Differences in Weight Loss by Race and Ethnicity in the PRIDE Trial: a Qualitative Analysis of Participant Perspectives

Abstract

Background Many Diabetes Prevention Program (DPP) translation efforts have been less effective for underresourced populations. In the cluster-randomized Prediabetes Informed Decision and Education (PRIDE) trial, which evaluated a shared decision-making (SDM) intervention for diabetes prevention, Hispanic and non-Hispanic Black participants lost less weight than non-Hispanic White participants at 12-month follow-up. Objective To explore perspectives about weight loss from PRIDE participants of different racial and ethnic groups. Participants Sample of participants with prediabetes who were randomized to the PRIDE intervention arm (n=24). Approach We conducted semi-structured interviews within three groups stratified by DPP participation and % weight loss at 12 months: (DPP+/WL+, enrolled in DPP and lost >5% weight; DPP+/WL−, enrolled in DPP and lost <3% weight; DPP−/WL−, did not enroll in DPP and lost <3% weight). Each group was further subdivided on race and ethnicity (non-Hispanic Black (NHB), non-Hispanic White (NHW), Hispanic). Interviews were conducted on Zoom and transcripts were coded and analyzed with Dedoose. Key Results Compared to NHW participants, Hispanic and NHB participants more often endorsed weight loss barriers of limited time to make lifestyle changes due to long work and commute hours, inconvenient DPP class locations and offerings, and limited disposable income for extra weight loss activities. Conversely, facilitators of weight loss regardless of race and ethnicity included retirement or having flexible work schedules; being able to identify convenient DPP classes; having a strong, positive support system; and purchasing supplementary resources to support lifestyle change (e.g., gym memberships, one-on-one activity classes). Conclusions We found that NHB and Hispanic SDM participants report certain barriers to weight loss more commonly than NHW participants, particularly barriers related to limited disposable income and/or time constraints. Our findings suggest that increased lifestyle change support and flexible program delivery options may be needed to ensure equity in DPP reach, participant engagement, and outcomes.

Examining paradoxical session attendance and weight loss relationships in a clinic based lifestyle modification intervention

“…Even after adjustment for various other sociodemographic and clinical factors, non‐Hispanic White participants were almost twice as likely as Hispanic participants, 2.5 times as likely as non‐Hispanic Asian participants, and almost 3 times as likely as non‐Hispanic Black participants to experience positive weight‐loss outcomes despite low session attendance. Studies have previously documented lower success at weight‐loss goal achievement through LMIs for non‐Hispanic Black participants specifically, and there is increasing study regarding how socio‐cultural factors and longstanding societal inequities, including the daily stress of discrimination, could be contributing to worse health outcomes for people from historically marginalized communities 39–42 . However, our study contributes to the new finding that non‐Hispanic White participants are more likely to achieve weight loss goals despite low engagement, which could suggest that non‐Hispanic White patients experience better healthcare overall (access, racial concordance, quality of care) and societal privileges than racially and ethnically minoritized people.…”

Liraglutide 3.0 mg in the treatment of adults with obesity and prediabetes using real‐world UK data: A clinical evaluation of a multi‐ethnic population

“…9,10 However, most participants in previous clinical trials are of white ethnicity; some research points towards those of Black African ethnicity experiencing less weight reduction. 11,12 Clinical trials also do not commonly report participant socioeconomic status, and it is unclear whether efficacy translates to individuals of diverse socioeconomic backgrounds. 13 For instance, lower socioeconomic status is associated with reduced BW loss 10 years following metabolic surgery.…”

“…Meta‐analysis shows that 65.3% of patients reduce weight by >5% 9,10 . However, most participants in previous clinical trials are of white ethnicity; some research points towards those of Black African ethnicity experiencing less weight reduction 11,12 . Clinical trials also do not commonly report participant socioeconomic status, and it is unclear whether efficacy translates to individuals of diverse socioeconomic backgrounds 13 .…”

Curated collections for educators: Nine key articles and article series for teaching qualitative research methods

“…Qualitative data goes beyond quantitative data, accounting for human and social factors resulting in specific outcomes. It has clear benefits when used in fields such as medical education, 1–3 physician wellness, 4–6 and health equity 7–9 . Its scope has been expanded to clinical research and patient care, and it serves an especially important role in quality improvement initiatives 10 .…”

“…It has clear benefits when used in fields such as medical education, [1][2][3] physician wellness, [4][5][6] and health equity. [7][8][9] Its scope has been expanded to clinical research and patient care, and it serves an especially important role in quality improvement initiatives. 10 Qualitative methods can lead to better understanding of the patient experience and thus provide valuable insights not accessible through quantitative methods.…”