Hybrid Health IT and Telehealth–Delivered Behavioral Weight Loss Services for Primary Care Patients With Cardiovascular Risk Factors: Intervention Component Design and Pragmatic Randomized Feasibility Trial

Background: Intensive lifestyle interventions (ILI) improve weight loss and cardiovascular risk factors, but health care systems face challenges in implementing them. We engaged stakeholders to cocreate and evaluate primary care implementation strategies for ILI components. Objective: This study aimed to describe the design of intervention components and implementation strategies and to evaluate the feasibility of pragmatic trial enrollment and randomization procedures, as well as the acceptability and preliminary effectiveness of the interventions. Methods: The study setting was a single, urban primary care office. Patients with a BMI ≥27 kg/m² and ≥1 cardiovascular risk factor were sent a single electronic health record (EHR) message between December 2019 and January 2020 offering services to support a weight loss goal of 10 pounds in 10 weeks. All patients who affirmed interest were pragmatically enrolled in a trial offering basic lifestyle support (BLS), which provided a scale that transmits weight data to the EHR using cellular networks, a coupon to enroll in lifestyle coaching resources through a partnering fitness organization, and periodic EHR messages encouraging use of those resources. About half (n=42) of participants were randomized by an EHR algorithm to also receive customized lifestyle support (CLS), including weekly email messages adaptive to weight loss progress and telephonic coaching by a nurse for those facing challenges. Interventions and assessments spanned from January to July 2020, with disruption by the COVID-19 pandemic. Weight data were collected from administrative sources. Qualitative analysis of stakeholder recommendations and patient interviews assessed intervention acceptability, appropriateness, and sustainability. Results: Over 6 weeks, 426 patients were sent the EHR invitation message, and 80 (18.8%) patients affirmed interest in the weight loss goal and were enrolled. Overall, 48 of 80 (60%) trial participants lost weight at 6 months; 12 (15%) exhibited weight loss ≥5%, with no significant difference between CLS and BLS arms (P=.85). During the 12 weeks of adaptive MyChart (Epic Systems) messaging, 18 (43%) CLS patients and 8 (21%) BLS patients performed daily self-weighing (P=.06), and 22 (52%) CLS patients and 14 (37%) BLS patients enrolled in referral-based lifestyle resources (P=.18). Conclusions: Pragmatic enrollment, randomization, and data collection procedures proved feasible, and interventions showed preliminary effectiveness warranting further study in a larger trial.