The Effectiveness of Two Community-Based Weight Loss Strategies among Obese, Low-Income US Latinos

Abstract

Background Latino immigrants have high rates of obesity and face barriers to weight loss. Objective Evaluate the effectiveness of a case-management (CM) intervention with and without community health workers (CHWs) for weight loss. Design Two-year, randomized controlled trial comparing two interventions to each other and to usual care (UC). Participants/setting Eligible participants included Latinos with a Body Mass Index of 30-60 and one or more heart disease risk factors. The 207 participants recruited from 2009-2011 had a mean age of 47 years and were mostly female (77%). At 24 months, 86% of the sample was assessed. Intervention The CM+CHW (n=82) and CM (n=84) interventions were compared to each other and to UC (n=41). Both included an intensive 12 month phase followed by 12 months of maintenance. The CM+CHW group received home visits. Main outcome measures Weight change at 24 months. Statistical Analyses Generalized estimating equations using intent-to-treat. Results At 6 months, mean weight loss in the CM+CHW arm was −2.1 kg (95% CI −2.8, −1.3) or −2% of baseline weight (−1%, −2%) compared to −1.6 kg (−2.4, −0.7; % weight change: −2%, −1%, −3%) in CM and −0.9 kg (−1.8, 0.1; % weight change: −1%, 0%, −2%) in UC. By 12 and 24 months, differences narrowed and CM+CHW was no longer statistically distinct. Men achieved greater weight loss than women in all groups at each time point (p<0.05). At 6 months, men in the CM+CHW arm lost more weight (−4.4 kg, −6.0, −2.7) compared to UC (−0.4 kg, −2.4, 1.5), but by 12 and 24 months differences were not significant. Conclusions Incorporation of CHWs may help promote early weight loss, especially among men, but it did not achieve weight maintenance. Social and environmental influences may need to be addressed to achieve sustained weight loss in Latino immigrant populations.

Diabetes Prevention Interventions in Latin American Countries: a Scoping Review

“…In particular, the interventions we identified in our review (see Table 2) illustrate the potential usefulness of: 1) community health workers (“promotoras”) for diabetes screening 54 and delivery of lifestyle modification programs; 55–59 2) multiple modes of program delivery beyond face-to-face sessions; 60 3) information technology to automate and enhance program delivery; 61 4) leveraging of pre-existing familial relationships to engage in and sustain lifestyle modifications; 62 and 5) innovative environmental change strategies such as collaborations with local food stores and markets to promote healthy behaviors. 63 …”

“…54–58 In three of the interventions, community health workers delivered culturally tailored community-based versions of the Diabetes Prevention Program (DPP) for groups of Spanish-speaking Latinos, 56–58 and in one RCT CHWs in one arm provided supplemental support to participants beyond an adapted DPP program delivered by health educators. 59 Ruggiero et al, and Ockene et al explicitly described use of Community Based Participatory Research (CBPR) methods to work with community stakeholders to translate the DPP and adapt it to provide culturally specific information on diabetes risk and strategies to improve diet and physical activity. The use of CBPR methods is critically important in both U.S. and LAC settings to gain buy-in from key stakeholders, ensure the cultural appropriateness of programs, and increase the likelihood that programs found to be effective will be disseminated and maintained over the long-term.…”

“…Despite their positive findings, these studies had limitations. All of the trials except Rosas et al 59 did not examine whether gains in outcomes were maintained beyond the end of the intervention period, and Rosas et al found that weight loss gains achieved during the intervention at 6 months were not sustained at the end of the intervention at 12 months or at 24 months. Moreover, one promising intervention, the Ruggiero et al evaluation of the culturally adapted 1-year intensive DPP program did not include a control group.…”

Evaluation of a culturally-adapted lifestyle intervention to treat elevated cardiometabolic risk of Latino adults in primary care (Vida Sana): A randomized controlled trial

“…The interventions were not more effective than usual care according to the primary outcome of change in weight at 24 months. 115 The Vida Sana study specifically addresses the gap in evidence and health services for obesity management and type 2 diabetes prevention among high-risk Latino adults in primary care settings. Primary care is an ideal setting for behavioral lifestyle interventions.…”

Identifying the Complexity of Multiple Risk Factors for Obesity Among Urban Latinas

“…In addition, there have been a number of interventions aimed at reducing obesity in this population, including a 2-year randomized controlled trial comparing usual care with a case-management and community health care worker weight loss intervention [14] in a sample comparable to the Washington Heights and Inwood Informatics Infrastructure for Comparative Effectiveness Research (WICER) study. Perez and colleagues also reported the results of a systematic review of 22 studies on obesity treatment interventions conducted in the U.S. for overweight or obese Latino adults (1990–2010) [15].…”