Health Coach-Based Primary Care Programs Linked to Reduced Cardiovascular Risk

February 9, 2021
Patrick Campbell

An intervention implementing the use of a health coach in a primary care setting based on the 2013 AHA/ACC/Task Force for the Management of Overweight and Obesity in Adults guidelines was associated with greater weight loss and improvements in blood glucose levels and HDL-C compared to usual care.

A new study from Pennington Biomedical Research Center of Louisiana State University is outlining the potential reduction in cardiovascular risk derived from a lifestyle intervention program led by health coaches at primary care clinics.

Results of the study indicate the intervention, which consisted of weekly sessions for 6 months followed by monthly sessions for 18 months, was associated with decreased blood sugar levels and improvements in cholesterol as well as cardiometabolic risk scores.

“Our results demonstrate lifestyle intervention and weight-loss programs can be successful for people in underserved, low-income communities if you bring the program to where they are, removing barriers to participation,” said principal investigator Peter Katzmarzyk, PhD, the Marie Edana Corcoran Endowed Chair in Pediatric Obesity and Diabetes and associate executive director for population health sciences at the Pennington Biomedical Research Center, in a statement from the American Heart Association.

With the aim of fathering their understanding of how various lifestyle interventions could influence overall health and cardiovascular risk, Katzmarzyk and colleagues created the Promoting Successful Weight Loss in Primary Care in Louisiana (PROPEL) Trial. Conducted between April 2016 and September 2019, the trial was designed to assess the effects of a 24-month high-intensity lifestyle intervention at 18 primary care clinics in Louisiana. In total, 803 patients were recruited for the trial.

For inclusion in the study, participants needed to be between 20-75 years old, have a BMI between 30-50 kg/m2, and be a patient at 1 of the 18 participating clinics. Key exclusion criteria were being a current participant in a different weight loss program, use of weight loss medication, a history of bariatric surgery in the last 2 years, or having lost more than 10 pounds in the 6 months. Outcome measures of interest for the analysis included changes in fasting blood glucose (FBG), total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein (LDL-C), triglycerides, and metabolic syndrome severity z score (MetS-Z).

Of the 803 patients included in the study, 67% were Black and 84% were women. After allocation, 351 patients received usual care and 452 received the intensive lifestyle intervention. Those receiving the intervention received a 24-month high-intensity lifestyle-based obesity treatment program delivered by health coaches within a clinic setting. These sessions were initially delivered weekly for the first 6 months and then delivered monthly for months 7-24. Those allocated to usual care group continued to receive their normal primary care.

Investigators pointed out guidelines created by the 2013 American Heart Association/American College of Cardiology and Task Force for the Management of Overweight and Obesity in Adults served as the basis of the PROPEL intervention program.

At the end of the trial, those in the intervention arm experienced significantly greater weight loss than those in the usual care arm (mean difference, -4.51%; 95% CI, -5.93 to -3.10; P <.01). Upon analysis, results suggested FBG was decreased more in the intervention arm at months but not 24 months when compared to the usual care group. Results also indicated those in the intervention arm saw greater increases in HDL-C at both 12 (4.1 mg/dL; 95% CI, 2.4-5.7; P <.01) and 24 months (4.6 mg/dL; 95% CI, 2.9-6.3; P <.01) at 24 months.

Additionally, the investigators’ analyses revealed those in the intervention arm saw greater decreases in total/HDL-C ratio and MetS-Z score in both the 12- and 24-month analyses—with mean differences of change of -0.31 (95% CI, -0.47 to -0.14; P <.01) and -0.21 (95% CI, -0.36 to -0.06; P=.01) at 24 months, respectively. Investigators noted there were no significant changes in total cholesterol, LDL-C, triglycerides, and blood pressure observed between either group at any point during the study period.

“A broader implementation of the PROPEL model could better allow people in under-resourced communities to receive effective treatment and, thus, help to reduce the prevalence of obesity and related health conditions and risks,” said Katzmarzyk.

This study, “Effects of a 2-Year Primary Care Lifestyle Intervention on Cardiometabolic Risk Factors,” was published in Circulation.