TREATMENT OF OBESITY IN UNDERSERVED RURAL SETTINGS-TOURS

描述(由申请人提供)： 美国农村地区的肥胖率、久坐不动的生活方式和冠心病的发生率高于非农村地区，但农村人口肥胖症的治疗很少受到研究关注。通常在城市环境中进行的疗效研究表明，生活方式干预在临床上产生了显著的减肥效果，但通常在治疗结束后体重会回升。最近的研究表明，以临床为基础的长期护理计划可以改善减肥的维持。因此，这一系列研究的下一个合乎逻辑的步骤是(A)将这些研究扩展到服务不足的人口所在的社区环境，以及(B)测试提供延长护理的替代和潜在更有效的方法，例如通过使用基于电话的维护计划而不是基于诊所的维护计划。TURES的主要目标是在一项随机对照试验中测试减肥维持计划的有效性，该试验在医疗服务不足的农村环境中进行。来自六个医疗服务不足的农村县的50-75岁肥胖女性(N=300)将被随机分配到三个为期18个月的肥胖治疗计划中的一个。每个治疗条件将包括最初的6个月的生活方式干预，然后是三个12个月的后续计划之一：(A)基于办公室的维护计划，(B)基于电话的维护计划，或(C)教育控制条件。在基线、6个月和18个月评估的因变量将包括体重，以及选定的一系列与健康相关的指标和生活质量衡量标准。据推测，与那些被分配到控制条件的参与者相比，被分配到这两个实验项目中的参与者将表现出更好的减肥效果。将审查干预计划-体重变化关系的潜在调解人和主持人，并对干预措施的成本和成本效益进行探索性分析。这项试验将提供重要的公共卫生信息，说明如何在与体重相关的慢性病和残疾的高风险人群中改善服务不足人群的肥胖管理。

DESCRIPTION (provided by applicant): Higher rates of obesity, sedentary lifestyle, and coronary heart disease are observed in rural than non-rural areas of the U.S., yet the treatment of obesity in the rural population has received little research attention. Efficacy studies, typically conducted in urban settings, show that lifestyle interventions produce clinically significant weight reductions, but a regaining of lost weight commonly follows the conclusion of treatment. Recent studies have demonstrated that clinic-based, extended-care programs can improve the maintenance of lost weight. Thus, the next logical steps in this line of research are (a) to extend these studies to community settings with underserved populations and (b) to test alternative and potentially more efficient methods of providing extended care, such as through the use of telephone-based rather than clinic-based maintenance programs. The primary objective of TOURS is to test the effectiveness of weight-loss maintenance programs in a randomized controlled trial, conducted in medically underserved rural settings. Obese women (N=300), ages 50-75 years, from six medically underserved rural counties will be randomly assigned to one of three 18- months long obesity treatment programs. Each treatment condition will include an initial 6-month lifestyle intervention followed by one of three 12-month follow-up programs: (A) an Office-based Maintenance Program, (B) a Telephone-Based Maintenance Program, or (C) an Education Control Condition. Dependent variables to be assessed at baseline, 6 months, and 18 months will include body weight, as well as a selected Array of health-related indicators and quality of life measures. It is hypothesized that participants assigned to either of the experimental programs will exhibit better maintenance of lost weight compared with those assigned to the control condition. Potential mediators and moderators of the intervention program-weight change relationship will be examined, and exploratory analyses of the costs and cost effectiveness of the interventions will be conducted. This trial will contribute important public health information regarding methods for improving obesity management in an underserved population at high risk for weight-related chronic diseases and disability.