Weight Loss Experiences of African American, Hispanic, and Non‐Hispanic White Men and Women with Type 2 Diabetes: The Look AHEAD Trial

Abstract

Objective: The aim of this study was to characterize weight loss, treatment engagement, and weight control strategies utilized by African American, Hispanic, and non-Hispanic white participants in the Action for Health in Diabetes (Look AHEAD) Intensive Lifestyle Intervention by racial/ethnic and sex subgroups. Methods: Weight losses at 1, 4, and 8 years among 2,361 adults with obesity and type 2 diabetes randomized to intervention (31% minority; 42% men) are reported by subgroup. Multivariable models within subgroups examine relative contributions of treatment engagement variables and self-reported weight control behaviors. Results: All subgroups averaged weight losses ≥ 5% in year 1 but experienced regain; losses ≥ 5% were sustained at year 8 by non-Hispanic white participants and minority women (but not men). Session attendance was high (≥ 86%) in year 1 and exceeded protocol-specified minimum levels into year 8. Individual session attendance had stronger associations with weight loss among Hispanic and African American participants than non-Hispanic white participants at 4 years (P = 0.04) and 8 years (P = 0.001). Daily self-weighing uptake was considerable in all subgroups and was a prominent factor associated with year 1 weight loss among African American men and women. Greater meal replacement use was strongly associated with poorer 1-year weight losses among African American women. Conclusions: Experiences of minority men and women with diabetes in lifestyle interventions fill important gaps in the literature that can inform treatment delivery.

Inequalities in Diabetes in the USA

“…After 8 years of intervention, all female patients from different ethnic groups lost weight similarly [30]. Among men, there was a trend toward less weight loss among African American and Hispanic men compared with Whites [30].…”

“…Lifestyle intervention: In 'The Action for Health in Diabetes (Look Ahead)" trial, 5,145 (36% minorities, 40% men) overweight/ obese subjects with type 2 diabetes were randomized to intensive lifestyle intervention and a control group of diabetes support and education [30]. The objective of the lifestyle intervention is a weight loss of 10% by decreased caloric and fat intake and increased physical activity [30]. After 8 years of intervention, all female patients from different ethnic groups lost weight similarly [30].…”

“…The objective of the lifestyle intervention is a weight loss of 10% by decreased caloric and fat intake and increased physical activity [30]. After 8 years of intervention, all female patients from different ethnic groups lost weight similarly [30]. Among men, there was a trend toward less weight loss among African American and Hispanic men compared with Whites [30].…”

Weight loss interventions for Hispanic women in the USA: a protocol for a systematic review

“…Our decision to focus our review on Hispanic women living in the USA stems from the knowledge that U.S. Hispanic women have unique attitudes, barriers, and facilitators related to weight loss with important socio-cultural contextual factors specific to the USA (e.g., acculturation, built environment, high burden of obesity, and related disease) meriting focused examination. Additionally, racial/ethnic- and sex-specific models exploring predictors of weight loss have demonstrated differences in key predictors of weight loss, further justifying the need to independently focus on Hispanic women [20].…”

“…Although DPP was a large trial, only 16% ( n = 154) of the intensive lifestyle intervention (ILI) group identified as Hispanic women and information including level of acculturation, years in the USA, and country of origin were not collected, thereby limiting generalizability to different sub-populations within the Hispanic community [16]. In the Look AHEAD trial, the longest randomized trial to evaluate the effectiveness of lifestyle modification on weight and cardiovascular-related health outcomes, Hispanic women comprised only 9% ( n = 240) of participants in the ILI group and weight loss achieved by year 1 was slowly regained over the next 3 to 7 years, including among Hispanic women [19, 20]. Additionally, similar to the DPP, the multicomponent lifestyle intervention delivered to participants makes it difficult to ascertain which specific intervention components were effective in inducing the observed weight loss.…”