Individualizing weight management program may increase success rate

A group of Sanford physicians and researchers began Profile four years ago with 50 pilot members in Sioux Falls. It has since expanded to more than 50,000 members at 27 locations in 10 states. In March, Profile celebrated a milestone -- the accumulated weight loss of its members surpassed the 1 million pound mark.

"The people for whom Profile works really love it," McCormack said. "We want to make it a program that works for everybody."

McCormack and SDSU associate professor Jessica Meendering work with co-investigator Alyssa Sorensen, a registered dietitian and nutrition and development coordinator at Profile, on the two-year, nearly $83,000 research project. It is funded through a partnership between Sanford Health and South Dakota State University, which began in 2014.

Stephen Herrmann, director of program development and training at Sanford Profile, said, "Though we are always doing focus groups and surveys to improve our program, it is helpful to have someone with a different perspective come in."

To begin identifying barriers to and facilitators of weight loss, the researchers focused first on approximately 70 Profile clients. These participants participated in a focus group, filled out a survey, wore a physical activity monitor and recorded how frequently they were eating different types of foods.

Based on those responses, the researchers customized the survey, asking questions about personality and home life, as well as weight-related issues. More than 1,200 people responded to the survey, which was sent to 20,000 Profile clients. The data are now being analyzed.

What helps one, hinders another

Health coaches, for example, showed up as both a plus and a minus, she explained. "That tells us programs like this need to be individualized."

"Some people prefer to interact with different health coaches, while others want to have the same coach every visit," McCormack said. Some clients want to build a relationship with one coach, while others appreciate the insights that different coaches bring to the table.

Administering a questionnaire when people enroll in the Profile program would help determine those preferences and increase client satisfaction, according to McCormack. Coaches can say based on the responses, "you are someone who wants a health coach but needs the same person for each visit."

Those insights will help coaches customize the Profile program based on individual personalities, she explained, including identifying clients' specific challenges and physical activities, for instance, that are easier to integrate into their schedules. "Nothing changes in the program overall, just how it's implemented."

When it comes to assessing what motivates Profile members, Herrmann agreed: "Personality is a big deal," pointing out that coaches now receive additional training in motivational interviewing. "If members are relationship-oriented, perhaps they need a workout partner; if they are goal-oriented, completing a 5K race may motivate them."

Examining activity levels, transition

Physical activity is important both for losing weight and for keeping that weight off in the long run, explained McCormack. Among focus group participants, those who were more successful at weight loss and maintenance had higher physical activity levels.

One of the barriers to physical activity is appearance, McCormack explained. "They are self-conscious about their looks when they are exercising."

Remedying that might mean switching to a different gym or working out at a different time. "A health coach can help identify barriers and work with participants to overcome them. The ultimate goal is to figure out what works and what doesn't," she noted.

Clients in the weight maintenance phase have overcome these barriers, but another obstacle can be transitioning from their structured meal plan to eating more grocery store foods.

"What we were hearing in our focus groups is that people who follow the structured meal plan are hesitant to change because it's working for them," she explained. That transition also involves incorporating fruits and whole grains into their diets, with the help of the health coaches.

"It's a comfort zone," Herrmann said. Some people have lost weight in the past, but find maintaining their weight loss challenging. However, he added, "We have to nudge them out of the nest by helping them improve their skills surrounding portion control, healthy choices and other lifestyle behaviors that will support lasting change."

Though this preliminary work has provided descriptive information, Herrmann looks forward to seeing the results from the larger study. "It will help us identify additional focus areas which will help move the needle toward better results, better membership engagement and lasting behavioral changes."