Gabriele Stumm1, Alexandra Blaik2, Siegfried Kropf3, Sabine Westphal4, Tanja Katrin Hantke5, Claus Luley2
14sigma GmbH, Bajuwarenring 19, D-82041 Oberhaching, Germany, 2Institute of Clinical Chemistry and Pathobiochemistry, and 3Institute of Biometry and Medical Informatics, Otto-von-Guericke University, Leipziger Straße 44, D-39120 Magdeburg, Germany, 4Municipal Hospital Dessau, Auenweg 38, D-06847 Dessau-Roßlau, Germany
The Active Body Control (ABC) weight-reduction program is based on telemonitoring of physical activity and nutrition together with telecoaching by weekly counseling letters sent by post or by e-mail. The study presented here reports the results of a 1-year follow-up of 49 patients with the metabolic syndrome who had lost weight with the aid of the ABC program in the preceding year. The weight regain after the second year in patients not receiving any further care (“ABC discontinued” group; n = 24) and the potential benefit of continuing with the ABC program with monthly counseling letters (“ABC continued” group; n = 25) were investigated. The relative weight changes after the first year had been respectively -13.4% and -11.4% in the “ABC discontinued” and “ABC continued” groups, and after the second year they decreased by respectively 4.4 and 2.8%. However, this difference in weight regains between the two groups was not statistically significant. It is concluded that three-quarters of the weight loss after 1 year is maintained after the second year. The decision whether to continue with the ABC program after 1 year should be made individually.
Obesity – consequences, obstacles, and a possible new way to fight it
Prevalence of obesity is still increasing steadily – with implication on its consequences such as type 2 diabetes, cardiovascular diseases, orthopaedic problems but also infertility in young women. Although there exist various weight-reduction programs, they seem not to be able to stop this epidemiological trend even when effective in the study population. One reason might be that, so far, successful interventions are resources- and cost-intensive and therefore not easily translated into routine primary care. In addition, they mainly focus on short-term weight reduction success and do not address long-term weight maintenance. Therefore, new effective and economic alternatives are therefore urgently needed.
Mobile self-tracking approaches to lifestyle improvements are currently under discussion, recent studies doubt efficacy for relevant long-term weight reduction. The Active Body Control (ABC) intervention combines mobile monitoring of daily physical activity and calorie intake with weekly individual feedback by experienced coaches over 6 – 12 months. This approach and has proven to achieve significant weight reduction in several studies (weight curve of all participants to date shown in Figure 1) (1, 2, 3, 4, 5). Extension of the program is easily possible with biweekly or monthly feedback by the coach to assist in weight maintenance.
The ABC program in details
In the ABC-program patients attend an initial 2-hour instruction meeting performed by their personal ABC coach (physicians and physician assistants qualified in nutritional medicine). The recommended diet is explained including shopping and cooking examples suitable for daily use. The diet consists of a combination of conventional calorie restriction, with reduction the calorie intake by 500 kcal/day and preference for carbohydrates with low glycemic index. The importance of daily moderate but regular physical activity is emphasized and patients are provided with an accelerometer programmed individually for each patient (sensor shown in figure 2). The small sensor is worn at the hip and calculates the daily walking distances and daily exercise-related energy expenditure in kilocalories, and in addition records meal calories in a simplified form. The actual balance between total calorie intake and calories used up by the basal metabolic rate plus physical activity can be checked by the patient at any time.
This self-tracking is combined by regular tele-medical coaching. Sensor data and self-reported daily body weights are transmitted once a week to a server at the Magdeburg University Hospital by means of a USB connection to a home computer with automatic extraction of new data. The personal ABC coach generates weekly individually tailored report letters using the ABC platform (see example in figure 3).
In the meantime, the ABC program has been rolled out and is offered by several coaches throughout Germany. In some cases physicians support their patients in weight reduction in addition to medical treatment of diabetes or other obesity related problems. In addition, as only one initial personal contact of patient and coach is required, the ABC-program is also suitable for weight reduction programs in companies, for health insurance initiatives and for other group or individual prospective clients.
Benefits in various situations
The ABC program was established in its current form 2010 by an intervention in obese, but otherwise healthy families (1) and resulted in highly significant weight loss in adult family members and a reduction of the BMI-SDS in children.
In the meantime, several approaches used the ABC- program. Weight reduction in young infertile women with obesity and polycystic ovarian syndrome resulted in a mean weight reduction of 7.9 kg accompanied of a pregnancy rate of 31% within 6 months compared to 2 kg weight loss and 5% fertility rate in the control, respectively (2). The ABC program has also shown promising effects in obesity-related gynaecological aspects of lowering of the pelvic floor and urinary incontinence (unpublished data).
Diabetic obese patients with oral antidiabetic or insulin treatment lost mean 11.8 kg during 6 months of ABC program and could highly significant lower their glucose, HbA1c level, and antidiabetic medication (3), whereas no such effects were seen in the control group (see figure 4).
In the diabetes prevention study presented in the abstract above overweight and obese patients with metabolic syndrome performed the ABC program for 12 months. Again, the tele-medical approach resulted in highly significant weight reduction: in an intention to treat analysis participants lost 11.4% of their initial weight (4). Even when left unattended for a second year, 9% weight reduction was still present in the medical examination after 24 months (5). This long-term effect emphasizes the value of the ABC program for real life style change instead of short-time dietetic effects of most other programs.
A major difference between the ABC program and other similar weight-reduction programs is that the ABC program uses a tele-medical approach including only one face-to-face meeting. Despite this short personal encounter, the weight reduction achieved in the ABC program is higher than in most comparable approaches. We believe that this satisfying efficacy of the ABC program is due to the fact that it moves the obesity treatment from the counselor’s office into the patient’s daily life. It enforces the patient´s continuous self-control which is boosted by the regular motivation letters from coaches who are closely connected with the patients and who respond individually.
The tele-medical character of the ABC program yields yet another advantage worth mentioning: the time expenditure is much smaller. The single instruction meeting at the start of the program takes 2 hours for both coaches and patients. Daily physical activity is measured automatically. Documentation of calorie intake is simple and takes the patient only a few minutes – such as the preparation of the regular individual report letter for the coach.
The minor time expenditure by the patients might contribute to their compliance with the program (75% attendance rate after 24 months). In addition, it is time efficient for the coach and results in lower program costs compared to other effective weight reduction settings.
Luley C, Blaik A, Aronica S, Dierkes J, Kropf S, Westphal S (2010) Evaluation of three new strategies to fight obesity in families. J Nutr Metab. 2010:751905
Blaik A, Brössner AB, Kleinstein J, Luley C, Isermann B, Westphal S (2012) 31% Spontankonzeptionsrate adipöser Frauen mit PCOS nach einer Lebensstilintervention durch das ABC-Programm. Aktuelle Ernährungsmedizin 37(03): DOI: 10.1055/s-0032-1312490
Luley C, Blaik A, Reschke K, Klose S, Westphal S. (2011) Weight loss in obese patients with type 2 diabetes: effects of telemonitoring plus a diet combination – the Active Body Control (ABC) Program. Diabetes Res Clin Pract. 91:286-292
Luley C, Blaik A, Götz A, Kicherer F, Kropf S, Isermann B, Stumm G, Westphal S (2014) Weight Loss by Telemonitoring of Nutrition and Physical Activity in Patients with Metabolic Syndrome for 1 Year. Journal of the American College of Nutrition 33(5):363-74
Stumm G, Blaik A, Kropf S, Westphal S, Hantke TK, Luley C (2016) Long-Term Follow-Up of the Telemonitoring Weight-Reduction Program “Active Body Control”. Journal of Diabetes Research Volume, Article ID 3798729, DOI: 10.1155/2016/3798729
The study was embedded within the “lifescience.biz” project kindly co-funded by the German Federal Ministry of Education and Research (BMBF), with reference number 01FC08063.