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Is there a Role for Lay Peer Coaches in the Treatment of Obesity in Primary Care?

  Gareth R Dutton*,      Janice M Phillips,  

Division of Preventive Medicine/Department of Medicine, University of Alabama at Birmingham, USA

*Corresponding author: Gareth Dutton, Associate Professor of Medicine, UAB Division of Preventive Medicine, 1717 11th Avenue South, Medical Towers 615, Birmingham, AL 35205, USA, Tel: 205-934-6876; E-mail: gdutton@uabmc.edu


Lifestyle interventions for weight loss have been developed and have demonstrated efficacy [1-4]. Despite this, translation of these programs to applied clinical settings such as primary care has been limited, even though weight loss programs delivered in primary care have the potential for widespread reach to patients affected by obesity. In fact, a variety of health organizations have called for greater involvement of primary care physicians in weight management [1,5,6]. However, there are numerous barriers to treatment delivery, including time constraints for physicians and other staff, insufficient reimbursement, and physician discomfort and/ or limited training in behavior change counseling [7-11]. In the context of these barriers, weight loss counseling infrequently occurs in this clinical setting [12,13], and primary care weight management programs have typically achieved limited success [14,15].

To address some of the limitations of previous primary care interventions, obesity treatment delivered by trained peer coaches may provide an innovative and practical alternative. Peer coaches, also referred to as community health workers (CHWs) or lay health educators, are typically defined as individuals who participate in some capacity in health promotion, receive training for intervention delivery (but have no formal professional healthcare training), and have an existing relationship or other connection with the population receiving care [16]. Importantly, peer coaches have successfully assisted in the management of other chronic conditions, including diabetes [17] and cardiovascular disease [18].

Peer coaches may be particularly useful for obesity interventions in primary care because coaches can serve as care extenders for the primary care team and may be more accessible to patients and more familiar with their personal experiences than healthcare providers [16,19,20]. Also, patients are accustomed to receiving ongoing care through their physician’s office. With appropriate training, coaches may be uniquely positioned to provide support, encouragement, and community linkages to promote adherence to long-term behavior change. Peer coaches may be especially effective for helping patients incorporate new or complex treatment regimens into their daily lives [19], which would have clear application to lifestyle interventions for obesity

In support of this idea, a handful of recent studies have examined obesity interventions delivered by peer coaches/CHWs in other applied settings, including community centers, churches, and senior centers [21-24]. Many of these peer-delivered interventions have achieved clinically meaningful weight loss that differed significantly from comparison conditions [21- 24]. In addition, a recent single-group pilot study examined the effects of a peer-based weight loss intervention specifically delivered in primary care, and this program also achieved significant weight reductions and was well-received by patients [25].

While these initial findings are encouraging, additional research is needed to better understand the potential impact of peer-delivered obesity interventions for primary care. In particular, randomized trials comparing peer-led interventions to alternative treatment options are needed. Such trials will require adequate sample sizes and extended follow-up to fully address this research question. Additional work is also needed to better understand individuals’ characteristics, background, and training that ideally prepare them to serve in the role of peer coach for obesity treatments. On a practical note, identifying and implementing reimbursement strategies for these clinical services will be important for the feasibility and sustainability of peer-delivered programs in primary care.

In summary, peer coaches may offer an efficient option for delivering weight loss programs in primary care. If peer-based weight management programs prove effective in primary care, this could offer a practical and sustainable approach for weight loss treatment delivery, which would have significant public health reach for the management of obesity and the reduction of weight-related health conditions. The development and evaluation of training and certification procedures for peer coaches, as well as standardized intervention materials to be used by coaches, could promote the dissemination of such programs to various health systems, providers, and practices.


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Article Information

Article Type: Editorial

Citation: Dutton GR, Phillips JM (2015) Is there a Role for Lay Peer Coaches in the Treatment of Obesity in Primary Care? Obes Open Access 1 (1): doi http://dx.doi.org/10.16966/2380-5528.e102

Copyright: © 2015 Dutton GR et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Publication history: 

  • Received date: 12 May, 2015

  • Accepted date:12 May, 2015

  • Published date: 18 May, 2015