Integrating Online Weight Management With Primary Care Support: Patient-Centered Strategies for Addressing Overweight and Obesity in Primary Care
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Obesity
- Sponsor
- Brigham and Women's Hospital
- Enrollment
- 840
- Locations
- 1
- Primary Endpoint
- Change in Body Weight at 12 Months
- Status
- Completed
- Last Updated
- 5 years ago
Overview
Brief Summary
The goal of this project is to adapt an evidence-based online weight management program and integrate it with population management support from primary care practices. Investigators then will conduct a three-arm, cluster-randomized trial to compare the effectiveness of 1) the combined intervention (online weight management program plus population management support) with 2) the stand-alone online weight management program and with 3) usual care, among overweight and obese primary care patients with type 2 diabetes or hypertension. The specific aims are:
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a. To adapt an online weight management program and integrate it with population management support, incorporating input from patients, primary care clinicians, and other stakeholders; afterward, investigators will acquire feedback on the positive and negative aspects of the intervention.
b. To compare the effectiveness of the combined intervention (online weight management program plus population management support) with the stand-alone online program and with usual care.
Hypothesis 1: The combined intervention will lead to greater weight loss at 12 months compared with the stand-alone online program and with usual care.
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To identify mediators of the combined intervention and the stand-alone online program.
Hypothesis 2: The effects of the combined intervention and the stand-alone online program on weight loss will be mediated by patients' level of engagement, changes in self-efficacy, and changes in diet and physical activity.
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To explore whether the effectiveness of the combined intervention and the stand-alone weight management program varies by patient characteristics.
Hypothesis 3: The interventions will be more effective among patients who are younger, white, and higher socioeconomic status, although the population management strategy may help to reduce these differences.
Detailed Description
Focus Groups and Key Informant Interviews: Focus groups will be conducted with 5 to 7 patients at the beginning of the study to obtain their feedback about an online program and the population health management support strategy. To be eligible for the focus groups, patients must have a Brigham and Women's Hospital (BWH) primary care clinician, be between ages 20-70 years old, and have a recent BMI (in the past year) between approximately 27 and 40 kg/m2. They should also be interested in weight management and/or motivated to lose weight. Phone interviews will be conducted at the end of the study to solicit feedback on the BMIQ program and the population health management intervention. Patients in the PROPS Study who are assigned to the online program or combined intervention arm, reach the 18-month timepoint, and complete the final study survey are eligible and will be invited to participate. Key Informant Interviews will be conducted at the beginning and the end of the study. To be eligible, the key informants must be clinicians or other staff who provide services to patients at one of the participating BWH primary care practices. There are a total of 165 clinicians in these practices, including staff physicians, residents or fellows, and nurse practitioners or physician assistants. Approximately 7 clinicians at each timepoint will be recruited as key informants and will also be asked to complete electronic surveys during the trial. After adapting the online weight management program and integrating it with the population management support strategy based on our focus groups and key informant interviews, investigators will conduct a three-arm cluster-randomized trial to compare the effectiveness of the combined intervention (online weight management program plus population management support) with the stand-alone online weight management program and with usual care. This will be a pragmatic clinical trial conducted in approximately 14 BWH primary care practices. To be eligible for the trial, patients must have an upcoming scheduled visit at a BWH primary care practice, BMI between 27 and 39.9 kg/m2 at enrollment, and a diagnosis of type 2 diabetes or hypertension. They also must be between ages 20 and 70 (inclusive) at enrollment, speak English or Spanish, and have access the Internet using a computer, tablet, or smart phone. Finally, patients must be motivated to lose weight. Investigators plan to recruit a total of 840 patients for the study (280 per arm). Patients who enroll in the trial will attend regular primary care visits at their practices and also will complete surveys by e-mail, regular mail, or phone.
Investigators
Heather J. Baer
Associate Epidemiologist
Brigham and Women's Hospital
Eligibility Criteria
Inclusion Criteria
- •upcoming or recent visit at primary care practice affiliated with Brigham and Women's Hospital
- •diagnosis of type 2 diabetes and/or hypertension
- •BMI \>= 27 and \< 40 kg/m2
- •motivated to lose weight
- •valid email address and access the Internet using a computer, tablet, or smartphone
- •English or Spanish-speaking
Exclusion Criteria
- •on insulin for treatment of their diabetes
- •MI, stroke, or atherosclerotic cardiovascular disease (ASCVD) procedure in last 6 months
- •Unstable angina
- •Currently pregnant or planning to become pregnant during the study period
- •Currently lactating
- •Has had bariatric surgery or planning to have bariatric surgery
- •\>5% weight loss in the last 6 months
- •Severe psychiatric illness or impaired mental status
- •Active or diagnosed history of and/or self-reported history of eating disorders
- •Self-reported average consumption of \> 14 alcoholic drinks/week
Outcomes
Primary Outcomes
Change in Body Weight at 12 Months
Time Frame: 12 months after the initial primary care visit
change in body weight from enrollment to 12 months
Secondary Outcomes
- Change in Body Weight at 6 Months(6 months after the initial primary care visit)
- Percent Weight Change at 6 Months(6 months after the initial primary care visit)
- Percent of Patients With at Least 5% Weight Loss at 12-months(12 months after the initial primary care visit)
- Changes in Diastolic Blood Pressure(12 months after the initial primary care visit)
- Changes in Triglycerides(12 months after the initial primary care visit)
- Changes in HbA1c Levels(12 months after the initial primary care visit)
- Changes in Diet, Specifically Processed Meats, as Measured by the PrimeScreen Questionnaire(12 months after the initial primary care visit)
- Change in Body Weight at 18 Months(18 months after the initial primary care visit)
- Percent Weight Change at 12-Months(12 months after the initial primary care visit)
- Percent Weight Change at 18-Months(18 months after the initial primary care visit)
- Percent of Patients With at Least 5% Weight Loss at 6 Months(6-months after the initial primary care visit)
- Changes in Self-efficacy Around Weight Loss at 12 Months(12 months after initial primary care visit)
- Changes in Systolic Blood Pressure(12 months after the initial primary care visit)
- Changes in Total Cholesterol(12 months after the initial primary care visit)
- Percent of Patients With at Least 5% Weight Loss at 18 Months(18-months after the initial primary care visit)
- Changes in LDL Cholesterol(12 months after the initial primary care visit)
- Changes in HDL Cholesterol(12 months after the initial primary care visit)
- Changes in Weight-related Quality of Life Assessed by the Impact of Weight on Quality of Life (IWQOL)-Lite Questionnaire(12 months after the initial primary care visit)
- Changes in Percentage of Patients Reporting Excellent/Very Good Health Status Assessed by Using a 5-point Scale Questionnaire From the 36-Item Short Form Health Survey(SF-36)(12 months after the initial primary care visit)
- Changes in Self-reported Physical Activity(12 months after the initial primary care visit)
- Changes in Diet, Specifically Whole Grains, as Measured by the PrimeScreen Questionnaire(12 months after the initial primary care visit)
- Changes in Diet, Specifically Sugar-sweetened Beverages, as Measured by the PrimeScreen Questionnaire(12 months after the initial primary care visit)
- Changes in Diet, Specifically Baked Products, as Measured by the PrimeScreen Questionnaire(12 months after the initial primary care visit)
- Changes in Diet, Specifically Fruits/Vegetables, as Measured by the PrimeScreen Questionnaire(12 months after the initial primary care visit)
- Changes in Diet, Specifically Fried Foods, as Measured by the PrimeScreen Questionnaire(12 months after the initial primary care visit)