Remote delivery of a weight management intervention for adults with intellectual disabilities: Results from a randomized non-inferiority trial.

COVID-19 broke the comparison. Face-to-face contact stopped from March to June 2020 and all 37 participants in that arm had telephone sessions instead, and 13 participant and partner pairs chose to stay on the telephone afterwards. Their 6-month weight loss was far below what the same programme had produced before, so this is not a clean test of remote against in-person delivery. Drop-out was high and uneven. By 24 months only 55% of the face-to-face group remained against 77% of the remote group, so the 18-month and 24-month comparisons rest on very different people in each arm. There was no workable remote way to measure height or waist circumference, so BMI and waist data were missing for 20, 12 and 14 participants at 6, 18 and 24 months. Only adults with mild-to-moderate intellectual disability were included, living in the community, with internet access at home, able to communicate in spoken language, and with a caregiver who agreed to act as a study partner. The results say nothing about people with more severe intellectual disability, people in institutional settings, or people without that support. The authors say they could not get useful measures of how closely people followed the diet and activity advice, and that the poor recorded compliance sat oddly with the amount of weight lost, so the adherence figures should not be taken at face value. Participants were paid for each session and each assessment and were given an iPad at 18 months, which is not how a routine clinic or community programme would run.

The authors declare they have no competing interests. The low-energy shakes used in the diet were provided by the trial and are a branded product (Profile by Sanford Health). Participants received a $5 gift card for each behavioural session and $20 for each of the five outcome assessments, and every participant was given an iPad at 18 months; study partners received $50 gift cards at 6, 12 and 18 months. No external funder is named in the text supplied.

Do not read this as proof that remote delivery beats home visits. COVID-19 forced the face-to-face group onto the telephone, their 6-month weight loss was 2.1 kg against the 6.8 kg expected from the group's earlier trial, and the authors themselves say the superiority finding should be interpreted cautiously. What the trial does show is that remote delivery was not worse.