:1) to 1 of 3 intervention arms: group phone (GP, n=71), individual phone (IP, n=80) or enhanced usual care (EUC, n=36). Identical interventions were delivered weekly by GP (~45 min, 12-15 participants) or IP (~15 min) across 6 mos. Participants in the EUC arm attended 1- 45 min. in-person session at baseline and were provided with printed materials on healthy eating, portion size and physical activity. An intent-to-treat analysis with multiple imputation for missing data (1-way ANOVA followed by 2 pairwise t-tests) was used evaluate our primary aim, weight change across 6 mos. (GP vs. IP and IP vs. EUC). Results: Clinically relevant weight loss was observed in the GP (-11.4 ± 6.7 kg, 11.7%) and the IP arms (-9.1 ± 6.8 kg, 9.2%) but not in the EUC arm (-2.6 ± 4.8 kg, 2.5%), with statistically significant differences between arms (p < 0.0001). Specifically, 6 mo. weight loss was significantly greater in the IP vs. EUC arms (6.5 kg, 97.5% CI [-9.8 to -3.2] but did not differ between the GP and IP arms (2.4 kg, 97.5% CI [-5.2 to 0.48]. Participant per session intervention delivery costs were ~ $7, $14, and $42 for the GP, IP and EUC arms, respectively. Conclusions: Weight management delivered by personnel associated with rural health clinics via telehealth represents a low-burden, affordable option that if implemented has the potential to provide weight management to underserved residents of rural areas with overweight/obesity.