© 2003 By Default! A Free sample background from Slide 1 Information Technology- Based Mechanism for the Management of Obesity Sandeep Bansal, MD Michael Matheny, MD, MS ID 286 Final Presentation

© 2003 By Default! A Free sample background from Slide 2 Background “Growing” Epidemic –46% of the US population with BMI ≥ 25 –14% of the US population with BMI ≥ –65% of the US population with BMI ≥ 25 –31% of the US population with BMI ≥ 30

© 2003 By Default! A Free sample background from Slide 3 Background Behavioral Risk Factor Surveillance System (2001) After full adjustment, adults with BMI were more likely to have After full adjustment, adults with BMI were more likely to have –DiabetesOR 3.44 –HypertensionOR3.50 –HyperlipidemiaOR1.91 –ArthritisOR2.03

© 2003 By Default! A Free sample background from Slide 4 Background Most recent interventions have focused on community and non-physician interventions for weight reduction Most recent interventions have focused on community and non-physician interventions for weight reduction In a recent survey, only 25% of patients indicated that their physician had provided fat-related dietary advice In a recent survey, only 25% of patients indicated that their physician had provided fat-related dietary advice Magnitude of health problem requires that physicians continue to strive to improve counseling performance Magnitude of health problem requires that physicians continue to strive to improve counseling performance

© 2003 By Default! A Free sample background from Slide 5 Goal & Target Goal Goal –to promote weight loss among overweight and obese patients in an outpatient adult primary care clinic using a tailored computer-based intervention and specialized counseling. Target Population Target Population –any overweight or obese patient presenting to see their primary care physician.

© 2003 By Default! A Free sample background from Slide 6 Intervention Overview Survey administered in waiting room, and subsequently entered into computer system by office staff Survey administered in waiting room, and subsequently entered into computer system by office staff Computer system will analyze survey information and print tailored education materials Computer system will analyze survey information and print tailored education materials PCP will be provided pop-up with survey excerpts to quickly document counseling PCP will be provided pop-up with survey excerpts to quickly document counseling

© 2003 By Default! A Free sample background from Slide 7 Intervention Physical Activity Questionnaire

© 2003 By Default! A Free sample background from Slide 8 Intervention Diet Questionnaire Many surveys are too detailed for a clinic setting, or require longitudinal collection (food log) Many surveys are too detailed for a clinic setting, or require longitudinal collection (food log) This study will use a 39 question short food survey previously validated with a food log comparison This study will use a 39 question short food survey previously validated with a food log comparison Primary Interest: Calories & Fat Intake Primary Interest: Calories & Fat Intake

© 2003 By Default! A Free sample background from Slide 9 Behavior Theory Transtheoretical Model Precontemplation Precontemplation –Has no intention to take action within the next 6 months Contemplation Contemplation –Intends to take action within the next 6 months Preparation Preparation –Intends to take action within the next 30 days and has taken some behavioral steps in this direction Action Action –Has changed overt behavior for less than 6 months Maintenance Maintenance –Has changed overt behavior for more than 6 months

© 2003 By Default! A Free sample background from Slide 10 Intervention Pre-Contemplation and Contemplation Goals: Education and Motivation Goals: Education and Motivation Graphic of disease-specific risk and potential to change risk with weight loss Graphic of disease-specific risk and potential to change risk with weight loss Basic recommendations for dietary and exercise modifications Basic recommendations for dietary and exercise modifications Web resources for additional information about dietary changes, exercise programs, and weight-loss support groups Web resources for additional information about dietary changes, exercise programs, and weight-loss support groups Follow up with telephone call after one month, with option of additional therapy Follow up with telephone call after one month, with option of additional therapy

© 2003 By Default! A Free sample background from Slide 11 Intervention

© 2003 By Default! A Free sample background from Slide 12 Intervention Preparation, Action, Maintenance Goals: Intensive tailored therapy Goals: Intensive tailored therapy In addition to tailored printed materials: In addition to tailored printed materials: –Reflexive appointment with nutritionist –Reflexive appointment with exercise trainer –Free trial of gym enrollment Follow-up with monthly phone call Follow-up with monthly phone call

© 2003 By Default! A Free sample background from Slide 13 Intervention Follow-up At subsequent visits, repeat surveys and enter into computer At subsequent visits, repeat surveys and enter into computer Printouts will include: Printouts will include: –All previous material –Graph of weight over time –Graph of disease-specific risk trends –Positive feedback for weight loss and lifestyle changes

© 2003 By Default! A Free sample background from Slide 14 Evaluation Clinics randomized to implement computer- based intervention or usual care Clinics randomized to implement computer- based intervention or usual care Primary Outcome: change in weight among overweight and obese patients over 12 months Primary Outcome: change in weight among overweight and obese patients over 12 months Secondary Outcomes: Secondary Outcomes: –Documentation of weight-loss counseling by PCP’s –Changes in dietary and exercise behavior –Sustained weight loss over time

© 2003 By Default! A Free sample background from Slide 15 Potential Barriers Costs Costs –Staff for data entry, follow-up phone calls –Increased burden on nutritionists, exercise trainers –Money for gym memberships PCP reluctance PCP reluctance –Time constraints Patient reluctance Patient reluctance –Burdensome questionnaire –Information overload

© 2003 By Default! A Free sample background from Slide 16 Sustainability Increased reimbursements for PCP’s based on preventive counseling Increased reimbursements for PCP’s based on preventive counseling If successful, include media and public health departments to increase funding in future If successful, include media and public health departments to increase funding in future

© 2003 By Default! A Free sample background from Slide 17 Expandability Scale up to non-health care arenas to target additional populations who are at risk but not necessarily plugged into health care Scale up to non-health care arenas to target additional populations who are at risk but not necessarily plugged into health care –Supermarkets –Laundromats –Hairdressers Computer program can be easily expanded to target other risk factors for disease Computer program can be easily expanded to target other risk factors for disease

© 2003 By Default! A Free sample background from Slide 18 Questions?