Rural Engagement in Primary Care for Optimizing Weight Reduction

NCT ID: NCT02456636

Last Updated: 2020-12-07

Study Results

Results available

Outcome measurements, participant flow, baseline characteristics, and adverse events have been published for this study.

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

1432 participants

Study Classification

INTERVENTIONAL

Study Start Date

2016-02-15

Study Completion Date

2019-12-30

Brief Summary

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The purpose of this study is to compare three methods for managing obesity in rural patients, to see which method will result in patients being able to attain their weight loss goal and maintain that weight loss.

Detailed Description

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Nearly 20% of the U.S. population lives in rural communities. Rural residents suffer at a higher rate from obesity and obesity-related illnesses, including diabetes, heart disease, and arthritis. Local primary care physicians are an important resource for treating obesity in rural areas because of a lack of other community resources.

This study is looking at how effective current, real-world primary care treatment models are in helping rural residents lose weight and maintain that weight loss. Physician clinics will be randomized (like picking numbers from a hat) to conduct one of the three methods. The method a participant is part of will depend on the method their physician's clinic is randomized to. The three methods involved in this study are:

1. Individual weight-management counseling in person (in clinic individual visits)
2. Group weight-management counseling, both in person and by telephone; the latter if preferred by the group (in clinic group visits)
3. Group weight-management counseling by telephone (phone group visits)

Participants will be in the study about 24 months. The number of in-person clinic visits and phone calls each participant will be asked to complete depends on the method.

Conditions

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Obesity

Keywords

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Weight loss Weight management Diabetes Heart disease

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Fee-for-Service Model (FFS, In clinic individual visits)

Participants will receive individual counseling from their physician or other healthcare professional during regular clinic visits.

Group Type ACTIVE_COMPARATOR

Fee-for-Service Model (FFS, In clinic individual visits)

Intervention Type BEHAVIORAL

To be performed by participant's doctor or other healthcare professional in their doctor's office.

Patient Centered Medical Home (PCMH, In clinic group visits)

Participants will take part in group weight-management counseling during in-person group visits; later sessions may be conducted via group telephone calls if the group prefers.

Group Type ACTIVE_COMPARATOR

Patient Centered Medical Home (PCMH, In clinic group visits)

Intervention Type BEHAVIORAL

To be performed by a registered dietitian, a nurse or other healthcare professional in their local setting.

Disease Management (DM, Phone group visits)

Participants will take part in group weight-management counseling by telephone.

Group Type ACTIVE_COMPARATOR

Disease Management (DM, Phone group visits)

Intervention Type BEHAVIORAL

To be performed by obesity treatment specialists with relevant graduate training and experience with weight loss counseling via telephone.

Interventions

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Fee-for-Service Model (FFS, In clinic individual visits)

To be performed by participant's doctor or other healthcare professional in their doctor's office.

Intervention Type BEHAVIORAL

Patient Centered Medical Home (PCMH, In clinic group visits)

To be performed by a registered dietitian, a nurse or other healthcare professional in their local setting.

Intervention Type BEHAVIORAL

Disease Management (DM, Phone group visits)

To be performed by obesity treatment specialists with relevant graduate training and experience with weight loss counseling via telephone.

Intervention Type BEHAVIORAL

Other Intervention Names

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Individual weight management counseling Group weight management counseling (in-person and telephone) Group weight management counseling (telephone)

Eligibility Criteria

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Inclusion Criteria

* BMI between 30 kg/m2 and 45 kg/m2.
* Live in a rural location.
* Have clearance from their primary care provider to participate in a diet and exercise weight control intervention.
* Have access to a telephone.
* One individual per household will be permitted to enroll in the study.

Exclusion Criteria

* History of heart attack in the last six months, stroke in the last six months, or new cancer diagnosis in the last six months.
* History of bariatric surgery or planning bariatric surgery in the next two years.
* Pregnancy within the last six months or planned within the next two years or currently pregnant or lactating.
* Serious medical conditions where weight loss is contraindicated.
* End stage renal disease or end stage liver disease.
* Other medical contraindications as determined by the patient's primary care physician (PCP); documented PCP clearance will be obtained.
* Participants who are already enrolled in, or planning to enroll in another research study where weight loss is targeted.
* Participants who plan to relocate outside of their provider's service area or who plan to leave their primary care clinic in the next 2 years.
* Unable to read and understand English.
Minimum Eligible Age

20 Years

Maximum Eligible Age

75 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Patient-Centered Outcomes Research Institute

OTHER

Sponsor Role collaborator

University of Kansas Medical Center

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Christie Befort, PhD

Role: PRINCIPAL_INVESTIGATOR

University of Kansas Medical Center

Locations

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University of Kansas Medical Center

Kansas City, Kansas, United States

Site Status

Countries

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United States

References

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Saint Onge JM, Fagan M, Befort CA. The association between the obesogenic environment and 6-month and 24-month weight change in a rural weight loss intervention trial in the United States. Prev Med. 2022 May;158:107040. doi: 10.1016/j.ypmed.2022.107040. Epub 2022 Apr 7.

Reference Type DERIVED
PMID: 35398370 (View on PubMed)

Tang F, Befort CA, Wick J, Gajewski BJ. Unifying the analysis of continuous and categorical measures of weight loss and incorporating group effect: a secondary re-analysis of a large cluster randomized clinical trial using Bayesian approach. BMC Med Res Methodol. 2022 Jan 26;22(1):28. doi: 10.1186/s12874-021-01499-0.

Reference Type DERIVED
PMID: 35081912 (View on PubMed)

Katzmarzyk PT, Apolzan JW, Gajewski B, Johnson WD, Martin CK, Newton RL Jr, Perri MG, VanWormer JJ, Befort CA. Weight loss in primary care: A pooled analysis of two pragmatic cluster-randomized trials. Obesity (Silver Spring). 2021 Dec;29(12):2044-2054. doi: 10.1002/oby.23292. Epub 2021 Oct 29.

Reference Type DERIVED
PMID: 34714976 (View on PubMed)

Goessl CL, VanWormer JJ, Pathak RD, Ellerbeck EF, Befort CA. Affective disorders, weight change, and patient engagement in a rural behavioral weight loss trial. Prev Med. 2021 Nov;152(Pt 2):106698. doi: 10.1016/j.ypmed.2021.106698. Epub 2021 Jun 24.

Reference Type DERIVED
PMID: 34175347 (View on PubMed)

Befort CA, VanWormer JJ, Desouza C, Ellerbeck EF, Gajewski B, Kimminau KS, Greiner KA, Perri MG, Brown AR, Pathak RD, Huang TT, Eiland L, Drincic A. Effect of Behavioral Therapy With In-Clinic or Telephone Group Visits vs In-Clinic Individual Visits on Weight Loss Among Patients With Obesity in Rural Clinical Practice: A Randomized Clinical Trial. JAMA. 2021 Jan 26;325(4):363-372. doi: 10.1001/jama.2020.25855.

Reference Type DERIVED
PMID: 33496775 (View on PubMed)

Befort CA, Kurz D, VanWormer JJ, Ellerbeck EF. Recruitment and reach in a pragmatic behavioral weight loss randomized controlled trial: implications for real-world primary care practice. BMC Fam Pract. 2020 Mar 3;21(1):47. doi: 10.1186/s12875-020-01117-w.

Reference Type DERIVED
PMID: 32126987 (View on PubMed)

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Other Identifiers

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PCORI-1402-09413

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

STUDY00002654

Identifier Type: OTHER

Identifier Source: secondary_id

RE-POWER

Identifier Type: -

Identifier Source: org_study_id