May 05, 2022
Population health researcher Christie Befort, PhD, received a $4.5 million grant from the National Cancer Institute to fund her work exploring sustainable obesity treatment options for people in rural communities.
More than 40% of American adults have obesity, and that number is growing. From 1999 to 2018, U.S. obesity prevalence increased from 30.5% to 42.4%. Being overweight or having obesity is linked with a higher risk of getting 13 types of cancer. These cancers make up 40% of all cancers diagnosed in the United States each year.
Those living in rural communities are not just more likely to have obesity; they are also at greater risk for class 3 obesity, which means they have a body mass index (BMI) of 40 or higher. According to Dr. Befort, PhD, associate director for cancer prevention and control at The University of Kansas Cancer Center, the rate of class 3 obesity is increasing at a rate three times higher in rural communities compared to urban areas.
“Rural residents often lack access to weight control programs and food and physical activity resources that promote healthy lifestyles, especially in small or remote rural areas,” Dr. Befort said. “It is paramount that obesity treatment is offered in rural primary care, especially to reach those who have severe obesity or co-morbid medical conditions because they are at the greatest risk for developing obesity-related cancers.”
Weighing Treatment Approaches
Dr. Befort’s project, called RE-TOOL, is a five-year randomized controlled trial involving 16 rural clinics and 560 patients. She will test a novel team-based approach that connects specialists with primary care providers and the patient via telemedicine. By bringing together the entire team for quarterly clinic visits, in combination with a comprehensive group-based lifestyle intervention, Dr. Befort and her team will determine if this approach yields greater weight loss compared to standard quarterly primary care visits.
She will build on the findings from her RE-POWER project, a five-year, Patient-Centered Outcomes Research Institute (PCORI)-funded study. Dr. Befort and her team evaluated three delivery of care models – fee-for-service individual visits versus in-clinic or telephone group-based visits. The in-clinic group-based approach led to much higher weight loss compared to in-clinic individual visits, but the research team saw benefits across all approaches.
“We are taking the lessons learned from RE-POWER and addressing the strengths and the barriers of the models we tested,” Dr. Befort said. “With RE-TOOL, the goal is to pinpoint a sustainable model, from both financial and workforce standpoints, for a rural health clinic setting.”
Support from a primary care provider during behavioral weight loss is essential to address co-morbid medical conditions, evaluate medications and explore options for weight loss medications or bariatric surgery. Primary care practices must capitalize on guideline-based medical management, Dr. Befort said. “It is so important for this to occur at the primary care level,” Dr. Befort said. “That’s how you reach the people who really need support.”