Extended-Care Programs for Weight Management in Rural Communities

Abstract

Rural counties in the United States have higher rates of obesity,^1-3 sedentary lifestyle,^3,4 and associated chronic diseases^1,5-7 than nonrural areas, yet treatment of obesity in the rural population has received little research attention. Efficacy trials, typically conducted with urban participants and by experts working in academic medical centers, show that lifestyle interventions involving diet, exercise, and behavior modification produce clinically significant weight reductions.^8-11 Nonetheless, participants commonly regain one-third to one-half of their lost weight during the year following treatment.^8,12,13 If lost weight is not maintained, the associated health benefits also may not be sustained.^8,14 Extended-care programs that include clinic-based follow-up sessions may improve the maintenance of lost weight.^8,11,12,15 However, in rural communities, distance to health care centers represents a significant barrier to ongoing care.^1,5,7 Therefore, it is important to examine alternative venues for the treatment of obesity as well as alternative methods of delivering extended care, such as the use of telephone counseling rather than face-to-face sessions.⁷