Dialing In: Effect of Telephonic Wellness Coaching on Weight Loss | Page 4

Published Online: February 25, 2014
Min Tao, PhD; Krishna Rangarajan, MS; Michael L. Paustian, PhD, MS; Elizabeth A. Wasilevich, PhD, MPH; and Darline K. El Reda, DrPH, MPH
The respondents targeted for telephonic wellness coaching reported a small but significant weight loss. It is unclear whether weight loss can be sustained beyond 1 year and whether the small weight loss observed has meaningful longterm health benefits. Sustaining weight loss is a persistent issue in weight loss programs.32 We only identified 1 published study that followed telephonic weight loss program participants for up to 2 years, and that study reported no significant weight loss among telephonic coaching participants at 2 years compared with participants who received a mail intervention or usual care.33,34 It is worth noting that in this HealthPartners clinical trial, participants who received either phone, mail, or usual care were all highly motivated volunteers who responded to mail or a clinic poster about the trial. Because a major technique in telephonic wellness coaching is motivational interviewing, the benefit of intervention may be limited to participants who are already highly motivated. As shown in this study, wellness coaching participants who started in the preparation stage benefited significantly from the program. Participants who were already in the action stage reported weight loss, but showed no additional benefit from completing the program. Additional studies with different populations and additional settings are needed to fully address the impacts of telephonic wellness coaching on both short-term and long-term weight loss.

Research suggests that a moderate amount of weight loss has potential benefits for obese patients.35,36 But the amount of weight loss observed in this telephonic wellness coaching program is less than 1% of total body weight and among a healthier population. Future studies on telephonic wellness coaching and weight loss may need to also report details on nutritional and physical activity components of the programs that could be associated with weight loss and the sustainability of these behaviors. If the lifestyle changes adopted through wellness coaching result in a sustainable, small amount of weight loss, this may improve health outcomes in the long term.

Take-Away Points

Telephonic wellness coaching programs are popular interventions for a large population because of their versatility and convenience.
  • This large retrospective study observed small weight loss among telephonic wellness coaching participants more than 6 months after they finished the program.

  • It evaluated factors that impact weight loss among wellness coaching participants, including participants’ initial stage of change, motivation level, and intensity of coaching received. This information can assist decision making of whether to offer telephonic wellness coaching programs to a population. The analysis on successful elements of wellness coaching programs can help compare telephonic wellness coaching programs or improve program design.
Author Affiliations: Clinical Epidemiology and Biostatistics, Health Care Value, Blue Cross Blue Shield of Michigan (BCBSM).

Funding Source: None.

Author Disclosures: Drs Tao, Paustian, and El Reda all report being employed by BCBSM. Mr Rangarajan and Dr Wasilevich report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.

Authorship Information: Concept and design (MT, KR, MLP, EAW, DKER); acquisition of data (MT, DKER); analysis and interpretation of data (MT, KR, MLP, DKER); drafting of the manuscript (MT, EAW, DKER); critical revision of the manuscript for important intellectual content (MT, MLP, EAW, DKER); statistical analysis (MT, KR); and supervision (MT, DKER).

Address correspondence to: Min Tao, PhD, Tower 500, Renaissance Ctr, Detroit, MI 48243. E-mail: mtao@bcbsm.com.
1. Centers for Disease Control and Prevention. Chronic disease prevention and health promotion: obesity. http://www.cdc.gov/chronicdisease/ resources/publications/aag/obesity.htm. Accessed January 2013.

2. Criqui MH, Mebane I, Wallace RB, Heiss G, Holdbrook MJ. Multivariate correlates of adult blood pressures in nine North American populations: the Lipid Research Clinics Prevalence Study. Prev Med. 1982;11(4):391-402.

3. Dyer AR, Elliott P. The INTERSALT study: relations of body mass index to blood pressure. INTERSALT Co-operative Research Group. J Hum Hypertens. 1989;3(5):299-308.

4. Stamler R, Stamler J, Riedlinger WF, Algera G, Roberts RH. Weight and blood pressure. Findings in hypertension screening of 1 million Americans. JAMA. 1978;240(15):1607-1610.

5. Haffner SM, Mitchell BD, Hazuda HP, Stern MP. Greater influence of central distribution of adipose tissue on incidence of noninsulin- dependent diabetes in women than men. Am J Clin Nutr. 1991;53(5):1312-1317.

6. Hu FB, Manson JE, Stampfer MJ, et al. Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. N Engl J Med. 2001;345(11): 790-797.

7. Goran MI, Ball GD, Cruz ML. Obesity and risk of type 2 diabetes and cardiovascular disease in children and adolescents. J Clin Endocrinol Metab. 2003;88(4):1417-1427.

8. Kahn SE, Hull RL, Utzschneider KM. Mechanisms linking obesity to insulin resistance and type 2 diabetes. Nature. 2006;444(7121):840-846.

9. Health implications of obesity. National Institutes of Health Consensus Development Conference Statement. Ann Intern Med. 1985;103(6 pt 2):1073-1077.

10. Kurth T, Gaziano JM, Berger K, et al. Body mass index and the risk of stroke in men. Arch Intern Med. 2002;162(22):2557-2562.

11. Strazzullo P, D’Elia L, Cairella G, et al. Excess body weight and incidence of stroke: meta-analysis of prospective studies with 2 million participants. Stroke. 2010;41(5):e418-e426.

12. Rönmark E, Andersson C, Nystrom L, et al. Obesity increases the risk of incident asthma among adults. Eur Respir J. 2005;25(2):282-288.

13. Mandal S, Hart N. Respiratory complications of obesity. Clin Med. 2012;12(1):75-78.

14. Giovannucci E. Insulin and colon cancer. Cancer Causes Control. 1995;6(2):164-179.

15. Giovannucci E, Colditz GA, Stampfer MJ, Willett WC. Physical activity, obesity, and risk of colorectal adenoma in women (United States). Cancer Causes Control. 1996;7(2):253-263.

16. Must A, Jacques PF, Dallal GE, Bajema CJ, Dietz WH. Long-term morbidity and mortality of overweight adolescents. A followup of the Harvard Growth Study of 1922 to 1935. N Engl J Med. 1992;327(19):1350-1355.

17. Flegal KM, Graubard BI, Williamson DF, Gail MH. Excess deaths associated with underweight, overweight, and obesity. JAMA. 2005; 293(15):1861-1867.

18. Flegal KM, Graubard BI, Williamson DF, Gail MH. Cause-specific excess deaths associated with underweight, overweight, and obesity. JAMA. 2007;298(17):2028-2037.

19. Manson JE, Stampfer MJ, Hennekens CH, Willett WC. Body weight and longevity. A reassessment. JAMA. 1987;257(3):353-358.

20. Finkelstein EA, Trogdon JG, Cohen JW, Dietz W. Annual medical spending attributable to obesity: payer-and service-specific estimates. Health Aff (Millwood). 2009;28(5):w822-w831.

21. Institute HS. Moving to an Evidence-Based Health Coaching Practice. http://infocus.healthsciences.org/InFocus_Moving_to_an_Evidence- Based_Health_Coaching_Practice.html. Accessed January 2013.

22. Lichtenstein E, Glasgow RE, Lando HA, Ossip-Klein DJ, Boles SM. Telephone counseling for smoking cessation: rationales and metaanalytic review of evidence. Health Educ Res. 1996;11(2):243-257.

23. Stead LF, Perera R, Lancaster T. Telephone counselling for smoking cessation. Cochrane Database Syst Rev. 2006;19(3):CD002850.

24. Terry PE, Seaverson EL, Grossmeier J, Anderson DR. Effectiveness of a worksite telephone-based weight management program. Am J Health Promot. 2011;25(3):186-189.

25. Vanwormer JJ, Boucher JL, Pronk NP. Telephone-based counseling improves dietary fat, fruit, and vegetable consumption: a best-evidence synthesis. J Am Diet Assoc. 2006;106(9):1434-1444.

26. Hellerstedt WL, Jeffery RW. The effects of a telephone-based intervention on weight loss. Am J Health Promot. 1997;11(3):177-182.

27. van Wier MF, Ariëns GA, Dekkers JC, et al. Phone and e-mail counselling are effective for weight management in an overweight working population: a randomized controlled trial. BMC Public Health. 2009;9:6.

28. University of Michigan Health Resource Center. Health Risk Appraisal (HRA). http://www.hmrc.umich.edu/content.aspx?pageid=19 &fname=hra.txt. Accessed January 2013.

29. Johnson and Johnson Company, Wellness + Prevention Inc. Health Risk Assessment. http://www.healthmedia.com/products/digitalcoachingprograms/ succeed.htm. Accessed January 2013.

30. Tukey J. Exploratory data analysis Addison-Wesely; 1977.

31. SAS. SAS 9.2 Product Documentation. http://support.sas.com/documentation/ 92/index.html. Accessed January 2013.

32. Svetkey LP, Stevens VJ, Brantley PJ, et al. Comparison of strategies for sustaining weight loss: the weight loss maintenance randomized controlled trial. JAMA. 2008;299(10):1139-1148.

33. Jeffery RW, Sherwood NE, Brelje K, et al. Mail and phone interventions for weight loss in a managed-care setting: weigh-to-be one-year outcomes. Int J Obes Relat Metab Disord. 2003;27(12):1584-1592.

34. Sherwood NE, Jeffery RW, Pronk NP, et al. Mail and phone interventions for weight loss in a managed-care setting: weigh-to-be 2-year outcomes. Int J Obes (Lond). 2006;30(10):1565-1573.

35. Goldstein DJ. Beneficial health effects of modest weight loss. Int J Obes Relat Metab Disord. 1992;16(6):397-415.

36. Wing RR, Lang W, Wadden TA, et al. Benefits of modest weight loss in improving cardiovascular risk factors in overweight and obese individuals with type 2 diabetes. Diabetes Care. 2011;34(7):1481-1486.
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