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

Published:January 08, 2015DOI:https://doi.org/10.1016/j.jand.2014.10.020

      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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      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.