Marc-Andre Cornier, MD, professor and director of the Division of Endocrinology, Diabetes and Metabolic Diseases at the Medical University of South Carolina, explains recent research on a behavioral weight loss intervention.
The findings underscore the efficacy of virtual-based platforms for weight loss, said Marc-Andre Cornier, MD, endocrinologist, professor, and director of the Division of Endocrinology, Diabetes and Metabolic Diseases at the Medical University of South Carolina.
In a recent study, you found those who completed a behavioral weight loss intervention program during COVID-19 lockdowns exhibited superior outcomes than those in the program pre-COVID-19. Did this finding surprise you and what do you think accounts for it?
I think the findings were a surprise, and yet were not a surprise. This is a secondary analysis of a study that we had designed to examine the effects of time-restricted eating on weight loss. The overall design was group intervention, where people were randomized to either low-calorie diet with time restriction, in terms of when they could eat those calories, vs calorie restriction without any time restriction. So that was the overall goal of the study. And we had completed 2 cohorts pre-COVID-19, each cohort about 30 individuals, and they were group-based classes; people would come in every week. And then the third cohort started just prior to the initial COVID-19 shutdown. And then boom, all of a sudden, March 13th hit—I think that was the date—and we quickly transitioned that third cohort into virtual programming, where we had them meet still weekly, but through a virtual Zoom-based platform.
We had talked about just canceling that whole cohort altogether vs trying to switch them to a virtual platform and decided that we would give that a try. So what we were expecting, if you'd looked at the other research about weight gain during COVID-19, is that people tended to gain weight. [There are] many potential causes behind that, and so we anticipated that people would not do as well in that cohort. But we actually found that they did just fine. And I said, I'm surprised yet not surprised. What we found is, with the virtual platform, people were actually more adherent to coming to the classes. And we know that adherence predicts weight loss in just about every research study out there. And so, from that perspective, we were not surprised. So, they were more adherent to the program, therefore they lost as much, or if not more, weight. So we were surprised, because we thought maybe people wouldn't do as well because of the whole COVID-19 shut down. They're not going to be as active, potentially more, you know; they're at home, so they [had] more access to food more readily. But then what we found is that these people actually were more adherent and so did well.
Now, if you look at the actual figures from the research study, you'll see that they lost more weight before the COVID-19 shut down. After the COVID-19 shut down, they were on the same weight loss trajectory as the other cohort. So I personally don't conclude that they lost more weight, because the greater weight loss for that group was actually before the shutdown. The positive spin is that they then continued to lose as much weight, they didn't stop. So at the end of the day, they did lose more weight. I think that really tells us that these virtual programs and platforms work very well for weight loss. Basically from that moment on, we changed all our weight loss programs to virtual platforms and had a lot of success with that, whether it was in research studies or in more commercial-based weight loss programs that we had our at our center in Colorado.
The study also showed the COVID-19 cohort reported more sedentary time during the day and time in bed during weekdays. How did additional outcomes attenuate these findings?
I think, as expected, there was reduced activity, more sedentary time, and that, I think, has been generally the explanation for why people have gained weight during the COVID-19 pandemic. So one would have expected less weight loss in that group because of that, but yet we saw just as much weight loss, which suggests that they probably were reducing their calorie intake in a better way, which goes with the increased adherence to the program. Sleep, interestingly, we know that poor sleep is associated with weight gain, and so it's possible the fact that they got more sleep—and that's been shown in other studies—that that had something to do with the the improved weight loss that that group got.