Track: A randomized controlled trial of a digital health obesity treatment intervention for medically vulnerable primary care patients.

Abstract

Introduction

Obesity continues to disproportionately affect medically vulnerable populations. Digital health interventions may be effective for delivering obesity treatment in low-resource primary care settings.

Methods

Track is a 12-month randomized controlled trial of a digital health weight loss intervention in a community health center system. Participants are 351 obese men and women aged 21 to 65years with an obesity-related comorbidity. Track participants are randomized to usual primary care or to a 12-month intervention consisting of algorithm-generated tailored behavior change goals, self-monitoring via mobile technologies, daily self-weighing using a network-connected scale, skills training materials, 18 counseling phone calls with a Track coach, and primary care provider counseling. Participants are followed over 12months, with study visits at baseline, 6, and 12months. Anthropometric data, blood pressure, fasting lipids, glucose and HbA1C and self-administered surveys are collected. Follow-up data will be collected from the medical record at 24months.

Results

Participants are 68% female and on average 50.7years old with a mean BMI of 35.9kg/m(2). Participants are mainly black (54%) or white (33%); 12.5% are Hispanic. Participants are mostly employed and low-income. Over 20% of the sample has hypertension, diabetes and hyperlipidemia. Almost 27% of participants currently smoke and almost 20% score above the clinical threshold for depression.

Conclusions

Track utilizes an innovative, digital health approach to reduce obesity and chronic disease risk among medically vulnerable adults in the primary care setting. Baseline characteristics reflect a socioeconomically disadvantaged, high-risk patient population in need of evidence-based obesity treatment.

Department

Description

Provenance

Citation

Published Version (Please cite this version)

10.1016/j.cct.2016.03.006

Publication Info

Foley, Perry, Dori Steinberg, Erica Levine, Sandy Askew, Bryan C Batch, Elaine M Puleo, Laura P Svetkey, Hayden B Bosworth, et al. (2016). Track: A randomized controlled trial of a digital health obesity treatment intervention for medically vulnerable primary care patients. Contemporary clinical trials, 48. pp. 12–20. 10.1016/j.cct.2016.03.006 Retrieved from https://hdl.handle.net/10161/29913.

This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.

Scholars@Duke

Batch

Bryan Courtney Batch

Professor of Medicine

Type 2 Diabetes, Obesity/Overweight, Behavior change, Non-pharmacologic intervention, Health disparities

Svetkey

Laura Pat Svetkey

Professor of Medicine

Laura P. Svetkey, MD MHS is Professor of Medicine/Nephrology, Vice Chair for Faculty Development and Diversity in the Department of Medicine. She is also the Director of Duke’s CTSA-sponsored internal career development award program (KL2) and the Associate Director of Duke’s REACH Equity Disparities Research Center, in which she also leads the Investigator Development Core.

Dr. Svetkey has over 30 years of experience in the investigation of hypertension, obesity, and related areas, conducting NIH-sponsored clinical research ranging from behavioral intervention trials to metabolomics and genetics, with a consistent focus on prevention, non-pharmacologic intervention, health disparities and minority health. Her research has affected national guidelines, having served on the 2013 national Hypertension Guideline Panel (JNC) and the Lifestyle Guideline Working Group. She is an American Society of Hypertension certified hypertension specialist, and a member of the Association of American Physicians (AAP). She is the Associate Director, Core Director and Project PI of Duke’s NIH-sponsored REACH Equity Disparities Research Center (PI: Kimberly Johnson).

As Department of Medicine Vice Chair for Faculty Development and Diversity, she implements a wide range of programs to enhance the experience and advancement of faculty and trainees, with particular emphasis on those from racial and ethnic groups under-represented in medicine, and women.

Bosworth

Hayden Barry Bosworth

Professor in Population Health Sciences

Dr. Bosworth is a health services researcher and Deputy Director of the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT)  at the Durham VA Medical Center. He is also Vice Chair of Education and Professor of Population Health Sciences. He is also a Professor of Medicine, Psychiatry, and Nursing at Duke University Medical Center and Adjunct Professor in Health Policy and Administration at the School of Public Health at the University of North Carolina at Chapel Hill. His research interests comprise three overarching areas of research: 1) clinical research that provides knowledge for improving patients’ treatment adherence and self-management in chronic care; 2) translation research to improve access to quality of care; and 3) eliminate health care disparities. 

Dr. Bosworth is the recipient of an American Heart Association established investigator award, the 2013 VA Undersecretary Award for Outstanding Achievement in Health Services Research (The annual award is the highest honor for VA health services researchers), and a VA Senior Career Scientist Award. In terms of self-management, Dr. Bosworth has expertise developing interventions to improve health behaviors related to hypertension, coronary artery disease, and depression, and has been developing and implementing tailored patient interventions to reduce the burden of other chronic diseases. These trials focus on motivating individuals to initiate health behaviors and sustaining them long term and use members of the healthcare team, particularly pharmacists and nurses. He has been the Principal Investigator of over 30 trials resulting in over 400 peer reviewed publications and four books. This work has been or is being implemented in multiple arenas including Medicaid of North Carolina, private payers, The United Kingdom National Health System Direct, Kaiser Health care system, and the Veterans Affairs.

Areas of Expertise: Health Behavior, Health Services Research, Implementation Science, Health Measurement, and Health Policy

Bennett

Gary G. Bennett

Dean of Trinity College of Arts & Sciences

Gary G. Bennett, Ph.D., is dean of the Trinity College of Arts & Sciences at Duke University.  

As dean, Dr. Bennett is responsible for defining and articulating the strategic mission of Trinity College, ensuring a world-class liberal arts education in a research environment for all students, and attracting, retaining, and nurturing a diverse community of distinguished faculty.

Dr. Bennett is a professor of psychology & neuroscience, global health, medicine, and nursing, and is the founding director of the Duke Digital Health Science Center.  He is a global leader in designing, testing, and disseminating digital behavior change interventions. Dr. Bennett developed the interactive obesity treatment approach (iOTA); his recent work demonstrates the effectiveness of digital strategies in treating obesity in the primary care setting.

Nearly 20 years ago, Dr. Bennett created one of the first digital health research programs. His laboratory has since become a global leader in designing, testing, and disseminating digital behavior change interventions, especially for medically vulnerable populations. Dr. Bennett has authored nearly 200 scientific papers, and the National Institutes of Health have continuously funded his research program with more than $20m in grant support.  From 2018-2019, Dr. Bennett served as president of the Society of Behavioral Medicine, the nation's largest organization of behavioral change scientists. Dr. Bennett is an elected Academy of Behavioral Medicine Research and Behavioral Medicine Research Council member. 

Before assuming his role as dean of Trinity College in February 2023, Dr. Bennett served as vice provost for undergraduate education. He provided strategic vision and leadership for Duke’s undergraduate experience.  As vice provost, he oversaw the Office of Undergraduate Education, comprising 15 units that enrich Duke's undergraduate academic experience through academic advising, academic support, nationally competitive scholarships, merit scholar programs, financial aid, study abroad, and several co-curricular programs.  Under Bennett’s leadership, Duke introduced several advancements to make the undergraduate experience more enriching and equitable for all students, including the DukeLIFE program to support first-generation and low-income students, and QuadEx, Duke’s inclusive living and learning model that integrates undergraduates’ social, residential and intellectual experiences.

Dr. Bennett is a member of Duke's Bass Society of Fellows and is the founding director of Duke's undergraduate major in global health. He has served on committees to examine Duke's undergraduate curriculum and develop the university's strategic plan and has co-led the Board of Trustees Undergraduate Education Committee since 2018. His students' course ratings have repeatedly placed Dr. Bennett in the top 5% of Duke's undergraduate instructors.

Dr. Bennett has also co-founded three digital health ventures. Crimson Health Solutions developed digital disease management interventions and was acquired by Health Dialog in 2007. In 2014, he co­ founded Scale Down, a digital obesity treatment startup based on the science of daily self-weighing. Scale Down was acquired by Anthem in 2017. He is a co-founder of Coeus Health, a leading provider of health APIs. Dr. Bennett advises leading digital health and consumer electronic organizations on the science of health behavior change.

Before joining Duke in 2009, Dr. Bennett served on the Harvard School of Public Health and the Dana-Farber Cancer Institute faculties. Dr. Bennett earned a bachelor's degree at Morehouse College, an AM and PhD in clinical health psychology at Duke University, completed a clinical internship in medical psychology at the Duke University Medical Center, and was the Alonzo Yerby postdoctoral fellow in social epidemiology at the Harvard School of Public Health.

Dr. Bennett lives in Raleigh with his wife (also a Duke alum) and his two daughters.


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