Ethnic minorities and weight control research priorities: where are we now and where do we need to be?

What are the barriers to primary prevention of type 2 diabetes in black and minority ethnic groups in the UK? A qualitative evidence synthesis

BACKGROUND

This review aimed to synthesise available qualitative evidence on barriers and facilitators to the implementation of community based lifestyle behaviour interventions to reduce the risk of diabetes in black and minority ethnic (BME) groups in the UK.

METHODS

A search of medical and social science databases was carried out and augmented by hand-searching of reference lists and contents of key journals. Qualitative evidence was synthesised thematically.

RESULTS

A total of 13 papers varying in design and of mainly good quality were included in the review. A limited number of intervention evaluations highlighted a lack of resources and communication between sites. A lack of understanding by providers of cultural and religious requirements, and issues relating to access to interventions for users was reported. Behaviour change was impeded by cultural and social norms, and resistance to change. There were variations in the way dietary change and physical activity was approached by different groups and contrasting practices between generations.

CONCLUSIONS

Qualitative data provided insight into the ways that providers might improve or better design future interventions. Acknowledgement of the way that different groups approach lifestyle behaviours may assist acceptability of interventions.

Effects of a culturally tailored intervention on changes in body mass index and health-related quality of life of Latino children and their parents

PURPOSE

To evaluate the effects of a multicomponent, family-based, culturally tailored intervention for overweight Latino children and their parents.

DESIGN

One group pretest/posttest with clinic comparison group.

SETTING

Community health center in Milwaukee, Wisconsin.

SUBJECTS

54 Spanish-speaking, Latino families with children 8 to 11 years of age at enrollment and a body mass index (BMI) > 85th percentile. Thirty-one completed the 12-month follow-up.

MAIN OUTCOME

Measures. BMI, fitness measures, self-reported eating patterns, sedentary behaviors, and quality of life scales.

INTERVENTION

Index child and one (index) parent participated in interactive sessions and physical activity reinforced by family goal-setting, staff support, and supplemental activities.

RESULTS

Small but statistically significant changes in child BMI z score (Δ = .13 SD, p < .001) and parent fitness (Δ = .74, p < .04) were documented by paired t-test. Quality of life increased significantly for children (combined Pediatric Quality of Life Inventory score Δ = 10.7, p < .001) and parents (Short Form Health Survey12 mental composite score Δ = 8, p < .022; Wilcoxon rank sum test). BMI z score for clinic comparison children (n = 31) increased significantly during the same time period (Δ = .23 SD, paired t = 4.32, p < .0002).

CONCLUSIONS

A culturally tailored program for Latino families reduced BMI for enrolled children and significantly enhanced quality of life for children and parents. Intervention approaches that integrate cultural and social circumstances and emphasize goal setting and life style changes may be fruitful for this population of at-risk children.

Dietary interventions for weight loss and cardiovascular risk reduction in people of African ancestry (blacks): a systematic review

Objective

To systematically review weight and cardiovascular risk reduction in blacks by diet and lifestyle changes.

Design

Randomised and non-randomised controlled trials of diet with/without lifestyle changes with duration of intervention ≥3 months, and published between January 1990 and December 2009, were searched in electronic databases including MEDLINE, EMBASE, CINAHL and CCTR (Cochrane Controlled Trials Register). Studies were included if they reported weight/BMI changes with changes in at least one of the following: systolic and diastolic blood pressure, fasting plasma lipids and glucose, and glycated haemoglobin.

Setting

Clinical, community and church-based interventions.

Subjects

Study participants were of African ancestry (blacks).

Results

Eighteen studies met the inclusion criteria. Average mean difference in weight loss was −2·66 kg, with improvements in all outcomes except total cholesterol. No significant difference was observed in outcome measures between all studies and studies that recruited only healthy participants or patients with type 2 diabetes.

Conclusions

Diet and lifestyle changes result in weight loss with improvements in cardiovascular risk factors in blacks. However, more culturally tailored programmes have been suggested to motivate and encourage blacks to participate in intervention trials.

Assessing the Stages of Change Among African American Women in a Weight Management Program

The objective of this study was to assess the relationship between stage of change (SOC) and behavioral outcomes among African American women entering obesity treatment in two settings. Fifty-five overweight/obese (body mass index = 26.50-48.13), but otherwise healthy African American women, 23 to 56 years old, attended a 13-week weight loss-treatment program that took place at churches (n = 36) or a university (n = 19). Participants were weighed, completed SOC measures, and had a physical fitness test at pre- and posttreatment. Pretreatment measures of SOC placed 47% of the participants as actors, 31% as contemplators, and 22% as maintainers. Of the 45 women who reported posttreatment SOC, 7% regressed, 44% did not change, and 31% progressed in SOC. Pretreatment SOC predicted posttreatment weight loss in the church setting but not in the university setting. At churches, contemplators lost more weight than actors and maintainers. The church may be a more conducive setting for weight change behaviors for African American women who are categorized as contemplators in the SOC model.

Internet delivered behavioral obesity treatment

OBJECTIVES

To evaluate the efficacy of an Internet behavioral weight loss program; and determine if adding periodic in-person sessions to an Internet intervention improves outcomes.

METHODS

481 healthy overweight adults (28% minority) were randomized to one of 3 delivery methods of a behavioral weight loss program with weekly meetings: Internet (n=161), InPerson (n=158), or Hybrid (Internet+InPerson, n=162). Outcome variables were weight at baseline and 6 months and percent of subjects achieving a 5 and 7% weight loss. The study took place in two centers in Vermont and Arkansas from 2003 to 2008.

RESULTS

Conditions differed significantly in mean weight loss [8.0 (6.1) kg vs. 5.5 (5.6) kg vs. 6.0 (5.5) kg], for InPerson, Internet, and Hybrid respectively, p<0.01, n=462). Weight loss for InPerson was significantly greater than the Internet and Hybrid conditions (p<0.05). Although the proportion reaching a 5% weight loss did not differ, the proportion losing 7% did differ significantly (56.3% vs. 37.3% vs. 44.4% for InPerson, Internet, and Hybrid respectively, p<0.01).

CONCLUSIONS

These results demonstrate that the Internet is a viable alternative to in-person treatment for the delivery and dissemination of a behavioral weight-control intervention. The addition of periodic in-person sessions did not improve outcomes.

Changes in Health-Related Quality of Life among African-Americans in a lifestyle weight loss program

PURPOSE

Changes in health-related quality of life (HRQoL) were assessed in clinically obese, African-American adults after completion of a weight loss program that resulted in modest average weight loss.

METHODS

Data were analyzed for 87 men and women who provided weight measurements after an initial 10-week weight loss program (Phase 1) and a subsequent clinical trial to evaluate three weight maintenance approaches (Phase 2) over an additional 8 to 18 months. HRQoL was assessed using the Short Form SF-36 questionnaire. Intra-person changes in HRQoL were assessed and analyzed for associations with weight change within each phase. Non-parametric bivariable analyses and multivariable linear regression were used in statistical analyses.

RESULTS

Changes in HRQoL were modest; clinically significant intra-subject improvements in SF-36 domains of general health and vitality and in the mental component summary score were observed after Phase 1 but were attenuated during Phase 2. Improvements in vitality were significantly associated with greater weight loss in Phase 1, but no HRQoL change scores during Phase 2 were associated with weight change.

CONCLUSIONS

Short-term improvements in general health and vitality were observed. The vitality domain of the SF-36 appeared to be the domain of HRQoL most responsive to modest weight change.

Systematic prevention of overweight and obesity in adults: a qualitative and quantitative literature analysis

To date, most interventions aimed at preventing obesity have underemphasized the application of systematic intervention development, implementation and evaluation. The present review provides a thorough insight in factors promoting implementation and/or effectiveness in interventions aimed at preventing overweight/obesity among adults. A total of 46 studies evaluating interventions aimed at preventing obesity were reviewed, followed by both qualitative and quantitative analyses. The Intervention Mapping protocol and the Environmental Research framework for weight Gain prevention (EnRG) were applied to analyse and classify the included studies. The interventions were categorized by setting (workplace, community, health care) and target group (ethnic minorities, pregnant women, [pre]menopausal women, smokers, people with intellectual disabilities). Generally, interventions were found to have potential in changing energy balance-related behaviours and anthropometric outcomes. Effect sizes for changes in body mass index ranged between -0.09 and 0.45. When the programme goal specifically aimed at weight management, the intervention was found to be more successful than interventions with programme goals that were aimed at preventing cardiovascular disease or improving general health status. Although a considerable part of studies included motivational interventions, only some actually assessed the effects on potential cognitive mediators. A general lack of reporting underlying theoretical models for behaviour change was observed as well as the inclusion of linkage groups and strategies to promote empowerment.