We know little about how to deliver efficacious behavioral obesity treatments to socioeconomically disadvantaged patients in the primary care setting. This is a major public health challenge. Socioeconomically disadvantaged populations have the greatest exposure to obesogenic risk factors and the highest rates of obesity and related chronic diseases. However, there has been little success in promoting clinically significant weight loss outcomes in this population. There is emerging evidence supporting the efficacy of eHealth weight loss approaches, particularly when they include interpersonal support from care providers. Our group has conducted preliminary studies of eHealth obesity treatment interventions in community health centers. Community health centers are particularly important primary care settings because they mainly serve socioeconomically disadvantaged patients - thus targeting those with greatest need - while offering great dissemination potential. Primary care providers in these settings may play an important role in stimulating patient behavior change. However, it is unclear how to optimally involve community health center providers in obesity treatment interventions, given their clinical demands and limited ancillary resources. We propose a novel, systems-based intervention approach that integrates and informs primary care providers without being burdensome. In keeping with the best evidence, it includes ancillary care providers as interventionists. Tailored skills training, self-monitoring and feedback are offered using eHealth technologies. The study will be conducted in collaboration with Piedmont Health Services, Inc. (PHS), a community health center system in rural North Carolina. The PHS patient population has great racial/ethnic and geographic diversity, but is unified by profound socioeconomic disadvantage and high rates of obesity and related chronic diseases (e.g. diabetes and CVD). We propose a cluster randomized trial in which the six PHS community health centers will be randomized into one of two treatment arms: 1) standard primary care;or 2) primary care plus a 12-month eHealth behavioral weight loss intervention (iOTA), which includes interactive self-monitoring and feedback, tailored skills training materials 18 telephone counseling calls, and provider counseling. The primary outcome is weight change at 12 months. Participants will be PHS patients with obesity and a cardiometabolic comorbidity. Participants will be followed over 12 months with assessments at baseline and 6 and 12 months post baseline.

Public Health Relevance

Use of efficacious eHealth obesity treatment strategies in the primary care setting might dramatically reduce the high rates of obesity and related chronic diseases found among socioeconomically disadvantaged patients. !

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Research Project (R01)
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Psychosocial Risk and Disease Prevention Study Section (PRDP)
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Kuczmarski, Robert J
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Duke University
Internal Medicine/Medicine
Schools of Medicine
United States
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Bennett, Gary G; Steinberg, Dori; Askew, Sandy et al. (2018) Effectiveness of an App and Provider Counseling for Obesity Treatment in Primary Care. Am J Prev Med 55:777-786
Foley, Perry; Steinberg, Dori; Levine, Erica et al. (2016) Track: A randomized controlled trial of a digital health obesity treatment intervention for medically vulnerable primary care patients. Contemp Clin Trials 48:12-20