Improving Weight Loss and Cardiometabolic Risk in Black Primary Care Patients with Obesity and Diabetes

Type 2 diabetes is a major health concern in the United States, and the Deep South has higher rates of obesity, diabetes, and other chronic conditions than other regions. Modest weight loss can significantly improve cardiometabolic risk and several health outcomes in patients with diabetes. This study will examine the effectiveness of integrating primary care with a health coach who remotely delivers care, facilitated by the patient portal of an electronic medical record (EMR), in patients with obesity and type 2 diabetes. We will also assess the contextual factors of the intervention settings that may influence utilization and dissemination of the weight loss intervention. The study group will include primary care patients aged 18-70 years with obesity and type 2 diabetes. We will randomly assign 352 individuals equally to an EMR-facilitated behavioral weight loss intervention and a usual care group for 24 months. Patients in the weight loss group will receive a comprehensive, high-intensity behavioral weight loss program delivered by a health coach using interactive electronic health (eHealth) technology including video conferencing, with a strong emphasis on bi-directional communication. Through an EMR patient portal, patients will have access to program materials and personalized weight loss graphs to track their progress. Patients in the usual care group will continue to receive routine medical care by their primary care practitioner. We hypothesize that patients in the weight loss group will have greater and clinically significant percent reductions in body weight compared to patients in the usual care group. We further hypothesize that patients in the weight loss group will have greater improvements in secondary outcomes, including fasting plasma glucose, hemoglobin A1c, cardiovascular disease risk factors, and patient-reported outcomes such as medication use, sleep quality, mobility, dietary intake, physical activity, and quality of life. Finally, we will study the implementation of the intervention using focus groups, semi-structured interviews, and cost-effectiveness analysis in order to better understand external validity and implementation outcomes. The proposed study will significantly advance the translation of evidence-based weight loss strategies into primary care that are widely applicable to the growing diabetes population in the United States, particularly in the Deep South.