Weight management in rural health clinics: Results from the randomized midwest diet and exercise trial.

Abstract

Rural living adults have higher rates of obesity compared with their urban counterparts and less access to weight management programs. Previous research studies have demonstrated clinically relevant weight loss in rural living adults who complete weight management programs delivered by university affiliated interventionists. However, this approach limits the potential reach, adoption, implementation, and maintenance of weight management programs for rural residents. Weight management delivered through rural health clinics by non-physician clinic associated staff, for example, nurses, registered dieticians, allied health professionals, etc. has the potential to improve access to weight management for rural living adults. This trial compared the effectiveness of a 6-month multicomponent weight management intervention for rural living adults delivered using group phone calls (GP), individual phone calls (IP) or an enhanced usual care control (EUC) by rural clinic associated staff trained by our research team. Rural living adults with overweight/obesity (n=187, age∼50years 82% female, body mass index ∼35kg/m2) were randomized (2:2:1) to 1 of 3 intervention arms: GP, which included weekly∼45min sessions with 7-14 participants (n=71), IP, which included weekly∼15min individual sessions (n=80), or EUC, which included one-45min in-person session at baseline. Weight loss at 6months was clinically relevant, that is, ≥5% in the GP (-11.4kg, 11.7%) and the IP arms (-9.1kg, 9.2%) but not in the EUC arm (-2.6%, -2.5% kg). Specifically, 6month weight loss was significantly greater in the IP versus EUC arms (-6.5kg. p≤0.025) but did not differ between the GP and IP arms (-2.4kg, p>0.025). The per participant cost per kg. weight loss for implementing the intervention was $93 and $60 for the IP and GP arms, respectively. Weight management delivered by interventionists associated with rural health clinics using both group and IP calls results in clinically relevant 6months weight loss in rural dwelling adults with overweight/obesity with the group format offering the most cost-effective strategy. Clinical trial registration: ClinicalTrials.gov (NCT02932748).