Travel burden in a rural primary care behavioral weight loss randomized trial: Impact on visit attendance and weight loss.

Abstract

Rural residents have higher obesity rates and need access to treatment. Travel burden may limit use and effectiveness of clinic-based behavioral weight loss treatment, which includes frequent visits. This paper examines the impact of travel distance and time on visit attendance and weight loss during a 2-year cluster randomized trial. Thirty-six primary care practices were randomized to 1 of 3 methods of providing behavioral weight loss counseling: individual clinic visits, group clinic visits, or group phone visits. Participants in the clinic visit conditions were included in this secondary analysis (n = 875). Travel distance and time was measured using ArcGIS and categorized as <15 miles (and minutes) or ≥15 miles (and minutes). Percent visit attendance and percent weight loss were measured 6 and 24 months. Participants traveling ≥15 miles (n = 211) had lower attendance than those traveling <15 miles (n = 664) for individual clinic visits, both in the first 6 months (81.4% vs 89.1%, respectively; P = .005) and between 7 and 24 months (52.8% vs 61.6%, respectively; P = .02). Travel time revealed similar findings. Neither travel distance nor time had an effect on attendance to group clinic visits. Travel distance and time were not significantly associated with weight loss for either individual or group visits. Travel burden to clinics was associated with visit attendance for individual visits but not for group visits and was not significantly associated with weight loss. Assessment of travel burden as a potential barrier to clinic-based weight loss interventions should be based on local empirical data.