title: Translating an evidence-based lifestyle intervention program into primary care: lessons learned.
abstract: The E-LITE (Evaluation of Lifestyle Interventions to Treat Elevated Cardiometabolic Risk in Primary Care) trial evaluated the feasibility and potential effectiveness of translating an evidence-based lifestyle intervention for the management of obesity and related risk factors in a primary care setting. Delivered by allied health care providers, the intervention promoted at least 7% weight loss and at least 150 minutes per week of moderate-intensity physical activity through gradual, sustainable lifestyle changes. Activities included interactive group lessons, food tasting, guided physical activity, and technology-mediated self-monitoring and behavioral counseling. This article discusses insights and potential areas for improvement to strengthen program implementation for dissemination of the E-LITE program to other primary care settings. We focus on (a) the role of allied health professionals in program delivery, (b) strengthening program integration within a primary care clinic, and (c) the use of information technology to extend the reach and impact of the program. Our experience shows the feasibility of implementing an evidence-based lifestyle intervention program combining group-delivered nutrition and behavioral counseling, physical activity training, and technology-mediated follow-up in a primary care setting. Challenges remain, and we offer possible solutions to overcome them.
authors.affiliation: Palo Alto Medical Foundation Research Institute, Palo Alto, CA 94301, USA. blonsteina@pamfri.org
authors.forename: Andrea C
authors.initials: AC
authors.lastname: Blonstein
authors.forename: Veronica
authors.initials: V
authors.lastname: Yank
authors.forename: Randall S
authors.initials: RS
authors.lastname: Stafford
authors.forename: Sandra R
authors.initials: SR
authors.lastname: Wilson
authors.forename: Lisa Goldman
authors.initials: LG
authors.lastname: Rosas
authors.forename: Jun
authors.initials: J
authors.lastname: Ma
mesh_terms: D002318:Cardiovascular Diseases / Q000517:prevention & control*; D003376:Counseling / Q000458:organization & administration; D004032:Diet; D055317:Evidence-Based Practice; D015444:Exercise; D015438:Health Behavior; D006293:Health Promotion / Q000379:methods / Q000458:organization & administration; D006801:Humans; D020407:Internet; D008019:Life Style; D011320:Primary Health Care / Q000379:methods / Q000458:organization & administration*; D015397:Program Evaluation; D015431:Weight Loss
keywords: behavior change; chronic disease; health education; nutrition; obesity; patient education; physical activity/exercise; process evaluation; program planning and evaluation
references.citation: Obes Res. 2004 Sep;12(9):1426-34
references.pmid: 15483207
references.citation: JAMA. 2010 Jan 20;303(3):235-41
references.pmid: 20071471
references.citation: Diabetes Care. 2008 Apr;31(4):684-9
references.pmid: 18252904
references.citation: Ann Intern Med. 2003 Dec 2;139(11):930-2
references.pmid: 14644896
references.citation: Health Aff (Millwood). 2001 Nov-Dec;20(6):64-78
references.pmid: 11816692
references.citation: Ann Intern Med. 2005 Apr 19;142(8):611-9
references.pmid: 15838067
references.citation: Diabetes Care. 2002 Dec;25(12):2165-71
references.pmid: 12453955
references.citation: Arch Intern Med. 2009 Feb 9;169(3):313-4
references.pmid: 19204224
references.citation: N Engl J Med. 2002 Feb 7;346(6):393-403
references.pmid: 11832527
references.citation: JAMA. 2003 Apr 23-30;289(16):2083-93
references.pmid: 12709466
references.citation: Prev Med. 1995 Nov;24(6):546-52
references.pmid: 8610076
references.citation: Ann Intern Med. 2008 Oct 7;149(7):ITC4-1-15; quiz ITC4-16
references.pmid: 18838723
references.citation: BMC Fam Pract. 2009 Nov 12;10:71
references.pmid: 19909549
references.citation: Med Care. 2006 Nov;44(11):964-71
references.pmid: 17063127
references.citation: Ann Intern Med. 2001 Jan 2;134(1):1-11
references.pmid: 11187414
references.citation: Am J Prev Med. 2009 Dec;37(6):505-11
references.pmid: 19944916
references.citation: Diabetes Care. 2011 Jan;34(1):216-9
references.pmid: 20889854
references.citation: JAMA. 2006 Dec 20;296(23):2848-51
references.pmid: 17179462
references.citation: J Adolesc Health. 2009 May;44(5):502-4
references.pmid: 19380100
references.citation: Prev Med. 2004 Oct;39(4):815-22
references.pmid: 15351551
references.citation: Arch Intern Med. 1999 Oct 11;159(18):2177-83
references.pmid: 10527295
references.citation: Arch Intern Med. 2010 Sep 27;170(17):1566-75
references.pmid: 20876408
references.citation: Ann Fam Med. 2005 May-Jun;3(3):209-14
references.pmid: 15928223
references.citation: Diabetes Care. 2007 Jun;30(6):1374-83
references.pmid: 17363746
references.citation: Arch Intern Med. 2003 May 12;163(9):1046-50
references.pmid: 12742801
references.citation: N Engl J Med. 2001 May 3;344(18):1343-50
references.pmid: 11333990
references.citation: JAMA. 1999 Oct 27;282(16):1523-9
references.pmid: 10546691
references.citation: J Gen Intern Med. 2009 Sep;24(9):1073-9
references.pmid: 19562419
references.citation: Arch Fam Med. 2000 May;9(5):426-33
references.pmid: 10810947
references.citation: Arch Fam Med. 2000 Jul;9(7):631-8
references.pmid: 10910311
references.citation: Health Aff (Millwood). 2009 Sep-Oct;28(5):w822-31
references.pmid: 19635784
references.citation: Diabetes Educ. 2009 Mar-Apr;35(2):199-204, 208
references.pmid: 19321806
references.citation: Ann Intern Med. 2003 Jan 7;138(1):24-32
references.pmid: 12513041
references.citation: JAMA. 2002 Oct 9;288(14):1775-9
references.pmid: 12365965
references.citation: Obesity (Silver Spring). 2009 May;17(5):1077-85
references.pmid: 19197264