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Rural residents have higher obesity rates and need access to treatment. Travel burden may limit use and effectiveness of clinic-based behavioral weight loss treatment, which includes frequent visits. This paper examines the impact of travel distance and time on visit attendance and weight loss during a 2-year cluster randomized trial. Thirty-six primary care practices were randomized to 1 of 3 methods of providing behavioral weight loss counseling individual clinic visits, group clinic visits, or group phone visits. Participants in t