Rural Engagement in TelemedTeam for Options in Obesity Treatment Solutions (RE-TOOL)

PROJECT SUMMARY/ABSTRACT
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. Most worrisome, the prevalence of class 3 obesity (BMI ≥ 40),
which contributes the highest cancer risk, is increasing at a rate 3 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. It is paramount that obesity
treatment be offered in rural primary care, especially to reach those who have Class 3 obesity and/or co-
morbid medical conditions who carry the highest obesity-related cancer risk. Medical management by a
primary care provider (PCP) during behavioral weight loss is essential to address co-morbid medical
conditions, evaluate obesogenic medications, and explore options for guideline-recommended
pharmacotherapy and surgical treatment. However, there has been a missed opportunity in primary care-
based obesity treatment trials for capitalizing on guideline-based medical management. The current trial builds
on lessons learned in our recently completed RE-POWER trial conducted in rural primary care clinics, which
demonstrated significantly greater weight loss with in-clinic group visits versus individual visits, and highlighted
the need for medical management by the local PCPs. RE-TOOL (Rural Engagement in TelemedTeam for
Options in Obesity Treatment SoLutions) is a cluster RCT (n = 16 clinics and 560 participants) designed to
enhance sustainable access to obesity treatment in rural communities. TelemedTeam is a novel team-based
telemedicine approach that pairs intensive telemedicine group visits with quarterly individual team-based clinic
visits that simultaneously engage the patient, the local PCP, and the lifestyle coach to help activate the patient.
This novel collaborative telemedicine solution combines the benefits of group-based treatment with home-
based telemedicine delivery, and critically, integrates team-based care in local rural clinics to capitalize on the
importance of medical management and access to local support and resources. The primary hypothesis is that
TelemedTeam will result in greater % weight loss at 24 months compared to Enhanced Usual Care
consisting of quarterly PCP visits only. Secondary outcomes include the proportion achieving ≥5% and 10%
weight loss, diet quality, physical activity, quality of life, and medical treatment process outcomes. Exploratory
analyses will assess reach, adoption, and implementation and investigate rural sociocultural and spatial
predictors of treatment effects.

Grant Number: 5R01CA268034-04
NIH Institute/Center: NIH
Principal Investigator: Christie Befort