Feature-based Designs to Increase the Reach of Effective Weight-loss Programs

Abstract

Because of the prevalence and associated health-care costs of obesity, it is widely recognized today as a serious public health issue. The Affordable Care Act (ACA) passed in 2010 includes provisions for all adults to be screened and behavioral intervention offered to those with a body mass index (BMI) of > 30 kg/m2. While the measure is intended to improve access to weight-loss resources for millions of Americans affected, it may not achieve its intended effect in part because of the inability of disadvantaged populations for whom the burden of obesity is the greatest to access ACA-supported services. The objectives of this study were to identify the characteristics that, paired with an evidence-based weight-loss intervention, will have the highest potential reach while achieving a clinically meaningful weight loss, and whether likely participation differs by gender, race, ethnicity or socioeconomic status. Using characteristics from the most effective adult weight-loss studies that use technology to expand reach, three alternative interventions were examined. Findings show that, while the majority of participants favor the traditional ACA face-to-face model, a program delivered completely online may appeal to racial and ethnic minority groups, which were more likely to choose alternative program structures. Alternative program structures should continue to be explored as an important next step toward developing viable referral options for primary care physicians and could have far-reaching impact toward reducing the disparity of obesity and obesity-related disease among disadvantaged populations.