Phone-based coaching helps rural Americans keep the weight off—without breaking the bank

Most people who lose weight regain some or all of it back within one to five years unless they make long-term changes to their diet and exercise habits.

Rural Americans face additional challenges. According to health economist Tiffany Radcliff, PhD, they have higher observed rates of obesity, less access to healthy foods and fewer options for exercise, compared to their urban counterparts.

“In addition, they have less access to local obesity prevention programs and those that are available often lack nutritionists, registered dietitians or other weight management experts,” said Radcliff, who led the study along with Murray J. Côté, PhD.

The pair, who are both with the Texas A&M University School of Public Health, and their collaborators from the University of Florida and Kansas University Medical Center found that more rural residents sustained their weight loss when they received one-on-one coaching over the telephone compared to those who received weight-loss messaging via email or mail.

“Coaching uses more resources and therefore costs more than education materials alone,” Radcliff said, adding that the regular coaching sessions typically lasted 15-20 minutes, including time for problem-solving, discussing goals and progress, and establishing approaches to set and achieve these goals.

For the study, published in PLOS One, Radcliff and Côté used data from the Rural LEAP randomized trial to evaluate program delivery costs alongside participants’ weight outcomes and health care expenses.

The 18 individual telephone counseling sessions were delivered through Florida county extension offices and cost $555 per participant (about $31 per session) over one year, with more than 75% of this cost going to staffing. The cost for the comparison group that received educational materials via email or mail was $27 per participant over one year.

More than 34% of participants in the telephone intervention group experienced at least 10% weight loss at the end of the intervention, compared to 17% in the mail/email group. In addition, 6.4% percent of the telephone intervention group were expected to keep the weight off over five years, compared to 5.4% for the other group.

“This is encouraging given that dedicated weight-loss centers with long-term lifestyle maintenance programs are often unavailable in rural areas,” Radcliff said.

Using simulation methods to predict weight regain patterns based on what was observed during the trial, the team identified another benefit of individual coaching: lower out-of-pocket health care costs for five years following the intervention.

Analyzing participant-reported health status revealed that the group assigned to individual coaching had an additional cost of only $7,731 to $8,156 per additional Quality-Adjusted Life Year (QALY) gained, which is well-below the $150,000 per QALY that is used as a standard for evaluating whether an intervention is cost-effective.

“This analysis also considered whether small changes in the model and its assumptions would lead to different results,” Côté said. “In this case, individual telephone-based coaching remained a cost-effective approach.”

Meanwhile, Radcliff noted that more people in the United States are overweight or obese than ever before, which increases their risk for health issues such as high blood pressure, diabetes and heart disease.

“The population we studied faces unique challenges in losing weight and keeping it off, and individual telephone counseling appears to be a cost-effective option for weight maintenance,” she said.