06 Mar Online Access to Dietitian Improved Weight Loss
MedicalResearch.com: What are the main findings of the study?
Dr. Green: We found that Group Health patients who were overweight and had hypertension were more likely to have lost 10 pounds in six months if they had secure online access to a dietitian than if they received only information and usual care. The patients really loved this intervention—and having access to a dietitian to work with them toward a healthier lifestyle. Although blood pressure and heart risk trended lower in the intervention group, the differences weren’t significant—unlike their weight.
MedicalResearch.com: Were any of the findings unexpected?
Dr. Green: Patients reported being “shocked” when they were told their heart age (based on their risk factors) was higher than their actual age. This motivated most people to change.
Another surprise was that some of the patients in the dietitian group continued to have high blood pressure even after they ate healthier, were more active, and lost weight. The dietitians told them (and sent a staff message to their doctor) that they needed medications to control their blood pressure. But many of the participants did not want to do this. They wanted to work even harder on lifestyle. Doing all the right things may not be enough, but it might lead to needing less–or lower doses of–blood pressure medications. Next time we would work harder on having the doctors encourage their patients to get their blood pressure under control or add a pharmacist to the team. (See below, answer to last question.)
MedicalResearch.com: What should clinicians and patients take away from your report?
Dr. Green: Sometimes clinicians and patients feel pessimistic about reducing the risk of heart disease and stroke. But following the Dietary Approaches to Stop Hypertension (DASH) diet—with eight to 10 servings of vegetables and fruits per day—can have a really positive impact. And overweight people with hypertension can lose more weight if they have a scale, a pedometer, and an in-person visit with a dietitian where they make a plan to reduce their heart risk—followed by secure messaging with the dietitian to receive ongoing feedback and report their blood pressure, weight, and intake of vegetables and fruit on the DASH diet. Some people might still need medications—but probably less of them.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Dr. Green: Since this study proved the intervention is feasible, we’re planning a larger randomized controlled trial, where we will tailor the e-care for the patients who have hypertension or high cholesterol. We’ll pair each patient with either a pharmacist or a dietitian, depending on their individual needs.
e-Care for Heart Wellness: A Feasibility Trial to Decrease Blood Pressure and Cardiovascular Risk
Beverly B. Green, MD, MPH, Melissa L. Anderson, MS, Andrea J. Cook, PhD, Sheryl Catz, PhD,
Paul A. Fishman, PhD, Jennifer B. McClure, PhD, Robert J. Reid, MD
Am J Prev Med 2014;46(4):368–377