Community-based Weight Loss Program Research Articles

Cost-Effectiveness Analysis of a Community-Based Telewellness Weight Loss Program

The purpose of this study was to perform a cost-effectiveness analysis of the Koa Family Program, a community-based telewellness weight reduction intervention for overweight and obese women aged 21-45 years with low income. The Koa Family Program resulted in an approximately 8-pound weight loss as demonstrated in an RCT published previously. Estimates for the cost-effectiveness were derived from the prospective 25-week RCT including 70 women (25 kg/m2≤BMI<40 kg/m2). The analysis was from a program-funder perspective. Base case costs, as well as low and high scenario costs, were estimated from the services provided to intervention participants. The incremental costs were compared with the incremental effectiveness, with weight loss being the outcome of interest. Costs were in 2021 U.S. dollars. Cost-effectiveness was assessed using the incremental cost-effectiveness ratio and the incremental net benefit. The statistical uncertainty was characterized using an incremental net benefit by willingness-to-pay plot and a cost-effectiveness acceptability curve. The base case average cost per participant was $564.39. The low and high scenario average costs per participant were $407.34 and $726.22, respectively. Over the 25-week study timeframe, participants lost an average 7.7 pounds, yielding a base case incremental cost-effectiveness ratio of approximately $73 per extra pound lost. The probability that the Koa Family Program is cost-effective is 90%, assuming a willingness-to-pay of $115 for a 1-pound reduction, and is 95%, assuming a willingness-to-pay of $140. The Koa Family Program provides good value with cost-effectiveness in line with other weight-loss interventions. This is a striking finding given that the Koa Family Program serves a more vulnerable population than is typically engaged in weight loss research studies.

S1464 Participation in a Community-Based Weight Loss Program Showed Significant Improvement in Patient Reported Outcomes of Their Mental and Physical Health

S1464 Participation in a Community-Based Weight Loss Program Showed Significant Improvement in Patient Reported Outcomes of Their Mental and Physical Health

Motivation for weight loss among completers of a free community-based weight loss program in a US-Mexico border region: A self-determination theory perspective.

This study explores the perceptions and motivation for weight loss among participants who completed a free community-based weight loss program in a predominantly Hispanic and low-income region along the US-Mexico border using a Self-Determination Theory (SDT) perspective. This manuscript is timely as qualitative research on the effect of motivation as a factor in behavioral interventions to reduce overweight or obesity is currently lacking. Individual semi-structured interviews were conducted with 20 participants (80%, n = 16 female) who completed a community weight-loss intervention to assess motivation for weight loss and participating, and the role of social support and self-efficacy in weight loss. Directed content analysis was used with SDT guiding the questions and subsequent theme analysis. The findings communicate perspectives of participants relevant to 8 prominent themes. The regulation types and constructs related to SDT included: non-regulation, external regulation, introjected regulation, identified regulation, integrated regulation, and intrinsic regulation as well as competence and relatedness. Participants mentioned external sources of motivation, such as wanting to improve their physical appearance, and motivation due to financial incentives. Fewer participants reported intrinsic motivators, which the literature suggests are more likely to create lasting change and improved health behaviors. Understanding the motivation for behavior change and completion of weight loss programs is essential to help participants reach their goals effectively and sustain weight loss. A greater emphasis during weight loss programs on the motives for individuals to lose weight may help improve outcomes in weight-loss interventions. Additionally, increasing strategies targeted at enhancing intrinsic motivation for weight loss may be beneficial.

Team members influence retention in a First Peoples’ community-based weight-loss program

The aim of this study was to evaluate program retention factors in a repeated team-based weight-loss and healthy lifestyle program for Aboriginal and Torres Strait Islander Peoples. Data comprised 3107 participants in 10 Aboriginal Knockout Health Challenge contests. Multiple variable and bivariate analyses compared age, gender, self-reported behaviors (physical activity and fruit and vegetable consumption) and objectively measured weight between completers and non-completers. First-time participants (n = 3107) who completed were more likely to be female, be older, weigh less and have more completing members in their team; only the number of team members completing was significant among participants (n = 1245) who took part in a second contest participation. Multivariate results were similar, with a participant’s odds of completing on their first and second participation occasion increasing by 1.16 and 1.18, respectively, with every teammate completed. Given that the strongest effect centered on a social factor, this highlights the importance of having community-driven design and the benefits of a group-based approach to engage and maintain First Peoples’ engagement in preventive health programs. Further, by identifying a change in factors associated with retention in successive weight-loss attempts, this study improves understanding of retention in weight-loss programs more generally.

Bariatric Surgery Improves Renal Function in Patients With Obesity.

BackgroundObesity affects 93.3 million adults in the United States and is a predisposing factor for the development and progression of chronic kidney disease (CKD). The objective of this study is to examine the association between weight loss and renal function in participants undergoing bariatric surgery following a 12-week multidisciplinary, community-based weight loss program.MethodologyThis is a retrospective chart review of participants who voluntarily enrolled in a 12-week multidisciplinary weight loss program prior to bariatric surgery from 2009 to 2018. The primary outcome was to assess the association between weight loss and renal function in participants undergoing bariatric surgery. Secondary outcomes included changes in hemoglobin A1c, lipids, fasting glucose, and blood pressure.ResultsAmong the 55 participants, baseline glomerular filtration rate (GFR) was 49 mL/min/m2, 80% were female, and the average baseline weight was 131 kg. At one-year post-intervention, 69% of patients improved in the CKD stage, with 45% of the participants improving from stage 3A to stage 2. GFR improved to 15 mL/min/1.73m2 (p = 0.025), and there was a negative correlation (rs = -0.3556) between weight and GFR (p = 0.013). Participants with hyperlipidemia had a 12 mL/min/1.73m2 rise in GFR, while participants without the diagnosis at one year had a 24 mL/min/1.73m2 rise in GFR (p = 0.007).ConclusionsThis study demonstrated improved renal function and reduced progression of CKD following a combined lifestyle and surgical intervention, indicating the importance of a comprehensive approach for the management of the chronic disease.

Overweight and obese men’s experiences in a sport-based weight loss intervention for men

In Western countries, such as Australia and the UK, a significantly greater proportion of men (relative to women) are overweight and obese, yet relatively few weight loss interventions have been developed that sufficiently target men. This lack of male-focused programming may be in part because ‘traditional’ weight loss programs are unappealing for what is considered a ‘hard-to-reach’ population. One program that appears to have such appeal for men is the MAN v FAT Football (MVFF) program, based out of the United Kingdom, which is designed for men with a body mass index of (or greater than) 27.5. MVFF encourages men’s participation in a community-based weight loss program that incentivizes weight loss through participation in a football league, and since 2016 MVFF has supported the weight loss efforts of several thousand men. Using MVFF as an exemplar, our aim was to derive insight into how men experience a male-only competitive, sport-based weight loss program. We recruited twenty-seven players (Mage = 41.13, SD = 9.93), and ten coaches (Mage = 31.8, SD = 11.55) from program locations throughout the United Kingdom. Using semi-structured interviews and thematic analysis, we identified several appraisal aspects of the program that players and coaches considered important, including the appeal of sport, competition on a level playing field, being part of a team, camaraderie, accountability, men sharing issues with other men, gender-sensitized environment, likeminded and similar men, and perceptions that traditional weight loss programs are tailored towards women. Player experiences (i.e., competence and enjoyment) and functional supports in the program (e.g., player handbook, weight loss coach) were reported to drive outcomes of effective weight loss and program retention. Interventions aiming to target men may be more successful working with rather than against formulations of identity such as masculinities, and this can be achieved by tailoring program content (e.g., messaging), settings (e.g., among men sharing similar characteristics such as body-type or goals), and mode of delivery (e.g., through organized sports, and leveraging competition to drive healthy behaviours).

Weight change among repeat participants of an Aboriginal community-based weight loss program

BackgroundCommunity-based weight loss programs may have potential to address overweight and obesity at the population level. However, participation patterns and individual outcomes from these programs are understudied. This study examined repeat participation patterns and participant weight change between contests over seven years of an Aboriginal Australian team-based program in order to identify (1) predictors of repeat participation and (2) associations with weight change between contests.MethodsData for the 12 contests from 2012 to 2018 were merged, with probabilistic record matching. A total of 7510 enrolments were registered for the 12 contests, representing 4438 unique people. Contest lengths varied from 10 to 16 weeks in duration. Non-repeat participants were those who only competed once in the program by the end of 2018, and repeaters were those who competed in at least two contests. Associations between repeat participation and participant baseline (i.e., first participation occasion) characteristics, change in diet and physical activity and percent change in weight during the first participation occasion were examined using crossed random effects (for person and team) regression adjusted for exposure to the program. Weight percentage change between contests was calculated for consecutive participation occasions occurring at least three months apart, converted to percent change per month. Weight change was regressed on number of repeat participation occasions adjusted for age, gender, baseline weight at first participation occasion, and weight percent change in the immediately preceding contest.ResultsOne-third of the 4433 participants participated more than once, with women more likely than men to repeat. A 1% reduction in weight during a competition was associated with an increase in weight of 0.05% per month between competition end and subsequent participation. Regain was smaller the heavier participants were at their first participation.ConclusionsWhile individuals benefit from weight loss through program participation, strengthening strategies for weight loss maintenance within or following the program could improve long-term weight outcomes and reduce weight cycling.

Impact of a Community-Based Weight Loss Program on Renal Function.

IntroductionObesity is associated with increased morbidity and mortality and is an independent risk factor for the development and progression of chronic kidney disease (CKD). This study investigated the effect of a community-based, lifestyle-focused, weight-loss intervention on renal function among participants at baseline following 12 weeks of therapy. MethodsA retrospective analysis of adults enrolled in a weight management program from 2009 to 2014 was conducted. Participants consumed at least 800 kilocalories per day in meal replacements, attended weekly behavioral education classes, and expended approximately 300 kilocalories per day in physical activity. The primary outcome was the association of weight loss and changes in glomerular filtration rate (GFR). Secondary outcomes included changes in blood sugar levels, lipid parameters, blood pressure, and the use of medication for hypertension and diabetes mellitus. ResultsOf the 71 participants, 63.4% were female, the average weight was 289 pounds, the average body mass index (BMI) of 53, and baseline GFR 47 ml/min/1.73m2. Following 12 weeks of the intervention, 76.1% of participants improved in CKD stage, 22.4% remained within the same stage, and 1.5% progressed to a higher stage (3A to 3B). Analysis revealed a correlation between weight loss and improved GFR (p=0.0006). Improvements were noted in blood sugar levels, blood pressure, and lipids (p<0.05). Medications were reduced in 61.8% of participants for hypertension and 83.3% for diabetes.ConclusionsA significant correlation was observed between weight loss and improved renal function, with most participants improving in CKD stage. Participants also improved in markers of chronic disease and required fewer medications. When controlling for both diabetes and hypertension, the effect of improved renal function persisted.

Non-pharmacological Weight Loss Program in a Rural Community: Feasibility Study

Background Obesity is a complex health problem that affects over one-third of US adults. Obesity rates are higher in rural communities, which may not have the resources to address. A community-based non-pharmacological weight loss program was implemented to address the limitations of managing rural obesity, specifically cost and transportation. Methods A descriptive study was used to explore the feasibility of an 8-week non-pharmacological weight loss program that included nutrition and healthy lifestyle education for overweight or obese adult residents of a rural community in Western Maryland (n=23). Results The program was low-cost and had high participant satisfaction. Participants whom completed the program showed an increase in motivation to making lifestyle changes (p=0.0002); consumed fewer calories from fat (p=0.029); and had a small change in BMI (p=0.0389). The increase in physical activity minutes with program completion was not statistically significant (p=0.2285). Weather, family and work obligations were barriers to attendance. Conclusions This rural community-based weight loss program was feasible, addressed the barriers of cost and transportation, and can be adapted to meet the needs of other rural communities. Keywords: obesity, obesity intervention, rural, community, feasibility, non-pharmacological DOI: http://dx.doi.org/10.14574/ojrnhc.v19i2.516

Weight loss and weight gain among participants in a community-based weight loss Challenge

BackgroundTo describe the characteristics of participants who registered for multiple annual offerings of a community-based weight loss program called The Challenge, and to determine participant characteristics associated with weight change over multiple offerings of The Challenge occurring during the years 2010–2016.MethodsMultivariable linear mixed effects analyses were conducted to describe percent weight change within and between offerings of The Challenge by participant characteristics.ResultsThere were 669 and 575 participants included in the within and between analyses, respectively, for offerings of The Challenge. Among the 434 participants who lost weight in their first attempt at The Challenge and completed the initial weigh-in for a subsequent offering of The Challenge, 22.4% maintained their weight loss or had greater weight loss by the next Challenge, 40.3% gained back some weight, and 37.3% gained back all or more of the weight they lost during their first Challenge. Men had a significantly greater percent weight loss compared to women in their first and second Challenge and men were more likely to gain weight between Challenges. Participants who returned to more Challenges had a greater accumulated percent weight loss compared to those who returned to fewer Challenges.ConclusionsThe current weight loss Challenge appears to contribute to helping a percentage of participants lose weight and maintain some or all of the weight loss.

The social network – using social media to support individuals with traumatic brain injury participating in a pilot study weight-loss program

ABSTRACTObjectives To (1) describe the process of implementing social media (Facebook group) among individuals with traumatic brain injury (TBI) enrolled in a weight-loss intervention; (2) discuss thematic content and logistics as administrators of the Facebook group; (3) provide examples of social media engagement among users, and (4) examine differences in characteristics of social media users versus non-users.Participants Individuals enrolled in a community-based weight-loss program ≥ 6 months post-TBI, BMI ≥ 25, 18–64 years, with physician’s clearance.Results Of 22 participants, 10 joined the closed Facebook group (M age = 44.4 years) with a median time since injury of 5.5 years. Six of 10 made contributions to the group (M posts = 12.5). 58% of participants who reported mild or moderate impairment utilised the Facebook group, compared to 30% of participants with severe impairment. Facebook users achieved an average weight loss of −6.2 ± 6.6 pounds after the 12-week core program compared to −5.2 ± −9.2 pounds among non-users. Facebook users perceived their injuries to be less severe and their time since injury was shorter.Conclusion Future research is needed to evaluate the role of social media within weight-loss interventions to determine if it provides meaningful impacts in weight-loss efforts and engagement among individuals with TBI.

Efficacy of a Weight Loss Intervention for African American Breast Cancer Survivors.

Purpose African American women with breast cancer have higher cancer-specific and overall mortality rates. Obesity is common among African American women and contributes to breast cancer progression and numerous chronic conditions. Weight loss interventions among breast cancer survivors positively affect weight, behavior, biomarkers, and psychosocial outcomes, yet few target African Americans. This article examines the effects of Moving Forward, a weight loss intervention for African American breast cancer survivors (AABCS) on weight, body composition, and behavior. Patients and Methods Early-stage (I-III) AABCS were randomly assigned to a 6-month interventionist-guided (n = 125) or self-guided (n = 121) weight loss program supporting behavioral changes to promote a 5% weight loss. Anthropometric, body composition, and behavioral data were collected at baseline, postintervention (6 months), and follow-up (12 months). Descriptive statistics and mixed models analyses assessed differences between groups over time. Results Mean (± standard deviation) age, and body mass index were 57.5 (± 10.1) years and 36.1 (± 6.2) kg/m2, respectively, and 82% had stage I or II breast cancer. Both groups lost weight. Mean and percentage of weight loss were greater in the guided versus self-guided group (at 6 months: 3.5 kg v 1.3kg; P < .001; 3.6% v 1.4%; P < .001, respectively; at 12 months: 2.7 kg v 1.6 kg; P < .05; 2.6% v 1.6%; P < .05, respectively); 44% in the guided group and 19% in the self-guided group met the 5% goal. Body composition and behavioral changes were also greater in the interventionist-guided group at both time points. Conclusion The study supports the efficacy of a community-based interventionist-guided weight loss program targeting AABCS. Although mean weight loss did not reach the targeted 5%, the mean loss of > 3% at 6 months is associated with improved health outcomes. Affordable, accessible health promotion programs represent a critical resource for AABCS.

Adding An Activity Tracker To An Ongoing Community-based Weight-loss Program

Adding An Activity Tracker To An Ongoing Community-based Weight-loss Program

A Quasi-Experiment to Assess the Impact of a Scalable, Community-Based Weight Loss Program: Combining Reach, Effectiveness, and Cost.

Primary care addresses obesity through physician oversight of intensive lifestyle interventions or referral to external programs with demonstrated efficacy. However, limited information exists on community program reach, effectiveness, and costs across different groups of participants. To evaluate a scalable, community weight loss program using reach, effectiveness, and cost metrics. Longitudinal pre-post quasi-experiment without control. Enrolled participants in Weigh and Win (WAW), a community-based weight loss program. A 12-month program with daily social cognitive theory-based email and/or text support, online access to health coaches, objective weight assessment through 83 community-based kiosks, and modest financial incentives to increase program reach. Number of participants, representativeness, weight loss achievement (3%, 5% of initial weight lost), and cost of implementation. A total of 40,308 adults (79% women; 73% white; BMI = 32.3 ± 7.44, age = 43.9 ± 13.1 years) enrolled in WAW. Women were more likely than men to enroll in the program and continue engagement beyond an initial weigh-in (57% vs. 53%). Based on census data, African Americans were over-represented in the sample. Among participants who engaged in the program beyond an initial weigh-in (n = 19,029), 47% and 34% of participants lost 3% and 5% of their initial body weight, respectively. The average duration for those who achieved 5% weight loss was 1.7 ± 1.3years. African American participants were more likely to achieve 5% weight loss and remain enrolled in the program longer compared to non-African American participants (2.0 ± 1.3 vs. 1.6 ± 1.2years). Implementation costs were $2,822,698. Cost per clinically meaningful weight loss for African Americans ($257.97/3% loss; $335.96/5% loss) was lower than that for Hispanics ($318.62; $431.10) and Caucasians ($313.65; $441.87), due to the higher success rate of that subgroup of participants. Weigh and Win is a scalable technology-supported and community-based weight loss program that reaches a large number of participants and may contribute to reducing health disparities.

Community Weight Loss to Combat Obesity and Disability in At-Risk Older Adults.

Among older, overweight, and obese adults with either cardiovascular disease or the metabolic syndrome, reduced mobility and loss of leg strength are important risk factors for morbidity, disability, and mortality. It is unclear whether community-based approaches to weight loss may be an effective solution to this public health challenge. An 18-month three-site, randomized controlled trial conducted by YMCA staff, with blinded assessors, enrolled 249 older, overweight, and obese adults with either cardiovascular disease or metabolic syndrome with randomization to three interventions: weight loss alone (WL), weight loss + aerobic training (WL + AT), and weight loss + resistance training (WT + RT). The dual primary outcomes were 400-m walk time in seconds and knee extensor strength in Newton meters. All groups lost weight from baseline: average baseline adjusted change of -6.1% (95% confidence interval [CI]: -7.5 to -4.7) for WL only, -8.6% (95% CI: -10.0 to -7.2) for WL + AT, and -9.7% (95% CI: -11.1 to -8.4) for WL + RT. Combined, the two physical activity + WL training groups had greater improvement in walk time than WL alone (mean difference 16.9 seconds [95% CI: 9.7 to 24.0], p < .0001). Baseline adjusted change in knee extensor strength was no greater with WL + RT than WL + AT (mean difference -3.6 Nm [95% CI: -7.5 to 0.3], p = .07). At risk, older, overweight and obese adults can achieve clinically significant reductions in body weight with community-based weight loss programs. The change in percent weight loss and improvements in mobility are significantly enhanced when either RT or AT is combined with dietary WL.

Guideline-concordant weight-loss programs in an urban area are uncommon and difficult to identify through the internet.

To determine the reliability of Internet-based information on community-based weight-loss programs and grade their degree of concordance with 2013 American Heart Association, American College of Cardiology, and The Obesity Society weight-management guidelines. An online search was conducted for weight-loss programs in the Maryland-Washington, DC-Virginia corridor. Content analysis was performed to abstract program components from their websites, and then 80 programs were randomly selected for a telephone survey to verify this information. Reliability of Internet information was determined in comparison with telephone interview responses. Of the 191 programs, 1% were graded as high, 8% as moderate, and 91% as low with respect to guideline concordance based on website content. Fifty-two programs participated in the telephone survey (65% response rate). Program intensity, diet, physical activity, and use of behavioral strategies were underreported on websites as compared to description of these activities during the phone interview. Within the subsample, 6% of programs were graded as high based on website information, whereas 19% were graded as high after the telephone interview. Most weight-loss programs in an urban, mid-Atlantic region do not currently offer guideline-concordant practices and fail to disclose key information online, which may make clinician referrals challenging.

Effects of a community based weight loss intervention in rural New York: A pilot study

OBJECTIVE: The purpose of this longitudinal study is to evaluate the outcomes of a weight loss intervention in a rural community wellness center.METHODS: This six month (Oct'13‐ April'14) community based weight loss program was coordinated by the Plattsburgh City Recreation Department and SUNY Plattsburgh. Nineteen overweight adults (18 female, 1 male) aged 18 to 60 years (43.7 ± 12.2 years) residing in Clinton County, NY were recruited through local advertisements. Participants were charged a one time @100 fee. The program comprised twice‐weekly group exercise and bi‐monthly nutrition education classes. Paired samples t‐test and McNemer tests were performed to examine the pre‐post program outcomes.RESULTS: Individuals completing the program averaged a weight loss of 29.2 ± 22.5 pounds and inches loss of 22.04 ± 12.2. Significant reduction in BMI (3.4 ± 2.2, p &lt; 0.001), % body fat (3.4 ± 2.3, p &lt; 0.001), systolic blood pressure (11.3 ± 13.6, p &lt; 0.05), diastolic blood pressure (7.75 ± 8.3, p &lt; 0.05) and total cholesterol (20.33 ± 33.1, p &lt; 0.10) were observed at 6 months. Prevalence of prehypertension and hypertension reduced from 80% to 46% (n =11, McNemar test: NS). Although not statistically significant, fasting lipids and blood glucose improved regardless of age. While there was no significant change in diet, consumption of roots and tubers decreased significantly.CONCLUSIONOur program results indicate that participants who complete a self‐paid, structured rural community‐based weight loss program can achieve significant weight loss with improvement in cardiovascular risk factors regardless of age.Funding: Presidential Research Award, SUNY Plattsburgh

Personal and relational wellness in a community-based weight loss program for women: Implications for weight loss programs

The purpose of this research was to describe the participants’ perspectives of a community-based weight loss program for women. Five focus groups were conducted with participants from the Weight Wise Women program in two community facilities in southeastern North Carolina. Focus group participants (N= 50) from three cohorts of the Weight Wise Women program were between 40-64 years of age, and all had a body mass index of &gt; 25. Data analyses consisted of coding and organizing information from observations, notes and transcriptions into themes. Three broad categories emerged. The first, personal wellness, included learning, health, control over life, and self-efficacy and secondly relational wellness included social and peer structure, support from instructors, and collaboration. The final category was specific comments about the program. Participants viewed this program as an effective way to lose weight. Implications include suggestions for community weight loss programs that could improve participant experiences, outcomes and the health of the community.

Comparison of Weight Loss by Weight Classification in a Commercial, Community-based Weight Loss Program

Comparison of Weight Loss by Weight Classification in a Commercial, Community-based Weight Loss Program

Incremental Benefit of Adherence in a Community-based Weight Loss Program

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