Piloting a patient navigator program to facilitate uptake and persistence with evidence-based weight loss interventions

Abstract Millions of adults in the U.S. with overweight or obesity would like to improve their health and quality of life via weight loss, yet utilization of evidence-based weight loss interventions is low. Instead, adults commonly attempt self-guided weight loss, which has poor efficacy. When adults do use evidence-based interventions

(which include behavioral, dietary, commercial, surgical, and pharmacological options), long-term engagement is suboptimal, as some individuals select interventions that are poorly matched to their needs. The proposed project is designed to test the use of patient navigators to increase uptake of and persistence with evidence-

based weight loss interventions. Navigators have been successfully used in other areas of healthcare to facilitate engagement with various treatment and prevention services. However, no data are available on the feasibility, acceptability, or efficacy of a weight loss navigator program in adults. In the proposed study, the

weight loss navigator will assess treatment barriers and preferences, provide education about evidence-based options, support decision making, and address ambivalence about change. The navigator will not directly provide weight loss intervention; rather, the navigator’s role will be to assist participants in utilizing existing

evidence-based interventions for weight loss from other sources. Navigators will maintain long-term relationships with participants to monitor adherence and acceptability of the selected intervention and, as needed, revisit other intervention options. Participants (N = 68 adults with a BMI >27 kg/m2 who are interested

in weight loss) will be randomly assigned for a 12-month period to either enhanced care or the navigator condition. Enhanced care and navigator counseling will be delivered remotely. Participants in enhanced care will receive education about weight loss options, dietary intake, and physical activity through workshops and

standardized text messages. In the navigator condition, participants will attend individual sessions and receive personalized text messages. Assessments will be conducted at months 0, 6, and 12, with the primary outcome, weight loss, being assessed remotely with wireless scales. The proposed research project is highly responsive

to NIDDK’s new “Small R01” funding opportunity, which supports pilot clinical trials that acquire preliminary data regarding the effects of an intervention. Specifically, this project will 1) demonstrate the feasibility and acceptability of various aspects of the project, 2) calculate effect sizes for weight loss and utilization of

evidence-based interventions, and 3) collect qualitative feedback from navigators and participants to inform improvements in the navigator program for future research. This innovative project will provide much needed data about the promise of navigators in meeting the needs of adults with overweight and obesity. It is expected

that if benchmarks for this study are met, funding will be sought for a fully powered clinical trial that examines efficacy, cost, mediators, and moderators. This line of research has the potential for a large impact on clinical practice and public health by enhancing the utilization of evidence-based weight loss interventions.