RT Journal
A1 Perri MG, Limacher MC, Durning PE, et al
T1 Extended-care programs for weight management in rural communities: The treatment of obesity in underserved rural settings (tours) randomized trial
JF Archives of Internal Medicine
JO Archives of Internal Medicine
YR 2008
FD November 24
VO 168
IS 21
SP 2347
OP 2354
DO 10.1001/archinte.168.21.2347
UL http://dx.doi.org/10.1001/archinte.168.21.2347
AB Background 
    Rural counties in the United States have higher rates of obesity, sedentary lifestyle, and associated chronic diseases than nonrural areas, yet the management of obesity in rural communities has received little attention from researchers.Methods 
    Obese women from rural communities who completed an initial 6-month weight-loss program at Cooperative Extension Service offices in 6 medically underserved rural counties (n = 234) were randomized to extended care or to an education control group. The extended-care programs entailed problem-solving counseling delivered in 26 biweekly sessions via telephone or face to face. Control group participants received 26 biweekly newsletters containing weight-control advice.Results 
    Mean weight at study entry was 96.4 kg. Mean weight loss during the initial 6-month intervention was 10.0 kg. One year after randomization, participants in the telephone and face-to-face extended-care programs regained less weight (mean [SE], 1.2 [0.7] and 1.2 [0.6] kg, respectively) than those in the education control group (3.7 [0.7] kg; P = .03 and .02, respectively). The beneficial effects of extended-care counseling were mediated by greater adherence to behavioral weight-management strategies, and cost analyses indicated that telephone counseling was less expensive than face-to-face intervention.Conclusions 
    Extended care delivered either by telephone or in face-to-face sessions improved the 1-year maintenance of lost weight compared with education alone. Telephone counseling constitutes an effective and cost-efficient option for long-term weight management. Delivering lifestyle interventions via the existing infrastructure of the Cooperative Extension Service represents a viable means of adapting research for rural communities with limited access to preventive health services.Trial Registration 
    clinicaltrials.gov Identifier: NCT00201006