Effective interventions targeting comorbid obesity and depression are critical given the increasing prevalence and worsened outcomes for patients with both conditions. RAINBOW is a type 1 hybrid design randomized controlled trial. The objective is to evaluate the clinical and cost effectiveness and implementation potential of an integrated, technology-enhanced, collaborative care model for treating comorbid obesity and depression in primary care. Obese and depressed adults (n=404) will be randomized to usual care enhanced with the provision of a pedometer and information about the health system’s services for mood or weight management (control) or with the Integrated Coaching for Better Mood and Weight (I-CARE) program (intervention). The 12-month I-CARE program synergistically integrates two proven behavioral interventions: problem-solving therapy with as-needed intensification of pharmacotherapy for depression (PEARLS) and standardized behavioral treatment for obesity (Group Lifestyle Balance™). It utilizes traditional (e.g., office visits and phone consults) and emerging care delivery modalities (e.g., patient web portal and mobile applications). Follow-up assessments will occur at 6, 12, 18, and 24 months. We hypothesize that compared with controls, I-CARE participants will have greater improvements in weight and depression severity measured by the 20-item Depression Symptom Checklist at 12 months, which will be sustained at 24 months. We will also assess I-CARE’s cost-effectiveness and use mixed methods to examine its potential for reach, adoption, implementation, and maintenance. This study offers the potential to change how obese and depressed adults are treated—through a new model of accessible and integrative lifestyle medicine and mental health expertise—in primary care.

The adapted acceptance measures showed acceptable psychometric properties and significant associations with actual Web site use, which correlated with weight loss. Better understanding of technology acceptance and use in e-health weight-loss interventions may improve participant adherence and outcome.

Obesity is one of the top health priorities in the United States. Primary care physicians are the designated “gatekeepers” for obesity prevention, detection, and treatment. However, they and the current U.S. health care structure and reimbursement systems are often ill-equipped to implement evidence-based obesity care. The Group Lifestyle Balance™ (GLB) program is a group-delivery adaptation of the predominantly one-on-one lifestyle intervention proven efficacious in the Diabetes Prevention Program (DPP) trial. Participant intervention goals are 7% weight loss and sustained moderate physical activity of 150 minutes or more each week. Sequential instruction and coaching encompasses nutrition, behavior modification, and physical activity principles. The E-LITE (Evaluation of Lifestyle Interventions to Treat Elevated Cardiometabolic Risk in Primary Care) trial evaluates the feasibility and potential effectiveness of delivering the GLB program, supplemented with food tasting and supervised physical activity during each of 12 group sessions, and electronic communication for long-term follow up, in a primary care setting. Benefits and potential areas for improvement in three areas of implementation emerged during the 15-month E-LITE trial: (1) delivery of an established lifestyle intervention program by specialized professionals, (2) integration of a lifestyle intervention program into a primary care clinic, and (3) information technology use in a primary care-based lifestyle intervention program. Our experience shows the feasibility of implementing an evidence-based lifestyle intervention program combining group-delivered nutrition and behavioral counseling, physical activity training, and technology-mediated follow-up in a primary care clinic setting, but challenges remain, and we offer possible solutions to overcome them.

Objective: 'DASH for Asthma' (n 90) was a 6-month randomized controlled trial that demonstrated potential benefits of a DASH (Dietary Approaches to Stop Hypertension) behavioural intervention for improving diet quality and asthma control by comparing intervention to usual care in adults with uncontrolled asthma. The present study examined acceptability and feasibility of the intervention from the perspective of intervention participants and lifestyle coaches. Design: Grounded in Social Cognitive Theory, the 3-month intensive stage, including three individual and eight group sessions, focused on diet modifications and behavioural self-regulation. The 3-month maintenance stage contained telephone consultations. Participants and lifestyle coaches completed surveys including 5-point Likert scales and open-ended questions. We analysed data using descriptive and inductive content analyses. Subjects: Forty-six intervention participants (survey response rate was 65-72 %) and two lifestyle coaches. Results: Participants and lifestyle coaches were highly satisfied (all mean ratings >4) with individual and group sessions. Participants identified mastery of knowledge and skills (awareness, goal setting, self-monitoring, problem solving), social learning (class members sharing experiences and ideas) and good coaching skills (reflective listening, empathy, motivational counselling) as important contributors to selfefficacy and programme satisfaction. Participants also valued personalized feedback received in individual sessions. Lifestyle coaches viewed participant engagement as a facilitator to effective sessions. Finally, participants and lifestyle coaches identified food tasting as beneficial for observational learning and facilitation of participant engagement. High class attendance and self-monitoring rate also reflected the high engagement among participants. Conclusions: The DASH behavioural intervention was feasible and highly acceptable to participants with uncontrolled asthma and lifestyle coaches.