Improving diet quality of people living with obesity: Protocol for a randomized controlled trial to build effective dietetic service delivery using technology in a primary health care setting (Preprint)

Abstract

Almost a third of Australian adults are living with obesity, yet most cannot access medical nutrition therapy from dietitians i.e., the health professionals trained in dietary weight management services. Across the health system, primary care doctors readily identify people who may benefit from weight management services but there are limited referral options in the community. Dietitians are trained to provide evidence informed dietary treatment of overweight and obesity but are underutilized and under-resourced. The chat2 (Connecting Health and Technology 2) trial will test combining new technologies for dietary assessment with behavior change techniques to improve outcomes for people living with obesity.

To compare the effectiveness of a one-year digital dietary intervention with standard care on body weight reduction and improved diet quality, in adults living with obesity delivered by dietitians in a primary care setting.

This randomized controlled trial (RCT) will compare a 1-year digital tailored feedback dietary intervention with a control group in 430 adults living with obesity (body mass index (BMI) ≥30 to ≤ 45 kg/m2). The primary outcomes measured at a baseline, six and 12 months, are changes in body weight and diet quality score (DQS). A four-day image-based dietary assessment tool (mobile Food Record; mFR) will be used to measure DQS. Secondary outcomes include dual-energy absorptiometry (DXA) body composition, total cholesterol, triglyceride, low-density lipoprotein (LDL), high-density lipoprotein (HDL), glycated hemoglobin (HbA1c) and fasting glucose. The intervention group will receive eight video counselling sessions with a trained dietitian delivered over 12 months to support dietary behavior change and relapse prevention. Both groups will receive feedback on their clinical chemistry and DXA scans at each timepoint.

Participant recruitment commenced in July 2023 and will end in August 2024. Data analysis will commence in 2025, with the anticipated publication of results in 2026.

If found to be effective, the results of this RCT will support the delivery of effective evidence-based weight management advice using new technologies. By improving community access to high quality dietetic services, it will ensure more effective utilization of the dietetic workforce to improve outcomes for people living with obesity.

Australian New Zealand Clinical Trials Registry ACTRN12622000803796.