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.

项目总结/摘要 综合行为治疗在促进减肥和改善临床结果方面有效 在肥胖的成年人中。然而，绝大多数肥胖者从未迈出第一步， 启动这些治疗（即使成本和获取障碍减少），严重限制了 基于证据的体重管理治疗的人群影响。为了应对这一挑战， 随着越来越多的人获得全面的减肥治疗，我们的团队开发了一种工具， 旨在增加在符合条件但不符合条件的人群中开展循证行为减肥治疗的机会。 寻求治疗的成年人（“动员工具”）。作为该工具的一部分，患者回答简短的问题， 自动化、个性化的反馈。这种反馈的目标是经验和理论上相关的 使用支持患者自主性的动机访谈方法进行治疗启动的结构。 该工具由患者在预定的初级保健预约前几天完成，包含 患者的初级保健提供者（PCP）的明确认可，利用PCP的影响力， 依靠PCP来进行体重咨询。它还被设计成低负担和高可接受性， 如果有效，项目完成方案将促进传播。我们之前进行了一项群集随机可行性试点试验 为动员工具有效性的全面测试计划提供信息。飞行员表示， 工具的可用性、信息量和趣味性都很高;可行性目标得到满足;效果信号是 观察我们现在准备进行一项有充分把握度的随机分组临床试验， 动员工具和静态治疗描述（比较工具）的效果，并检查如何 影响因关键人口因素而异。我们将招募并随机分配PCP（n=36）和患者， 肥胖（n=828），即将与入组的PCP进行预约。所有入组患者将完成 动员工具或比较工具，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（主要结局）、会议出席率和体重减轻 6个月时的结局（次要结局）。因为减肥计划在历史上有较低的 男性、黑人/非裔美国人、年轻人、收入较低的人以及 教育程度，我们将招募不同的人群，以比较不同性别的影响， 种族、年龄、收入和教育。如果有效，拟议的动员工具可在内部传播， 初级保健实践，以增加开始循证减肥的肥胖成年人的数量 治疗，导致更大的人口体重减轻和人口健康的有意义的变化。