Managing Obesity by Leveraging Health Information Technology to Lower Cancer Risk

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Obesity is an important risk factor for many serious diseases including many types of cancer.2-36 In the United States, obesity disproportionally affects underserved population groups such as racial and ethnic minorities, persons with lower socioeconomic status, and persons living in rural areas.1,37,38 These underserved groups are also at increased risk for developing and dying from cancer.39-42 Large clinical trials, such as Look AHEAD (Action for Health in Diabetes), have shown that a multicomponent weight loss intervention combining diet, physical activity, and behavioral modification is effective in achieving long term weight loss which resulted in a lower incidence of obesity-related cancers.43-45 As a result, clinical practice guidelines recommend the delivery of obesity interventions in primary care settings. However, it is unknown if such weight loss interventions work well in underserved populations or in rural settings because of limited access to healthcare resources and community facilities for a healthy lifestyle and/or because the target population may have different cultural and social backgrounds. To overcome these specific barriers to implementing a weight loss intervention, we propose a practice- based clinical trial to translate the efficacious Look AHEAD Intensive Lifestyle Intervention (ILI) to underserved populations. In this project, we will modify the intervention to be delivered through Health IT specifically the patient portal in the electronic health record (EHR) and will work with the Methodist Medical Group to establish partnerships between the investigators and community stakeholders. This project tests whether the Look AHEAD Intensive Lifestyle Intervention (ILI) will result in significant weight loss when delivered through Health IT- EHR patient portal compared to a Comparison intervention. This project will be conducted in 2 stages: a formative assessment stage (Stage 1) and a clinical trial stage (Stage 2). During Stage 1, we will modify the interactive technology-based Look AHEAD ILI that we already developed for the TARGIT study (Active Intervention Group). We will also adapt the Look AHEAD Comparison condition (DSE group) for our Comparison condition.56 We will also optimize the protocol for acceptability in underserved populations and in a rural setting. During Stage 2, we will randomly assign 250 participants to either the Comparison Group or the Active Intervention Group to address the primary aim of testing the hypothesis that a multicomponent, behavioral weight loss intervention delivered through Health IT – EHR patient portal will lead to significantly greater weight loss 12 months after enrollment compared with a comparison group. Our Health IT-based intervention is potentially cost-effective and thus disseminable to any practice-based physician group with access to an EHR with a patient portal. We have chosen the Socio-ecological Model as our conceptual model to assist with understanding social determinants of health as related to the study intervention and weight loss.