title: Obesity treatment for socioeconomically disadvantaged patients in primary care practice.
abstract: BACKGROUND
  Few evidence-based weight loss treatment options exist for medically vulnerable patients in the primary care setting.
  
  
  METHODS
  We conducted a 2-arm, 24-month randomized effectiveness trial in 3 Boston community health centers (from February 1, 2008, through May 2, 2011). Participants were 365 obese patients receiving hypertension treatment (71.2% black, 13.1% Hispanic, 68.5% female, and 32.9% with less than a high school educational level). We randomized participants to usual care or a behavioral intervention that promoted weight loss and hypertension self-management using eHealth components. The intervention included tailored behavior change goals, self-monitoring, and skills training, available via a website or interactive voice response; 18 telephone counseling calls; primary care provider endorsement; 12 optional group support sessions; and links with community resources.
  
  
  RESULTS
  At 24 months, weight change in the intervention group compared with that in the usual care group was -1.03 kg (95% CI, -2.03 to -0.03 kg). Twenty-four-month change in body mass index (calculated as weight in kilograms divided by height in meters squared) in the intervention group compared with that in the usual care group was -0.38 (95% CI, -0.75 to -0.004). Intervention participants had larger mean weight losses during the 24 months compared with that in the usual care group (area under the receiver operating characteristic curve, -1.07 kg; 95% CI, -1.94 to -0.22). Mean systolic blood pressure was not significantly lower in the intervention arm compared with the usual care arm.
  
  
  CONCLUSIONS
  The intervention produced modest weight losses, improved blood pressure control, and slowed systolic blood pressure increases in this high-risk, socioeconomically disadvantaged patient population. Trial Registration  clinicaltrials.gov Identifier: NCT00661817.
authors.affiliation: Duke Obesity Prevention Program, Duke University, Durham, NC 27708, USA. gary.bennett@duke.edu
authors.forename: Gary G
authors.initials: GG
authors.lastname: Bennett
authors.forename: Erica T
authors.initials: ET
authors.lastname: Warner
authors.forename: Russell E
authors.initials: RE
authors.lastname: Glasgow
authors.forename: Sandy
authors.initials: S
authors.lastname: Askew
authors.forename: Julie
authors.initials: J
authors.lastname: Goldman
authors.forename: Debra P
authors.initials: DP
authors.lastname: Ritzwoller
authors.forename: Karen M
authors.initials: KM
authors.lastname: Emmons
authors.forename: Bernard A
authors.initials: BA
authors.lastname: Rosner
authors.forename: Graham A
authors.initials: GA
authors.lastname: Colditz
mesh_terms: D001521:Behavior Therapy; D001794:Blood Pressure; D015992:Body Mass Index; D057186:Comparative Effectiveness Research; D003376:Counseling; D005260:Female; D006801:Humans; D006973:Hypertension / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000628:therapy*; D011320:Primary Health Care / Q000592:standards / Q000706:statistics & numerical data / Q000639:trends; D012648:Self Care; D012959:Socioeconomic Factors; D013689:Telephone; D016896:Treatment Outcome; D035862:Vulnerable Populations / Q000706:statistics & numerical data; D015431:Weight Loss