Optimizing Telehealth-delivery of a Weight Loss Intervention in Older Adults

Eligibility Criteria

• * Community-dwelling adult living independently (not a resident of a nursing home or an assisted living);
• * Aged 65-85 years 85 (unclear benefits of weight loss if \>85 years)7-9
• * Obesity (body mass index: ≥30 kg/m2);
• * English-speaking;
• * medical clearance by PCP (Primary Care Provider)
• * Callahan cognitive screen ≥ 3 correct items; items (a score of three or more correct items indicates an ability to consent);
• * OARS (Older Americans Resources and Services)survey score of ≥12; (a score of 12 or more indicates no impairments or disability)
• * Readiness to change score of ≥6/10;
• * documented diagnosis in the electronic health record of dementia of any type;
• * documented diagnosis in the electronic health record of weight loss surgery in the past;
• * untreated psychiatric disorder that would impair the ability to participate (bipolar, schizophrenia) based on medical record review;
• * life-threatening illness;
• * terminal illness (e.g., palliative care, hospice patient) based on medical record review whose life expectancy is \<12 months as determined by a physician;
• * nursing home or hospital admission in past three months;
• * advanced comorbidities based on medical record review;
• * heart - recent hospital admission for heart failure, myocardial infarction, stroke in past 3 months, unstable disease (new york class III or IV congestive heart failure);
• * chronic renal failure - chronic kidney disease stage IV or V (e.g., GFR \[glomerular filtration rate\] \<30ml/min);
• * non-skin cancer - history of requiring active treatment in the past year;
• * liver failure or cirrhosis;
• * chronic obstructive pulmonary disease - on oxygen or requiring steroids;
• * weight loss contraindication as noted by the PCP;
• * instability of weight loss, which is greater than 5% weight loss in the past 12 weeks;
• * anti-obesity medications including orlistat, semaglutide, liraglutide, tirzepetide, naltrexone-bupropion and phentermine prior to initiation of study procedures;
• * current use of bone acting medications (e.g., raloxifene, calcitonin, parathyroid hormone during the past year, Parathyroid Hormone Analogues (PTH-analogues \[e.g., teriparatide, abaloparatide\], sclerostin) inhibitors (romosozumbab), RANK ligand inhibitors (denosumab) or bisphosphonates during the last two years;
• * osteoporosis by medical record (t-score -2.5 and below on hip or spine scan) or history of fragility fractures;
• * elective surgery in next 12 months;
• * recent (\<1 mo) COVID-19 infection;
• * current or past participation (in the past 12 months) in another weight-loss study;
• * Planning on moving out of the area in the next 18 months.