Weight management in rural health clinics: The Midwest diet and exercise trial.

Obesity prevalence is higher in rural compared to urban residents. Rural health clinics offer a potential venue for delivery of weight management. However, traditional programs require travel to attend on-site meetings which is impractical or inconvenient for rural residents. Clinic staff in most rural settings are unlikely to be trained to provide effective weight management. Remote delivery using group phone conferences (GP) or individual phone calls (IP), by staff associated with rural clinics eliminates the need for travel to attend on-site meetings. The effectiveness of these approaches will be the focus of this trial. Staff at five primary care clinics, serving primarily rural residents, will be trained to deliver GP and IP interventions and an enhanced usual care (EUC), (i.e., individual face-to-face meetings (~45 min) at clinic site, four times across 18 mos.). Two hundred overweight/obese adults (BMI ≥ 25.0-45.0 kg/m2, age ≥ 21 yrs.) will be recruited through each clinic and randomized to GP (n = 80), IP (n = 80), or EUC (n = 40) to compare weight loss (0-6 mos.), weight maintenance (7-18 mos.), and weight change during a 6 mo. no contact follow-up (19-24 mos.) between intervention arms. The GP and IP interventions will be identical in lesson plan content, diet, and physical activity. The only difference between groups will be the delivery format (group vs. individual) and session duration (GP ~45 min/session; IP ~15 min/session). Primary (body weight) and secondary outcomes (waist circumference, energy/macronutrient intake, physical activity) will be assessed at baseline, 6, 12, 18 and 24 mos. Cost and contingent valuation analyses will also be completed. NCT REGISTRATION: NCT02932748.

A virtual reality intervention (Second Life) to improve weight maintenance: Rationale and design for an 18-month randomized trial.

Despite the plethora of weight loss programs available in the US, the prevalence of overweight and obesity (BMI≥25kg/m(2)) among US adults continues to rise at least, in part, due to the high probability of weight regain following weight loss. Thus, the development and evaluation of novel interventions designed to improve weight maintenance are clearly needed. Virtual reality environments offer a promising platform for delivering weight maintenance interventions as they provide rapid feedback, learner experimentation, real-time personalized task selection and exploration. Utilizing virtual reality during weight maintenance allows individuals to engage in repeated experiential learning, practice skills, and participate in real-life scenarios without real-life repercussions, which may diminish weight regain. We will conduct an 18-month effectiveness trial (6 months weight loss, 12 months weight maintenance) in 202 overweight/obese adults (BMI 25-44.9kg/m(2)). Participants who achieve ≥5% weight loss following a 6month weight loss intervention delivered by phone conference call will be randomized to weight maintenance interventions delivered by conference call or conducted in a virtual environment (Second Life®). The primary aim of the study is to compare weight change during maintenance between the phone conference call and virtual groups. Secondarily, potential mediators of weight change including energy and macronutrient intake, physical activity, consumption of fruits and vegetables, self-efficacy for both physical activity and diet, and attendance and completion of experiential learning assignments will also be assessed.