Increasing initiation of evidence-based weight loss treatment

项目摘要/摘要 综合行为疗法在促进减肥和改善临床结果方面是有效的 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(即使降低了成本和获取障碍)，严重限制了 循证体重管理治疗对人群的影响。应对这一挑战并采取 利用越来越多的人获得全面减肥治疗的优势，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启动循证行为减肥治疗 寻求成人治疗(“动员工具”)。作为这一工具的一部分，患者回答简短的问题并接受 自动的、个性化的反馈。这种反馈的目标是经验和理论上的相关性。 使用支持患者自主的激励性访谈方法开始治疗的构建。 该工具由患者在预定的初级保健预约前几天完成，其中包含 患者的初级保健提供者(PCP)明确认可，利用PCP的影响力而不是 依靠PCP发起体重咨询。它还被设计成负担小，可接受性高 如果有效的话，PCP将有助于传播。我们之前进行了一项集群随机可行性试点试验 通知对动员工具的有效性进行全动力测试的计划。飞行员表明， 工具具有高度的可用性、信息量和趣味性；实现了可行性目标；并发出了效果的信号 观察到的。我们现在准备进行一项动力充足的整群随机临床试验来比较 动员工具和静态治疗说明(比较工具)的效果，并审查如何 关键人口统计因素的影响各不相同。我们将招募和随机选择PCP(n=36)和患有 肥胖(n=828)，即将与登记的初级保健医生预约。所有登记的患者将完成 动员工具或比较工具，视其随机化臂而定，并将被告知 他们可以免费获得全面的减肥治疗。我们将对这两个学习臂进行比较 开始减肥治疗的比例(主要结果)、参加治疗的次数和减肥 6个月的结果(二次结果)。因为减肥计划历来有较低的 男性，黑人/非裔美国人，年轻，收入较低，收入较低 教育程度，我们将招募不同的人口，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 初级保健做法，以增加启动循证减肥的肥胖成年人数量 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。

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.