Final Research Report

View this project's final research report.

Journal Citations

Article Highlight: People living in rural areas are more likely to have obesity than those living in cities, and they are also less likely to have access to weight loss programs. This study compared three ways to treat obesity in rural populations: regular in-person clinic sessions, in-person group sessions, and phone-based group sessions. In a JAMA paper published in January 2021, the study found that people in the in-person group sessions averaged greater weight loss after 24 months than the other two groups.

Peer-Review Summary

Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.

The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments. 

Peer reviewers commented and the researchers made changes or provided responses. Those comments and responses included the following:

  • The reviewers generally found the report to be well written and had few comments.
  • The reviewers commented on the researchers’ description of how they handle replacing a site that dropped out of the study, noting that replacing a site in a cluster-randomized trial is difficult and likely to result in some potential bias when comparing the two interventions. The researchers responded by adding the loss and replacement of a site as a study limitation because of the possibility of bias and also described sensitivity analyses they performed which did not indicate the presence of bias in the sample due to the replaced site.
  • The reviewers asked the researchers how they accounted for delivering their group-based disease management intervention to patients in multiple clusters, so that patients in different clusters had related experiences. The researchers explained that they modeled this part of the intervention after the disease management industry where call centers are centralized and not specific to a practice. They acknowledged that having correlations among patients from different clusters created a statistical challenge but reported that they have used this as an opportunity to develop new statistical methods for small clusters of patients being mixed among randomized clusters of practices.
  • The reviewers asked the researchers to address the problem of rebound weight gain over time that would reduce between-group differences seen early in weight-loss interventions. The researchers added a paragraph to the report discussing the weight regain between 6 and 24months postintervention and noted the importance of studying longer-term interventions to support the maintenance of a healthy diet and physical changes.

Conflict of Interest Disclosures

Project Information

Christie Befort, PhD
University of Kansas Medical Center Research
Midwestern Collaborative for Treating Obesity in Rural Primary Care

Key Dates

September 2014
January 2021

Study Registration Information


Has Results
Award Type
Health Conditions Health Conditions These are the broad terms we use to categorize our funded research studies; specific diseases or conditions are included within the appropriate larger category. Note: not all of our funded projects focus on a single disease or condition; some touch on multiple diseases or conditions, research methods, or broader health system interventions. Such projects won’t be listed by a primary disease/condition and so won’t appear if you use this filter tool to find them. View Glossary
Populations Populations PCORI is interested in research that seeks to better understand how different clinical and health system options work for different people. These populations are frequently studied in our portfolio or identified as being of interest by our stakeholders. View Glossary
Intervention Strategy Intervention Strategies PCORI funds comparative clinical effectiveness research (CER) studies that compare two or more options or approaches to health care, or that compare different ways of delivering or receiving care. View Glossary
Research Priority Area
State State The state where the project originates, or where the primary institution or organization is located. View Glossary
Last updated: May 18, 2022