A technology-assisted health coaching intervention, known as Goals for Eating and Moving (GEM), failed to achieve clinically important weight loss in a primary care setting, according to a recent cluster-randomized controlled trial. The study, published in the Annals of Family Medicine, investigated the efficacy of GEM compared to enhanced usual care (EUC) over a 12-month period.
The trial enrolled 489 patients across 19 primary care teams, with 9 teams randomized to GEM and 10 to EUC. Participants were overweight or obese adults with weight-related comorbidities. The GEM intervention included one in-person and up to 12 telephone-delivered coaching sessions, supporting goal setting and engagement with weight management programs through a software tool. The EUC arm received educational handouts.
Lack of Significant Weight Loss
At 12 months, the mean adjusted weight change was -1.4 kg in the GEM arm and -0.8 kg in the EUC arm, a non-significant difference (P = .48). There were also no statistically significant differences in secondary outcomes such as changes in waist circumference, blood pressure, or dietary habits. The estimated proportion of patients with weight loss of at least 5% was 22.8% in the GEM arm and 16.9% in the EUC arm.
Exploratory Findings on Physical Activity
Exploratory analyses revealed that the GEM arm had a greater change in the mean number of weekly minutes of moderate to vigorous physical activity (excluding walking) compared to the EUC arm (difference = 113.4 min/wk; 95% CI, 0.0-226.7). However, the researchers cautioned that this finding should be considered exploratory due to the lack of adjustment for multiple comparisons.
Challenges and Limitations
The study authors noted several potential reasons for the null findings. The GEM intervention did not increase attendance at intensive weight management programs like MOVE! and the Diabetes Prevention Program (DPP), which faced disruptions during the study period. The GEM intervention was also considered a low- to moderate-intensity approach, with participants receiving fewer than half of the offered coaching sessions.
"The GEM intervention may not have adequately addressed the needs of our diverse patient population," the authors stated. They highlighted barriers such as food insecurity, mental health issues, and social determinants of health, which may have been inadequately addressed despite efforts to recruit coaches from diverse backgrounds.
The COVID-19 pandemic also presented challenges, potentially worsening existing barriers for the study's patient population in New York City. The study acknowledges limitations, including its location in two health systems in New York City, potentially limiting generalizability. The pandemic also led to a higher dropout rate (27.2%) and fewer recruited patients than anticipated.
Implications for Future Interventions
Despite the negative results, the researchers suggest that the findings can inform the development of future weight management interventions. They emphasize the need for higher-intensity interventions and those that integrate lifestyle modifications with medication and bariatric surgery options. The study also underscores the importance of addressing social determinants of health and ensuring sufficient contact and support for patients engaged in weight management programs.
