Please select the eligibility criteria that correspond to the clinical trial below.
Title: Loss - Louisiana Obese Subjects Study
Brief Summary: LOSS is a pragmatic clinical evaluation of intensive medical approaches to weight loss for individuals with extreme obesity (body mass index \[BMI\] 40-60 kg/m2). The intensive medical treatment is designed to produce 25% weight loss from baseline and to maintain at least 20% weight loss from baseline. The intensive medical treatment is compared to a usual care treatment model where individuals utilize self directed approaches to weight loss. The active treatment period is three years, followed by two years of observation.


Options:
A: Inclusion Criteria:

* child is age 6.0 through 12.9 years at baseline
* child's BMI exceeds the 95th percentile for age and sex (CDC criteria
* parent can respond to interviews and questionnaires in English
* child has obtained well-child care from HVMA for at least the previous 15 months.

Exclusion Criteria:

* children who do not have at least one parent who is able to follow study procedures for 1 year
* families who plan to leave HVMA within the study time frame
* families for whom the primary care clinician thinks the intervention is inappropriate, e.g., emotional or mental difficulties
* children with chronic conditions that substantially interfere with growth
B: Inclusion Criteria:

* Adult patients over 18 years
* BMI ≥ 25
* Enrolling in PCN programs for overweight/ obesity or depression able and willing to give written informed consent in English

Exclusion Criteria:

* Children and pregnant women
* Patients whose obesity is co-managed by an obesity specialist or tertiary care center
* Patients who are unable to participate in regular clinic visits or programs due to geographic, social or physical reasons
C: Inclusion Criteria:

* Participant in the Exclusive Provider Organization (EPO), Managed Care Organization (MCO) and Preferred Provider Organization (PPO) programs of the Louisiana State Employees Group Benefits Health Insurance
* Agree to travel for treatment to the assigned study site
* Agree to randomized treatment assignment
* Male and females age 20-60 years
* Body Mass Index \>40kg/m2 but \< 60 kg/m2
* Females must be non-pregnant and using an approved contraception method
* Complete Blood Count (CBC): normal hematocrit, white count and platelet count, unless waived by Principal Investigator (PI)
* Uric Acid \<9.0 mg/dl
* Normal Creatinine
* Normal Thyroid Stimulating Hormone (TSH)
* Negative urine pregnancy test for women of childbearing potential
* Able to give written informed consent
* Able to comply with study procedures

Exclusion Criteria:

Factors that may limit adherence to interventions or affect conduct of the trial:

* Unable or unwilling to give informed consent or communicate with local study staff
* Hospitalization for psychiatric illness or substance use/abuse within the past year
* Self-report of alcohol or substance abuse within the past twelve months
* Current major depressive episode or history of suicidal behaviors
* Endorsement of significant recent suicidal ideation (as determined by PI)
* Travel plans that do not permit participation
* History of prior bariatric surgery, small bowel resection, or extensive bowel resection
* Current use of chronic systemic corticosteroids, appetite suppressants, antipsychotic medication, herbal medications for weight loss or any medication not approved by the PI.
* Another member of the household is a participant or staff member in the study
* History of eating disorder such as anorexia nervosa, bulimia, or binge eating
* Diagnosis of schizophrenia, other psychotic disorders, bipolar disorder, or personality disorder (as determined by the PI)
* Currently pregnant or nursing or plans to become pregnant in the next five years
* Except for non-melanoma skin cancer, cancer requiring treatment in the past five years, unless the prognosis is excellent
* Self report of Human Immunodeficiency Virus (HIV) positive, hepatitis C or active tuberculosis
* Cardiovascular disease event within the past year
* Severe congestive heart failure (New York Heart Association \[NYHA\] Functional Class III, IV)
* Second degree or greater heart block
* Blood Pressure \>160 systolic or \>100 diastolic on two consecutive visits, unless treated and re-screened
* Based upon responses to psychological screening or an interview, patients may be excluded by the study psychologist.
* Other medical, psychiatric, or behavioral limitations that in the judgment of the investigator may interfere with study participation or the ability to follow the intervention protocol.
* Pregnancy is to be avoided during the study. Women who have not had a hysterectomy or oophorectomy must have a negative urine pregnancy test result at screening. Women of childbearing potential will be allowed to participate if they have undergone tubal ligation, or use one of the following types of contraception: properly used condom or diaphragm, oral contraceptives, hormonal implant, or intrauterine device (IUD). Sexual abstinence may constitute an acceptable birth control method for this study with investigator approval. Women with male partners who have had a successful vasectomy (more than one year of unprotected sexual intercourse without pregnancy) are not required to use additional birth control methods as long as the relationship remains exclusive, and the woman agrees to use an approved contraception method with any other male partner. Questions regarding individual patient contraceptive practices should be directed to the Principal Investigator.
D: Inclusion Criteria:

* Children ages 2 years 0 months to 5 years 11 months
* BMI percentile at or above the 95th percentile for age- and gender, but no more than 100% above the median BMI for age and gender.
* English-speaking
* Live within 50 miles of Cincinnati Children's Hospital Medical Center (CCHMC)
* Medical clearance from the child's pediatrician to participate.

Exclusion Criteria:

* Medical conditions known to promote obesity (e.g., Prader-Willi syndrome, Cushing's syndrome)
* Already involved with another weight control program
* Taking weight-affecting medications (e.g., steroids).
* A disability or illness that would preclude them from engaging in at least moderate intensity physical activity
* Developmental disability

Answer: C