TOURS
Treating Obesity in Underserved Rural Settings

Funded by: National Heart, Lung, and Blood Institute
Subcontract from:Subcontract from the University of Florida
Project Period: 7/03 - 6/07

Abstract

Objective: The Treating Obesity in Underserved Rural Settings (TOURS) research study entails a three-arm randomized controlled trial to test the effectiveness of interventions designed to promote successful long-term weight management in an important but underserved population, namely, obese women in medically underserved rural counties. Participants will be assigned randomly to one of three 18-month long treatment programs that will be delivered in rural communities through Cooperative Extension Offices. Each treatment condition will include a six month lifestyle intervention for weight loss followed by one of three 12-month follow-up programs: (A) an Office-Based Maintenance Program, (B) a Telephone-Based Maintenance Program, or (C) an Education Control Condition. The interventions in Groups A and B are based on a “continuous-care/problem-solving model” that conceptualizes obesity as a chronic condition requiring ongoing problem-solving for successful long-term management. Group C is the control group. The primary and secondary aims of the trial and its principal hypotheses are listed below.

Primary Aim:
• Evaluate the effects on weight change of two problem-solving-based, weight-loss maintenance interventions delivered via office-based or telephone-based contacts to obese women in rural counties.

Secondary Aims include the following (and others):
• Conduct exploratory analyses comparing the interventions with regard to their costs and cost-effectiveness. (This sub-task is led by Dr. Radcliff in the Division of Health Care Policy and Research.)

Methods: Comparison of costs across the various experimental arms will be measured according to average costs per participant in each group. The average cost per participant in each group will be calculated as the sum of program and participant costs divided by the number of participants in the group. We will use standard statistical methods to determine whether each of the maintenance programs differs from the education control group and to determine whether average cost for the maintenance programs differ from each other. The cost-effectiveness analysis will take the ratio of costs to outcome for one or more of the following outcomes of interest: weight loss (in kg or BMI points), change in prescription drugs costs for conditions related to obesity, and change in health-related quality of life and will use standard methods to ensure accurate results.

Current Project Status: The first cohort of participants is entering Phase 2 of the project; they have been assigned randomly to a 12-month follow-up program for weight maintenance. Recruitment of the second cohort and primary data collection for both cohorts is currently in progress.

Key Staff: Perri, Radcliff, Bobroff, Limacher, Martin, Stevens

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