Clinical Research Project:Obesity Group Visits: A Novel Way to Approach the Obesity Epidemic in an Inner-City Setting

临床研究项目：肥胖团体访问：解决内城肥胖流行病的新方法

• 批准号: 10349524
• 负责人: THEODORE C FRIEDMAN
• 金额: $ 30.63万
• 依托单位: CHARLES R. DREW UNIVERSITY OF MED & SCI
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-28 至 2024-02-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10349524
• 关键词: Address; Adult; American; Antidiabetic Drugs; Antihypertensive Agents; Arthritis; Body Weight; Body Weight Changes; Body Weight decreased; Body mass index; Clinical; Clinical Research; Consensus; Consent; County; Data; Development; Dietitian; Doctor of Philosophy; Dose; Eating; Effectiveness; Enrollment; Evaluation; Family Physicians; Fatty acid glycerol esters; Feedback; Food; Glycosylated hemoglobin A; Group Therapy; Health Care Costs; Health Policy; Health Services; Healthy Eating; Hypertension; Indigent; Individual; Insulin; Intention; International; Intervention; Lead; Los Angeles; Measurement; Measures; Medical; Mental Depression; Minority; Modeling; Morbidity - disease rate; Non-Insulin-Dependent Diabetes Mellitus; Nurse Practitioners; Obesity; Obesity Epidemic; Participant; Patients; Pharmaceutical Preparations; Physical activity; Physicians; Population; Program Sustainability; Provider; Quality of life; Questionnaires; Research Project Grants; Review Literature; Running; Scanning; Suggestion; Testing; Translational Research; Underserved Population; Uninsured; United States; Visit; Weight; adult obesity; arm; cancer type; cardiovascular disorder risk; coronary artery calcium; coronary calcium scoring; cost effective; fatty liver disease; health care settings; health disparity; high risk; indexing; individualized medicine; inner city; innovation; interest; minority patient; novel; obese patients; obese person; obesity prevention; obesity treatment; outpatient facility; patient oriented; personalized approach; primary outcome; programs; randomized trial; stem; treatment as usual; treatment group; waist circumference; weight loss program

Abstract The obesity epidemic has led to and without intervention, will continue to lead to a large increase in health care costs in the US. Innovative, high-volume programs are needed to address the obesity epidemic. However, a literature review reveals that there is no consensus for optimal weight loss programs leading to a great need for innovative weight loss programs, particularly those that address underserved populations. Traditional provider- patient visits usually involve one provider with one patient. The group visit model (also called shared group visit) is one provider with multiple patients and the patients themselves supply support and information to each other. This model may be ideal for treating obesity in an inner-city population, an hypothesis that will be tested in our study. Utilizing the feedback and suggestions from stakeholders who have met together over the past 3 years as well as preliminary data from the POWER (Preventing Obesity With Eating Right) program that consented 651 obese patients at MLK-Outpatient Center over a 3-year period, we plan to test our hypothesis that an affordable, widely- scalable patient-centered group treatment approach to obesity with multiple culturally-sensitive components is at least as effective and more sustainable than an individualized approach to obesity with a dietician. We will perform a randomized trial of 18 months duration over a 5-year period testing either a shared composite group visit approach (450 participants) with an individualized dietician-led program (150 participants). We will use an intention to treat analysis. Endpoints of interest for both arms of this study will be assessed at 3, 6 and 12 months and compared to baseline and will include 1) % of patients who lost 5% of their initial body weight (primary outcome), 2) weight change, 3) waist circumference, 4) change in HbA1c. A subset of 125 patients in the composite group arm and 75 patients in the dietitian-led arm will undergo coronary artery calcium scanning and perivascular fat measurement at baseline and after 12-months of intervention. We expect that this study will answer the question about effectiveness of a group versus individualized treatment approaches for obesity and develop a group visit approach that is sustainable in an underserved adult obese population in a routine health care setting. Our study will examine this unique approach to treating obesity and inform health care policy and help stem the tide of the obesity epidemic and reduce health care costs.

抽象的 肥胖的流行导致有没有干预，将继续导致医疗保健大幅增加 在美国的成本。需要创新的大量计划来解决肥胖症流行。但是， 文献综述表明，最佳减肥计划尚无共识 创新的减肥计划，特别是那些解决服务欠缺的人群的计划。传统提供商 - 患者就诊通常涉及一名患者的提供者。小组访问模型（也称为共享小组访问） 是一个有多个患者的提供者，患者本身彼此提供支持和信息。 该模型可能是在城市内部人口中治疗肥胖症的理想选择，这是在我们的 学习。 利用过去三年中共​​同见面的利益相关者的反馈和建议 作为同意651肥胖的权力的初步数据（防止肥胖与饮食正确） 在3年的时间内，MLK Outpatient中心的患者计划检验我们的假设，即负担得起的，广泛的 具有多种文化敏感成分的可扩展以患者为中心的肥胖方法是 与营养师的个性化肥胖方法相比，至少与个性化的肥胖方法一样有效，更可持续。 我们将在5年的测试中进行18个月持续时间的随机试验 小组访问方法（450名参与者）具有个性化的营养师领导的计划（150名参与者）。我们将 使用意图来治疗分析。本研究的两个臂的关注终点将在3、6和 12个月，与基线相比，将包括1）损失最初体重5％的患者 （主要结果），2）体重变化，3）腰围，4）HBA1C的变化。 125名患者的子集 营养师主导的组合组和75例患者将接受冠状动脉钙扫描 以及在基线和12个月后的血管周脂肪测量。 我们希望这项研究将回答有关小组和个性化治疗的有效性的问题 肥胖的方法并开发了一种在服务不足的成人肥胖中可持续的小组访问方法 在常规医疗保健环境中的人口。我们的研究将研究这种独特的治疗肥胖和 为医疗保健政策提供信息，并有助于阻止肥胖流行的潮流并降低医疗保健成本。