Building Capacity to Address Obesity in the State of Kansas in Collaboration with Community Organizations

Project Summary/Abstract
This application is being submitted in response to the Notice of Special Interest (NOSI) identified as
NOT-CA-25-004. Obesity increases risk for 13 types of cancer and now affects over 40% of the U.S. adult
population, with even higher prevalence among rural Americans. Across states, Kansas ranks near the top of
national rankings for obesity, contributing to cancer and a range of health problems, placing considerable
burden on the state’s healthcare system, workforce, and overall quality of life. While obesity rates have
increased for all population groups, some groups face systematic barriers contributing to worse obesity
prevalence, including rural residents and certain racial/ethnic minority groups. In Kansas, 26% of the
population live in designated rural counties, and the rural population is spread out over 99% of the land area.
The high prevalence of obesity in Kansas calls for an integrated approach that spans multiple sectors of
society across both rural and urban areas. The parent clinical trial for this supplement, called RETOOL (Rural
Engagement in TelemedTeam for Options in Obesity Treatment Solutions) is testing the implementation of a
novel team-based approach to treating obesity in rural primary care clinics throughout the state of Kansas. In
RETOOL and our previous trials, we have engaged a Patient Advisory Board and Community Advisory Board,
trained over 200 local clinicians, and collaborated with local partners to link patients with local community
resources. We have observed significant and clinically meaningful changes in weight, nutrition, physical
activity, and quality of life, but we have also learned first-hand how individual level outcomes are deeply
influenced by a complex system in which individuals live. This supplement will allow us to expand beyond
intervention at the individual, medical provider, and clinic or community setting and address broader policy,
systems, and environmental changes within a complex system. This supplement coincides with a statewide
endeavor supported by the Kansas Department of Health and Environment (KDHE) to develop an Obesity
Plan that addresses priorities for both rural and urban areas. With this supplement, we will utilize expertise and
resources from the RETOOL parent grant and KU Cancer Center. The objectives are to 1) describe and
visualize the prevalence of obesity and its behavioral determinants in the state of Kansas overall and by
subgroups (age, sex, race/ethnicity, rural-urban continuum, regions, social disadvantage), 2) convene key
collaborators across multiple sectors to conduct systems mapping and an environmental scan, and develop an
Obesity Plan for the State of Kansas, and 3) identify the most promising policy, systems, and environmental
initiatives across rural and urban areas toward a significant whole of systems effort to address obesity in
Kansas. The overall goal is to develop shared knowledge and collaborations across sectors that will lead to
future studies addressing whole of systems approaches.

Grant Number: 3R01CA268034-04S1
NIH Institute/Center: NIH
Principal Investigator: Christie Befort