Increasing initiation of evidence-based weight loss treatment

越来越多地开始开展循证减肥治疗

基本信息

批准号：
10735201
负责人：
Megan Apperson McVay
金额：
$ 61.94万
依托单位：
UNIVERSITY OF FLORIDA
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-09-01 至 2028-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10735201
关键词：
Address Adoption Adult African American Age Appointment Behavior Therapy Behavioral Black race Body Weight Changes Body Weight decreased Body mass index Characteristics Chronic Disease Clinic Clinical Cluster randomized trial Counseling Data Demographic Factors Disparity Distress Education Eligibility Determination Enrollment Ensure Equity Ethnic Origin Evidence based treatment Feedback Frequencies Gender Goals Income Individual Insurance Carriers Intervention Interview Low income Maintenance Mediator Methods Modeling Obesity Obesity Epidemic Outcome Participant Patients Pattern Population Population Heterogeneity Primary Care Provider Race Randomized Reach, Effectiveness, Adoption, Implementation, and Maintenance Risk Sampling Schedule Signal Transduction Testing United States Centers for Medicare and Medicaid Services Weight Weight maintenance regimen Woman Work adult obesity arm cost depressive symptoms design diabetes prevention program effectiveness testing evidence base feasibility trial higher education improved intervention effect men mortality motivational enhancement therapy novel obese patients obesity treatment participant enrollment pilot trial population health primary care clinic primary care patient primary care practice primary care provider primary outcome randomized, clinical trials recruit secondary outcome tool treatment center two-arm study uptake usability weight loss intervention weight loss program

项目摘要

PROJECT SUMMARY/ABSTRACT Comprehensive behavioral treatments are effective at promoting weight loss and improving clinical outcomes among adults with obesity. However, a large majority of individuals with obesity never take the first step of initiating these treatments (even when barriers to cost and access are reduced), severely limiting the population impact of evidence-based weight management treatments. To address this challenge and take advantage of growing access to comprehensive weight loss treatments, our team has developed a tool designed to increase initiation of evidence-based behavioral weight loss treatments among eligible but non- treatment seeking adults (“mobilization tool”). As part of this tool, patients answer brief questions and receive automated, individually tailored feedback. This feedback targets empirically and theoretically relevant constructs for treatment initiation using a Motivational Interviewing approach that supports patient autonomy. The tool is completed by patients in the days prior to a scheduled primary care appointment and contains explicit endorsement by patients’ primary care provider (PCPs), taking advantage of PCPs’ influence while not relying on PCPs to initiate weight counseling. It is also designed to be low burden and high acceptability to PCPs to facilitate dissemination, if effective. We previously conducted a cluster randomized feasibility pilot trial to inform plans for a fully powered test of the effectiveness of the mobilization tool. The pilot showed that the tool was highly usable, informative, and enjoyable; feasibility goals were met; and a signal of an effect was observed. We are now prepared to conduct an adequately powered cluster randomized clinical trial to compare the effects of the mobilization tool and a static treatment description (comparator tool), and to examine how effects differ across key demographic factors. We will recruit and randomize PCPs (n=36) and patients with obesity (n=828) who have an upcoming appointment with enrolled PCPs. All enrolled patients will complete either the mobilization tool or the comparator tool, depending on their randomization arm, and will be informed that they have free access to comprehensive weight loss treatment. We will compare the two study arms on the proportion who initiate weight loss treatment (primary outcome), session attendance, and weight loss outcomes at 6 months (secondary outcomes). Because weight loss programs historically have had lower uptake by individuals who are men, Black/African American, younger, have lower income, and have lower educational attainment, we will recruit a diverse population to allow for comparisons of effects across gender, race, age, income, and education. If effective, the proposed mobilization tool could be disseminated within primary care practices to increase the number of adults with obesity who initiate evidence-based weight loss treatment, resulting in greater population weight loss and meaningful changes in population health.

项目概要/摘要综合行为治疗可有效促进减肥和改善临床结果然而，大多数肥胖症患者从未迈出第一步。启动这些治疗（即使成本和获取障碍减少），严重限制了为了应对这一挑战并采取基于证据的体重管理治疗的人口影响。利用越来越多的综合减肥治疗方法，我们的团队开发了一种工具旨在增加符合条件但不符合条件的人开始基于证据的行为减肥治疗成人寻求治疗（“动员工具”）作为该工具的一部分，患者回答简短的问题并接受治疗。自动化的、个性化的反馈。这种反馈的目标是与经验和理论相关的。使用支持患者自主权的动机访谈方法构建治疗启动。该工具由患者在预定的初级保健预约前几天完成，包含得到患者初级保健提供者 (PCP) 的明确认可，利用 PCP 的影响力而不是依靠 PCP 发起体重咨询的目的也是为了减轻负担并提高接受度。 PCP 促进传播（如果有效）我们之前进行了整群随机可行性试点试验。为动员工具有效性的全面动力测试计划提供信息试点表明工具非常实用、信息丰富且令人愉快；实现了可行性目标，并显示出效果；我们现在准备进行一项足够有力的集群随机临床试验来进行比较。动员工具和静态治疗描述（比较工具）的效果，并检查如何我们将招募 PCP (n=36) 和患者并对其进行随机分组。即将与登记的 PCP 进行预约的肥胖症 (n=828) 所有登记的患者都将完成。动员工具或比较工具，具体取决于其随机分组，并将被告知他们可以免费获得全面的减肥治疗，我们将比较两个研究组。开始减肥治疗的比例（主要结果）、会议出席率和减肥情况 6 个月时的结果（次要结果）因为减肥计划历来较低。男性、黑人/非裔美国人、较年轻、收入较低且拥有较低收入的个人的吸收率教育程度，我们将招募不同的人群，以便比较不同性别的影响，种族、年龄、收入和教育程度。如果有效，拟议的动员工具可以在内部传播。初级保健实践，以增加开始循证减肥的肥胖成人人数治疗，从而导致更大的人口体重减轻和人口健康的有意义的变化。