UF researchers receive $3.7 million to evaluate weight management programs for rural residents

The University of Florida has received a $3.7 million grant from the National Heart, Lung and Blood Institute to test the effectiveness of long-term weight management programs geared to people living in rural areas.

“We’re trying to find ways to tackle the serious problem of obesity and sedentary lifestyle in rural areas, which typically have little access to programs that promote physical fitness and proper nutrition,” said principal investigator Michael G. Perri, Ph.D., dean of the UF College of Public Health and Health Professions.

The occurrence of obesity in rural areas of the United States is significantly higher than in urban areas. In a 2012 study conducted by Perri and co-investigators at the University of Kansas Medical Center, the researchers found that almost 40 percent of rural adults were obese compared with just over 33 percent of urban adults. Several lifestyle differences may contribute to higher obesity rates in rural areas, including a traditional farm diet of high-fat, high-calorie foods, and increased mechanization of rural occupations such as farming and logging.

Perri has argued for the concept of obesity as a chronic condition requiring continuous care, and in three previous National Institutes of Health-funded trials, he and his team have evaluated treatment approaches for helping rural residents achieve long-term success in weight management following an intervention program.

“We are taking the best research we have from efficacy studies conducted in academic research centers with middle-class, urban and suburban participants and attempting to translate it into a format that matches the needs of rural residents who typically have fewer economic resources,” said Perri, the Robert G. Frank endowed professor of clinical and health psychology.

In a prior study, the researchers found that telephone counseling is just as effective as in-person counseling at helping participants keep weight off. Phone counseling offers a cost-effective and convenient option for rural residents, who may have to travel long distances for care.

In the new five-year study, Rural Lifestyle Eating and Activity Program, or Rural LEAP, researchers will compare three strategies for long-term weight management: individual phone counseling, group phone counseling and counseling via email or U.S. mail. If effective, group phone counseling could represent a more cost-effective treatment option that could reach larger numbers of patients.

“A key aspect of translational research, which is at once the most difficult and yet has the highest impact, is to disseminate the findings at the academic center into the communities it serves," said David S. Guzick, M.D. Ph.D., UF senior vice president for health affairs and president, UF Health. "The work of Dr. Perri and his colleagues is a stellar example of translating research results into improved health, which is at the heart of our mission at UF Health.”

The UF study will include 540 men and women ages 21 to 75 with a body mass index of 30 to 45 living in 10 rural counties in north Florida. All participants will participate in a four-month lifestyle program with face-to-face group sessions led by local providers at UF/IFAS Extension county offices. During the sessions, trained extension agents will use cognitive-behavioral strategies to help participants modify eating and exercise habits. Program content has been tailored to address concerns voiced by rural residents in previous studies, such as strategies for coping with stress and a lack of social support for weight loss, techniques for eating away from home, and cooking demonstrations of low-fat, low-calorie versions of traditional Southern dishes. Participants also will be instructed to exercise at a moderate intensity for 210 minutes per week, equivalent to 30 minutes of walking a day.

Following the intervention program, participants will be randomized to one of the three 12-month follow-up treatment programs. Counselors will focus on helping participants sustain the eating and physical activity changes they made during the initial four months of treatment.

At the conclusion of 22 months of participation, researchers will evaluate the program’s cost-effectiveness, as well as its effect on participants’ weight, physical activity, nutrition, blood pressure, lipid profiles and blood sugar levels.

“The driving impetus for this research is the development of a scalable, low-cost, yet highly effective treatment for weight management,” Perri said.

UF co-investigators include Marian Limacher, M.D., of the College of Medicine; Linda Bobroff, Ph.D., R.D., from the Institute for Food and Agricultural Sciences; and David Janicke, Ph.D., Danny Martin, Ph.D., P.T., and Kristina von Castel-Roberts, Ph.D., R.D., of the College of Public Health and Health Professions.

Rural LEAP is supported by the National Heart, Lung and Blood Institute of the National Institutes of Health under award number R18HL112720.