Introduction. Efficacy of interventions in research settings may not translate to usual-care settings. The impact of interventions varies depending upon factors, such as the proportion and composition of the population reached and engaged, as well as participation and implementation characteristics of providers. Methods.A lifestyle intervention meant to achieve a 5% loss of body weight in six months was offered to obese, indigent adult patients in a Family Medicine residency outpatient clinic. Implementation variables were assessed, including determination of individual patient penetration and participation rate, demographic representativeness, completion rate, outcomes, and differential impact, as well as setting participation rates and implementation fidelity.Results. From a population of 743 potentially eligible patients, 356 were invited to participate (48% penetration) and 158 were enrolled (44% participation). Those enrolled were heavier (BMI of 42.6 vs 39.0), younger (43.5 vs 47.0 years) and more likely female (87% vs 69%) than those not enrolled. Individual completion rate was 81%; overall weight loss was negligible. Setting participation was broad, but fidelity to background standard of care was only 50%. Conclusions.Providers were eager for a tool to help their obese, indigent patients lose weight, but the intervention proved ineffective and the usual care of enrolled patients was not strongly supportive of their weight loss efforts. KS J Med 2016;9(4):77-82. IMPLEMENTATION OF A LIFESTYLE PROGRAMcontinued.

Introduction. Modest weight loss (5 to 7%) reduced the incidenceof type II diabetes in the Diabetes Prevention Program (DDP) trial.A DPP-inspired lifestyle intervention requiring minimal patientself-data collection and tailored to low-SES patients throughminimal cost was developed for our indigent, obese patients. Methods. Obese (BMI ≥ 30 kg/m2), indigent (≤ 200% FederalPoverty Level) adults (age 18 - 70) were offered a nocostweight loss intervention as an adjunct to their usual primarycare in a residency outpatient clinic. The interventionprovided options for diet plans and social support. The goalwas to achieve a 5% loss of body weight over six months. Results. The sample (n = 158) was 86% female and 62% white,with a median age of 45 and median BMI of 40.9. Two-thirds ofsubjects chose the 50% diet; YMCA membership was selected byall but one. The 5% weight loss goal was met by 12.8%; another8.7% gained that amount. Subjects who either had pre-existingYMCA membership or used their provided membership weresuccessful, relative to those who received but never used theirmembership (0.6% loss vs 0.9% gain; p < 0.05). Changes in weightover six months were observed in the youngest (gain of 3.9 lbs.,p < 0.05) and the oldest (loss of 4.0 lbs., p < 0.05) age quartiles. Conclusions. A DPP-inspired lifestyle intervention tailoredto low-SES patients did not lead to overall weight loss, reinforcingthat weight reduction programs must provide a significantamount of support for participants to see success.Older age and a behavioral commitment to physical activityimproved the likelihood of success. KS J Med 2016;9(4):83-87.

What is applied gerontology? At the American Association of Retired Persons (AARP), program design and delivery is a function not only of the utilization of research but also of the use of older volunteers and common sense in addressing the problems of aging. The authors argue that applied gerontology encompasses these elements and a definition is proposed.