The United States Preventive Services Task Force (USPSTF) recommends that primary care providers use the 5As framework (Assess, Advise, Agree, Assist, Arrange) to provide counseling to obese patients. Providers frequently do not counsel patients due to barriers such as competing demands and low perceived competency which may contribute to poor patient attendance to effective weight management programs. Patient-centered medical homes can use team-based care to address these barriers, increase attendance to intensive weight management programs, and provide weight management services to those who do not to attend. We developed and formatively evaluated an innovative, technology-assisted 5As-based intervention to promote weight loss, behavior change, and increase enrollment in intensive programs (e.g. the MOVE! program from the Veteran?s Affairs (VA) and the Diabetes Prevention Program) within medical homes. This intervention, called GEM (Goals for Eating and Moving), uses 4 components to deliver 5As counseling?the GEM online tool, health coach counseling, brief primary care team counseling, and follow-up telephone coaching. The GEM tool is a mobile-friendly software program delivered via tablet computers in the primary care setting to facilitate counseling by a health coach and primary care staff. Our preliminary data suggest that the GEM intervention is feasible and acceptable to patients and staff and facilitates 5As counseling. A randomized trial is needed to examine its impact on weight loss and health outcomes. We will conduct a cluster-randomized controlled trial at 2 urban health centers: the VA New York Harbor and at sites within the Montefiore Medical Group (MMG) to assess the efficacy of the GEM intervention compared to Enhanced Usual Care. We will recruit 512 patients from 16 primary care teams (8 from VA sites, 8 from MMG sites), each with 2 or more primary care providers. Eligible patients with a Body Mass Index of ?30 kg/m2 or >25 kg/m2 and comorbidities with upcoming primary care appointments will be recruited via mail with follow up telephone calls. Patients within primary care teams randomized to the intervention group will receive the GEM intervention and those in the control group will receive Enhanced Usual Care. The primary outcome will be weight loss at the end of the 1 year intervention. We will use the RE-AIM evaluation framework to assess the reach (proportion of eligible patients who enroll), efficacy (weight loss and other related outcomes), adoption (acceptability to primary care teams), implementation (intervention fidelity) and maintenance (sustainability of weight change and program components between 12 and 24 months post-randomization).

Public Health Relevance

This study will evaluate the efficacy of an innovative, technology-assisted weight management intervention designed to treat obesity within Patient-Centered Medical Home models of primary care that deliver care through multi-professional teams. This intervention, called Goals for Eating and Moving (GEM), may enhance lifestyle-focused obesity treatment by integrating a novel mobile-friendly tool and health coaching within medical homes to address barriers to obesity counseling and increase attendance to effective, intensive weight management programs (e.g. the Diabetes Prevention Program and MOVE! ).

Agency
National Institute of Health (NIH)
Institute
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Type
Research Project (R01)
Project #
5R01DK111928-05
Application #
10000126
Study Section
Health Services Organization and Delivery Study Section (HSOD)
Program Officer
Kuczmarski, Robert J
Project Start
2016-09-20
Project End
2021-08-31
Budget Start
2020-09-01
Budget End
2021-08-31
Support Year
5
Fiscal Year
2020
Total Cost
Indirect Cost
Name
New York University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
121911077
City
New York
State
NY
Country
United States
Zip Code
10016