14 hours ago
Peer-Led Weight Loss Maintenance Proves Superior
Can a mentor/peer-led strategy surpass professionally led behavioral weight management sessions in helping patients with obesity maintain weight loss? If the findings of a recently published study are any indication, then the promise of keeping weight off after initial weight loss might be closer than ever.
Obesity treatments (eg, bariatric surgery, lifestyle management, and medications like GLP-1s) have been shown in clinical trials and real-life settings to help patients with obesity lose anywhere from 10% to 60% of excess body weight, with added improvements in cardiovascular disease risk factors.
Tricia M. Leahey, PhD
But these gains are commonly fleeting, Tricia M. Leahey, PhD, lead study author, a professor in the Department of Allied Health Sciences, and director of the Institute for Collaboration on Health Intervention and Policy at the University of Connecticut in Storrs, Connecticut, told Medscape Medical News .
'Regardless of how people lose weight, they tend to regain the weight they lost. It starts quickly after initial treatment, and within 1-3 years, most have returned to their pretreatment weight,' she said.
Biology plays a critical role.
'Because of biology — what we call metabolic adaptation to weight loss — the brain is always trying to push people back to their heaviest fat mass, unless they have tools like medicines or surgery,' said Gretchen Aames, PhD, clinical health psychologist and assistant professor of psychology in the Mayo Clinic College of Medicine in Jacksonville, Florida. 'I think that people underestimate the effort that it takes to keep the weight off,' she said.
'There's also psychology and behavior that's associated with weight management,' said Leahy, who added that continuous care strategies (ie, regular professional contact, skills training, and behavioral and social support sessions that are delivered biweekly and gradually tapered over time) can be costly.
From Professional to Peer Support
Leahy and her colleagues have conducted several studies examining the potential role that trained mentors (people who have previously faced and overcome a health situation) and 'peer dyads' (patient pairs initiating health behavior change matched to support one another) might play in helping individuals with obesity maintain initial weight loss.
Their latest effort was a two-phase, proof-of-concept trial in which participants first received a 4-month online obesity treatment lifestyle intervention that was based on the National Diabetes Prevention Program (DPP). (DPP is a lifestyle change program designed to help prevent or delay diabetes in adults with prediabetes.)
In phase 2, participants who achieved ≥ 5% weight loss were randomly assigned to an 18-month patient-provided weight maintenance program (n = 153) or to professionally delivered, 90-minute standard-of-care (SOC) sessions (n = 134) tapered over time. Participants' mean age was 53.6 years, and the majority (83.6%) were women.
Patient-directed programs were delivered by two trained mentors who had previously lost ≥ 7% of body weight and kept it off for ≥ 1 year and who held 90-minute group sessions tapered over time. In the first seven sessions, the content was focused on peer training, empathic listening, and sandwich feedback (initiating feedback with a supportive comment, providing constructive suggestions or support, and ending with a supportive comment.)
Peers were study participants who were randomly paired by gender and age range (18-30 years, 30-40 years); reciprocal support was composed of weekly progress reports and feedback exchanges delivered by text or email.
'We tried to match participants based on similarity and familiarity (ie, how much peers felt similar to or familiar with one another),' explained Leahey. 'We also did relationship development and induction activities (to create emotional closeness) and avoid conflict,' she said.
Participants receiving the mentor/peer intervention were better able to maintain their weight loss compared with SOC participants (mean weight change at month 18: 0.77 [standard deviation, 0.46] kg vs 2.37 [standard deviation, 0.50] kg, respectively) throughout the trial. They also achieved significantly lower cardiovascular measures, namely diastolic blood pressure and resting heart rate, and engaged in significantly more physical activity.
Are Mentor/Peer-Delivered Weight Maintenance Programs Ready for Prime Time?
'A lot of people don't have access to these maintenance interventions due to insurance access or availability of trained providers,' said Kathryn M. Ross, PhD, MPH, senior research scientist at Advocate Aurora Health Research Institute, Milwaukee, and author of the accompanying editorial. 'Looking into newer models that have more implementation potential, such as peer and mentor support, has a lot of potential.'
Kathryn M. Ross, PhD, MPH
'But we don't know from one study if this is something that is ready to take country-wide in clinical practice,' she said. 'It's also unclear which components of the patient-delivered program are critical for successful implementation.'
A key element is training. Leahey emphasized that the researchers continued to refine the training model study by study, eventually landing on factors like age, gender, and empathic listening and feedback strategies that encouraged compassion and cohesiveness.
'I have some patients doing this for me,' said Nida Latif, MD, a family practitioner and obesity specialist running a private practice in Westland, Michigan, and spokesperson for the Obesity Medicine Association, pointing to one in particular.
'She achieved a lot of success (she had bariatric surgery in her 30s and is now in her 60s; she has maintained a BMI of 27-28, from a BMI of 50), she reversed her diabetes and atrial fibrillation and is off all blood pressure medications,' said Latif.
Though Latif said that the patient is a great advocate and has taken some of the burden off her shoulders in terms of time and resource utilization, she emphasized the need for professional oversight.
'Every so often, I have to harness her back. She's come so far that she's forgotten how difficult the change process is. I help her understand that it's a slow process. I identify struggles, the importance of helping patients change just one habit over a period of three to four weeks so they become more consistent,' said Latif.
'Even if it's someone who has had success, they need to adjust to whomever they're trying to help. And touch base with me every so often to discuss challenges.'
Chronic Disease and Chronic Maintenance
An important challenge to weight loss maintenance is the disease itself. Though a chronic illness, obesity is not always accepted as such by physicians or insurers, leaving patients to grapple with weight cycling on their own.
Gretchen Aames, PhD
'If you have to leave your biases at the door,' said Aames. 'There are studies that show that the prevailing thought among primary care physicians and nurses is that weight loss is the patient's responsibility: Eat less, move more. Instead, they should take the time to figure out what their patients know, what they've tried, and things that are sustainable,' she said.
'Maybe they need a little bit of coaching and information and can run with it. Others will need more. We don't know enough yet who is the right person for the peer strategy or the critical components of this type of intervention that will help people.'
For now, physicians might want to help patients build their own support networks to help them keep on track without having to try to set something up within an already time- and resource-crunched practice, said Ross.
Locally run DPP programs (eg, by the Young Men's Christian Association or churches) are a good starting point.
The study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases. Leahey, Ross, Aames, and Latif reported no relevant financial relationships.
