Primary Care Obesity Management in the Southeast_PROMISE

 描述(由申请人提供)：初级保健为肥胖患者提供了一个熟悉和可访问的临床场所，以接受以证据为基础的生活方式干预，以控制体重。然而，在初级保健中实施此类计划存在许多障碍，而且初级保健医生或医疗团队其他成员之前提供的干预措施往往表明，患者的体重得到了适度和暂时的减轻。由训练有素的同行教练提供的减肥治疗可能为初级保健中的体重管理提供一种可行和有效的替代方案。虽然同伴教练已经成功地提供了针对其他慢性病(例如，2型糖尿病)的行为干预以及非临床环境(例如，社区中心)的肥胖干预，但缺乏关于将同伴提供的减肥干预转化为初级保健的有效性的研究。我们的初步工作表明，由同伴教练在初级保健中提供的减肥干预可以在临床上实现显著的体重减轻，在初级保健中采用是可行的，并受到患者的欢迎。在这项申请中，我们建议进行一项为期18个月的随机对照试验，比较肥胖治疗的效果，其中包括：1)与同行教练面对面和电话联系(同伴教练治疗)，或2)与初级保健提供者常规接触加上自我指导的干预材料(标准护理)。这项减肥试验将包括从10个初级保健实践中随机抽取的375名肥胖成年人。主要结果将是18个月时体重的变化。次要结果将包括以患者为中心的关键结果，包括生活质量、身体和社会功能、情绪和治疗满意度。还将对同伴教练干预的成本效益进行评估。这是一项关于初级保健中提供肥胖治疗的创新替代方案的有效性和可持续性的新调查。如果同伴教练的干预被证明是有效的，它将对患者、临床医生和卫生系统产生重大的临床和公共卫生影响。这些潜在的好处包括：1)改善患者的临床和心理社会结果，2)增加初级保健提供者管理肥胖症患者护理的治疗选择，3)减少医疗保健利用率和成本。

 DESCRIPTION (provided by applicant): Primary care offers a familiar and accessible clinical venue for patients affected by obesity to receive evidence- based lifestyle interventions for weight management. However, there are numerous barriers to the implementation of such programs in primary care, and previous interventions delivered by primary care physicians or other members of the healthcare team have often demonstrated modest and temporary weight loss for patients. Weight loss treatment delivered by trained peer coaches may offer a viable and effective alternative to address weight management in primary care. While peer coaches have successfully delivered behavioral interventions for other chronic conditions (e.g., type 2 diabetes) as well as obesity interventions in non-clinical settings (e.g., community centers), research is lacking on the effectiveness of translating peer- delivered weight loss interventions to primary care. Our preliminary work suggests that a weight loss intervention delivered in primary care by peer coaches can achieve clinically significant reductions in weight, is feasible for adoption in primary care, and is well-received by patients. In this application, we propose to conduct an 18-month randomized controlled trial comparing the effects of obesity treatment that includes either: 1) in-person and telephone-based contacts with peer coaches (peer coach treatment), or 2) routine contact with a primary care provider plus self-directed intervention materials (standard care). This weight loss trial will include 375 obese adults randomized from 10 primary care practices. The primary outcome will be changes in body weight at month 18. Secondary outcomes will include key patient-centered outcomes, including quality-of-life, physical and social functioning, mood, and treatment satisfaction. The cost- effectiveness of the peer coach intervention will also be evaluated. This is a novel investigation of the effectiveness and sustainability of an innovative alternative for obesity treatment delivery in primary care. If the peer coach intervention proves effective, it would have significant clinical and public health implications for patients, clinicians, and health systems. These potential benefits include: 1) improvement of clinical and psychosocial outcomes for patients, 2) increased treatment options for primary care providers to manage the care of obese patients, and 3) reduced healthcare utilization and costs.