Kansas primary care weighs in: a pilot randomized trial of a chronic care model program for obesity in 3 rural Kansas primary care practices.

CONTEXT: Obesity is a chronic disease of epidemic proportions in the United States. Primary care providers are critical to timely diagnosis and treatment of obesity, and need better tools to deliver effective obesity care. PURPOSE: To conduct a pilot randomized trial of a chronic care model (CCM) program for obesity care in rural Kansas primary care. METHODS: We enrolled 107 participants to a 6-month, 2-armed, randomized trial comparing a CCM for obesity with usual care. The primary outcome was weight change at 90 days. The usual care arm received educational weight loss materials and outcome assessments at day 0, 90, and 180. The active arm received the same elements as the usual care arm plus a multicomponent obesity CCM. FINDINGS: The Day 90 mean +/- SD weight change for the active arm (n = 34) and control arm (n = 33), respectively, was -4.5 +/- 7.7 pounds and -2.4 +/- 8.1 pounds (P = .27 for difference). The Day 180 mean +/- SD weight change for the active (n = 27) and control (n = 27) arms, respectively, was -9.4 +/- 10.3 pounds and -2.1 +/- 10.7 pounds (P = .01 for difference). There was no significant change in physical activity, or fruit and vegetable intake at day 90 or day 180. CONCLUSIONS: Improving the recognition and treatment of obesity in primary care settings is a critical initiative. Rural populations suffer disproportionately with obesity, and better methods of delivering obesity care are needed for this population. Further research is needed to establish the effectiveness of a CCM approach for obesity care.

A qualitative assessment of weight control among rural Kansas women.

OBJECTIVE: To explore weight control beliefs, attitudes, knowledge, and practices among rural Kansas women, and to characterize the relationship of these women with their primary-care providers around weight control. DESIGN: Qualitative research using focus groups. SETTING: Three separate communities of rural Kansas. PARTICIPANTS: Six focus groups among 31 women during fall 2006. INTERVENTION: Two focus groups in each community, each of 2-hour duration. A focus group moderator's guide was used to explore the roles of individuals, primary-care practice teams, and communities around weight control. ANALYSIS: This study used a qualitative analysis with an iterative process and standard techniques. The analysis team summarized central findings, descriptive topic areas, and general themes. RESULTS: There were 5 broad themes that emerged from these focus groups. These themes are lack of support from primary-care providers; primary-care offices as community resources; lack of resources for promoting dietary change, but adequate resources for physical activity; the importance of group support and inclusiveness; and a need for more intensive interventions for weight control. CONCLUSIONS AND IMPLICATIONS: Rural populations have an above-average prevalence of obesity and related comorbidities. Rural communities need better approaches for addressing the obesity epidemic.