Abstract
Background
Latino immigrants have high rates of obesity and face barriers to weight loss.
Objective
To evaluate the effectiveness of a case-management (CM) intervention with and without
community health workers (CHWs) for weight loss.
Design
This was a 2-year, randomized controlled trial comparing two interventions with each
other and with usual care (UC).
Participants/setting
Eligible participants included Latinos with a body mass index of 30 to 60 and one
or more heart disease risk factors. The 207 participants recruited during 2009-2010
had a mean age of 47 years and were mostly women (77%). At 24 months, 86% of the sample
was assessed.
Intervention
The CM+CHW (n=82) and CM (n=84) interventions were compared with each other and with
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 to −1.3)
or −2% of baseline weight (95% CI −1% to −2%) compared with −1.6 kg (95% CI −2.4 to −0.7;
% weight change, −2%, −1%, and −3%) in CM and −0.9 kg (95% CI −1.8 to 0.1; % weight
change, −1%, 0%, and −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; 95% CI −6.0
to −2.7) compared with UC (−0.4 kg; 95% CI −2.4 to 1.5), but by 12 and 24 months differences
were not significant.
Conclusions
This study demonstrated that incorporation of CHWs may help promote initial weight
loss, especially among men, but not weight maintenance. Additional strategies to address
social and environmental influences may be needed for Latino immigrant populations.
Keywords
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References
- Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010.JAMA. 2012; 307: 491-497
- Direct medical cost of overweight and obesity in the USA: A quantitative systematic review.Obes Rev. 2011; 12: 50-61
US Census Bureau. Hispanic Heritage Month. 2012. http://www.census.gov/population/hispanic/data/2012.html. Accessed November 25, 2014.
- Effect of degree of weight loss on health benefits.Obesity Res. 1995; 3: 211s-216s
- Effectiveness of Primary Care Interventions for Weight Management in Children and Adolescents: An Updated, Targeted Systematic Review for the USPSTF.Agency for Healthcare Research and Quality (US), Rockville, MD2010 Jan (Report No. 10-05144-EF-1)
- Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.N Engl J Med. 2002; 346: 393-403
- Ethnic minorities and weight control research priorities: Where are we now and where do we need to be?.Prev Med. 2008; 47: 583-586
- One-year results of the Think Health! study of weight management in primary care practices.Obesity (Silver Spring). 2012; 20: 1249-1257
- The Latino Health Project: Pilot testing a culturally adapted behavioral weight loss intervention in obese and overweight Latino adults.Ethn Dis. 2012; 22: 51-57
DeNavas-Walt C, Proctor BD, Smith JC. Income, Poverty, and Health Insurance Coverage in the United States: 2011. 2012. http://www.census.gov/prod/2012pubs/p60-243.pdf. Accessed November 25, 2014.
- Hispanics and health insurance coverage: The rising disparity.Med Care. 2008; 46: 1086-1092
- Food insecurity is associated with chronic disease among low-income NHANES participants.J Nutr. 2010; 140: 304-310
- The impact of language barriers on the health care of Latinos in the United States: A review of the literature and guidelines for practice.J Midwif Womens Health. 2002; 47: 80-96
- Effectiveness of a community health worker intervention among African American and Latino adults with type 2 diabetes: A randomized controlled trial.Am J Public Health. 2011; 101: 2253-2260
- Evaluating clinic and community-based lifestyle interventions for obesity reduction in a low-income Latino neighborhood: Vivamos Activos Fair Oaks Program.BMC Public Health. 2011; 11: 98
Profile of General Population and Housing Characteristics: 2010. http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=DEC_10_DP_DPDP1. Accessed November 17, 2013.
- Case management to reduce risk of cardiovascular disease in a county health care system.Arch Intern Med. 2009; 169: 1988-1995
- Health promotion from the perspective of social cognitive theory.Psychol Health. 1998; 13: 623-649
- The transtheoretical model of health behavior change.Am J Health Promot. 1997; 12: 38-48
- The CES-D scale: A self-report depression scale for research in the general population.Appl Psychol Measure. 1977; 1: 385-401
- Psychosocial functioning in the obese before and after weight reduction: Construct validity and responsiveness of the Obesity-Related Problems scale.Int J Obes Relat Metab Disord. 2003; 27: 617-630
- US Household Food Security Survey Module—Spanish: Three-Stage Design, with Screeners. US Dept of Agriculture, Economic Research Service, Washington, DC2012
- Longitudinal data analysis using generalized linear models.Biometrika. 1986; 73: 13-22
- A multiple comparison procedure for three- and four-armed controlled clinical trials.Stat Med. 1999; 18: 787-798
- Statistical Analysis with Missing Data.2nd ed. Wiley, Hoboken, NJ2002
Adam Gilden Tsai MD M. Treatment of obesity in primary care practice in the United States: A systematic review. J Gen Intern Med. 2009;24(9):1073-1079.
- A meta-analysis of psycho-behavioral obesity interventions among US multiethnic and minority adults.Prev Med. 2008; 47: 573-582
- Obesity treatment for socioeconomically disadvantaged patients in primary care practice.Arch Intern Med. 2012; 172: 565-574
- One-year results of a community-based translation of the Diabetes Prevention Program: Healthy-Living Partnerships to Prevent Diabetes (HELP PD) Project.Diabetes Care. 2011; 34: 1451-1457
- Male inclusion in randomized controlled trials of lifestyle weight loss interventions.Obesity (Silver Spring). 2012; 20: 1234-1239
- Translating the Diabetes Prevention Program lifestyle intervention for weight loss into primary care: A randomized trial.JAMA Intern Med. 2013; 173: 113-121
- Treatment of obesity in primary care practice in the United States: A systematic review.J Gen Intern Med. 2009; 24: 1073-1079
- Dietary and lifestyle interventions for weight management in adults from minority ethnic/non-White groups: A systematic review.Obes Rev. 2010; 11: 769-776
Biography
L. G. Rosas is research director and instructor of medicine, Program on Prevention Outcomes and Practices, Stanford Prevention Research Center, Stanford University, Palo Alto, CA.
Biography
R. S. Stafford is a professor of medicine, Program on Prevention Outcomes and Practices, Stanford Prevention Research Center, Stanford University, Palo Alto, CA.
Biography
B. A. Goldstein is an instructor of medicine and a senior biostatistician, Quantitative Sciences Unit, Department of Medicine, Stanford University, Palo Alto, CA.
Biography
S. Thiyagarajan is a project manager, Abbott, Alameda, CA; at the time of the study, she was a data analyst/manager, Program on Prevention Outcomes and Practices, Stanford Prevention Research Center, Stanford University, Palo Alto, CA.
Biography
R. L. Drieling is a doctoral degree student, Department of Epidemiology, School of Public Health, University of Washington, Seattle, and National Cancer Institute Biobehavioral Cancer Prevention and Control Program Affiliate, Fred Hutchinson Cancer Research Center, Seattle, WA; at the time of the study, she was research director, Program on Prevention Outcomes and Practices, Stanford Prevention Research Center, Stanford University, Palo Alto, CA.
Biography
P. P. Romero is a study coordinator and case manager, Fair Oaks Clinic of San Mateo Medical Center, Redwood City, CA.
Biography
J. Ma is an associate scientist, Palo Alto Medical Foundation Research Institute, Palo Alto, CA, and a consulting assistant professor, Stanford Prevention Research Center, School of Medicine, Stanford University, Palo Alto, CA.
Biography
V. Yank is an instructor of medicine, General Medical Disciplines, Stanford School of Medicine, Stanford University, Palo Alto, CA; at the time of the study, she was a joint fellow at the Stanford Prevention Research Center and the Palo Alto Medical Foundation Research Institute, Palo Alto, CA.
Article info
Publication history
Published online: January 08, 2015
Accepted:
September 23,
2014
Footnotes
Supplementary materials: Table 1 is available online at www.andjrnl.org
STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.
FUNDING/SUPPORT This study was funded by National Heart, Lung, and Blood Institute grant no. R01 HL089448, and the REDCap data management tools were supported by the National Institutes of Health (grant no. UL1 RR025744).
Identification
Copyright
© 2015 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.
