Obesity and obesity-related conditions such as diabetes and cardiovascular disease pose serious challenges to health care systems world-wide.1 In the US, current obesity (body mass index [BMI] >30 kg/m2) rates are 35% for men and 40% for women,2 and in the European Union, between 36.1% and 67.5% of the adult population is considered overweight or obese (BMI >25 kg/m2).3 Excess body weight is strongly associated with increased morbidity and mortality,4 in part due to increased risks of type 2 diabetes, cardiovascular disease, and certain cancers.5 Obesity also constitutes a significant financial burden for modern health care systems,6 and mathematical modelling has demonstrated that significant health care savings could be made even through very modest weight loss (4.2% of body weight) in obese adults that are at high risk of developing diabetes or cardiovascular disease.7
Modifiable lifestyle factors are strongly associated with type 2 diabetes: in the US, 87.5% of adults diagnosed with diabetes are overweight or obese (BMI >25 kg/m2), 73.6% have systolic blood pressure >140 mmHg and 40.8% are physically inactive.8 Current American Association of Clinical Endocrinologists and American College of Endocrinology (AACE/ACE) clinical practice guidelines recommend preventing progression to diabetes in overweight (BMI >25 kg/m2) high-risk pre-diabetic or metabolic syndrome patients through lifestyle therapy aimed at stimulating weight loss.9 However, poor adherence to prescribed lifestyle and medical therapies is associated with increased morbidity and mortality in diabetes patients. Fortunately, known barriers to lifestyle changes, such as physical discomfort during exercise, tiredness, lack of time, and lack of motivation, may be alleviated by supportive counselling.10–12
In fact, behavioral health counselling programs that include consistent support from a health coach offering education, skill building and support, effectively reduce chronic disease risks associated with excess weight,13 and remote digital health counselling programs with human coaching have recently emerged as effective and scalable alternatives to face-to-face or in-person counselling programs.14 These remotely delivered programs retain high level personal interactions with health coaches and offer support and education aimed at behavior change, while at the same time being delivered flexibly using modern tele-communications to increase accessibility over large geographical areas.15
At the 27th AACE meeting, which was held in Boston, MA, May 16–20, 2018, Dr Dhiren Patel, a diabetes specialist at the Alpert Medical School of Brown University and at Massachusetts College of Pharmacy in Boston, MA, and colleagues, presented results from a study demonstrating the value of a remote digital health coaching model in the care of type 2 diabetes patients in the Unites States.16
In Dr Patel’s study, carried out between June 2014 and November 2017, 756 patients were paired up with dedicated health advisors who engaged with the patients for up to 12 months to deliver personalized education, motivational strategies, and patient accountability through online and telephone communication channels, with the aim of promoting lifestyle changes leading to weight loss.
“Our study participants were in communication with their health advisor weekly for the first 3 months, then monthly thereafter, via phone, text messages and email. The health advisors used motivational interviewing techniques to determine barriers to care compliance and to identify patient-specific solutions to enhance their engagement but were not involved in prescriptive guidance or clinical decision-making”, explains Dr Patel.
“At 3 months, the study participants had lost an average of 2.2 kg (4.9 lbs) and reduced their glycated hemoglobin (HbA1c), a long-term marker of hyperglycemia, from 8.4% to 7.4%. At the end of the study, participants had lost an average of 2.0 kg (4.5 lbs) and reduced their HbA1c to 7.5%. We also observed a 19% increase in foot exams and a 17% increase in eye exams in patients that had previously been non-compliant.”
Dr Patel points out that although technology-based methods to deliver effective diabetes self-management education and support are recommended by the American Diabetes Association’s 2018 Standards of Medical Care in Diabetes guidelines, very few studies have demonstrated the long-term success of such efforts. “Our study is one of the first of its kind to show impact over time of a non-prescriptive digital health coaching program producing behavioral changes that lead to better health outcomes and improved quality of life.”
Although the 2.0 kg weight loss reported in Dr Patel’s study is less pronounced than the weight loss reported in many other weight loss studies,17 it is important to point out that Dr Patel helped his patients lose weight by supporting the implementation of healthy lifestyle changes, not by prescribing a specific weight-loss diet regimen. If Dr Patel’s successful health coaching approach can be combined with more traditional weight loss regimens, there is a chance that we might finally be able to stem the rising global tide of obesity. Only time, and further clinical trials, will tell.
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