Jane Garvin

Design of a cluster-randomized controlled trial of a diabetes prevention program within African–American churches: The Fit Body and Soul study

Evidence from varied community settings has shown that the Group Lifestyle Balance (GLB) Program and other adaptations of the Diabetes Prevention Program (DPP) intervention are effective in lowering diabetes risk. Most DPP data originated from studies of pre-diabetic whites, with only sparse evidence of the effect of DPP in African Americans (AAs) in community settings. This paper describes the design, methods, baseline characteristics and cost effective measures, of a single-blinded, cluster-randomized trial of a faith-based adaptation of the GLB program, Fit Body and Soul (FBAS). The major aims are to test efficacy and cost utility of FBAS in twenty AA churches. Randomization occurred at the church level and 604 AA overweight/obese (BMI≥25kg/m(2)) adults with fasting plasma glucose range from normal to pre-diabetic received either FBAS or a health-education comparison program. FBAS is a group-based, multi-level intervention delivered by trained church health advisors (health professionals from within the church), with the goal of ≥7% weight loss, achieved through increasing physical activity, healthy eating and behavior modification. The primary outcome is weight change at 12weeks post intervention. Secondary outcomes include hemoglobin A1C, fasting plasma glucose, waist circumference, blood pressure, physical activity level, quality of life measures, and cost-effectiveness. FBAS is the largest known cohort of AAs enrolled in a faith-based DPP translation. Reliance on health professionals from within the church for program implementation and the cost analysis are unique aspects of this trial. The design provides a model for faith-based DPPs and holds promise for program sustainability and widespread dissemination.

Characteristics Influencing Weight Reduction Among Veterans in the MOVE!® Program

Obesity is a common health problem for veterans. This study explored background and program characteristics associated with a 5% weight reduction for veterans enrolled in MOVE!®, a weight management program. For data analysis, 404 veteran records were examined using logistic regression. Background characteristics included socio-demographic variables, comorbidity, body mass index, rurality, and Veterans Administration (VA) priority group. Program characteristics included the program type (group attendee or self-managed) as well as the number and type of provider contacts. Thirteen percent of participants achieved a 5% weight reduction. Age in years (odds ratio [OR] = 1.04) and the number of group visits (OR = 1.05) were significant predictors for achieving a 5% weight reduction. Given the importance of weight reduction, health professionals should consider these significant predictors when planning weight-reduction programs for veterans.

Weight Reduction Goal Achievement with High‐Intensity MOVE!® Treatment

OBJECTIVE The purpose of this study was to examine the effect of high-intensity treatment with the behavioral weight reduction program, MOVE!(®), available at Veterans Administration Medical Centers, on achieving at least a 5% weight reduction 6 months after enrolling in the program. MOVE!(®) is free to veterans but little is known about the recommended number of sessions. DESIGN AND SAMPLE Using longitudinal clinical data from electronic health records of 216 MOVE!(®) program participants, weight reduction was examined in this secondary data analysis. MEASURES Based on the 2013 guidelines for overweight and obesity management, weights were evaluated at baseline and 6 months following enrollment in the program, and high-intensity MOVE!(®) was determined by attending 14 or more sessions within the first 6 months following enrollment. RESULTS High-intensity MOVE!(®) participants were five times as likely to achieve at least the 5% weight reduction goal at 6 months compared to those participants with low intensity, while controlling for age, gender, and race (OR = 4.74; CI: 1.3, 17.2; p < .02). CONCLUSION This research supports the 2013 recommendations for high-intensity lifestyle intervention as participants who completed 14 or more sessions were almost five times more likely to achieve a 5% weight reduction.

Percent weight reduction required to achieve minimal clinically important improvements in health-related quality of life among African Americans: A secondary analysis of the fit body and soul study

Objective To calculate the percent weight reduction required to achieve minimal clinically important improvement (MCII) in health-related quality of life (HRQOL) Design Secondary data analysis from the longitudinal cohort of a single-blinded, cluster-randomized community trial to test the efficacy of the faith-based adaptation of the Diabetes Prevention Program Setting African-American churches Participants This study included 472 congregants with a body mass index of ≥ 25 and fasting plasma glucose<126 mg/dl. Main Outcome Measure Percent weight reduction required to achieve the MCII in HRQOL measured by two instruments, SF-12 and EQ-5D, one year following baseline Analysis The percent weight reduction required to achieve established MCII in SF-12 Physical Component Summary (PCS), SF-12 Mental Component Summary (MCS), and EQ-5D Health Status (HS) at one-year follow-up were calculated using fitted linear regression models. In addition to models for the total sample, we generated models, stratified by baseline BMI, PCS, and HS, to calculate the percent weight reduction required to achieve MCII in HRQOL for those most in need of weight reduction and those in need of improved HRQOL. Results The percent weight reduction was a significant predictor of improvement in the SF-12PCS and the EQ-5DHS but not SF-12MCS. To achieve a MCII in SF-12PCS and EQ-5DHS, 18% and 30% weight reductions were required, respectively. A smaller percent weight reduction was required when the baseline BMI was ≥ 40. Conclusions and Implications Improvements in HRQOL among African-American congregants seeking weight reduction required more than the 3–5% weight reduction associated with improvements in physical health.