Higher rates of obesity, sedentary lifestyle, and coronary heart disease are observed in rural than non-rural areas of the U.S., yet the treatment of obesity in the rural population has received little research attention. Efficacy studies, typically conducted in urban settings, show that lifestyle interventions produce clinically significant weight reductions, but a regaining of lost weight commonly follows the conclusion of treatment. Recent studies have demonstrated that clinic-based, extended-care programs can improve the maintenance of lost weight. Thus, the next logical steps in this line of research are (a) to extend these studies to community settings with underserved populations and (b) to test alternative and potentially more efficient methods of providing extended care, such as through the use of telephone-based rather than clinic-based maintenance programs. The primary objective of TOURS is to test the effectiveness of weight-loss maintenance programs in a randomized controlled trial, conducted in medically underserved rural settings. Obese women (N=300), ages 50-75 years, from six medically underserved rural counties will be randomly assigned to one of three 18- months long obesity treatment programs. Each treatment condition will include an initial 6-month lifestyle intervention followed by one of three 12-month follow-up programs: (A) an Office-based Maintenance Program, (B) a Telephone-Based Maintenance Program, or (C) an Education Control Condition. Dependent variables to be assessed at baseline, 6 months, and 18 months will include body weight, as well as a selected Array of health-related indicators and quality of life measures. It is hypothesized that participants assigned to either of the experimental programs will exhibit better maintenance of lost weight compared with those assigned to the control condition. Potential mediators and moderators of the intervention program-weight change relationship will be examined, and exploratory analyses of the costs and cost effectiveness of the interventions will be conducted. This trial will contribute important public health information regarding methods for improving obesity management in an underserved population at high risk for weight-related chronic diseases and disability.
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