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The Treatment of Obesity in Underserved Rural Settings (TOURS) Randomized Trial

Michael G. Perri, PhD; Marian C. Limacher, MD; Patricia E. Durning, PhD; David M. Janicke, PhD; Lesley D. Lutes, PhD; Linda B. Bobroff, PhD; Martha Sue Dale, MAg; Michael J. Daniels, ScD; Tiffany A. Radcliff, PhD; A. Daniel Martin, PhD

Arch Intern Med. 2008;168(21):2347-2354.

Background  Rural counties in the United States have higher rates of obesity, sedentary lifestyle, and associated chronic diseases than nonrural areas, yet the management of obesity in rural communities has received little attention from researchers.

Methods  Obese women from rural communities who completed an initial 6-month weight-loss program at Cooperative Extension Service offices in 6 medically underserved rural counties (n = 234) were randomized to extended care or to an education control group. The extended-care programs entailed problem-solving counseling delivered in 26 biweekly sessions via telephone or face to face. Control group participants received 26 biweekly newsletters containing weight-control advice.

Results  Mean weight at study entry was 96.4 kg. Mean weight loss during the initial 6-month intervention was 10.0 kg. One year after randomization, participants in the telephone and face-to-face extended-care programs regained less weight (mean [SE], 1.2 [0.7] and 1.2 [0.6] kg, respectively) than those in the education control group (3.7 [0.7] kg; P = .03 and .02, respectively). The beneficial effects of extended-care counseling were mediated by greater adherence to behavioral weight-management strategies, and cost analyses indicated that telephone counseling was less expensive than face-to-face intervention.

Conclusions  Extended care delivered either by telephone or in face-to-face sessions improved the 1-year maintenance of lost weight compared with education alone. Telephone counseling constitutes an effective and cost-efficient option for long-term weight management. Delivering lifestyle interventions via the existing infrastructure of the Cooperative Extension Service represents a viable means of adapting research for rural communities with limited access to preventive health services.

Trial Registration  clinicaltrials.gov Identifier: NCT00201006

Author Affiliations: Departments of Clinical and Health Psychology (Drs Perri, Durning, Janicke, and Lutes and Ms Dale), Epidemiology and Biostatistics (Dr Daniels), and Physical Therapy (Dr Martin), College of Public Health and Health Professions, Department of Medicine, College of Medicine (Dr Limacher), and Department of Family, Youth, and Community Sciences, Institute for Food and Agricultural Sciences Extension (Dr Bobroff), University of Florida, Gainesville; Department of Psychology, East Carolina University, Greenville, North Carolina (Dr Lutes); and Division of Health Care Policy and Research, University of Colorado Health Sciences Center, and Veterans' Affairs Eastern Colorado Healthcare System, Denver (Dr Radcliff).

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