Telehealth intervention seen to help MS patients lose weight in trial

A six-month telehealth program designed to help participants change their dietary and lifestyle habits resulted in an increased level of physical activity and clinically relevant weight loss for most obese people with multiple sclerosis (MS) who took part, a clinical trial found.

In fact, about 2 in 3 of these MS patients (65%) lost at least 5% of their body weight during the telehealth intervention.

The researchers also observed that patients on the weight loss program experienced less fatigue, better quality of life, and increased mobility compared with those who continued to receive treatment as usual.

These “findings demonstrate the efficacy of a behavioral intervention for [people with MS] and obesity, with clinically significant weight loss for two-thirds of participants in the treatment condition. Weight loss may also lead to improved mobility and quality of life,” the researchers wrote.

The study, “Modifying diet and exercise in multiple sclerosis (MoDEMS): A randomized controlled trial for behavioral weight loss in adults with multiple sclerosis and obesity,” was published in the Multiple Sclerosis Journal.

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Obesity can increase the risk of developing MS, accelerate disease progression toward increasing disability, and make some symptoms more severe and harder to manage.

Thus, cutting calories and keeping a healthy weight often is seen as a modifiable lifestyle habit that may lessen disease severity. However, weight loss interventions and special diets have provided mixed results for people with MS.

Telehealth, or telemedicine, may bridge the gap for patients who are unable to attend in-person appointments, helping them engage more regularly in lifestyle interventions and other programs, and adhering more consistently to treatment plans. Yet, no randomized controlled study has tested the efficacy of behavioral weight loss programs, offered via telehealth, in MS.

“The development of an effective intervention for obesity in MS may aid our understanding of how weight loss and accompanying lifestyle modifications influence disease severity, symptom burden, and functional decline,” the researchers wrote.

To determine the feasibility and potential benefits of such an intervention, researchers at the University of Missouri-Kansas City conducted a clinical trial called MoDEMS study (NCT04255953).

Their study tested the efficacy of a six-month telehealth program, designed to encourage patients to eat healthy and exercise more.

Altogether, 64 adults with MS — 53 women and 11 men, with a mean age of 46.7 — completed the study. All but two patients had relapsing-remitting MS, with a mean disease duration of 10.8 years. One patient had primary progressive MS, and one secondary progressive MS.

All patients had a body mass index, or BMI — a measure of body fat based on weight and height — ranging from 29 to 50. That means all fell into the categories of overweight or obese, per U.S. guidelines. Fewer than half (41%) reported MS-related disability, and most (86%) were on disease-modifying therapies.

The patients were randomly assigned to enter the six-month telehealth program or to continue their treatment as usual. After the first six months were complete, those in the treatment-as-usual arm had the opportunity to also engage in the telehealth program.

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As part of the telehealth program, participants attended a total of 24 weekly remote group sessions. Each session lasted about one hour, and was conducted by a trained psychology PhD student and/or a registered dietician. The leader(s) facilitated conversations about healthy diet, exercise, and behavior change, and encouraged participants to set goals for the following week.

Daily calorie goals established for patients in the intervention ranged from 1,200 to 1,500 calories for those weighing less than 250 pounds (113.4 kg), or 1,500 to 1,800 calories for those weighing more than 250 pounds. Patients were encouraged to eat at least five servings of fruit and vegetables per day, and to engage in moderate physical activity for up to 2.5 hours a week.

Those in the treatment-as-usual arm were emailed monthly newsletters containing information about healthy eating.

The results showed that patients in the telehealth program lost an average 8.6% of their body weight over six months, compared with 0.7% among those in the treatment-as-usual arm.

Similarly, participants in the intervention experienced significantly greater reductions in their waist circumference, BMI, and fat tissue, compared with those in the control group. There also were more patients in the program who experienced a 5% reduction in their body weight (64.7% vs. 7%), or even a 10% reduction (41% vs. 3%).

While each patient set individual goals, all “were generally encouraged to aim for 10% weight reduction,” the researchers wrote.

Overall, findings show that participation in a behavioral telehealth weight loss program causes significant weight loss and improved mental [quality of life] among [people with MS] and obesity.

The intervention also resulted in a 46.2-minute increase in the time spent on moderate to vigorous physical activity each week, compared with a decrease by 5.6 minutes per week in the treatment-as-usual arm. Patients in the virtual program also walked farther on a six-minute walk test and reported less fatigue, but differences between the two groups were not significant.

Finally, patients on the telehealth program reported an average increase of 1.4 points over six months in the the mental scale of the MS Quality of Life Inventory, indicating better mental quality of life. This was compared with an average decrease of 2.3 points in patients on treatment as usual.

“Overall, findings show that participation in a behavioral telehealth weight loss program causes significant weight loss and improved mental [quality of life] among [people with MS] and obesity,” the researchers concluded.

These positive results led researchers to call for further study into other effects of weight loss in MS.

“Future research should also examine the impact of weight loss on MS disease severity and progression, including exacerbations, lesion count, and biomarkers of neurodegeneration,” the researchers wrote.

This study was funded in part by the National MS Society.