Weight Loss in Underserved Patients - A Cluster-Randomized Trial

Peter T. Katzmarzyk, From the Pennington Biomedical Research Center, Baton Rouge (P.T.K., C.K.M., R.L.N., J.W.A., K.D.D., E.F.M., P.J.B., W.D.J.), the Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport (C.L.A., T.C.D.), and Ochsner Clinic Foundation, Center for Outcomes and Health Services Research (E.G.P.-H.) and Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute (C.J.L.), Ochsner Clinical School-University of Queensland School of Medicine (E.G.P.-H., C.J.L.), the Department of Medicine, Division of Endocrinology and Metabolism (T.K.T., V.F.) and the Department of Medicine, Section of General Internal Medicine and Geriatrics (J.G.), Tulane University Health Sciences Center School of Medicine, Southeast Louisiana Veterans Health Care System (T.K.T., V.F.), the College of Pharmacy, Xavier University of Louisiana (K.B.K., D.F.S.), and the Department of Internal Medicine, Louisiana State University School of Medicine, and Program in Health Policy and Systems Management, Louisiana State University School of Public Health (B.S.), New Orleans - all in Louisiana.
Corby K. Martin, From the Pennington Biomedical Research Center, Baton Rouge (P.T.K., C.K.M., R.L.N., J.W.A., K.D.D., E.F.M., P.J.B., W.D.J.), the Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport (C.L.A., T.C.D.), and Ochsner Clinic Foundation, Center for Outcomes and Health Services Research (E.G.P.-H.) and Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute (C.J.L.), Ochsner Clinical School-University of Queensland School of Medicine (E.G.P.-H., C.J.L.), the Department of Medicine, Division of Endocrinology and Metabolism (T.K.T., V.F.) and the Department of Medicine, Section of General Internal Medicine and Geriatrics (J.G.), Tulane University Health Sciences Center School of Medicine, Southeast Louisiana Veterans Health Care System (T.K.T., V.F.), the College of Pharmacy, Xavier University of Louisiana (K.B.K., D.F.S.), and the Department of Internal Medicine, Louisiana State University School of Medicine, and Program in Health Policy and Systems Management, Louisiana State University School of Public Health (B.S.), New Orleans - all in Louisiana.
Robert L. Newton, From the Pennington Biomedical Research Center, Baton Rouge (P.T.K., C.K.M., R.L.N., J.W.A., K.D.D., E.F.M., P.J.B., W.D.J.), the Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport (C.L.A., T.C.D.), and Ochsner Clinic Foundation, Center for Outcomes and Health Services Research (E.G.P.-H.) and Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute (C.J.L.), Ochsner Clinical School-University of Queensland School of Medicine (E.G.P.-H., C.J.L.), the Department of Medicine, Division of Endocrinology and Metabolism (T.K.T., V.F.) and the Department of Medicine, Section of General Internal Medicine and Geriatrics (J.G.), Tulane University Health Sciences Center School of Medicine, Southeast Louisiana Veterans Health Care System (T.K.T., V.F.), the College of Pharmacy, Xavier University of Louisiana (K.B.K., D.F.S.), and the Department of Internal Medicine, Louisiana State University School of Medicine, and Program in Health Policy and Systems Management, Louisiana State University School of Public Health (B.S.), New Orleans - all in Louisiana.
John W. Apolzan, From the Pennington Biomedical Research Center, Baton Rouge (P.T.K., C.K.M., R.L.N., J.W.A., K.D.D., E.F.M., P.J.B., W.D.J.), the Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport (C.L.A., T.C.D.), and Ochsner Clinic Foundation, Center for Outcomes and Health Services Research (E.G.P.-H.) and Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute (C.J.L.), Ochsner Clinical School-University of Queensland School of Medicine (E.G.P.-H., C.J.L.), the Department of Medicine, Division of Endocrinology and Metabolism (T.K.T., V.F.) and the Department of Medicine, Section of General Internal Medicine and Geriatrics (J.G.), Tulane University Health Sciences Center School of Medicine, Southeast Louisiana Veterans Health Care System (T.K.T., V.F.), the College of Pharmacy, Xavier University of Louisiana (K.B.K., D.F.S.), and the Department of Internal Medicine, Louisiana State University School of Medicine, and Program in Health Policy and Systems Management, Louisiana State University School of Public Health (B.S.), New Orleans - all in Louisiana.
Connie L. Arnold, From the Pennington Biomedical Research Center, Baton Rouge (P.T.K., C.K.M., R.L.N., J.W.A., K.D.D., E.F.M., P.J.B., W.D.J.), the Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport (C.L.A., T.C.D.), and Ochsner Clinic Foundation, Center for Outcomes and Health Services Research (E.G.P.-H.) and Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute (C.J.L.), Ochsner Clinical School-University of Queensland School of Medicine (E.G.P.-H., C.J.L.), the Department of Medicine, Division of Endocrinology and Metabolism (T.K.T., V.F.) and the Department of Medicine, Section of General Internal Medicine and Geriatrics (J.G.), Tulane University Health Sciences Center School of Medicine, Southeast Louisiana Veterans Health Care System (T.K.T., V.F.), the College of Pharmacy, Xavier University of Louisiana (K.B.K., D.F.S.), and the Department of Internal Medicine, Louisiana State University School of Medicine, and Program in Health Policy and Systems Management, Louisiana State University School of Public Health (B.S.), New Orleans - all in Louisiana.
Terry C. Davis, From the Pennington Biomedical Research Center, Baton Rouge (P.T.K., C.K.M., R.L.N., J.W.A., K.D.D., E.F.M., P.J.B., W.D.J.), the Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport (C.L.A., T.C.D.), and Ochsner Clinic Foundation, Center for Outcomes and Health Services Research (E.G.P.-H.) and Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute (C.J.L.), Ochsner Clinical School-University of Queensland School of Medicine (E.G.P.-H., C.J.L.), the Department of Medicine, Division of Endocrinology and Metabolism (T.K.T., V.F.) and the Department of Medicine, Section of General Internal Medicine and Geriatrics (J.G.), Tulane University Health Sciences Center School of Medicine, Southeast Louisiana Veterans Health Care System (T.K.T., V.F.), the College of Pharmacy, Xavier University of Louisiana (K.B.K., D.F.S.), and the Department of Internal Medicine, Louisiana State University School of Medicine, and Program in Health Policy and Systems Management, Louisiana State University School of Public Health (B.S.), New Orleans - all in Louisiana.
Eboni G. Price-Haywood, From the Pennington Biomedical Research Center, Baton Rouge (P.T.K., C.K.M., R.L.N., J.W.A., K.D.D., E.F.M., P.J.B., W.D.J.), the Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport (C.L.A., T.C.D.), and Ochsner Clinic Foundation, Center for Outcomes and Health Services Research (E.G.P.-H.) and Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute (C.J.L.), Ochsner Clinical School-University of Queensland School of Medicine (E.G.P.-H., C.J.L.), the Department of Medicine, Division of Endocrinology and Metabolism (T.K.T., V.F.) and the Department of Medicine, Section of General Internal Medicine and Geriatrics (J.G.), Tulane University Health Sciences Center School of Medicine, Southeast Louisiana Veterans Health Care System (T.K.T., V.F.), the College of Pharmacy, Xavier University of Louisiana (K.B.K., D.F.S.), and the Department of Internal Medicine, Louisiana State University School of Medicine, and Program in Health Policy and Systems Management, Louisiana State University School of Public Health (B.S.), New Orleans - all in Louisiana.
Kara D. Denstel

Abstract

BACKGROUND: Evidence of the effectiveness of treatment for obesity delivered in primary care settings in underserved populations is lacking. METHODS: We conducted a cluster-randomized trial to test the effectiveness of a high-intensity, lifestyle-based program for obesity treatment delivered in primary care clinics in which a high percentage of the patients were from low-income populations. We randomly assigned 18 clinics to provide patients with either an intensive lifestyle intervention, which focused on reduced caloric intake and increased physical activity, or usual care. Patients in the intensive-lifestyle group participated in a high-intensity program delivered by health coaches embedded in the clinics. The program consisted of weekly sessions for the first 6 months, followed by monthly sessions for the remaining 18 months. Patients in the usual-care group received standard care from their primary care team. The primary outcome was the percent change from baseline in body weight at 24 months. RESULTS: All 18 clinics (9 assigned to the intensive program and 9 assigned to usual care) completed 24 months of participation; a median of 40.5 patients were enrolled at each clinic. A total of 803 adults with obesity were enrolled: 452 were assigned to the intensive-lifestyle group, and 351 were assigned to the usual-care group; 67.2% of the patients were Black, and 65.5% had an annual household income of less than $40,000. Of the enrolled patients, 83.4% completed the 24-month trial. The percent weight loss at 24 months was significantly greater in the intensive-lifestyle group (change in body weight, -4.99%; 95% confidence interval [CI], -6.02 to -3.96) than in the usual-care group (-0.48%; 95% CI, -1.57 to 0.61), with a mean between-group difference of -4.51 percentage points (95% CI, -5.93 to -3.10) (P<0.001). There were no significant between-group differences in serious adverse events. CONCLUSIONS: A high-intensity, lifestyle-based treatment program for obesity delivered in an underserved primary care population resulted in clinically significant weight loss at 24 months. (Funded by the Patient-Centered Outcomes Research Institute and others; PROPEL ClinicalTrials.gov number, NCT02561221.).