# Adapting Online Obesity Treatment for Primary Care Patients in Poverty

> **NIH NIH K23** · MIRIAM HOSPITAL · 2024 · $188,244

## Abstract

Project Summary
Poverty affects over 37 million individuals in the U.S., subjecting them to syndemics – clustered, mutually enhancing
epidemics such as obesity, diabetes, and depression that arise from and perpetuate socioeconomic inequality. Syndemic
theory underscores a pathway to mitigate syndemics by intervening on a single target within the cluster. Obesity’s high
prevalence in poverty; role in increasing leading causes of death (e.g., cardiovascular disease, cancer, dementia); and
adverse psychosocial effects (e.g., increased depression) make it a crucial, high priority target. While structural and social
factors contribute to obesity in poverty, research shows the effectiveness of individual-level interventions in improving
health behaviors and weight when highly responsive to overburdened populations’ needs. At the same time, evidence
guiding refinement of interventions is sparse as participants with socioeconomic disadvantage are underrepresented in
obesity treatment research. Reflecting this phenomenon, Rx Weight Loss, a fully automated online obesity treatment, has
seen limited use among patients with low income despite past work showing it can be delivered effectively through
primary care at low cost. Since 72.8% of adults in poverty have a usual primary care provider, and 83% have Internet
access, this gap in adoption represents a significant opportunity for public health impact through adaptation of RxWL that
increases relevance for traditionally underserved populations. Further, this research is poised to fill a critical gap in
obesity treatment literature. Thus, this application aims to revise RxWL content and the process by which primary care
providers refer patients to the program (referenced collectively as the “RxWL package”) to maximize responsiveness,
reach, and effectiveness for those in poverty. Using mixed methods data collection, this project structures research
activities using the Social Marketing Assessment and Response Tool (SMART) and examines implementation outcomes
identified by the Consolidated Framework for Implementation Research (CFIR). Primary care provider (n = 23) and
patient (n = 16) stakeholders will provide feedback on the existing RxWL package (Aim 1); insights and scientific
knowledge will be integrated to produce a low-cost RxWL package prototype (i.e., a PDF with embedded links
approximating the intended program) for usability testing (n = 8 providers, 10 patients; Aim 2); and data will drive
development of a finalized RxWL package to disseminate through primary care and evaluate in an open trial (n = 12
providers, 32 patients; Aim 3). Aim 3 will examine both implementation and preliminary clinical outcomes, including
effects on weight loss and syndemic sequelae; obtain insights for further refinement; and indicate readiness for a larger R-
funded clinical trial. Revising RxWL holds high potential to reduce health disparities for those from socioeconomically
disadvantaged backgrounds. Moreover, findi...

## Key facts

- **NIH application ID:** 10914238
- **Project number:** 5K23DK136978-02
- **Recipient organization:** MIRIAM HOSPITAL
- **Principal Investigator:** Po-hun Chou
- **Activity code:** K23 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $188,244
- **Award type:** 5
- **Project period:** 2023-09-01 → 2028-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10914238

## Citation

> US National Institutes of Health, RePORTER application 10914238, Adapting Online Obesity Treatment for Primary Care Patients in Poverty (5K23DK136978-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10914238. Licensed CC0.

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