The Louisiana Trial to Reduce Obesity in Primary Care
Background: Louisiana currently ranks first among US states in obesity. Obesity increases the risk of type 2 diabetes, heart disease, stroke, gallbladder disease, respiratory problems, quality of life, and several cancers. Obesity and its health problems greatly affect underserved populations, and Louisiana is characterized by high levels of poverty and food insecurity and low health literacy, all of which may contribute to the state’s obesity levels. While the high rates of obesity are of great concern, a greater concern is that our healthcare system has failed to deliver medical interventions capable of producing even modest weight loss.
The American Heart Association, American College of Cardiology, and the Obesity Society have released a set of treatment guidelines for obese patients that are adaptable to real-life settings and could add effective methods for obesity treatment in the primary care setting. Modest weight loss is achievable in some settings; however, there has been no successful translation of this achievement to primary care practices.
Objective: To test the effectiveness of a 24-month, patient-centered, pragmatic, and scalable obesity treatment program delivered within primary care to an underserved population.
Methods: We will randomly assign 14 primary care clinics serving low-income populations with a high percentage of African Americans throughout Louisiana to either a comprehensive obesity treatment program or the current obesity treatment under Medicaid/Medicare.
Patient and Stakeholder Engagement: Patients and stakeholders will be engaged at all phases of the project. We will initiate and maintain the process of building trust among the community, investigators, and the primary care clinics by expanding existing, and fostering new, trusted relationships. The partnerships will seek the well-being of people through research, education, and service. Community-based participatory research principles will be rooted in four key aspects of community engagement and outreach:
- create community and patient awareness;
- inform the community of the study’s benefits;
- involve patients and stakeholders as collaborators through active participation in the study; and
- provide mechanisms to convey information back to the community.
Anticipated Impacts: This project is designed to be economical and scalable to large patient populations. Given the low uptake of the current Medicaid/Medicare reimbursement for obesity, we anticipate that the results will impact the way that obesity treatment options are funded in the future. This study will have a direct impact on improving healthcare delivery and outcomes.