University of Florida researchers to study treatment of obesity in rural people

In the battle against obesity, rural people face unique challenges when attempting to lose weight.

Now with the help of a $2.6 million grant from the National Institutes of Health, University of Florida researchers will study the effectiveness of a treatment plan designed to help rural women overcome barriers of limited access to health care and cultural differences in order to lose weight and keep it off.

Michael Perri, Ph.D., a professor in the department of clinical and health psychology at the UF College of Health Professions, is leading the four-year study to examine the effectiveness of a weight-loss maintenance program delivered through in-person or telephone contact with obese women in the rural North Central Florida counties of Bradford, Columbia, Dixie, Lafayette, Levy and Putnam.

The UF researchers also will evaluate how well the special services affect the participants’ blood pressure, lipid profiles, blood sugar levels and physical fitness — all important indicators of overall health.

Recent data show that the rates of obesity, sedentary lifestyle and heart disease are higher in rural areas in the United States than in densely populated cities. Very few studies have addressed the treatment of obesity in rural settings, Perri said.

A shortage of health professionals and lifestyle differences contribute to the increased prevalence of obesity in rural settings. “Compared to their urban counterparts, rural populations have been slower to adopt lifestyle changes related to behavioral risk factors for heart disease, such as reductions in fat intake and the adoption of active lifestyles,” Perri said. “Rural families traditionally have consumed high-fat, high-calorie diets that were offset to some extent by vigorous physical labor necessary for farming, logging and other activities. Increased mechanization of rural occupations has reduced these levels of caloric expenditure, thereby contributing to higher rates of obesity in rural areas.”

Compounding these obstacles to healthy weight is the fact that people, regardless of where they live, have trouble maintaining their weight after a successful weight loss. In most weight-loss studies, participants gain back 50 percent of the lost weight within 18 months after the completion of treatment.

Perri points to physiological factors such as decreased metabolic rate due to dieting, exposure to an environment rich in fattening foods and psychological issues to explain the difficulty people have when trying to maintain weight loss.

“Most obese people cannot on their own sustain the substantial degree of psychological control needed to cope effectively with this unfriendly combination of environment and biology,” said Perri, who has argued for the concept of obesity as a chronic condition requiring continuous care. “Long-term success is more likely to occur when obese patients are provided with extended care regimens specifically designed to enhance long-term progress.”

The UF study will include 300 women between the ages of 50 and 75 who are considered obese (body mass index of 30 or higher, which usually means a person is about 30 or more pounds overweight).

During the first phase of the study, the women will participate in a six-month weight-loss program that combines a low-calorie, low-fat diet with daily 30-minute walks and an emphasis on learning problem-solving skills to overcome barriers to weight loss.

The women will meet in weekly group sessions at Florida County Extension Offices, where family and consumer sciences agents will provide counseling on healthy foods, appropriate physical activity and behavioral skills.

Following the weight-loss portion of the study, participants will be randomly assigned to one of three 12-month follow-up programs to help them keep the weight off: office-based group counseling, telephone-based counseling or a comparison group that will receive written educational materials.

Researchers want to determine if participants who receive office-based or telephone-based follow-ups will be able to maintain their weight loss significantly better than those women who will not receive follow-up care by a health provider. If telephone contact proves to be just as effective as office-based visits, it could be a practical solution to overcoming geographical constraints for rural residents.

The multidisciplinary team includes UF researchers Marian Limacher, M.D., a cardiologist and professor at the College of Medicine, Danny Martin, Ph.D., an associate professor of physical therapy at the College of Health Professions, and Linda Bobroff, Ph.D., a registered dietitian and professor of family, youth and community sciences at the Institute for Food and Agricultural Sciences. The research project is associated with the National Rural Behavioral Health Center based at the College of Health Professions.

Researchers plan to recruit participants this fall and begin treatment groups in January 2004.