Weight loss and self-efficacy in obese/overweight patients with type 2 diabetes and chronic kidney disease in a lifestyle intervention pilot study

Background: Patients with nutrition-related chronic diseases, including type 2 diabetes (T2D) and chronic kidney disease (CKD), benefit from counseling from registered dietitians (RDs). However, in-person counseling approaches can be inconvenient and expensive, making them difficult to implement and maintain. Technology-based methods of remote contact provide patients with accessible and inexpensive opportunities to reduce disease risks. Objective: This pilot study examined differences in weight loss and self-efficacy after 6 months in a remotely-delivered lifestyle intervention. Methods: Participants were randomized to an intensive Social Cognitive Theory (SCT)-based lifestyle intervention (n=7) or a standard behavior treatment (SBT) group (n=7). The intervention group was provided with an iPad to participate in SCT-based live WebEx sessions with an RD, access to MyNetDiary (an online tool to log dietary intake, exercise, and body weight), and email feedback from an RD weekly for the first month and biweekly thereafter. Height and weight were measured at baseline and 6 months. The Weight Efficacy Lifestyle (WEL) and Self-Efficacy for Exercise (SEE) questionnaires were completed by participants at baseline and 6 months. The Mann-Whitney U Test examined differences in percent weight loss and percent change in self-efficacy scores (baseline, 6 months). Because of the small sample size, the Last Observation Carried Forward method was used to handle missing data. Results: The participants were predominantly white (71.4%), male (71.4%) and currently or living as married (57.1%) with a mean age of 65.9±9.7 years and body mass index 34.8±5.4 kg/m2. At 6 months, the intervention group had a significantly greater percent weight loss (median = 3.7%, n=7) than the SBT group (median = 0%, n=7), U = 6.0, z=-2.42, and p=0.016, with a large effect size (r=0.65). No significant differences were noted in percent change for the WEL and SEE scores (WEL median = 0%, n=7, p=0.883; SEE median = 0%, n=7, p=0.472). Conclusion: At 6 months, the intervention group demonstrated significantly greater weight loss. While improvements in self-efficacy were observed for some participants, no differences were noted overall due to this small sample. These results support the development and implementation of technology-based programs for patients with T2D and CKD. Additional research is required to determine the role of the SCT-based counseling methods.