Vida Sana y Completa Obesity and Food Insecurity Study

Prior treatment

• Previous diagnosis of diabetes (other than during pregnancy) or diabetes documented in the EHR
• Diagnosis of cancer (other than non-melanoma skin cancer) that is/was active or treated with radiation or chemotherapy within the past 2 years
• Diagnosis of bipolar disorder or psychotic disorder within the last 2 years, or currently taking a mood stabilizer or antipsychotic medication
• Initiation or change in type or dosing of antidepressant medications within 2 months prior to enrollment (The patient will be re-contacted for a later cohort once his/her regimen has been stable for at least 2 months unless the person declines to participate altogether.)
• Have had or plan to undergo bariatric surgery during the study period
  • Other exclusions:

Other illness

• Serious medical condition anticipated to prevent person from walking
  • 1 mile (e.g., severe pulmonary disease or aortic stenosis)
• Severe medical comorbidities that require aggressive treatment: e.g., stage 4 or greater renal disease, class III or greater heart failure, unstable coronary artery disease, liver or renal failure;
• Diagnosis of a terminal illness and/or in hospice care;

Other

• Inability to speak, read or understand Spanish
• Having no reliable telephone service
• Having no regular Internet access via a computer and/or mobile device (e.g., smartphone)
• Plan to move out of the area during the study period
• Planned pregnancy
• Family/household member of another study participant or of a study staff member
• Investigator discretion for clinical safety or protocol adherence reasons

• Age: Lower age limit - 18 years, Upper age limit - NONE
• Race/ethnicity: self-reported Latinx ethnicity
• Sex: Female
• Body mass index: ≥ 30 kg/m2
• One or more metabolic risk factors as follows:
• Fasting plasma glucose of 100 to 125 mg/dL or HbA1c of 5.7 to 6.4 if detected by a recent (within the past year), documented, blood-based diagnostic test in the Electronic Health Record (EHR) in the last year
• Waist circumference \>40 inches in men and \>35 inches in women (≥35 inches in men and ≥31 inches in women, if of Asian descent) as measured by the study coordinator
• Triglycerides \>150 mg/dL as documented in the EHR in the last year
• High-density lipoprotein cholesterol (HDL-C) \<40 mg/dL in men and \<50 mg/dL in women as documented in the EHR in the last year
• Systolic blood pressure \>120 mmHg or diastolic blood pressure \>80 mmHg as measured by study coordinator
• Food insecurity: Defined as answering yes to one or both questions of the Hunger Vital Sign
• PCP approval of patient contact for study screening
• Able and willing to enroll and provide informed consent, i.e., to meet the time and data collection requirements of the study, be randomized to one of 2 study arms, participate for 24 months, and authorize extraction of relevant information from the EHR.