Individuals with mobility related disabilities (MRDs) represent a sizeable and growing segment of the US adult population, with high rates of obesity, and limited options for successful weight management. Adults with MRDs face numerous barriers to weight management including the lack of affordable, accessible transportation to attend on-site meetings or engage in physical activity (PA), lack of accessible exercise facilities with accessible fitness equipment, and difficulty with food shopping and meal preparation. There is virtually no information regarding the comparative effectiveness of methods of delivery for weight management in adults with MRDs. We previously evaluated an enhanced version of the Stop Light Diet (eSLD = SLD+portion controlled entres and low calorie shakes) for weight management in adults with both intellectual with MRDs. When prescribed in conjunction with a monthly behavioral intervention, delivered in an individual, home visit format, the eSLD resulted in significantly greater weight loss at 6 and 12 mos. when compared with a meal plan diet in adults with MRDs. Although these results are encouraging, alternative strategies to provide weight management to larger numbers of adults with MRDs, potentially improve outcomes, and reduce costs, are warranted. Therefore, we propose a two-arm randomized trial to compare body weight following weight loss (6 mos.) and maintenance (18 mos.) between interventions delivered either remotely via group video conferencing on a tablet computer to participants in their homes (GR), or during individual home visits (IH). Both intervention arms will use an eSLD and self-monitor body weight using electronic scales. The GR arm will include group behavioral counseling and group PA delivered remotely via video conferencing on a tablet computer to participants in their homes, and use commercially available web-based applications for self- monitoring/participant feedback for diet and PA. The IH arm will include behavioral counseling delivered during individual home visits, a prescription for self-directed PA, and self-monitoring of diet and PA using conventional paper and pencil self-reports. The primary aim will be to compare weight loss (0-6 mos.) between the two interventions. We expect significantly greater weight loss in the GR compared with IH arm. Secondarily we will compare mean weight loss from 0-18 mos., the proportion of participants achieving ? 5% weight loss from baseline, changes in cardiovascular risk factors and quality of life, and conduct a cost analysis. In addition, we will explore the influence of behavioral session attendance, compliance with the recommendations for diet (energy intake, number of entres /shakes, servings of fruits/vegetables), PA (min of moderate-vigorous PA, min sedentary time), and self-monitoring of diet and PA, self-efficacy for dietary change and PA, dietary self- regulation, social support for diet/PA, barriers to PA, sleep, and medications on weight loss at 6 and 18 mos.
The remote delivery format, using an enhanced Stop Light diet, may provide clinically meaningful weight loss for adults with mobility related disabilities. This format represents a potentially scalable and cost-effective strategy that could be used by agencies to provide weight management for adults with mobility related disabilities irrespective of geographic location. Thus, we believe that the likelihood of translation of this research into practice is reasonable and promising. !
