#498: The PROPEL Trial & Weight Loss Interventions in Primary Care – John Apolzan, PhD
Oct 10, 2023
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This podcast explores the PROPEL trial, a weight loss intervention program in primary care in Louisiana. It discusses cultural appropriation in recipe modification, the importance of combining lifestyle interventions and weight loss drugs for type 2 diabetics, and current research projects on food waste and stress. The significance of physical activity, positive outlook, and a healthy diet is also emphasized.
The Propel trial tested the effectiveness of a high-intensity lifestyle-based weight loss program in a primary care setting, achieving a weight loss of just shy of the target of 5% over a 24-month duration.
The intervention in the Propel trial focused on nutrition, physical activity, and psychological constructs, enabling participants to make positive changes in their dietary habits and decrease fat intake.
Deep dives
The Propel trial focused on achieving 5% weight loss in a pragmatic primary care setting in Louisiana
The Propel trial, which stands for Promoting Successful Weight Loss in Primary Care in Louisiana, aimed to test the 2013 obesity guidelines in a practical primary care setting. The goal was to achieve a 5% weight loss over two years in individuals with a low income and predominantly African American population. The trial involved 450 participants across nine clinics, with health coaches providing individual and small group sessions to deliver a traditional lifestyle intervention.
The intervention successfully resulted in almost 5% weight loss
The intervention group in the Propel trial achieved a weight loss of 4.99%, just shy of the target of 5%. The intervention included focusing on weight loss in the first six months and weight loss maintenance from month six to 24. Participants had weekly contact during the initial six months, followed by monthly contact for the remainder of the study duration. The health coaches played a vital role in delivering the intervention, which proved effective in helping participants achieve significant weight loss.
Baseline dietary intake among participants was low, but positive changes were observed
At baseline, participants in the Propel trial had low fruit and vegetable intake. Although the intervention did not significantly increase fruit and vegetable consumption at the group level, it did decrease the percentage of energy from fat intake. The focus on nutrition, physical activity, and psychological constructs enabled participants to make positive changes in their dietary habits.
Next steps may involve combining lifestyle interventions with weight loss drugs and expanding access through insurance and government programs
Future research in the field of weight loss interventions may explore the combination of lifestyle interventions with weight loss drugs, recognizing the potential benefits of both approaches. This could be implemented through programs delivered by registered dietitians or healthcare providers in primary care settings. Additionally, expanding access to these interventions through insurance coverage or government programs could help reach a larger population and have a more significant impact on improving health outcomes.
The PROPEL (Promoting Successful Weight Loss in Primary Care in Louisiana) trial was a cluster-randomized weight loss trial, specifically tailored to address the pressing health concerns of an underserved population in Louisiana, where obesity rates have reached alarming levels.
The core of the intervention comprises a pragmatic, high-intensity lifestyle-based obesity treatment program, thoughtfully designed to be integrated within primary care settings. Over a 24-month duration, this multi-component weight loss program is delivered by skilled health coaches who are embedded in primary care clinics, with the aim of instigating substantial and sustainable weight loss outcomes.
In this study, 803 participants were enrolled, of whom 67% identified as Black and 84% as female, thereby ensuring a diverse representation. The research design randomized 18 clinics, allocating them equally into two groups: usual care and an Intensive Lifestyle Intervention (ILI). The usual care group continued to receive their customary primary care, serving as the benchmark against which the ILI’s efficacy will be measured.
In this episode we have the opportunity to delve deeper into the intricacies of the PROPEL trial and gain insights from one of its lead researchers, Dr. John Apolzan of the Pennington Biomedical Research Center.
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