Abstract Body: Introduction: Excess visceral adipose tissue (VAT) is more discriminatory of obesity-related cardiometabolic risk than body mass index (BMI) but is not routinely assessed by clinicians. It is not known whether providing patients with direct visualization of VAT could improve cardiometabolic health.

Hypothesis: We tested dual hypotheses that presenting patients with body fat imaging results will be superior to BMI alone, and that giving reports directly to patients will be superior to giving reports to their providers when comparing changes in risk perception, lifestyle and cardiometabolic outcomes.

Methods: The BODY-REAL study is a single-site, 2x2 factorial design pilot trial, randomizing adults with BMI≥25, A1C≥5.7% and additional cardiovascular risk factors to 1) receive a visual report of body fat distribution based on MRI analysis or BMI alone and 2) have the report received by the patient or their provider. At 2 weeks, 3 months and 6 months from baseline, we used validated survey instruments to assess physical activity, medication adherence, risk perception of diabetes and heart disease, and measured changes in BMI, blood pressure, lipid profile, A1C and fasting glucose. We created analysis of covariance models and linear models with both fixed and random (time-updated) effects.

Results: 29 patients (31% female) were assigned to 4 study arms, with average baseline BMI of 33.6 kg/m². Changes in HDL and preventive behaviors varied by report recipient, and lifestyle changes by report type. Among patient-received reports, those with MRI data (vs BMI data) showed a mild but significant increase in HDL over time (p=0.047). Preventive behavior scores increased over time among those with provider-received reports (p=0.009), regardless of report type. Lifestyle scores decreased among those with BMI data vs MRI data (p=0.004), regardless of report recipient. There were no significant changes over time in BMI, blood pressure, LDL, total cholesterol, A1C or risk perception associated with body fat imaging vs BMI data, or with patient- vs provider-received reports.

Conclusions: This pilot study demonstrated potential for direct-to-patient visualization of VAT to improve HDL and preventive behaviors, however was likely underpowered to detect significant change in cardiometabolic risk indicators, thus warranting further investigation.