Evidence-based Weight Loss Intervention Research Articles

Abstract P193: Sex Moderates Diet Quality Differences in Integrated Collaborative Care for Comorbid Obesity and Depression: Post-Hoc Analysis of the Research Aimed at Improving Both Mood and Weight Randomized Clinical Trial

Background: High-quality diets, such as the Dietary Approaches to Stop Hypertension (DASH), are associated with lower risk for obesity and obesity-related chronic diseases. It is unclear whether diet quality improves aside from reduced calories in evidence-based behavioral weight loss interventions. Objective: Leveraging data from the Research Aimed at Improving Both Mood and Weight (RAINBOW) randomized trial, the objective of this post hoc analysis is to investigate (1) whether the study intervention was associated with improved diet quality in adults with comorbid obesity and depression, compared to usual care; and (2) whether the associations were modified by sex. Methods: Participants completed 24-hour dietary recalls at baseline, 6, 12, 18, and 24 months. Dietary outcomes included the DASH score as the composite measure of diet quality and its components. Between-group differences in dietary outcomes were examined among 409 participants and by sex, using repeated-measures mixed-effects linear models. Results: Changes in DASH scores did not differ between the intervention and usual care control groups through 24 months in both women and men. Compared with controls, men in the intervention group had significantly decreased nut, seed, and legume intake at 6 (mean difference, -1.1; 95% CI, -1.9, -0.3 servings/day; P=0.01) and 12 months (-1.0; -2.0, -0.0 servings/day; P=0.048). Compared with controls, women in the intervention group had significantly decreased fruit and vegetable intake at 18 (-1.8; -2.9, -0.6 servings/day; P=0.002) and 24 months (-1.1; -2.2, -0.1 servings/day; P=0.03), and whole grain intake at 24 months (-0.5; -0.9, -0.1 servings/day; P=0.03), but increased percent calories from fat at 24 months (3.6; 0.6, 6.5; P=0.02). Conclusions: Diet quality not only did not improve in an effective behavioral weight loss intervention but deteriorated in women, in particular. These post-hoc findings warrant confirmation and may suggest that behavior change techniques targeting diet quality that are tailored to women and men need to be an explicit focus of behavioral weight loss interventions aside from caloric reductions.

Efficacy of the Diabetes Prevention Program Group Lifestyle Balance Program Modified for Individuals with TBI (GLB-TBI): Results from a 12-month Randomized Controlled Trial.

Obesity after traumatic brain injury (TBI) is a public health issue and no evidence-based weight loss interventions exist to meet the unique needs of individuals after TBI. To (a) examine the efficacy of the Diabetes Prevention Program Group Lifestyle Balance for TBI (GLB-TBI) weight-loss intervention compared to an attention control for primary (weight-loss) and secondary health outcomes; (b) determine participant compliance with the GLB-TBI; and (c) determine if compliance is associated with improved outcomes. Individuals with moderate to severe TBI, age 18-64 years, ≥6 months postinjury, and body mass index of ≥25 kg/m2 were randomized to a 12-month, 22-session GLB-TBI intervention or attention control condition. Weight-loss (lbs.), anthropometric, biomarkers, and patient-reported outcomes were collected at baseline, 3, 6, and 12 months. The GLB-TBI group (n = 27) lost 17.8 ± 41.4lbs (7.9%) over the 12-month program and the attention control group (n = 27) lost 0 ± 55.4lbs (0%). The GLB-TBI group had significant improvements in diastolic blood pressure, triglycerides, and HDL cholesterol. GLB-TBI attendance was 89.6% and weekly self-monitoring of diet and activity was 68.8%. Relative to baseline, the GLB-TBI compliant group (≥80% attendance; ≥85% self-monitoring; n = 10) had a statistically significant decrease in weight at each assessment, the noncompliant group had a significant decrease between 6 and 12 months (n = 17), with no change in weight in the attention control group (n = 27). Findings suggest for adults with TBI who are overweight or obese, participation in the GLB-TBI can significantly reduce weight and metabolic risk factors and increase self-reported habits for diet and exercise.

Abstract B041: Community-health worker delivered weight loss and maintenance intervention for rural African American adults

Abstract Introduction: Excess body weight is a critical modifiable risk factor for numerous cancers and one of the top public health problems in the country. Unfortunately, underserved groups bear a disproportionate burden, with African Americans having the highest rates of obesity. Behavioral weight loss interventions have been recommended by several governmental agencies to treat obesity and improve cancer risk, control, and survivorship. However, health care provider shortages in underserved areas have resulted in access gaps. Community Health Workers (CHWs), trusted community members, have filled these gaps and been successful in changing health behaviors (e.g. dietary intake, screening), associated with weight loss or cancer, but have not been thoroughly engaged to deliver evidence-based behavioral weight loss interventions. To increase reach among the underserved, community-based weight loss and maintenance interventions are critical. Methods: Building on a 10+ year partnership between community and academic researchers, an evidence-based behavioral weight loss program was adapted for African Americans of faith to create a group-based, CHW-delivered weight loss and maintenance intervention. With the intention of recruiting two CHWs per church, a total of 61 CHWs were recruited and underwent 28 hours of training over 4-6 weeks to deliver the intervention. A total of 31 churches were randomized to a Weight Loss Only arm (16 core lessons) or a Weight Loss + Maintenance arm (16 core + 12 maintenance lessons) in this cluster randomized controlled trial (n=440). Actual weight and height (BMI—body mass index), dietary behaviors, and physical activity were assessed at 0, 6, 12, and 18 months. Linear mixed models and fit by restricted maximum likelihood were implemented using SAS 9.2. All analyses were conducted with the intention-to-treat principle. Results: The intervention produced significant weight loss from baseline to 6-months (-2.47 (-3.13, -1.80)), with 23.7% of all participants losing at least 5% of their body weight. Among those with clinically significant weight loss (≥5%) at 6 months, there was a statistical trend of lower weight regain in the Weight Loss + Maintenance at 12 months. Participants in the Weight Loss + Maintenance arm also reported higher levels of physical activity at 12 months. There were no significant differences between arms at 18 months. Discussion: The intervention produced significant weight loss from baseline to 6-months on par with other evidence-based weight loss interventions for African Americans, including adaptations that utilized health professionals. Compared to health-care professionals, CHWs may be a more cost-effective way to deliver evidence-based behavioral weight loss interventions. Engagement of institutional infrastructures already in place in communities, such as churches, may be a feasible way to sustainably implement and disseminate evidence-based weight loss interventions for those not reached by traditional healthcare institutions Citation Format: Karen Yeary, Carol Cornell, Page Moore, C. Heath Gauss, Elaine Prewitt, Jerome Turner. Community-health worker delivered weight loss and maintenance intervention for rural African American adults [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B041.

Assessing the Feasibility of an Online Training Designed to Enable Community Health Workers to Deliver a Comprehensive, Evidence-Based Weight Loss Intervention for Rural African Americans of Faith.

Obesity is a critical modifiable risk factor in cancer prevention, control, and survivorship. Comprehensive weight loss interventions (e.g., Diabetes Prevention Program (DPP)) have been recommended by governmental agencies to treat obesity. However, their high implementation costs limit their reach, especially in underserved African American (AA) communities. Community health workers (CHWs) or trusted community members can help increase access to obesity interventions in underserved regions facing provider shortages. CHW-led interventions have increased weight loss. However, in-person CHW training can be costly to deliver and often requires extensive travel to implement. Web-based trainings have become common to increase reach at reduced cost. However, the feasibility of an online CHW training to deliver the DPP in AAs is unknown. The feasibility of an online CHW training to deliver the DPP adapted for AAs was assessed. The online training was compared to an in-person DPP training with established effectiveness. CHW effectiveness and satisfaction were assessed at baseline and 6weeks. Nineteen participants (in-person n = 10; online n = 9) were recruited. At post-training, all scored higher than the 80% on a knowledge test required to deliver the intervention. All participants reported high levels of training satisfaction (88.9% of online participants and 90% of in-person participants rated the training as at least 6 on a 1-7 scale) and comfort to complete intervention tasks (78% of online participants and 60% of in-person participants scored at least 6 on a 1-7 scale). There were no significant differences in outcomes by arm. An online CHW training to deliver the DPP adapted for AAs faith communities produced comparable effectiveness and satisfaction to an evidence-based in-person CHW training. Further research is needed to assess the cost-effectiveness of different CHW training modalities to reduce obesity.

Implementation costs of a community health worker delivered weight loss intervention in black churches serving underserved communities.

Black adults bear a disproportionate burden of the obesity epidemic but are underrepresented in weight loss research and lose less weight than their white counterparts in weight loss interventions. Comprehensive behavioral weight loss interventions cause weight loss, but their high cost have stymied their implementation in black and other underserved communities. Recent translations of evidence-based weight loss interventions for black communities have been designed to increase intervention reach. However, the costs of implementing such interventions have seldom been reported in the context of a randomized controlled trial. Thus, the costs of implementing a community-health worker delivered Diabetes Prevention Program (DPP) adaptated for rural black adults of faith (The WORD) are reported.Data from a randomized controlled effectiveness trial conducted in 31 churches (n = 440) were used to calculate implementation costs. All participants received the 16-session core weight loss intervention and weight loss data was collected at baseline and 6 months.Participants lost an average of 2.53 kg at 6 months. Total implementation costs were $340.95 per participant. Thus, the implementation cost was $138 per kg.This is one of the few comprehensive examinations of costs for a DPP translation for black adults of faith and provide initial data from which practitioners and policy makers can use to determine the engagement of churches to disseminate the DPP through churches. Future studies are needed to confirm the extent churches are a cost-effective strategy to cause weight loss in black communities.

Body mass index and attitudes towards health behaviors among women with endometrial cancer before and after treatment

IntroductionSome experts have argued that obesity-related malignancies such as endometrial cancer are a “teachable moment” that lead to meaningful changes in health behaviors. It is unclear if endometrial cancer survivors...

Incremental cost-effectiveness of evidence-based non-surgical weight loss strategies.

Recent medical advancements have led to new modes of treatment for non-surgical weight loss, including several new medications. Our aim was to conduct an incremental cost-effectiveness analysis for all commercially available, evidence-based non-surgical weight loss interventions for people with excess weight. We identified interventions through a systematic review of randomized controlled trials that reported weight loss 12 months from baseline. We then meta-analysed the results, sourced costs and performed an incremental cost-effectiveness analysis from the payer perspective. Cost-effectiveness was presented in terms of cost per kilogram lost and quality-adjusted life years (QALY) gained. We further performed sensitivity analyses on costs and duration of benefits, and a probabilistic sensitivity analysis. Ten interventions were identified for inclusion: six pharmaceutical products (Alli, Xenical, Qsymia, Contrave, Belviq and Saxenda), two lifestyle modification programmes (Weight Watchers Meetings and Online), one food replacement and lifestyle programme (Jenny Craig) and one intragastric balloon system (Orbera). At an incremental cost-effectiveness ratio of $30 071 per additional QALY gained, only Weight Watchers Meetings was cost-effective. Sensitivity analyses revealed that for the medications to become incrementally cost-effective, costs would have to decrease by as much as 91%. Results are highly dependent on duration that benefits are maintained. Despite several newly available interventions, Weight Watchers Meetings is currently the only evidence-based, commercially available, cost-effective option for non-surgical weight loss. Other interventions, specifically medications, are more effective but priced too high to be cost-effective.

Digital Weight Loss Intervention for Parents of Children Being Treated for Obesity: A Prospective Cohort Feasibility Trial.

BackgroundThe prevalence of childhood obesity continues to increase, and clinic-based treatment options have failed to demonstrate effectiveness. One of the strongest predictors of child weight is parent weight. Parental treatment for weight loss may indirectly reduce obesity in the child. We have previously demonstrated the effectiveness among adults of a fully automated, evidence-based digital weight loss intervention (Track). However, it is unknown if it is feasible to deliver such a treatment directly to parents with obesity who bring their child with obesity to a weight management clinic for treatment.ObjectiveThe objective of our study was to evaluate the feasibility of and engagement with a digital weight loss intervention among parents of children receiving treatment for obesity.MethodsWe conducted a 6-month pre-post feasibility trial among parents or guardians and their children aged 4-16 years presenting for tertiary care obesity treatment. Along with the standard family-based treatment protocol, parents received a 6-month digital weight loss intervention, which included weekly monitoring of personalized behavior change goals via mobile technologies. We examined levels of engagement by tracking completed weeks of self-monitoring and feasibility by assessing change in weight.ResultsParticipants (N=48) were on average 39 years old, mostly female (35/42, 82% ), non-Hispanic Black individuals (21/41, 51%) with obesity (36/48, 75%). Over a quarter had a yearly household income of <US $25,000, and about a third had the equivalent of a high school education. Children were on average 10 years old and had a body mass index of 29.8 kg/m2. The median percentage of weeks participants tracked their behaviors was 77% (18.5/24 total weeks; interquartile range [IQR] 6.3 to 100). The median number of attempts via phone or text message (short message service) required to complete one tracking week was 3.3 (IQR 2.6 to 4.9). Nearly half (23/48, 48%) had high levels of engagement, completing 80% (19/24) or more weeks of tracking. Of the 26 participants with weight measurements reported at 6 months, of which 81% (21/26) were self-reported, there was a median 2.44 kg (IQR −6.5 to 1.0) decrease in weight.ConclusionsIt is feasible to deliver an evidence-based digital weight loss intervention to parents or guardians whose children are enrolled in a weight management program. Given the feasibility of this approach, future studies should investigate the effectiveness of digital weight loss interventions for parents on child weight and health outcomes.

Genetic Predictors of Behavioral Weight Loss: Current Status and Future Directions.

In this issue of Obesity, Hollensted and colleagues (1) report on their analysis of whether genetic loci previously implicated in childhood obesity predict the magnitude of weight loss with lifestyle intervention among 754 children and adolescents with overweight. Genetic risk scores combining 15 single-nucleotide polymorphisms (SNPs) from the most recent genome-wide association studies (GWAS) did not significantly predict change in BMI standard deviation score during the intervention. One of the 15 SNPs, LMX1B rs3829849, did predict weight loss independently. This study represents an important advance in understanding whether known genetic predictors of childhood BMI may inhibit children from losing weight with lifestyle methods. It is the largest study to date, tested a comprehensive list of the most recent genetic variants associated with childhood BMI, employed an evidence-based weight-loss intervention, and achieved a median weight loss of 0.20 BMI standard deviation score or roughly 10% weight loss. It should be noted that weight loss was reported at varying time points (follow-up: 6-24 months; median: 1.25 years). In addition, children who did not complete a minimum of 6 months of the program were excluded. These factors could have created variability in measurement of BMI and/or bias from excluding those who were not successful, potentially limiting the detection of genetic effects. Nonetheless, these results contribute to a growing literature indicating that SNPs related to BMI in GWAS largely do not appear to predict the magnitude of weight loss in behavioral interventions. Prominent examples include a lack of association of the FTO region with weight loss in a meta-analysis including 9,563 participants (2). In a joint analysis of the Action for Health in Diabetes (Look AHEAD) trial and the Diabetes Prevention Program (DPP), only one of a comprehensive list of 91 SNPs predicted magnitude of weight loss in the lifestyle interventions (3). MC4R mutations causing monogenic obesity also did not predict magnitude of weight loss with lifestyle intervention in children (4). That said, the progress in identifying genetic variation predictive of weight loss should be recognized. In the meta-analysis of Look AHEAD and DPP, the obesity-related allele of MTIF3 rs1885988 predicted greater weight loss. One copy of the obesity risk allele conferred an additional loss of 1.48 kg, and two copies predicted a 2.96-kg weight loss (3). Moreover, using a gene-centric assay, ABCB11 and RANK were shown to relate to magnitude of weight loss in Look AHEAD (5). In the Hollensted et al. paper, LMX1B rs3829849 also significantly predicted weight loss. Although not yet of sufficient magnitude to guide clinical recommendations, such findings provide a platform for replication and extension with increasing sample sizes and may ultimately be employed as part of a weight-loss genetic risk score. It is noteworthy that the search for genetic predictors of weight loss has been limited almost exclusively to SNPs related to BMI in GWAS. No genome-wide analysis of weight loss has been conducted, but it could lead to the discovery of novel genetic loci related to weight loss, as was observed for bariatric surgery (6). Such new discoveries could ultimately contribute to a genetic risk score sufficiently predictive of weight loss for clinical application. JMM reports personal fees from Weight Watchers, outside the submitted work.

Adapting a Behavioral Weight Loss Intervention for Delivery via Facebook: A Pilot Series Among Low-Income Postpartum Women.

BackgroundEfforts to translate evidence-based weight loss interventions, such as the Diabetes Prevention Program (DPP), to low-income postpartum women have resulted in poor intervention attendance and high attrition. Strategies that improve engagement and retention in this population are needed to maximize the reach of evidence-based weight loss interventions.ObjectiveThe objective of this study was to adapt a DPP-based weight loss intervention (Fresh Start) for Facebook delivery and to evaluate its feasibility among low-income postpartum women.MethodsThis study comprised 3 single-group pilot studies where feasibility outcomes iteratively informed changes from one pilot to the next. We paralleled the in-person program for Facebook delivery by translating the protocol to a content library of Facebook posts with additional posts from lifestyle coaches. Low-income postpartum women were recruited from Women, Infants, and Children (WIC) clinics in Worcester, Massachusetts. Participants were enrolled into a 16-week weight loss intervention delivered via Facebook. During the first 8 weeks, Facebook intervention posts were delivered 2 times per day, with additional posts from coaches aiming to stimulate interaction among participants or respond to participants’ questions and challenges. For the following 8 weeks, posts were delivered once per day without additional coaching. Feasibility outcomes were engagement (defined by number of likes, comments, and posts measured throughout intervention delivery), acceptability, and retention (survey at follow-up and assessment completion rate, respectively). Changes in weight were also assessed at baseline and follow-up.ResultsPilot 1 had a retention rate of 89% (24/27), and on average, 62% (17/27) of women actively engaged with the group each week during the 8-week coached phase. Mean weight loss was 2.6 (SD 8.64) pounds, and 79% (19/27) would recommend the program to a friend. Pilot 2 had a retention rate of 83% (20/24), and on average, 55% (13/24) of women actively engaged with the group weekly during the 8-week coached phase. Mean weight loss was 2.5 (SD 9.23) pounds, and 80% (16/24) would recommend the program to a friend. Pilot 3 had a retention rate of 88% (14/16), and on average, 67% (11/16) of women actively engaged with the group weekly during the 8-week coached phase. Mean weight loss was 7.0 (SD 11.6) pounds, and 100% (16/16) would recommend the program to a friend.ConclusionsOur findings demonstrated that a Facebook-delivered intervention was acceptable and could be feasibly delivered to low-income postpartum women. Future research is needed to evaluate the efficacy of a Facebook-delivered weight loss intervention.

Perceived barriers and facilitators of initiation of behavioral weight loss interventions among adults with obesity: a qualitative study

BackgroundEvidence-based behavioral weight loss interventions are under-utilized. To inform efforts to increase uptake of these interventions, it is important to understand the perspectives of adults with obesity regarding barriers and facilitators of weight loss intervention initiation.MethodsWe conducted a qualitative study in adults with obesity who had recently attempted weight loss either with assistance from an evidence-based behavioral intervention (intervention initiators) or without use of a formal intervention (intervention non-initiators). We recruited primary care patients, members of a commercial weight loss program, and members of a Veterans Affairs weight loss program. Intervention initiators and non-initiators were interviewed separately using a semi-structured interview guide that asked participants about barriers and facilitators of weight loss intervention initiation. Conversations were audio-recorded and transcribed. Data were analyzed with qualitative content analysis. Two researchers used open coding to generate the code book on a subset of transcripts and a single researcher coded remaining transcripts. Codes were combined into subthemes, which were combined in to higher order themes. Intervention initiators and non-initiators were compared.ResultsWe conducted three focus groups with participants who had initiated interventions (n = 26) and three focus groups (n = 24) and 8 individual interviews with participants who had not initiated interventions. Intervention initiators and non-initiators were, respectively, 65% and 37.5% white, 62% and 63% female, mean age of 55 and 54 years old, and mean BMI of 34 kg/m2. Three themes were identified. One theme was practical factors, with subthemes of reasonable cost and scheduling compatibility. A second theme was anticipated effectiveness of intervention, with subthemes of intervention content addressing individual needs; social aspects influencing effectiveness; and evaluating evidence of effectiveness. A third theme was anticipated pleasantness of intervention, with subthemes of social aspects influencing enjoyment; anticipated dietary and tracking prescriptions; and identity and self-reliance factors. Different perspectives were identified from intervention initiators and non-initiators.ConclusionsStrategies to engage individuals in evidence-based weight loss interventions can be developed using these results. Strategies could target individuals’ perceived barriers and benefits to initiating interventions, or could focus on refining interventions to appeal to more individuals.

Abstract P377: Multicomponent Workplace Wellness Program Results in Weight Loss and Improved Cardiometabolic Indices

Introduction: Workplace wellness programs offer opportunities for decreasing obesity in adults. The effectiveness of such programs varies and is influenced by key intervention components (e.g. duration, intensity, content). We developed a multicomponent workplace wellness program, MyWay to Health (MW2H), which was adapted from an evidence-based weight loss intervention with demonstrated efficacy and meets the 2013 Guideline for the Management of Overweight and Obesity in adults. The purpose of this one-group pretest-posttest study was to evaluate program acceptability and effectiveness of MW2H on primary and secondary outcomes. Hypotheses: We hypothesized that MW2H would result in 1) clinically meaningful weight loss of ≥5%, and 2) improvements in cardiometabolic indices. Methods: During weeks 1-26, participants met privately with an interventionist for up to 24 weekly, 40-minute sessions, receiving training in eating and physical activity behavior change, self-regulation, and socioenvironmental strategies. During weeks 27-52, participants received maintenance support through phone calls, email, or in-person visits. Our primary outcome was percent weight loss. Secondary outcomes included improvement in BMI, waist circumference, HbA1c, cholesterol, and blood pressure. Outcomes were compared at baseline and 26 weeks; body weight only was measured at 52 weeks. Wilcoxin Signed Rank Tests were used to examine outcomes. Results: Participants (N=154) were mostly female (85%), White (75%), had a median age of 50 (Interquartile Range (IQR): 17) years, a median baseline BMI of 34.7 (IQR: 8.8), a median household income of $70,000 (IQR: $50,000), and 54% had a college degree or higher. Median number of in-person sessions attended was 19 (IQR: 4.0). Percent weight loss at 26 weeks (median [IQR]: 7.5% [6.8%]) was clinically meaningful, with 71% of participants achieving ≥5% weight loss. Statistically significant improvements in BMI, waist circumference, HbA1c, HDL cholesterol, and systolic and diastolic blood pressure (p&lt;0.001 for all) were observed. At week 52, body weight data were available for 106 (69%) participants. Median percent weight loss from baseline was 7.0% (IQR: 9.3%). Of participants who achieved ≥5% weight loss at week 26, 94% maintained this level of weight loss at week 52. Conclusions: The MW2H workplace wellness program was acceptable to participants, evidenced by high program attendance, and resulted in clinically meaningful and statistically significant improvements in body weight and cardiometabolic indices. A majority of participants achieved ≥5% weight loss by 26 weeks, and nearly all participants for whom data was available maintained this level of weight loss at week 52. Additional research is needed to optimize intervention components, identify factors that contribute to weight maintenance, and examine MW2H effectiveness in a more diverse population.

Seeds of HOPE: Incorporating Community-Based Strategies to Implement a Weight-Loss and Empowerment Intervention in Eastern North Carolina.

Seeds of HOPE (Health, Opportunities, Partnerships, and Empowerment) was a community-based participatory research project designed to implement an evidence-based weight loss and empowerment intervention aimed at increasing self-efficacy through peer support. HOPE Works, its model, has yielded significant weight loss and increases in participants' ability to set and achieve goals, including in consumption of fruits and vegetables and in physical activity.METHODS The Seeds of HOPE project was implemented through 3 peer leader recruitment approaches using Circle Leaders. Study participants met in hope circles to discuss various topics aimed at developing healthier lifestyles. Changes at 6-month intervals were assessed in health behaviors, weight, and hope. One-way ANOVA was used to test differences in mean change in weight and hope across the 3 recruitment approaches.RESULTS Study participants (N = 146) lost weight (-3.3 pounds, P = 0.003, 95% CI: -5.40 - -1.27). Fruit consumption significantly increased (P = 0.04, 95% CI: 0.01-0.41) while no changes in vegetable consumption or physical activity were observed. No differences based on different leader recruitment approaches were found.LIMITATIONS There were limitations in the power to fully detect differences across Circle Leader recruitment approaches; loss-to-follow up and representativeness of the sample were present. Further research is needed to determine if these approaches would be successful in other rural counties, with different genders, or with individuals in urban and/or higher socioeconomic populations.CONCLUSIONS Participants found modest success in weight loss and fruit consumption. Authors find that community engagement strategies are helpful in finding mutually acceptable adaptations to implement interventions such as Seeds of HOPE in diverse communities.

Weight loss and improved metabolic outcomes amongst rural African American women in the Deep South: six-month outcomes from a community-based randomized trial.

Obesity is highly prevalent in African American women, especially those in the rural southern USA, resulting in persistent health disparities. To test the effectiveness of an evidence-based behavioural weight loss intervention delivered by community health advisors to African American women in the rural south. Overweight or obese African American women (30-70 years) from eight counties in Mississippi and Alabama participated in a 24-month randomized controlled trial of an evidence-based behavioural weight loss programme augmented with community strategies to support healthy lifestyles (Weight Loss Plus, N = 154) compared to the weight loss programme alone (Weight Loss Only, N = 255). This study reports on 6-month outcomes on primary (weight change) and secondary (waist circumference, blood pressure, lipids, fasting blood glucose) outcomes, coinciding with the completion of the intensive weight loss phase. Weight Loss Only participants lost an average of 2.2 kg (P < 0.001). Weight Loss Plus participants lost an average of 3.2 kg (P < 0.001). The proportion of the total sample that lost at least 5% of their body weight was 27.1% with no difference between treatment groups. Similarly, we observed statistically significant reductions in blood pressure, waist circumference and triglycerides in each treatment group, with no statistical differences between groups. Trained lay health staff and volunteers from the rural southern USA were able to deliver a translation of a high-intensity behavioural intervention targeted to African American women, resulting in clinically meaningful weight loss and improvement in other metabolic outcomes in a significant proportion of participants.

Evaluation of an Evidence-Based Weight Loss Trial for Urban African American Adolescents and Caregivers

Rates of obesity are among the highest for African American adolescents in the US. However, African American adolescents benefit the least from evidence-based weight loss interventions, often experiencing poor treatment retention and low motivation. Participant evaluations provide key information for future development of family-based weight loss interventions able to address these barriers. The purpose of this study was to examine the experiences of African American adolescent and caregivers participating in the FIT Families trial for program satisfaction and content palatability. Content analysis was used to analyze semi-structured exit interviews from 136 African American adolescents [median age 14 years, 69% female] and caregiver pairs [primarily mothers] participating in a family-based 6-month behavioral weight loss intervention that was delivered either in the home or in an office setting. Participants reported most program practices [location, parent involvement, interpersonal relationship with weight loss counselors] and intervention content [cognitive behavioral skills training, motivational interviewing, contingency management] were helpful. Many adolescents [49%] and their caregivers [47%] reported that the program was acceptable overall, however noted that areas for refinement did exist. Participants reported that managing the logistics of weekly sessions was hard. Families expressed a desire for more engaging skills-based learning and the inclusion of exercise sessions and additional tailoring to needs and interests. Individualization, active learning, and support around parenting continues to be beneficial when designing interventions.

Evaluation of an Evidence-Based Weight Loss Trial for Urban African American Adolescents and Caregivers

Rates of obesity are among the highest for African American adolescents in the US. However, African American adolescents benefit the least from evidence-based weight loss interventions, often experiencing poor treatment retention and low motivation. Participant evaluations provide key information for future development of family-based weight loss interventions able to address these barriers. The purpose of this study was to examine the experiences of African American adolescent and caregivers participating in the FIT Families trial for program satisfaction and content palatability. Content analysis was used to analyze semi-structured exit interviews from 136 African American adolescents [median age 14 years, 69% female] and caregiver pairs [primarily mothers] participating in a family-based 6-month behavioral weight loss intervention that was delivered either in the home or in an office setting. Participants reported most program practices [location, parent involvement, interpersonal relationship with weight loss counselors] and intervention content [cognitive behavioral skills training, motivational interviewing, contingency management] were helpful. Many adolescents [49%] and their caregivers [47%] reported that the program was acceptable overall, however noted that areas for refinement did exist. Participants reported that managing the logistics of weekly sessions was hard. Families expressed a desire for more engaging skills-based learning and the inclusion of exercise sessions and additional tailoring to needs and interests. Individualization, active learning, and support around parenting continues to be beneficial when designing interventions.

A randomized pilot study of a community-based weight loss intervention for African-American women: Rationale and study design of Doing Me! Sisters Standing Together for a Healthy Mind and Body

IntroductionDespite the high prevalence of obesity among African-American women and modest success in behavioral weight loss interventions, the development and testing of weight management interventions using a community-based participatory research (CBPR) approach have been limited. Doing Me!: Sisters Standing Together for Healthy Mind and Body (Doing Me!) is an intervention adapted from an evidence-based behavioral obesity intervention using a CBPR approach. The purpose of Doing Me! is to test the feasibility and acceptability of this adapted intervention and determine its efficacy in achieving improvements in anthropometrics, diet, and physical activity. MethodsSixty African-American women, from a low-income, urban community, aged 30–65years will be randomized to one of two arms: 16-week Doing Me! (n=30) or waitlist control (n=30). Doing Me! employs CBPR methodology to involve community stakeholders and members during the planning, development, implementation, and evaluation phases of the intervention. There will be thirty-two 90-minute sessions incorporating 45min of instruction on diet, physical activity, and/or weight management plus 45min of physical activity. Data will be collected at baseline and post-intervention (16weeks). DiscussionDoing Me! is one of the first CBPR studies to examine the feasibility/acceptability of an adapted evidence-based behavioral weight loss intervention designed for obese African-American women. CBPR may be an effective strategy for implementing a weight management intervention among this high-risk population.

The WORD (Wholeness, Oneness, Righteousness, Deliverance): design of a randomized controlled trial testing the effectiveness of an evidence-based weight loss and maintenance intervention translated for a faith-based, rural, African American population using a community-based participatory approach

BackgroundThe positive effects of weight loss on obesity-related risk factors diminish unless weight loss is maintained. Yet little work has focused on the translation of evidence-based weight loss interventions with the aim of sustaining weight loss in underserved populations. Using a community-based participatory approach (CBPR) that engages the strong faith-based social infrastructure characteristic of rural African American communities is a promising way to sustain weight loss in African Americans, who bear a disproportionate burden of the obesity epidemic. ObjectivesLed by a collaborative community–academic partnership, The WORD aims to change dietary and physical activity behaviors to produce and maintain weight loss in rural, African American adults of faith. DesignThe WORD is a randomized controlled trial with 450 participants nested within 30 churches. All churches will receive a 16-session core weight loss intervention. Half of the churches will be randomized to receive an additional 12-session maintenance component. MethodsThe WORD is a cultural adaptation of the Diabetes Prevention Program, whereby small groups will be led by trained church members. Participants will be assessed at baseline, 6, 12, and 18months. A detailed cost-effectiveness and process evaluation will be included. SummaryThe WORD aims to sustain weight loss in rural African Americans. The utilization of a CBPR approach and the engagement of the faith-based social infrastructure of African American communities will maximize the intervention's sustainability. Unique aspects of this trial include the focus on weight loss maintenance and the use of a faith-based CBPR approach in translating evidence-based obesity interventions.

Live vs electronically delivered weight-loss interventions: paying for feasible interventions.

Live vs electronically delivered weight-loss interventions: paying for feasible interventions.

Adding evidence-based behavioral weight loss strategies to a statewide wellness campaign: a randomized clinical trial.

We determined the efficacy and cost-effectiveness of adding an evidence-based Internet behavioral weight loss intervention alone or combined with optional group sessions to ShapeUp Rhode Island 2011 (SURI), a 3-month statewide wellness campaign. We randomized participants (n = 230; body mass index = 34.3 ±6.8 kg/m(2); 84% female) to the standard SURI program (S) or to 1 of 2 enhanced programs: SURI plus Internet behavioral program (SI) or SI plus optional group sessions (SIG). The primary outcome was weight loss at the end of the 3-month program. Weight losses differed among all 3 conditions (S: 1.1% ±0.9%; SI: 4.2% ±0.6%; SIG: 6.1% ±0.6%; Ps ≤ .04). Both SI and SIG increased the percentage of individuals who achieved a 5% weight loss (SI: 42%; SIG: 54%; S: 7%; Ps < .001). Cost per kilogram of weight loss was similar for S ($39) and SI ($35); both were lower than SIG ($114). Although weight losses were greatest at the end of SURI with optional group sessions, the addition of an Internet behavioral program was the most cost-effective method to enhance weight losses.