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

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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.