health-smart for weight loss at uf jax clinics

Conditions: Obesity

Summary: the study will test the effectiveness of a culturally sensitive, evidence-based, multi-component, behavioral program for treating obesity called health-smart. this program is being implemented by community health workers at the primary care centers and followed by either of two physician-implemented behavioral counseling programs to prevent weight gain--programs that are implemented quarterly over 12 months.

objectives: aim 1 was to evaluate the effectiveness of the community health worker (chw)-implemented, clinic-located, evidence-based, 6-month health-smart weight loss (hswl) program, as indicated by participants' mean weight loss. aim 2 was to compare the outcomes of the following two 12-month, clinic-based weight loss maintenance programs implemented by patients' physicians after these patients completed the 6-month weight loss intervention: the physician-implemented patient-centered, culturally sensitive weight loss maintenance (pccs-wlm) intervention, and the standard behavioral weight loss maintenance (sb-wlm) intervention. these two weight loss maintenance interventions differ in that the physicians who implemented the pccs-wlm intervention were trained to display patient-identified, culturally sensitive behaviors and attitudes when talking with patients about their weight and to support patients' engagement in health promoting (health-smart) behaviors in order to promote patients' weight loss maintenance, whereas physicians in the sb-wlm intervention were trained to use behavioral change principles and skills as well as motivational interviewing approaches to behavior change in order to promote patients' weight loss maintenance. aim 3 was to implement and evaluate a medical assistant-led program to integrate chws into health care teams. methods: participants were recruited from 21 primary care practices operated by an academic medical center. participants' eligibility criteria were: black women ages 21 years or older with a bmi of 30 kg/m2 or higher who had at least 2 clinic visits in the previous 24 months and were ready to change their diet and physical activity level. all participants received the 6-month chw-implemented hswl program to address aim 1. therefore, results from baseline to 6 months are presented as one group. the study was constructed as a cluster-randomized trial to address aim 2; thus, after the hswl program involving all participants was completed, clinics were randomized to the either the sb-wlm group or the pccs-wlm group. consequently, results after 6 months are presented separately for the two groups. clinics were randomized with patients nested within clinic. to address aim 1, a paired samples t-test and confidence interval of the proportion of the sample that achieved 5% or more weight loss by 6 months were used. to address aim 2, a logistic regression with participants nested within clinics and aim 2 study group as the independent variable was used. to address aim 3, which was to evaluate integration of chws into the health care team, a virtual meeting was held with the chws who remained at the end of the study (n=8) for the purpose of asking exploratory semi-structured questions about the clinical staff behaviors that helped them feel or not feel integrated into the clinical team and to identify what would improve and/or sustain integration of chws into the clinical team. content analysis using the constant comparison method was applied to the responses of the chws to the semi-structured questions asked. the communications and follow-through subscale of the teamstepps assessment tool was used to assess communication among the clinic staff as viewed by the participating clinic staff as a group and chws as a group. mean ratings of responses to this subscale for each of these groups were calculated.

Eligibility criteria:
inclusion criteria: * african american/black * female * age 21 years or older * bmi range ≥ 30kg/m2 (5) active patient of a participating clinic (i.e., at least 2 clinic visits in the last 24 months) * willing and ready to change one's diet and physical activity level * willing to be randomized to either of the two weight-loss maintenance intervention groups exclusion criteria: * any serious medical condition that likely affects weight, such as end stage renal disease or cancer * prior bariatric surgery within the last 5 years or plans for this surgery in the next 2 years * use of prescription or over-the-counter weight-loss medication within the last 6 months * pregnant or plan to get pregnant within the next 2 years * plan to relocate from the area within the next 2 years * having had unintentional weight loss (\>or = to 5% of body weight) within 6 months prior to enrollment * taking a daily dose of oral corticosteroid antipsychotic (clozapine, olanzapine, or risperidone) for less than 6 months

Keywords: women's health