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A toolbox approach to obesity treatment in primary care
Investigator (PI): Bessesen, Daniel
Performing Organization (PO): (Current): Denver Health, Diabetes and Endocrinology Division / (303) 436-6000
Supporting Agency (SA): Patient-Centered Outcomes Research Institute (PCORI)
Initial Year: 2013
Final Year: 2018
Record Source/Award ID: PCORI/IH-12-11-4571
Funding: Total Award Amount: $1,377,303
Award Type: Contract
Award Information: PCORI: More information and project results (when completed)
Abstract: Background: Obesity is common and causes many medical problems in adults, such as diabetes, high blood pressure, high cholesterol, sleep apnea, heart attack, and stroke. A range of treatments has been shown to be effective to treat obesity. These treatments include intensive lifestyle modification, meal replacements, and weight-loss medication. However, most primary care settings do not provide very much obesity treatment. This is because primary care providers (PCPs) are not well trained and because reimbursement for the treatments is not consistent. Hypothesis: If PCPs have training in weight management and if most of the cost of treatment is reimbursed, we believe that a "toolbox" of treatments can produce a clinically important amount of weight loss in a large group of patients. Design: We are proposing to establish a registry of patients who have obesity and at least one common medical condition related to their weight. From the registry, we will randomly select 350 people who will be offered treatments to assist with weight loss. The remainder of the patients in the registry can still receive treatment for obesity but will not have reimbursement for the treatments. We will conduct the study at Denver Health, which is a large public health care system that treats a low-income, ethnically diverse population. All 350 patients will be offered some self-monitoring tools for weight management and the chance to take a computer assessment to select the right treatment for weight loss. Patients who complete this and who record their food intake and physical activity for one week will be offered a "Level 2" treatment to help with weight loss. The Level 2 treatments will include a voucher for a commercial weight-loss program, an intensive group behavioral weight-loss program, meal replacements, fitness center membership, or weight-loss medication. Patients will be able to choose which treatment they want, with the approval of their PCP. A patient navigator at Denver Health will help with the computer assessment and with accessing the treatments. Each patient who completes the self-monitoring will be offered the Level 2 treatment for one year. We are interested to see what percentage of patients lose at least 5% of their starting weight. We will also look at changes in blood sugar, blood pressure, and cholesterol. We will look at how much it costs to do this intervention and whether patients need less medication for their weight-related conditions at the end of the study. Impact: If the study is successful, we plan to take the results to the leaders at Denver Health to see if they will make obesity treatment more broadly available for all patients there.
MeSH Terms:
  • Blood Glucose /analysis
  • Blood Pressure
  • Cholesterol /blood
  • Colorado
  • Ethnic Groups
  • Health Care Costs
  • Health Promotion /methods
  • Humans
  • Obesity /*therapy
  • Patient Navigation
  • Poverty
  • Primary Health Care /*methods
  • Registries
  • Self Care
  • Software
  • Weight Reduction Programs /*methods
Country: United States
State: Colorado
Zip Code: 80204
UI: 20143059
CTgovId: NCT01922934
Project Status: Completed
Record History: ('2017: Project extended to 2017.',) ('2018: Project extended to 2018.',)