Mobile Health Obesity Wellness Intervention in Rural Adults

National Institute on Aging, K23AG051681

8/15/16 – 4/30/23

John A. Batsis, MD, FACP, AGSF (University of North Carolina at Chapel Hill)

Stephen J. Bartels, MD (Dartmouth College); Summer B. Cook, PhD (University of New Hampshire); David F. Kotz, PhD (Dartmouth College); Curtis L. Petersen, MPH (Dartmouth College)

The national epidemic of obesity is also affecting older adults, and is associated with an increased risk of functional impairment, nursing home placement and early mortality. Conventional weight loss programs have the potential to reduce body fat, but are difficult to access for older obese adults due to transportation and mobility challenges. They may also lead to a detrimental loss of muscle and bone, paradoxically resulting in increased disability. The overarching goal of this Mentored Career Development Award is to develop the skills to become an independent researcher in community-based translational geriatric obesity research integrating innovative technology including mobile Health (mHealth), sensors, and video-conferencing with behavioral management to improve physical function. I will build upon the knowledge gained in my prior work using descriptive research to acquire the necessary skills and knowledge in this 5-year award to become an independent R01 investigator in geriatric obesity interventions research. Mentored activities, training, and coursework in key content areas will include: clinical trial methods (qualitative and quantitative); delivery of community-based obesity interventions using applied methods of telemedicine in rural populations; and enhancing health promotion using mHealth and sensors to facilitate behavioral change in older obese adults. Concurrently, I will conduct a program of pilot research aimed at developing and evaluating a technology assisted wellness intervention for obese older adults. First, I propose to assess the acceptability, usability, utility and perceived value of mHealth technology for obese older adults using a novel, adaptable mHealth device (Amulet) with remote sensing and self-monitoring capabilities, including strength, function, activity type, and real-time feedback (Qualitative assessment and Adapting Amulet). Second, I will conduct a single-arm, pilot feasibility study evaluating the potential effectiveness of a mHealth obesity wellness intervention (MOWI) for older obese adults in improving physical function (Develop & Refine MOWI). MOWI integrates Amulet with a weekly individual dietician-led nutritional session, along with twice weekly physical therapist led group exercise session. I will pilot test MOWI in a research-based setting over a 3-month period, and then deliver the intervention in the home setting using video-conferencing over a 6-month period (Evaluate Home MOWI). The primary clinical outcome is physical function, measured by observed muscle strength, observed physical fitness, and observed and self-reported life-task functioning. Secondary (exploratory) outcomes will include behavioral activation, objective physical activity, subjective health status, and subjective physical activity. The findings on the feasibility, acceptability, and preliminary estimates of effectiveness will be used in a future competitive application for an extramural R01 assessing the effectiveness of a home Telehealth-delivered MOWI in improving physical function in high-risk obese older adults as compared to an in-person intervention.

This career development award will assist the applicant in acquiring the skills to transition from large secondary epidemiological dataset analyses to health services interventions research allowing the development and testing of community based approaches to address the growing epidemic of obesity in older adults. A pilot study of the feasibility and effectiveness of a Mobile Health Obesity Wellness Intervention in older obese adults will be conducted to improve physical function and independence at home using a mobile health device. The strategy has the potential to improve the health of a rapidly aging demographic with obesity, reduce healthcare costs and if successful, allow program dissemination to distant, remote areas for improvement in healthcare quality.