Phone counseling works to reinforce weight loss, UF study finds
GAINESVILLE, Fla. — Telephone counseling may be just as successful as face-to-face counseling in helping people maintain weight loss, report University of Florida researchers.
The UF study is the first to demonstrate the effectiveness of telephone counseling for long-term management of obesity in rural communities. The findings appear in today’s (Nov. 24) issue of Archives of Internal Medicine.
In the study of women in underserved rural areas, those who received phone or face-to-face counseling following an initial weight-loss program did a better job of keeping the weight off than those in a control group.
“We found that the participants who received extended care were able to maintain their weight loss at higher levels than those participants who only received printed health education materials as a follow-up,” said lead investigator Michael G. Perri, a professor and interim dean of the UF College of Public Health and Health Professions. “The success of telephone counseling gives us a cost-effective alternative to face-to-face visits that is more convenient for rural residents who may need to travel long distances for care.”
Study participants included 234 obese women, ages 50 to 75, who live in rural communities in northern Florida. After completing a six-month weight-loss program, women in the study lost an average of 22 pounds. One year later, participants who had received phone or face-to-face counseling after treatment had regained less weight — on average, 2.5 pounds — than those in the education control group, who regained an average of 8 pounds.
Long-term care is an important component in weight-loss maintenance, said Perri, who has argued for the acceptance of obesity as a chronic condition that requires continuous care. Previous studies have shown that in the year following treatment, participants regain one-third to one-half of the weight lost.
During the first phase of the UF study, the women participated in a weight-loss program that combined a low-calorie diet with daily 30-minute walks and an emphasis on learning problem-solving skills to overcome barriers to weight loss. The women met in weekly group sessions in six rural counties.
“We also addressed special issues of concern for women in rural areas, such as low-calorie preparation of traditional ‘Southern’ dishes, strategies for coping with a lack of family support for weight loss and techniques for healthful eating away from home,” said Perri, a professor of clinical and health psychology.
After the weight-loss portion of the study, participants were randomly assigned to one of three 12-month follow-up programs to help them keep the weight off: face-to-face group counseling, phone counseling or a comparison group that received written educational materials. Participants were encouraged to use weight-control strategies and asked to log food intake on at least two weekdays and one weekend day per week.
Adherence to the behavioral weight control program, as measured by the food intake records, was significantly higher in the phone and in-person groups.
“The completion of written self-monitoring records was the single best behavioral predictor of weight change,” Perri said.
Although phone and in-person counseling were equally effective in helping participants maintain weight loss, program expenses per participant for phone counseling were half the cost of face-to-face counseling — $397 on average for in-person counseling versus $192 for those in the phone group. Phone counseling also offers other benefits for people in rural areas, researchers say.
“Because distance represents a major barrier to medical care in rural areas, the availability of a treatment modality that does not require time and costs for travel and attendance at clinic visits represents a potentially important approach to providing ongoing care to rural residents,” Perri said.
The UF study has significant implications for behavioral weight management programs, says John P. Foreyt, a professor and director of the Behavioral Medicine Research Center at Baylor University’s College of Medicine.
“The study demonstrated that telephone counseling is an inexpensive, effective strategy for helping people to maintain their weight losses,” Foreyt said. “Dr. Perri’s findings will have a major effect on the delivery of future weight management interventions. His results are a major breakthrough in the development of effective approaches for helping people to maintain healthier body weights.”
Perri is leading a new study called Rural Lifestyle Intervention Treatment Effectiveness Trial, or Rural LITE, supported by a $3.6 million grant from the National Heart, Lung and Blood Institute. The researchers hope to determine the minimum intensity of treatment required to produce clinically meaningful, long-term weight loss in rural men and women.