PLOS ONE · 12 authors, 5 centres
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This pilot study found that a 15-week telephone-based weight loss intervention is feasible for rural Ohio residents with overweight or obesity, with 90% completing follow-up surveys and 81.5% of the intervention group finishing the program. Adherence to weekly sessions was acceptable for nearly half of participants (48.1%). These findings support the development of larger trials to test the efficacy of remotely delivered weight loss programs in underserved rural populations.
**Background:** Rural populations in the United States experience higher rates of obesity, obesity-related comorbidities, and cancer compared to urban residents. Evidence-based lifestyle weight loss interventions have primarily been developed and tested in urban settings, and their direct translation to rural communities may not be feasible due to barriers such as geographic isolation, limited resources, and lower self-efficacy for healthy behaviors. This pilot study aimed to assess the feasibility of a 15-week telephone-based weight loss intervention tailored to rural Ohio residents with overweight or obesity.
**Methods:** This was a single-blind, 2-arm randomized controlled pilot study. Participants were recruited from rural Ohio counties via Facebook, flyers, previous study lists, referrals, and ResearchMatch/StudySearch. Eligibility criteria included: age 20–64 years, BMI ≥25 kg/m², not currently participating in a weight loss program, not meeting the 2018 Physical Activity Guidelines (150 min/week moderate or 75 min/week vigorous exercise), able to walk two city blocks, and able to speak/read English. Exclusions included prior cancer (except non-melanoma skin cancer), severe medical conditions, pregnancy/nursing, or inability to consent. Eligible participants were randomized 2:1 to a telephone-based weight loss intervention group (n=27) or an active control group (n=13). The intervention group received weekly 30–45 minute telephone counseling sessions from health coaches trained in exercise physiology and behavioral weight loss. The intervention targeted a 7% weight loss through caloric restriction (500–1000 kcal/day deficit, aiming for 1200–1800 kcal/day), increased physical activity (150–200 min/week moderate aerobic exercise plus 2–3 resistance sessions/week), and behavioral strategies (self-monitoring, goal-setting, barrier management, social support). Participants received a Fitbit, weight scale, and lifestyle modification manual. The active control group received education brochures on AICR physical activity and dietary guidelines, an exercise manual with online videos, and self-monitoring resources; they received a Fitbit and lifestyle manual at study end. Feasibility was defined as ≥80% of participants completing follow-up surveys at 15 weeks. Acceptable adherence was defined as the percentage of intervention participants attending ≥75% (≥12 of 15) of weekly sessions. Outcomes included anthropometrics (weight, BMI, body composition via Styku S100 3D scanner), lipid profile (Cholestech LDX), inflammatory markers (CRP, IL-6, TNF-α), physical activity (accelerometer and self-report), dietary intake (7-day food checklist), self-efficacy and social support questionnaires, and physical fitness (400-meter walk, lift and carry).
**Key Results:** Between September and December 2021, 423 individuals entered the online screening survey; 215 (50.8%) completed it, 98 (45.6%) were eligible, and 40 were enrolled and randomized. Baseline characteristics: intervention group mean age 49 (SD=10) years, 89% female, mean BMI 37 (SD=6) kg/m², mean body weight 228 (SD=41) lbs; control group mean age 51 (SD=9) years, 92% female, mean BMI 39 (SD=13) kg/m², mean body weight 229 (SD=59) lbs. Feasibility was demonstrated: 35 of 40 participants (88%, 95% CI 0.78–0.98) completed follow-up surveys at 15 weeks. In the intervention group, 22 of 27 (81.5%) completed the 15-week intervention; the average number of sessions attended was 9.7 (64.9%). Adherence (≥12 sessions) was achieved by 13 of 27 participants (48.1%). Common reasons for missed sessions included increased caregiver responsibilities due to COVID, being too busy, work conflicts, and illness. Five participants (19%) dropped out from the intervention group (three due to COVID workload, one family loss, one preferred non-telephone approach). In the control group, 2 of 13 (15%) were lost to follow-up.
**Clinical Implications:** This pilot study demonstrates that a 15-week telephone-based weight loss intervention is feasible for rural Ohio residents with overweight/obesity, with high retention (88% follow-up survey completion) and acceptable intervention completion (81.5%). However, adherence to the full dose of weekly sessions was modest (48.1%), suggesting that additional strategies may be needed to improve engagement, particularly during disruptions like the COVID-19 pandemic. The study successfully adapted evidence-based intervention components (diet, physical activity, behavioral counseling) for remote delivery, addressing barriers such as travel and limited local resources. The use of a portable 3D body scanner (Styku S100) and point-of-care lipid testing demonstrates the feasibility of comprehensive assessments in community settings. These findings support the development of a larger randomized controlled trial to evaluate the efficacy of this intervention for weight loss and potential cancer risk reduction in rural populations.