Increasing initiation of evidence-based weight loss treatment

越来越多地开始开展循证减肥治疗

• 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
• 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

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.

项目摘要/摘要 全面的行为治疗可有效促进体重减轻和改善临床结果 在肥胖的成年人中。但是，绝大多数肥胖者从未迈出第一步 启动这些处理（即使降低了成本和访问障碍），严重限制了 基于证据的体重管理治疗的人口影响。应对这一挑战并接受 我们的团队开发了一种工具 旨在提高合格但非合格但非合格行为减肥治疗的主动性 寻求成人的治疗（“动员工具”）。作为此工具的一部分，患者回答简短的问题并接受 自动化的，单独量身定制的反馈。该反馈紧急针对和理论上的针对性 使用支持患者自主权的动机访谈方法进行治疗计划的结构。 该工具由患者在预定的初级保健预约之前的几天内完成，并包含 患者初级保健提供者（PCP）的明确认可，利用PCP的影响而不是 依靠PCP来发起体重咨询。它也被设计为低燃烧和高可接受性 PCP，以促进传播（如果有效）。我们以前进行了一项群集随机可行性试验试验 为计划提供完全动机工具有效性的计划。飞行员表明 工具是高度可用，有益且令人愉快的；实现了可行性目标；效果的信号是 观察到。现在，我们准备进行适当动力的簇随机临床试验以比较 动员工具和静态治疗描述（比较器工具）的影响，并检查如何 关键人口因素的影响不同。我们将招募和随机对PCP（n = 36）和患者 肥胖（n = 828），他们即将任命的PCP任命。所有注册的患者将完成 动员工具或比较工具，具体取决于其随机臂，并将被告知 他们可以免费获得全面的减肥疗法。我们将在两个研究方面进行比较 启动减肥治疗（主要结果），会议出勤和减肥的比例 6个月的结果（次要结果）。因为减肥计划历史上较低 男人，黑人/非裔美国人，年轻，收入较低，较低的人的吸收 受教育程度，我们将招募潜水员人口，以比较性别的影响， 种族，年龄，收入和教育。如果有效，则可以将提议的动员工具传播 初级保健实践增加了肥胖的成年人数量，这些成年人启动基于证据的减肥 治疗，导致人口减少和人口健康的有意义变化。