UF researchers to study obesity treatment for rural residents

People living in rural America have higher rates of heart disease and obesity than those in urban areas, yet few weight-loss research trials have been conducted in rural settings.

A University of Florida research team plans to tackle the unique weight-loss challenges faced by rural residents in a new study called Rural Lifestyle Intervention Treatment Effectiveness Trial, or Rural LITE. The research is supported by a $3.6 million grant from the National Heart, Lung and Blood Institute.

“Most weight-loss trials have been efficacy studies conducted with middle-class, urban participants and delivered by teams of experts working in academic medical centers,” said principal investigator Michael G. Perri, Ph.D., interim dean of the UF College of Public Health and Health Professions. “But serious health disparities exist in rural areas where there are higher rates of poverty, more residents without health insurance, a greater percentage of people with chronic disease and fewer health professionals to treat them.”

About 49 million people, or 17 percent of the country’s population, live in rural areas, according to the 2000 U.S. Census.

The UF researchers will offer a weight-loss program at UF/IFAS County Extension Offices in eight rural counties in north Florida. In addition to measuring weight loss, researchers will also evaluate how well the lifestyle intervention program affects the participants’ blood pressure, lipid profiles and blood sugar levels — all important indicators of overall health.

“Compared to their urban counterparts, rural populations have been slower to adopt lifestyle changes that might alter risk factors for heart disease, such as reductions in saturated fat intake, increases in physical activity and smoking cessation,” said Perri, also a professor of clinical and health psychology. “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, contributing to higher rates of obesity in rural areas.”

The Rural LITE research program will build on the success of a previous study led by Perri that tested the effectiveness of a weight-loss program with long-term follow-up counseling services for women in rural counties.

“We found that the participants who received extended care were able to maintain their weight loss at higher levels than those participants who only received printed health education as a follow-up,” said Perri, who has argued for the concept of obesity as a chronic condition requiring continuous care. “In addition, telephone counseling was as successful as in-person counseling, giving us a cost-effective alternative to face-to-face visits that is more convenient for rural residents who may need to travel long distances for care.”

In the new study, researchers hope to determine the minimum intensity of treatment required to produce clinically meaningful, long-term weight loss in underserved community settings.

The UF study will include 542 men and women between the ages of 21 and 75 who are considered obese — those who have a body mass index of 30 or higher, which usually means a person is about 30 or more pounds overweight. The participants will be randomly assigned to one of three lifestyle intervention programs that will be conducted over a two-year period: eight treatment sessions and eight follow-up sessions by phone or in-person; 16 sessions and 16 follow-up meetings; or 24 treatment sessions and 24 follow-up appointments.

During the weight-loss sessions, UF researchers will use cognitive-behavioral strategies to help participants modify eating and exercise habits. Researchers have tailored the content of instructional materials to address particular areas of concern expressed by rural residents who participated in the previous study, such as cooking demonstrations of low-fat, low-calorie versions of traditional Southern dishes, coping strategies for stress and a lack of social support, and tips for eating away from home.

Participants will also be instructed to walk at a moderate intensity for 30 minutes most days of the week.

“We hope the results of this study will address two major barriers to research translation to underserved rural populations: the lack of infrastructure to offer services and the absence of an empirical database indicating the treatment dose that will produce the most significant long-term weight loss,” Perri said.

The multidisciplinary UF team includes Marian Limacher, M.D., of the College of Medicine; Linda Bobroff, Ph.D., from the Institute for Food and Agricultural Sciences; and David Janicke, Ph.D., Danny Martin, Ph.D., and Michael Daniels, Sc.D., of the College of Public Health and Health Professions.