Technology-Assisted Weight Loss Interventions in Primary Care: A Systematic Review

David M. Levine, Stella Savarimuthu, Allison Squires, Joseph Nicholson, Melanie Jay

Research output: Contribution to journalArticle

Abstract

BACKGROUND: The US Preventive Services Task Force recommends screening for and treating obesity. However, there are many barriers to successfully treating obesity in primary care (PC). Technology-assisted weight loss interventions offer novel ways of improving treatment, but trials are overwhelmingly conducted outside of PC and may not translate well into this setting. We conducted a systematic review of technology-assisted weight loss interventions specifically tested in PC settings. METHODS: We searched the literature from January 2000 to March 2014. Inclusion criteria: (1) Randomized controlled trial; (2) trials that utilized the Internet, personal computer, and/or mobile device; and (3) occurred in an ambulatory PC setting. We applied the Cochrane Effective Practice and Organization of Care (EPOC) and Delphi criteria to assess bias and the Pragmatic-Explanatory Continuum Indicator Summary (PRECIS) criteria to assess pragmatism (whether trials occurred in the real world versus under ideal circumstances). Given heterogeneity, results were not pooled quantitatively. RESULTS: Sixteen trials met inclusion criteria. Twelve (75 %) interventions achieved weight loss (range: 0.08 kg – 5.4 kg) compared to controls, while 5–45 % of patients lost at least 5 % of baseline weight. Trial duration and attrition ranged from 3–36 months and 6–80 %, respectively. Ten (63 %) studies reported results after at least 1 year of follow-up. Interventions used various forms of personnel, technology modalities, and behavior change elements; trials most frequently utilized medical doctors (MDs) (44 %), web-based applications (63 %), and self-monitoring (81 %), respectively. Interventions that included clinician-guiding software or feedback from personnel appeared to promote more weight loss than fully automated interventions. Only two (13 %) studies used publically available technologies. Many studies had fair pragmatism scores (mean: 2.8/4), despite occurring in primary care. DISCUSSION: Compared to usual care, technology-assisted interventions in the PC setting help patients achieve weight loss, offering evidence-based options to PC providers. However, best practices remain undetermined. Despite occurring in PC, studies often fall short in utilizing pragmatic methodology and rarely provide publically available technology. Longitudinal, pragmatic, interdisciplinary, and open-source interventions are needed.

Original languageEnglish (US)
Pages (from-to)107-117
Number of pages11
JournalJournal of General Internal Medicine
Volume30
Issue number1
DOIs
StatePublished - Jan 1 2015

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Weight Loss
Primary Health Care
Technology
Obesity
Microcomputers
Advisory Committees
Ambulatory Care
Practice Guidelines
Internet
Software
Randomized Controlled Trials
Organizations
Weights and Measures
Equipment and Supplies

Keywords

  • obesity
  • primary care
  • review
  • technology
  • weight loss

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Technology-Assisted Weight Loss Interventions in Primary Care : A Systematic Review. / Levine, David M.; Savarimuthu, Stella; Squires, Allison; Nicholson, Joseph; Jay, Melanie.

In: Journal of General Internal Medicine, Vol. 30, No. 1, 01.01.2015, p. 107-117.

Research output: Contribution to journalArticle

Levine, David M. ; Savarimuthu, Stella ; Squires, Allison ; Nicholson, Joseph ; Jay, Melanie. / Technology-Assisted Weight Loss Interventions in Primary Care : A Systematic Review. In: Journal of General Internal Medicine. 2015 ; Vol. 30, No. 1. pp. 107-117.
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