An Intermittent Fasting Intervention for Black Adults Can Be Feasibly Implemented in Black Churches: A Cluster Randomized Controlled Pilot Study

Abstract

BackgroundIntensive lifestyle interventions, including modest reductions in daily caloric intake (ie, continuous calorie energy reduction [CER]), are recommended by US national professional health organizations (eg, American Heart Association). However, they are less effective in Black communities. A burgeoning literature has reported the promise of intermittent fasting (IF) as an alternative strategy for weight loss. However, IF studies have been conducted with White participants predominately and provided participant resources not readily available in real-world situations. ObjectiveWeight-loss and weight-related outcomes of a scalable (ie, able to be widely disseminated and implemented) IF intervention developed with and for Black adults were compared with a CER intervention for the purpose of determining IF’s feasibility (ie, initial effectiveness, adherence, and acceptance) in a Black community. DesignA cluster randomized controlled pilot study was conducted. Participants/settingA total of 42 Black adults with a body mass index (calculated as kg / m2) ≥25 were recruited from 5 Black churches (3 IF and 2 CER) in Western New York State from September 2021 to May 2022. Participants were free of medical conditions that might have contraindicated participation in a weight-reduction program and other factors that might affect weight loss. InterventionsCommunity health workers delivered the 6-month, 16-session, faith-based IF and CER interventions. Main outcome measuresThe primary outcome was feasibility, consisting of initial effectiveness on body weight (ie, percent body weight lost from baseline to 6-month follow-up), adherence, and acceptability. Statistical analyses performedDescriptive statistics and linear mixed models accounting for within-church clustering were used. A baseline covariate corresponding to the outcome variable was included in the model. Intent-to-treat analysis was used. ResultsThere was statistically significant weight loss within both arms (IF: –3.5 kg; 95% CI –6 to –0.9 kg, CER: –2.9 kg; 95% CI –5.1 to –0.8 kg) from baseline to 6-month follow-up. Compared with CER, IF led to significantly lower daily energy intake (414.2 kcal; 95% CI 55.2 to 773.2 kcal) and fat intake (16.1 g; 95% CI 2.4 to 29.8 g). IF may result in lower fruit and vegetable intake (–103.2 g; 95% CI –200.9 to –5.5 g) and fiber intake –5.4 g; 95% CI –8.7 to –2 g) compared with CER. Participants in the IF arm completed a mean (SE) of 3.8 (1.4) more self-monitoring booklets compared with those in the CER arm (P = .02). Participants reported high levels of satisfaction with the program. ConclusionsAn IF intervention developed with and for Black adults can be feasibly implemented in Black churches. Larger studies need to be conducted to ascertain the extent IF can serve as a viable weight-loss alternative to CER interventions in Black communities.