Group Lifestyle Balance Program Research Articles

The association between food insecurity and physical activity in adults with serious mental illness living in supportive housing

Rates of food insecurity are high among adults with serious mental illness (SMI); this population also engages in less physical activity than the general population. However, the relationship between food insecurity and physical activity in this group has not been explored. We examined food insecurity prevalence and its association with physical activity in 314 adults with SMI living in supportive housing in New York City and Philadelphia and enrolled in an institutional review board-approved randomized controlled trial of a Peer Group Lifestyle Balance (PGLB) program. We analyzed 2014 baseline survey data, including demographic data and self-reported food security, and four self-reported physical activity outcomes: any physical activity per week (yes/no) and 2) total, 3) moderate, or 4) vigorous physical activity minutes per week. A logistic regression model examined food security as a predictor of any physical activity; zero-inflated negative binomial regression models were used for the other three physical activity outcomes; demographic and clinical predictors were assessed for inclusion in models. Over half of participants (51.7%) reported low or very low levels of food security. Relationships between food insecurity and three physical activity measures (any physical activity, total weekly minutes, and moderate weekly minutes) were non-significant; those with lower food security were more likely to engage in vigorous physical activity. The high food insecurity prevalence highlights the importance of measuring and addressing food security in populations experiencing SMI; measuring physical activity is also important for tailored lifestyle recommendations. Future studies should examine longitudinal changes in food security and physical activity.

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.

Psychosocial and Physical Activity Outcomes Among Group Lifestyle Balance Program Participants With Arthritis

Background: Weight loss and physical activity (PA) are recommended for arthritis management. The Group Lifestyle Balance (GLB) Program(TM) is an evidence-based, lifestyle change program for weight loss in individuals with prediabetes, but hasn’t been evaluated in people with arthritis. Purpose: The purpose of this study was to evaluate the effectiveness of an adapted version of the GLB program on PA and psychosocial outcomes related to weight loss among overweight (Body Mass Index >27) individuals with arthritis. Methods: A single-group, quasi-experimental design was used to examine the effects of the adapted GLB program on measures of PA and psychosocial outcomes. All participants (N=15) received the GLB program and completed the following surveys: CHAMPS PA, Self-Efficacy for PA (SE), Social Support for PA (SS), Weight Loss Efficacy (WEL) and Barriers to Healthy Eating (BHE) at baseline, 12-weeks, 6 months, and 12 months. Repeated measures ANOVA and the Friedman Test were used to examine changes over time. Results: Participants (aged 53-79 years) were primarily female (82%), white (94%), and college educated (94%). Significant improvements were found in BHE subsections of self-control and motivation (p=0.002), daily mechanics (p=0.042), and WEL subsections of availability (p=0.049), social pressure (p=0.010), physical discomfort (p=0.011), and positive activities (p=0.007). Weekly caloric expenditure (p=0.004), metabolic equivalent minutes (p=0.022) for all activities, and moderate-intensity activities (p=0.019) also showed significant improvements. However, most improvements were seen in the short-term. Conclusions: The GLB program should be further evaluated for its effectiveness in people with arthritis.

Abstract P185: Paradoxical Outcomes Among Group Lifestyle Balance Participants In Real-world Clinical Practice

Introduction: The CDC established the National Diabetes Prevention Program (NDPP) initiative in 2010, leading to implementation of numerous group-based lifestyle interventions, such as the 12-month Group Lifestyle Balance (GLB) program, in community and clinical settings. Heterogeneity in weight outcomes is common. While evidence suggests that session attendance is associated with greater weight loss, some participants do not achieve weight loss even with high session attendance. Conversely, some may achieve clinically significant weight loss (≥5%) with lower attendance. In this study, we sought to identify and characterize such paradoxical interventional outcomes. (i.e., high session attendance and <5% weight loss compared with low attendance and ≥5% weight loss). Hypothesis: No a priori hypotheses. Methods: We conducted a longitudinal descriptive analysis of overweight/obese GLB participants using electronic health record data from an integrated healthcare delivery system in Northern California (2010-2017). We focused on the 12-week intensive core phase of the curriculum because prior studies show that weight loss outcomes achieved during this period are highly correlated with long-term weight loss. We categorized patients into 4 mutually exclusive groups by session attendance (<9/≥9 session) and weight change from baseline to 12-weeks follow-up (<5%/≥5% weight loss). The threshold of 9 sessions corresponds to 75% adherence, a quality metric used by Medicare. Results: Among 1,818 evaluable participants, we identified 870 (47.9%) with paradoxical outcomes. Of these, 104 (12.0%) achieved ≥5% weight loss with <9 sessions attended (paradoxical responders) and 766 (88.0%) achieved <5% weight loss despite attending ≥9 sessions (paradoxical non-responders). The remaining 948 participants (52.1%) achieved weight loss consistent with a dose response, based on number of sessions attended. Conclusions: Nearly half of all GLB participants in this integrated health system had paradoxical outcomes, with more than 40% classified as paradoxical non-responders. These results suggest that session attendance may not be as sensitive a predictor of weight outcomes as previously thought, and other approaches are needed to understand the complex factors influencing goal attainment in behavioral lifestyle programs.

Leisure Sedentary Behavior Levels and Meeting Program Goals in a Community Lifestyle Intervention for Diabetes Prevention.

The importance of leisure sedentary behavior (LSB) change in diabetes prevention efforts is not well known. This study examines the relationships between changes in self-reported LSB and the primary intervention goals (weight and moderate-intensity to vigorous-intensity physical activity [MVPA]) during a community-based translation of the Diabetes Prevention Program (the Group Lifestyle Balance Program). A total of 322 adults at risk for type 2 diabetes were recruited from 3 community centers, a worksite, and military site. Community and worksite participants were randomized to immediate or delayed-delivery (control) intervention. All military site participants (n = 99) received immediate intervention. Logistic and linear generalized estimatingequations were used to determine associations between LSB changes and weight-related outcomes and MVPA. Results were obtained for 259 (80.4%) participants. The LSB decreased after 6 and 12 months (mean [95% confidence interval]: -25.7 [-38.6 to -12.8] and -16.1 [-28.2 to -3.9]min/d; both P < .05). Each 20-minute reduction in LSB was associated with a 5% increase in odds of meeting the weight-loss goal (6mo: odds ratio = 1.05 [1.002 to 1.102]; P = .042; adjusted model including MVPA), but LSB was not related to changes in reported MVPA minutes or MVPA goal achievement. Within the context of existing lifestyle intervention programs, reducing sedentary behavior has the potential to contribute to weight loss separately from reported MVPA improvement.

The effects of if-then plans on weight loss: results of the 24-month follow-up of the McGill CHIP Healthy Weight Program randomized controlled trial

BackgroundCurrent evidence suggests that some of the most effective weight loss approaches are changes in dietary and physical activity behaviors through lifestyle modification programs. The Group Lifestyle Balance (GLB) program is a group-based behavior modification program aimed at changing diet and physical activity for weight loss. It was developed to be more cost-effective and easier to disseminate than its individually administered parent program, the Diabetes Prevention Program (DPP). However, the average weight loss following participation in the GLB is only approximately 3.5%, with low long-term weight loss maintenance.PurposeWe aimed to optimize the weight loss outcomes of the GLB to increase the efficacy already afforded by its cost-effectiveness and ease of dissemination. We did this by integrating the habit formation tool of if-then plans into the program. This program is called the enriched GLB or the McGill Comprehensive Health Improvement (CHIP) Healthy Weight Program. Results at 3 and 12 months of participation have already been published elsewhere. They showed no between-group differences between the standard and enriched GLB but higher weight loss in both groups compared to the DPP. This paper reports the long-term weight loss maintenance data following participation in the program.MethodsOf the 172 participants enrolled at the beginning of the study, data from 110 participants were available and analyzed at 24 months, i.e., 12 months after the end of the 12-month intervention.ResultsNo between-group difference in weight loss maintenance was observed. Pooled results showed a significant weight regain from 12 to 24 months, i.e., an average of 7.85 lbs. of the 20.36 lbs. lost. However, participants from both groups were still 12.51lbs or 6.13% lighter at 24 months than at baseline.ConclusionIf-then plans did not result in a higher percentage of weight loss at 24-month follow-up compared to the standard GLB. However, at 24 months, both groups did show a maintenance of a significant portion of the weight lost at the end of intervention.Trial registrationClinicalTrials.gov Identifier: NCT02008435, registered 6 December 2013.

Health Behavior Change Following Stroke: Recommendations for Adapting the Diabetes Prevention Program–Group Lifestyle Balance Program

Objective. History of stroke increases risk for recurrent stroke, which is a significant issue faced by survivors. The Diabetes Prevention Program-Group Lifestyle Balance (DPP-GLB) program is an effective lifestyle modification intervention for ameliorating cardiovascular risk factors but has not been adapted to account for common stroke-related deficits. The purpose of this study was to determine appropriate adaptations to the DPP-GLB for adults with stroke. Design and Methods. In this phenomenological qualitative study, a total of 15 community-dwelling adults with stroke and 10 care-partners participated in 4 focus groups to review DPP-GLB curriculum materials and provide recommendations for adaptation. Focus groups were recorded and transcribed. Inductive content analysis was used to identify key themes. Results. Three themes were identified. First, physical, cognitive, sensory, and psychosocial stroke-related deficits could affect DPP-GLB participation. Second, existing DPP-GLB characteristics could facilitate participation by adults with stroke. Third, stroke-specific adaptations were recommended, including modified session content and format, adapted physical activity and dietary recommendations, and inclusion of care-partners. Conclusion. Current DPP-GLB content and structure may be insufficient to meet the unique needs of adults with stroke. The suggested adaptations should be incorporated into a stroke-specific curriculum and tested for preliminary efficacy for reducing recurrent stroke risk.

Adapting An Evidence-Based Healthy Lifestyle Program For People After Stroke

To create an appropriate adaptation of the Diabetes Prevention Program – Group Lifestyle Balance program (DPP-GLB) that meets the unique needs of people post stroke.

Changes in Physical Function and Body Composition among Group Lifestyle Balance Program Participants with Arthritis

Weight loss through diet and physical activity (PA) is recommended for osteoarthritis (OA) management. The Group Lifestyle Balance Program (GLBP) is an evidence-based, behavior change program designed to promote weight loss in individuals with prediabetes or metabolic syndrome through PA and healthy eating. To date, the GLBP has not been evaluated on those with OA specifically. PURPOSE: To examine the effects of the GLBP on measures of body composition and physical function (PF) in overweight and obese (BMI > 27) individuals with OA (N=15). METHODS: This study used a single-group, quasi-experimental design with repeated measures. All participants received the GLBP and outcome variables were obtained at baseline, 3, 6, and 12 months. Lean mass (LM), fat mass (FM), and body fat percentage (BF%) were obtained via bioelectric impedance. Total weight (WT), Body Mass Index (BMI), and waist circumference (WC) were also obtained. Measures of PF included the Short Physical Performance Battery (SPPB), grip strength (GS), 30-second chair stand test (CS30), and the Long Distance Corridor Walk (LDCW). The SPPB includes the time to complete 5 repeated chair stands (5CS), balance testing (side-by-side stand, semi-tandem stand, and tandem stand), and an 8-foot walk. The Friedman test was used to examine differences in SPPB scores and one-way repeated measures analysis of variance was used to examine mean differences in scores for all other outcomes. RESULTS: Participants had a mean age of 70.20 ± 3.95 years and were primarily white (93%), female (80%) and college educated (67%). There was a significant effect of time for WT (F(1.448, 20.275) = 6.591, p = .011), BMI (F(1.529, 21.408) = 6.474, p = .010), and WC (F(2.898, 40.566) = 4.826, p = .006). Bonferroni post hoc analyses indicated WT (p = .001), BMI (p = .002), and WC (p = .022) significantly improved from baseline to 3 months. There was also a significant effect of time for 5CS (F(3, 42) = 3.190, p = .033) and CS30 (F(3, 42) = 6.956, p = .001). Post hoc analyses indicated CS30 scores significantly improved from baseline to 3 months and from baseline to 12 months (p = .007). There were no significant differences observed for any other outcome measure (p > 0.05). CONCLUSION: The GLBP may be effective at improving weight and physical function measures in people with OA, but more research is warranted.

Development of a Videoconference-Adapted Version of the Community Diabetes Prevention Program, and Comparison of Weight Loss With In-Person Program Delivery.

IntroductionEffective, standardized, and easily accessible weight management programs are urgently needed for military beneficiaries. Videoconference interventions have the potential for widespread scaling, and can provide both real time interaction and flexibility in delivery times regardless of location, but there is little information on their effectiveness and acceptability.Materials and MethodsThis study as part of a larger weight loss trial describes the videoconference adaption of Group Lifestyle Balance (GLB) program, a community group-based Diabetes Prevention Program intervention, and provides a comparison of weight loss and meeting attendance between in-person and videoconference delivery modes over 12 weeks in adult family members of military service members. Forty-three participants were enrolled from two military installations and received either the videoconference-adapted or an in-person GLB program in a non-randomized trial design. Differences in program attendance and percent weight lost at 12 weeks were compared by independent samples t-tests and nonparametric methods. Group differences in the percentage of weight lost over the 12-week period were analyzed using a linear mixed model.ResultsAll GLB intervention components were successfully delivered by videoconference with minor adaptations for the different delivery mechanism. Participant retention was 70% and 96% in the in-person and videoconference groups, respectively (p = 0.04). Completing participants in both groups lost a significant percent body weight over the 12 week intervention (p < 0.001) and there was no difference in percent body weight after 12 weeks of intervention (6.2 ± 3.2% and 5.3 ± 3.4% for in-person and videoconference at 12 weeks, respectively; p = 0.60).ConclusionThis study describes the first videoconference adaption of the GLB program for use in military families. Attrition was lower in the videoconference group, and there were a similar levels of weight loss in both groups regardless of delivery modality. Videoconference weight loss interventions are effective and feasible for scaling to support healthy weight management in military as well as civilian populations.

Impact of a Community-Based Healthy Lifestyle Program on Individuals With Traumatic Brain Injury.

To examine adherence with and effect of an evidence-based healthy lifestyle intervention modified for individuals with traumatic brain injury (TBI). Pre-/postintervention without control. Community. Eighteen individuals with TBI: primarily male (61%), white (67%), with private insurance (50%). Mean age was 45.6 ± 12.3 years, weight 210 ± 42.6 lb, and body mass index 31.8 ± 4.6 (obese category) at baseline. The primary goal of the Diabetes Prevention Program Group Lifestyle Balance program is 5% to 7% weight loss through increased physical activity and improved dietary behaviors. Adherence (ie, session attendance and self-monitoring of dietary behaviors), physiologic changes (ie, weight loss, blood pressure; waist and arm circumference; and lipid profile), and quality of life (ie, self-reported health, quality of life, and step count). Average participant attendance (85% over 12 months) and self-monitoring (90% over 6 months) were high. Significant decreases were observed in diastolic blood pressure and waist and arm circumference from baseline through 12 months and from baseline to 3 months only for weight and total cholesterol. No significant changes were observed in self-reported health, quality of life, or step count. Participants demonstrated high adherence with the program, suggesting that individuals with TBI are able to successfully engage in the program and achieve significant weight loss and changes in key physiologic outcomes.

Usability of the Group Lifestyle Balance Program – Adapted for individuals with Impaired Mobility (GLB-AIM)

To evaluate participants’ assessment of usability.

Evaluation of the Group Lifestyle Balance Program in a Military Setting: An Investment Worth Expanding.

The Diabetes Prevention Program (DPP) demonstrated that lifestyle intervention programs were effective in preventing or delaying the onset of diabetes. The Group Lifestyle Balance (GLB) program translated the DPP curriculum into a 12-wk group intervention for those at risk for diabetes. This retrospective evaluation examined clinical outcomes for patients in the Diabetes Center of Excellence GLB program located at Wilford Hall Ambulatory Surgical Center from 2009 to 2013. Objectives included determining rates of retention, demographic characteristics of program completers, and changes in metabolic surrogates of disease prevalence. Adults with prediabetes or metabolic syndrome (MetS) were referred to the GLB program. Updated participant metabolic data were collected at regular intervals during their participation. During the 5-yr study, 704 patients attended the initial class. Overall, 52% of all participants completed the program with the greatest decline in participation occurring by the fourth week (30%). Baseline prevalence of conditions of interest for those who completed the program was prediabetes (93.2%), obesity (56.1%), and MetS (31.5%). GLB completers were older and retired (p < 0.05). A significant number of active duty military members (44.9%, p < 0.01, n = 53) dropped out of the program before the fourth week. Furthermore, those who completed the program saw a 2.0% reduction in prediabetes prevalence (p < 0.001), obesity decreased by 8.7% (p < 0.001), and MetS decreased by 6.8% (p < 0.01). Significant differences were found for central obesity, triglycerides, and fasting blood sugar (p < 0.001). The GLB program is a valuable DPP and was effective at improving clinical outcomes and reducing the incidence of prediabetes, obesity, and MetS for participants who completed the program. Every effort should be made to support and encourage GLB participants to complete the program.

Impact of a community-based lifestyle intervention program on health-related quality of life.

The presence of risk factors for type 2 diabetes and cardiovascular disease, or the conditions themselves, contributes to lower health-related quality of life (HRQoL) among adults. Although community-based lifestyle intervention programs have been shown to be effective for improving risk factors for these diseases, the impact of these interventions on HRQoL has rarely been described. To examine changes in HRQoL following participation in the Group Lifestyle Balance program, a community translation of the Diabetes Prevention Program lifestyle intervention for adults with prediabetes and/or the metabolic syndrome. Participants enrolled in the 12-month, 22-session intervention program (N=223) completed the EuroQol Health Questionnaire (EQ-5D-3L) at baseline, 6, and 12months. Linear mixed-effects regression models determined change in EQ-5D-visual analog scale (VAS) and Index scores post-intervention. Mean EQ-5D-VAS was improved by +7.38 (SE=1.03) at 6months and by +6.73 (SE=1.06) at 12months post-intervention (both; p<0.0001). Mean changes in EQ-5D index values were +0.00 (SE=0.01; NS) and +0.01 (SE=0.01; p<0.05), respectively. Adjusted for age, baseline score, and achieving intervention goals, mean change in EQ-5D-VAS was +11.83 (SE=1.61) at 6months and +11.23 (SE=1.54) at 12months (both; p<0.0001). Adjusted mean change in EQ-5D index value was +0.04 (SE=0.01) at 6months and +0.05 (SE=0.01) at 12months (both; p<0.01). Participation in a community lifestyle intervention program resulted in improved HRQoL among adults with prediabetes and/or the metabolic syndrome. These benefits to HRQoL, together with improved clinical and behavioral outcomes, should increase the appeal of such programs for improving health.

Yoga Combined With Health Education for Risk Reduction of Metabolic Syndrome: A Randomized Controlled Pilot Feasibility Study

Objective: The primary treatment for adults with risk factors for metabolic syndrome is lifestyle change, though adoption of traditional lifestyle programs is often limited. This pilot study tested the feasibility of conducting a randomized clinical trial comparing a novel targeted yoga program coupled to lifestyle education versus lifestyle education alone among adults with metabolic syndrome risk factors. Design and methods: Patients from primary care clinic were pre-screened electronically and further screened for metabolic syndrome. Consented participants were randomized to either a 12-week yoga program with lifestyle education or lifestyle education alone. Participants in the yoga arm received weekly 30 to 45 min of face-to-face yoga instruction, followed by 30 to 45 min of lifestyle education, and written instructions for home yoga practice and lifestyle changes. The lifestyle education was based on (EDU) the Group Lifestyle Balance Program that is adapted from the Diabetes Prevention Program. Participants in EDU only group received a weekly standardized curriculum matched in attention and time to the yoga with EDU arm. The primary outcome was to assess the feasibility of conducting a randomized trial by assessing recruitment rate and adherence to the protocol. Secondly, we aimed to collect preliminary data on changes in cardiometabolic factors including insulin resistance (IR) as measured by Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), blood pressure, fasting lipids, body weight and composition, habitual physical activity, and dietary intake from baseline to 12-week intervention. Results: We identified 238 adults at high risk for metabolic syndrome medical records review utilizing an electronic recruitment tool. Among eligible individuals, 67 (28%) were enrolled and 56 (84%) completed the 12-week assessment. The median attendance was 8 of 12 sessions for the yoga with EDU and 9 of 12 sessions for the EDU arm. Self-reported median frequency of home practice was 2.8 (IQR 1.4) times per week among the yoga with EDU group and 3.3 (IQR 1.1) times per week among the EDU group. Participants in the yoga with EDU arm versus EDU alone demonstrated a non-significant decrease in HOMA-IR (-0.21 (S.D. 0.99) versus 0.02 (S.D. 0.74), p=0.29). Both groups had similar changes in blood pressure, lipids, weight, body composition, energy intake, and physical activity from baseline to 12 weeks. Conclusions: It is feasible to implement yoga combined with EDU and conduct a prospective trial to assess effectiveness on cardiometabolic risk reduction in adults with metabolic syndrome.

Increasing the effectiveness of the Diabetes Prevention Program through if-then plans: study protocol for the randomized controlled trial of the McGill CHIP Healthy Weight Program.

BackgroundThe Diabetes Prevention Program (DPP) is highly effective in promoting weight loss in overweight and obese individuals. However, one-on-one DPP sessions are costly. As a cost-saving alternative, a group version of the DPP, called Group Lifestyle Balance program (GLB), has been developed but has been shown to be less effective. The aim of this two-arm parallel randomized controlled trial is to increase the effectiveness of the GLB by integrating habit formation techniques, namely if-then plans and their mental practice, into the program.Methods/DesignA total of 154 participants will be randomized to a standard or enriched GLB program. For the enriched GLB program, if-then plans and their mental practice will be integrated into the standard GLB program. Participants will be overweight or obese men and women (BMI of 28 to 45 kg/m2, waist circumference ≥ 88 for women, ≥ 102 for men, 18 to 75 years of age) who do less than 200 minutes of self-reported moderate or vigorous exercise per week. Measures will be completed at baseline, 3 months, post-intervention (12 months), and 12 months post-intervention (24 months). The primary outcome measure is weight loss at 3, 12, and 24 months. Secondary outcomes include percent reaching weight loss goal, physical activity at 3, 12, and 24 months, and weight-related risk factors (waist circumference, hemoglobin A1c, systolic/diastolic blood pressure, total cholesterol/HDL ratio). Standardized training of the life-style coaches, use of standardized manuals, and audio taping and reviewing of the sessions will ensure intervention fidelity.DiscussionThe study will provide evidence-based data on the effectiveness of an enhanced GLB intervention in promoting weight loss and in reducing weight-related risk factors for chronic health problems. Ethical clearance has been received from the Research Ethics and Compliance Board of the Faculty of Medicine Research and Graduate Studies Office at McGill University (Montreal, Canada).Trial registrationClinicalTrials.gov Identifier: NCT02008435. Registered 6 December 2013.

Design of a cluster-randomized controlled trial of a diabetes prevention program within African–American churches: The Fit Body and Soul study

Evidence from varied community settings has shown that the Group Lifestyle Balance (GLB) Program and other adaptations of the Diabetes Prevention Program (DPP) intervention are effective in lowering diabetes risk. Most DPP data originated from studies of pre-diabetic whites, with only sparse evidence of the effect of DPP in African Americans (AAs) in community settings. This paper describes the design, methods, baseline characteristics and cost effective measures, of a single-blinded, cluster-randomized trial of a faith-based adaptation of the GLB program, Fit Body and Soul (FBAS). The major aims are to test efficacy and cost utility of FBAS in twenty AA churches. Randomization occurred at the church level and 604 AA overweight/obese (BMI≥25kg/m2) adults with fasting plasma glucose range from normal to pre-diabetic received either FBAS or a health-education comparison program. FBAS is a group-based, multi-level intervention delivered by trained church health advisors (health professionals from within the church), with the goal of ≥7% weight loss, achieved through increasing physical activity, healthy eating and behavior modification. The primary outcome is weight change at 12weeks post intervention. Secondary outcomes include hemoglobin A1C, fasting plasma glucose, waist circumference, blood pressure, physical activity level, quality of life measures, and cost-effectiveness. FBAS is the largest known cohort of AAs enrolled in a faith-based DPP translation. Reliance on health professionals from within the church for program implementation and the cost analysis are unique aspects of this trial. The design provides a model for faith-based DPPs and holds promise for program sustainability and widespread dissemination.

A smartphone-supported weight loss program: design of the ENGAGED randomized controlled trial

BackgroundObesity remains a major public health challenge, demanding cost-effective and scalable weight management programs. Delivering key treatment components via mobile technology offers a potential way to reduce expensive in-person contact, thereby lowering the cost and burden of intensive weight loss programs. The ENGAGED study is a theory-guided, randomized controlled trial designed to examine the feasibility and efficacy of an abbreviated smartphone-supported weight loss program.Methods/designNinety-six obese adults (BMI 30–39.9 kg/m2) will be randomized to one of three treatment conditions: (1) standard behavioral weight loss (STND), (2) technology-supported behavioral weight loss (TECH); or (3) self-guided behavioral weight loss (SELF). All groups will aim to achieve a 7% weight loss goal by reducing calorie and fat intake and progressively increasing moderate intensity physical activity to 175 minutes/week. STND and TECH will attend 8 group sessions and receive regular coaching calls during the first 6 months of the intervention; SELF will receive the Group Lifestyle Balance Program DVD’s and will not receive coaching calls. During months 1–6, TECH will use a specially designed smartphone application to monitor dietary intake, body weight, and objectively measured physical activity (obtained from a Blue-tooth enabled accelerometer). STND and SELF will self-monitor on paper diaries. Linear mixed modeling will be used to examine group differences on weight loss at months 3, 6, and 12. Self-monitoring adherence and diet and activity goal attainment will be tested as mediators.DiscussionENGAGED is an innovative weight loss intervention that integrates theory with emerging mobile technologies. We hypothesize that TECH, as compared to STND and SELF, will result in greater weight loss by virtue of improved behavioral adherence and goal achievement.Trial registrationNCT01051713

Two-Year Results of Translating the Diabetes Prevention Program Into an Urban, Underserved Community

The purpose of the study was to examine the long-term effect of a Group Lifestyle Balance (GLB) program on weight, impaired fasting glucose, hypertension, and hyperlipidemia in an urban, medically underserved community. This study was a single-arm prospective intervention study that was designed to test the effectiveness of a community-based GLB intervention. In sum, 638 residents from 11 targeted neighborhoods were screened for body mass index ≥ 25 kg/m(2) and metabolic syndrome. Eligible individuals took part in a 12-week GLB intervention (n = 105) that addressed weight loss and physical activity. Subjects were followed for 24 months. The probability of being at risk for diabetes and cardiovascular disease was significantly reduced by 25.7% over the long-term follow-up. Of the participants who lost at least 5% of their body weight following the intervention, 52.6% maintained the 5% weight loss at their last follow-up time, weighing about 20 lb less than they did at baseline. Risk reduction and weight loss maintenance are possible following a GLB intervention and have substantial potential for future public health impact.

Long-term Strategies for Diabetes Prevention: Evaluation of the Group Lifestyle Balance Post-Core Sessions Focusing on Carbohydrate and Hunger Management

The Group Lifestyle Balance (GLB) program, adapted from the Diabetes Prevention Program lifestyle intervention, has demonstrated effectiveness in reducing risk factors for diabetes and cardiovascular disease. Although overall carbohydrate quality was addressed in the GLB program, carbohydrate modification has not been a specific focus. Long- term strategies for maintaining healthy lifestyle practices are lacking. The purpose of this application was to examine the effectiveness of a GLB traditional post-core (TPC) program compared to a carbohydrate modification and hunger focus post-core (CPC) program. Both TPC and CPC consisted of 9 monthly support sessions following completion of identical 12 weekly GLB sessions. The primary outcome was weight change; secondary outcomes included HbA1c, fasting glucose and lipid profile, systolic and diastolic blood pressure (SBP, DPB), and waist circumference (WC). A total of 60 participants with pre-diabetes and/or the metabolic syndrome were enrolled in four intervention groups. After completion of the initial 12 GLB sessions, participants were randomly assigned by group to TPC (N=31) or CPC (N=29). Between baseline and 4 months, by intention-to-treat analysis, similar significant weight loss was noted in both groups (TPC -4.0% vs. CPC -4.5%, p=0.41), along with significant decreases in HbA1c, SBP, DBP, and WC; no differences were noted between TPC and CPC groups. Assessments were also conducted 8 and 12 months from baseline. At 8 months the CPC program initially showed a significant fall in HbA1c (p=0.01); however, no significant fall was seen for TPC. At 12 months, similar significant weight loss (from baseline) was maintained by both groups (TPC-2.6% vs. CPC -3.8%, p=0.31) and similar significant decreases in SBP, DBP and WC were also noted. However, there were no differences between the groups for any measure. These results suggest that both post-core strategies were successful in maintaining a reduction in diabetes and CVD risk factors at 12 months.