Provider Counseling and Weight Loss Outcomes in a Primary Care-Based Digital Obesity Treatment

Background: Primary care-based digital health weight loss interventions offer promise for addressing obesity in underserved populations.

Objectives: To determine if primary care providers' weight counseling is associated with weight change during a weight loss intervention.

Design: This is a secondary analysis of a randomized clinical trial testing a 12-month primary care-based digital health weight loss intervention.

Participants: Participants were community health center patients with body mass indexes of 30-44.9 kg/m².

Interventions: The weight loss intervention included tailored behavioral goal setting; weekly goal monitoring via text messaging or interactive voice response calls; counseling calls; skills training material; and participant-tailored recommendations for provider counseling.

Main measures: At 6 and 12 months, participants' weight was measured and they reported if their provider delivered weight counseling (general or intervention-specific) at their most recent visit and their perception of providers' empathy. Providers' documentation of weight counseling was extracted from health records.

Key results: Participants (n = 134-141) were predominantly female (70%) and African American (55%) with a mean age of 51 years and BMI of 36 kg/m². Participant-reported provider weight counseling was not associated with weight change. However, participants whose providers documented intervention-specific counseling at any point during the intervention (n = 35) lost 3.1 kg (95% CI 0.4 to 5.7 kg) more than those whose providers documented only general weight counseling (n = 82) and 4.0 kg (95% CI 0.1 to 7.9 kg) more than those whose providers did not document weight counseling (n = 17). Perceptions of provider empathy were associated with greater weight loss from 6 to 12 months (0.8 kg per measure unit, 95% CI 0.07 to 1.5 kg, p = .03).

Conclusions: Provider counseling that focuses specifically on engagement in a weight loss intervention may enhance weight loss outcomes relative to more general weight loss advice. Counseling that enhances patients' perceptions of empathy may be most beneficial for patients' weight loss.

Trial registration: NCT01827800.