using partners to enhance long-term weight loss

Conditions: Obesity

Summary: this study involves an evaluation of the role of domestic partner support in a comprehensive weight loss initiation and maintenance program.

couples will be randomized to a comprehensive weight program directed at patients alone or involving their partners. in months 1-6, all patients will receive group-based weight loss program. in months 7-18, all patients will receive a telephone-based weight loss maintenance intervention. in the partner-assisted arm only, partners will participate in the intervention, learning and practicing communication skills and support strategies. in months 19-24, intervention will be withdrawn to examine sustainability of effects. due to covid-19, option of doing screening and outcome assessment visits and attending the group classes (including exercise) remotely via a video conference may be available. covid-19 survey will be administered every 3 month starting at screening/enrollment visit.

Eligibility criteria:
inclusion criteria (patients): * aged 18-74 years * bmi 27-29.9 kg/m2 plus at least one obesity-related comorbidity or bmi \>=30 kg/m2 * cohabitating and at least daily contact with a spouse/domestic partner * access to reliable transportation * desire to lose weight * speak and read english * agree to attend visits per protocol * score of at least 4 out of 6 on callahan cognitive screener * able to stand without assistance for weight measurements without assistance * possess individual email address * possess individual smart phone with data and texting plan * able to complete online screener without assistance * able to use a smartphone, tablet or computer with a video camera or webcam and microphone to download apps and to connect to a video conference call without assistance exclusion criteria (patients): * currently or planning to become pregnant or breastfeeding in the study timeframe * weight loss ≥ 5 lb in the month prior to screening * currently enrolled, or enrolled in previous 3 months, in a clinical or research program focusing on lifestyle change that could affect weight * significant dementia, schizophrenia, psychosis, or drug or alcohol abuse * chronic or unstable illness that would limit ability to participate (e.g., recent hospitalization; unstable heart disease in the 6 months prior to screening, chronic kidney disease stage 4 or higher) * living a nursing home or receiving visits from a home health care agency * planning to relocate in the next 2.5 years * current use of prescription or over-the-counter weight loss medications * history of bariatric surgery or planning to have bariatric surgery in the study timeframe * impaired hearing * currently receiving, or received in the past 6 months, treatment for cancer other than skin cancer * use of insulin, sulfonylureas, or meglinitides for diabetes * high diuretic dose * exertional chest pain, dizziness, or lightheadedness * pain or other condition than prohibits mild-moderate exercise * history of ascites requiring paracentesis inclusion criteria (partner): * aged 18 or older * willing to participate * access to reliable transportation * speak and read english * score of at least 4 out of 6 on callahan cognitive screener * possess smart phone with data and texting plan (not shared with index patient) * possess email address (not shared with index patient) * able to complete online screener without assistance exclusion criteria (partner): * bmi \<18.5 kg/m2 * significant dementia, schizophrenia, psychosis, or drug or alcohol abuse * residing in a nursing home or receiving home health care * impaired hearing * currently receiving, or received in the past 6 months, treatment for cancer other than skin cancer * chronic or unstable illness that would limit ability to participate (e.g., recent hospitalization; unstable heart disease in the 6 months prior to screening)