There is no doubt the pandemic has caused profound shifts in how health care is delivered in the USA. For many, especially in rural areas, access to care has always been challenging. Perhaps now that you can video call with your doctor without having to travel to their office may make accessing care easier. This, of course, is dependent on having good cellular reception and wifi, which is often spotty in rural areas.
In 2011, Medicare approved intensive behavioral counseling for obesity as a covered benefit, a chronic condition that impacts 42% of Americans. While uptake on this service has been on the low side, less than 1% of those eligible have availed of it; it does allow for 22 individual face-to-face visits over a 12-month timeframe.
A new paper in JAMA by Christine Befort and colleagues from the University of Kansas explores the role of alternative care models for delivering this service, namely comparing telephone-based group visits with in-person clinic group visits to support rural communities.
The study used cluster randomization to test the effectiveness of weight loss using these alternative models of delivery. Cluster randomization enables groups to be randomized versus individuals, which we often see in study design. The primary study question centered on the effectiveness of different models; group visits conducted via phone, in-clinic group visits, were compared to face-to-face fee-for-service individual care. The study included 1,407 participants.
Findings show that participants in group face-to-face visits experienced more significant weight loss than in-clinic face-to-face visits at 24 months; 4.4 kg vs. 2.6 kg, respectively. There was no significant difference between phone based group visits when compared to in-clinic face-to-face visits.
It is worth noting that all groups did lose weight in a timeframe where they may have gained weight had they not been part of this intervention. While the study shows promise concerning group visits for weight loss, it falls short in delivering clinically meaningful weight loss, explicitly reaching a 5% weight loss, the gold standard in weight loss outcomes.
Similar studies show 44% of participants in intensive weight loss programs reach the 5% benchmark after 12 months. This study opens up possibilities of supporting rural settings in pursuing pragmatic models to support weight loss. These models can be built upon and improved. After all, community weight loss programs like WW leverage group settings to good effect, so this paper adds more learnings to be explored. Flexible models will be necessary to tailor care to meet the needs of those who live in rural areas and cities alike.
Thanks for reading – Trina
(Opinions are my own)
Befort CA, VanWormer JJ, Desouza C, et al. Effect of Behavioral Therapy With In-Clinic or Telephone Group Visits vs In-Clinic Individual Visits on Weight Loss Among Patients With Obesity in Rural Clinical Practice: A Randomized Clinical Trial. JAMA. 2021;325(4):363–372. doi:10.1001/jama.2020.25855