Community-based Lifestyle Balance Program

OBJECTIVE(S): The Diabetes Prevention Program Research Group (DPP) showed that their Lifestyle Balance Program delayed or prevented the onset of diabetes. However, the resources to hire trained dieticians and to provide participant incentives may not be available in the community. With a focus on sustaining positive effects of the program and lowering cost while maintaining integrity, our study implements a modified version of the DPP Lifestyle Balance Program protocol using local community resources. The program supports Latino and African American disadvantaged women in achieving 7%weightloss, healthy eating, and 150 minutes of physical activity every week. We also evaluate the facilitators and barriers to reaching and maintaining these goals.

METHODS: The Community Based Lifestyle Balance Program, adapted from the Diabetes Prevention Program, includes a 3-month core curriculum (8 group nutrition and motivation classes, 6-8 individual health counseling session, journaling, and community physical activity sessions) and 3-month post core curriculum (field trips to the grocery store, health fair). To achieve the weight loss goal, participants will be asked to lower their fat intake and/or suggest a calorie limit. Participants gradually increase physical activity to a minimum 2.5 hours every week (about 30 minutes per day for 5 days each week). Participants are also invited to weekly exercise activities such as walking and dance classes. Participants are asked SF36, eating/exercise habits, mood, life satisfaction, community, demographics, family (finances, language, place of birth), and feelings about control over your health, and self-confidence at weeks 1, 12, 26 and at 6 months after the study.

FINDINGS / RESULTS: Results in the Latino women groups are very similar to those found in the Diabetes Prevention Project with 60% who met their weight goal of 7% of initial weight and 65% who consistently met the physical activity goal of at least 150 minutes per week. We also found that presence of depression is a powerful predictor of failure to meet weight loss and exercise goals. Of those who did not reach goal, 72% were depressed. Of those who reached goal only 22% were depressed. Data analysis is pending in the African American groups; 2 groups are currently in progress.

STATUS: As with the Diabetes Prevention Program, we find that nearly half of our Latino participants do not reach their weight loss or exercise goals. We will examine the impact of a short-term cognitive behavioral intervention shown to be effective for treating depression in low-income Latinas, on women's ability to benefit from the community based DPP intervention. We will integrate our CBT intervention within our community based DPP intervention, so that women will receive both interventions in an integrated manner. We will randomly assign low-income, depressed Latinas to: community-based DPP plus referral for community depression care or community-based DPP enhanced with a CBT intervention for depression. We have modified our intervention for young African American women to be integrated within a church setting so that women won't need to decide between their church commitment and their diet and exercise program. Our modified intervention is called "Building Healthy Temples."

IMPACT: Development of sustainable prevention strategies is critical especially for Latina and African American women who are overweight. This project moves one step closer to achieving sustainable preventative healthy lifestyle changes to decrease chronic disease among disadvantaged populations who have limited access to heath care.