obesity reviews

doi: 10.1111/obr.12211

Review

Effectiveness of Diabetes Prevention Program translations among African Americans C. D. Samuel-Hodge1,2, C. M. Johnson1,2, D. F. Braxton1,2 and M. Lackey3

1

Department of Nutrition, University of North

Carolina-Chapel Hill, Chapel Hill, NC, USA; 2

Center for Health Promotion and Disease

Prevention, University of North Carolina-Chapel Hill, NC, USA; 3

Health Sciences Library Global Engagement,

University of North Carolina-Chapel Hill, Chapel Hill, NC, USA

Received 10 June 2014; revised 13 June 2014; accepted 14 June 2014

Address for correspondence: Dr CD Samuel-Hodge, University of North Carolina-Chapel Hill, Nutrition, 1700 MLK Jr. Blvd., Room 250, CB # 7426, Chapel Hill, NC 27599-7426, USA. E-mail: [email protected]

Summary The Diabetes Prevention Program (DPP) demonstrated risk reduction for incident diabetes through weight loss among all participants, including African Americans. Several DPP translations have been conducted in less controlled settings, including primary care practices and communities; however, there is no detailed compilation of how effective these translations have been for African Americans. This systematic literature review evaluated DPP translations from 2003 to 2012. Eligible records were retrieved using a search strategy of relevant databases and gray literature. Retrieved records (n = 1,272) were screened using a priori criteria, which resulted in 21 full-text studies for review. Seventeen studies were included in the full-text qualitative synthesis. Seven studies had 100% African American samples and 10 studies had mixed samples with African American subgroups. African American participants’ average weight loss was roughly half of that achieved in the DPP intervention. However, with few higher-quality studies, small sample sizes and differences in intervention designs and implementation, comparisons across interventions were difficult. The suboptimal effectiveness of DPP translations among African American adults, particularly women, signals the need for enhancements to existing evidence-based interventions and more high-quality research that includes other at-risk African American subgroups such as men and younger adults of lower socioeconomic status. Keywords: Health promotion, intervention studies, minority health, translational medical research, weight reduction programmes. obesity reviews (2014) 15 (Suppl. 4), 107–124

Introduction Diabetes places a heavy burden on the lives of many African Americans, and preventing its onset represents a critically important public health challenge. The Diabetes Prevention Program (DPP) clearly demonstrated that the onset of diabetes (type 2) could be delayed, if not prevented, in persons already at risk for diabetes, when modest reductions in body weight were achieved through changes in lifestyle behaviours (eating habits and physical activity patterns) (1–3). With an intensive behavioural lifestyle intervention (16 core sessions lasting about 24 weeks), a © 2014 World Obesity

goal of losing 7% of body weight, and physical activity recommendations of at least 150 min per week, the DPP trial provided evidence of a 58% reduction in the risk of diabetes onset. These benefits were observed in both men and women, and in all age, body mass index (BMI), racial and ethnic groups studied (3). Follow-up studies have translated the DPP to more typical or ‘real-world’ settings and among other at-risk populations. Four reviews summarized the findings of these follow-up studies (4–7). They described the weight loss effectiveness of lifestyle interventions modelled on the DPP (4,5), modifications of the DPP curriculum relative to 107 15 (Suppl. 4), 107–124, October 2014

108 African Americans and DPP translations C. D. Samuel-Hodge et al.

outcome effectiveness in community-based studies (6) and the extent to which DPP findings can be generalized to populations and settings not represented in the original DPP (7). Although studies including African Americans were described in these reviews, none specifically focused on the weight loss effectiveness of DPP translations for African Americans, who represented 22% of the original DPP participants. Given that African Americans (especially women) are at high risk for diabetes and obesity (as a risk factor for diabetes), understanding the effectiveness of DPP-informed interventions in real-world settings provides important knowledge to guide African American-specific enhancements for maximum public health impact. These enhancements are particularly important to African American women because in the DPP trial, they had the lowest level of weight loss success (mean weight loss only 63% of that observed in white women (8)). This review aims to address the effectiveness of DPP translations in promoting modest weight loss among African Americans. A targeted look at the DPP outcomes across all racial/ethnic groups (45% of the total sample) showed African American men and women lost 6.6% and 4.9% of their initial body weight, respectively (8). Using these outcomes as a reference point, this review seeks to compare the weight loss results achieved by African Americans in studies described as DPP translations, and implemented in a variety of real-world settings. In this review, as in others discussing DPP translations, the main focus is on the effectiveness of DPP translations in producing modest weight loss, versus diabetes prevention (measured by incident diabetes). As such, this review also includes studies with persons already diagnosed with diabetes. Our rationale for this approach is that the DPP is a behavioural weight loss intervention designed to promote modest weight loss (goal of 7% over 24 weeks). Its effectiveness in reducing incident diabetes was achieved through weight loss. Moreover, modest weight loss is also important for those already diagnosed with diabetes, and is more generally recommended for overweight and obese adults. By including studies with patients already diagnosed with diabetes, or overweight/obese adults without diagnosed prediabetes, we broadly describe the translation of DPP into these different populations for whom modest weight loss would provide health benefits.

Methods A systematic literature review protocol, with inclusion/ exclusion criteria, was developed based on the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement before retrieving records (9,10). PRISMA guidelines are designed to improve transparency and complete reporting of systematic reviews, and include a 27-item checklist and four-phase flowchart (see Fig. 1). 15 (Suppl. 4), 107–124, October 2014

obesity reviews

Eligibility criteria, information sources and searches Records (n = 356) were identified using the following primary information sources: PubMed/MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials (Central). Additional sources (n = 916) for the gray literature included: Web of Science, Google Scholar and reference lists of review publications. The literature review began with preliminary searches to test usefulness of keywords for identifying relevant DPP translations. After creating a search strategy, we systematically searched online databases of PubMed/MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials to identify relevant records. Using the advanced search features, we did three separate searches and combined their results. The database search strategy was based on these search terms: (African American OR African Americans) AND (intervention OR program OR lifestyle) AND (weight loss). The words Diabetes Prevention Program were not included as keywords, in order to capture studies that may have not included ‘Diabetes Prevention Program’ in the title or abstract, but were DPP translations. For the Web of Science and Google Scholar searches, the same search terms were used with the addition of ‘Diabetes Prevention Program’. The literature review process also identified three DPP reviews and three additional reviews more broadly related to the DPP, e.g. weight loss in African Americans. Reference lists from these reviews were manually reviewed for potential DPP translations. All searches were restricted to English-language only and results were limited to 1 January 2003–3 September 2012. We chose the initial boundary of 2003 based on the publication date of the original DPP report.

Study selection Figure 1 shows the flow of records from identification through screening. Three co-authors completed screening based on a protocol developed for this review. Two reviewers independently reviewed the title and abstract of each article using the list of a priori criteria and a systematic procedure. When the two reviewers could not determine if the article met the initial inclusion criteria, the full text was reviewed. The decision to retain or discard an article was made during group discussions and determined by consensus. Initially, article titles and abstracts were screened to identify a broad list of possible DPP translation interventions with African American adults. We excluded articles that were duplicates or were unrelated (n = 1,192) because of language, type of article, intervention content or sample. Articles included were full-length research articles (excluded: abstracts, descriptive papers, reviews, position © 2014 World Obesity

obesity reviews

African Americans and DPP translations C. D. Samuel-Hodge et al. 109

Idenficaon

Records idenfied through database searching* (n = 356)

Addional records idenfied through other sources† (n = 916)

Screening

Records aer duplicates removed (n = 1,212)

Records screened (n = 1,212)

Unrelated records excluded (n = 1,192)

Eligibility

Addional records idenfied through manual search of review publicaons’ references (n = 136), screened (n = 9) and meeng inclusion criteria (n = 1)

Full-text arcles assessed for eligibility (n = 21)

Full-text arcles excluded, with reasons (n = 4)

Included

Duplicate papers from same study (n = 3)

Studies included in qualitave synthesis (n = 17)

Intervenon done before DPP and not DPP translaon (n = 1)

*Databases used included: PubMed/MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials (Central). Records refer to published items (articles, books, reports, dissertations, etc.) †Additional sources of gray literature included: Web of Science, Google Scholar and reference lists of review publications.

Figure 1 Search strategies.

statements, practitioner guidance reports); behavioural lifestyle interventions (excluded: interventions using pharmacotherapy, surgery or commercial weight loss products) and possible DPP translations (e.g. interventions described as a DPP translation, or use of the DPP 16-week core curriculum for weight loss, with restricted calories, low-fat diet and physical activity). Given the few published weight loss interventions including African Americans, there were no exclusion criteria for study design or minimum number of participants during the initial screening phase. However, studies that reported racial characteristics of the sample and did not report including African Americans, non-white or minority participants were immediately excluded. Studies that did not report racial characteristics, or reported including nonwhite or minority participants and met all other criteria, © 2014 World Obesity

were retained for the second round of screening. Additionally, we retained studies in which the authors described the work as DPP translations. The second level of screening was completed using the same approach. A double review process was used to review full-text articles, where two reviewers independently reviewed the articles and final decisions were made in a group discussion. Inclusion criteria focused on specific characteristics most salient to the DPP, such as the weight loss and physical activity goals and the 16-week core curriculum. Articles meeting the following criteria were retained for the full-text review (i) participants at risk for diabetes (e.g. overweight/obese weight status, elevated blood glucose); (ii) minimum sample size of ≥10 if African Americans were a subgroup (if study included 100% African Americans, then there was no sample size criterion); (iii) minimum 15 (Suppl. 4), 107–124, October 2014

110

African Americans and DPP translations C. D. Samuel-Hodge et al.

intervention duration of 3 months; (iv) physical activity recommendations of ≥150 min per week; (v) caloric restrictions to lose 0.5–2.0 lb per week; (vi) minimum set of behavioural components (goal setting, problem solving and self-monitoring of diet, physical activity and weight); (vii) primary outcome of weight loss; (viii) results reported as absolute weight loss in kilograms or percent of initial body weight lost and (ix) weight loss results reported for African Americans, or available from authors. We contacted corresponding authors to obtain additional information for studies that included non-white or minority participants and did not provide details, or for articles that did not report any racial characteristics. Two of our inclusion criteria – minimum sample size (≥10 if African Americans were a subgroup, and no minimum sample for studies with only African Americans) and intervention duration ≥3 months – require some explanation. For this review, we expected to find very few studies with only African Americans; furthermore, we expected those samples to be small, because many would be pilot studies. Thus, it seemed important to include these small studies to capture types of DPP translations. Recognizing that outcomes from such small studies would be unreliable, we established research quality criteria for this review, so we could summarize findings based only on the subset of higher-quality studies. Similarly, we wanted to retain articles from studies with mixed samples that had African American subgroups of comparable size to the full samples of studies with African Americans only. As the smallest sample size for the latter group of studies was n = 8, we selected 10 as a lower limit for African American subgroup size in the mixed sample studies. We selected a minimum of 3 months duration for the intervention because DPP was designed to produce modest weight loss (1–2 lb per week or 0.45–0.9 kg per week) for a weight loss goal of 7% of initial body weight in 24 weeks. Furthermore, losing 5% of initial body weight is often described as the lower limit for ‘clinically meaningful weight loss’. Weight loss rates of 0.5 to 1 lb per week are typically observed in behavioural weight loss interventions (11,12). The highest weight loss in DPP was 0.8 lb per week in white men, which means at 3 months (half of DPP’s duration) the largest weight loss expected was about 10 lb (4.5 kg). Assuming a mean initial body weight of 95–100 kg, a weight loss of 4.5 kg is about 5% of initial body weight. Thus, we chose a 3-month cut-off for intervention duration.

Data abstraction process A data abstraction process was used to record information for each retained study. Criteria for higher-quality studies were established before beginning the data abstraction process and analysis, and were informed by other quality 15 (Suppl. 4), 107–124, October 2014

obesity reviews

assessments (13–18). Studies of higher quality were characterized by (i) random allocation to study groups; (ii) sample size ≥30 and (iii) intention-to-treat analysis or low attrition (≤20%). Two reviewers abstracted data for each study into a table in a Microsoft Word® document. A primary reviewer abstracted the information, and a secondary reviewer reviewed the information. The abstraction highlighted characteristics of the study sample and design; intervention (duration, setting, interventionist and components); process (attendance and attrition); analysis and weight loss outcomes (with a focus on outcomes for African Americans). One abstraction table recorded information for studies with only African American participants, and in another table we recorded information for mixed sample studies. Final decisions about abstracted data were made following discussion by a group of three abstractors. The following weight loss outcomes for African Americans were recorded: absolute weight loss (kg), relative weight loss (% of initial body weight lost), categorical weight loss of ≥5% and ≥7% of initial body weight and a mean weight loss rate (calculated by dividing the absolute mean weight loss by the intervention duration in months). We calculated intervention duration as the time between baseline and the end of the weight loss intervention phase. For studies with weight loss and maintenance phases, the maintenance phase was excluded. We used absolute weight loss in the treatment group (not the difference between study groups) because our reference for assessing weight loss effectiveness was the absolute weight loss among African American participants in the DPP lifestyle intervention-treatment group.

Results Study population, design, duration and timing of follow-up measurements are listed in Table 1. In Table 2, we listed the weight loss intervention characteristics (setting, interventionist, intervention components, intervention contacts, format and frequency of contacts and estimated total dose based on reported number of contacts and duration of contacts). Study results are summarized in Tables 3 and 4 and Fig. 2. Tables and figures only present information for the weight loss phase. For studies with a maintenance phase, this information is not presented.

Study descriptions and intervention characteristics Seven studies (Table 1) included only African American participants (19–26). These studies ranged from eight to 344 participants, with six of the seven studies having fewer than 45 participants. Overall, eight to 175 participants were assigned to the treatment group. Most studies (four of seven) used a single treatment, quasi-experimental design; © 2014 World Obesity

© 2014 World Obesity Two-group parallel RCT

44 adults with BMI 25–45 (100% women) Treatment group, LSI + stress (n = 22) Control group, LSI only (n = 22)

Cox et al., 2013 (22)

Cramer et al., 2007 (27)

67 adults with diagnosed type 2 diabetes (100% minority; primarily AA; gender % not reported) Treatment group (not reported) Usual care group (not reported)

Two-group parallel RCT

Parallel group comparative RCT

One treatment group, quasi-experimental

26 adults with BMI ≥ 25 (85% women)

Yeary et al., 2011 (26)

152 adults ≥45 year with BMI ≥ 25 and diagnosed diabetes (82% AA; 81% women) Treatment group (n = 49; n = 41 AA) Reimbursable lifestyle group (n = 47; n = 42 AA) Usual care group (n = 56; n = 41 AA)

LSI only: 12-week DPP adaptation; group sessions

Two treatment groups (combined), quasi-experimental

37 adults with prediabetes (70% women)

Boltri et al., 2011 (20)

Mixed study samples Mayer-Davis et al., 2004 (33)

None

One treatment group, quasi-experimental

40 adults 18–64 year with BMI > 25 without diagnosed diabetes (85% women)

Dodani et al., 2009, 2010 (23,24)

Usual care: not reported

Reimbursable LSI: condensed version of DPP; 3 group + 1 individual in-person session Usual care: 1 individual session

None

None

Family/friend stratum: Family/friend-low support group (n = 65 index) Individual stratum: Individual-low support group (n = 31 index)

Two-group parallel RCT within each of two strata Family/friend stratum: Participants selected partners to enroll with them and were randomized to participate in classes with (high support) or without (low support) their partners Individual stratum: Participants could form teams within their class (high support); no teams in low support

344 total adults (n = 193 index)‡ with BMI ≥ 27 (90% women) Family stratum: 281 total (n = 130 index) Treatment group: Family/friend-high support group (n = 65 index + 78 partners) Individual stratum: (n = 63 index) Treatment group: Individual-high support group (n = 32 index) Control groups (n = 96 index)

Kumanyika et al., 2009 (25)

None

One treatment group, quasi-experimental

Attention control group: 16-week group-based DPP-adaptation + four health education sessions

8 adults with prediabetes (gender % not reported)

Two-group parallel RCT

Metformin: standard lifestyle recommendations + metformin (Glucophage) twice daily Placebo: standard lifestyle recommendations + placebo twice daily

Comparison or controlgroup(s)

Boltri et al., 2008 (21)

44 women ≥18 year with BMI 30–50 Treatment group (n = 21) Control group (n = 23)

Placebo-controlled, parallel group comparative RCT

2,921 adults ≥25 year with BMI ≥ 24 and impaired glucose tolerance (22% AA; 68% women, total study sample) Lifestyle group (n = 178 AA) Metformin group (n = 162 AA) Placebo group (n = 168 AA)

West et al., 2008 (8)* (The DPP study)

100% AA study samples Befort et al., 2008 (19)

Study design

Study population

Author, publication year

Table 1 Summaries of DPP translations among AA men and women

Duration: 9 months

Duration: 12 months

Duration: 12 weeks

Duration: 16 weeks

Duration: 6 weeks and 16 weeks Follow-up: 6 months and 12 months

Duration: 12 weeks

Duration: 6 months Follow-up: 12, 18, and 24 months

Duration: 16 weeks Follow-up: 12 months

Duration: 16 weeks

Duration: 6 months (16 core sessions) Follow-up: 12 months to 30 months at 6-month intervals

Weight loss intervention duration and follow-up (where applicable)†

obesity reviews African Americans and DPP translations C. D. Samuel-Hodge et al. 111

15 (Suppl. 4), 107–124, October 2014

One treatment group, quasi-experimental (weight loss phase) Two-group parallel RCT

Two-group parallel RCT

Two-group parallel RCT

Two-group parallel RCT

Two-group parallel RCT

Two-group parallel RCT

298 women with BMI ≥ 30 (14% AA, n = 43)

143 low-income women 40–64 year with BMI ≥ 25 (38% AA) Treatment group (n = 72; n = 27 AA) Control group (n = 71; n = 28 AA)

58 adults at risk for diabetes, 65 years or older, and BMI ≥ 25 (34% AA; 90% women) Treatment group (n = 31; n = 14 AA) Enhanced usual care group (n = 27; n = 6 AA)

301 adults with prediabetes, 25 ≤ BMI < 40 (25% AA; 58% women) Treatment group (n = 151; n = 39 AA) Control group (n = 150; n = 35 AA)

70 adults with or without diagnosed diabetes, BMI > 25 (41% AA; 90% women) Treatment group (n = 35; n = 14 AA) Control group (n = 35; n = 15 AA)

261 adults with 27 ≤ BMI ≤ 55 (65% AA; 84% women) Treatment group (n = 124; n = 82 AA‡) Control group (n = 137; n = 88 AA)

189 low-income women 40–64 year with BMI ≥ 27.5 (53% AA) Treatment group (n = 126; n = 67 AA) Control group (n = 63; n = 33 AA)

Perri et al., 2008 (34); Rickel et al., 2011 (35)

15 (Suppl. 4), 107–124, October 2014

Samuel-Hodge et al., 2009 (38)

Whittemore et al., 2009 (40)

Katula et al., 2011 (30)

Hess et al., 2012 (28)

Kumanyika et al., 2012 (32)

Samuel-Hodge et al., 2012, 2013 (36,37)

Duration: 16 weeks

Duration: 12 months Follow-up: 24 months

Intervention duration was calculated as the amount of time between baseline and the end of the weight loss phase of the intervention. For studies with a weight loss and a maintenance phase (or less intensive follow-up phase), the maintenance phase was not included in the study duration. ‡Index participants were the main treatment targets in this study. AA, African American; BMI, body mass index (kg m−2); DPP, Diabetes Prevention Program; LSI, lifestyle intervention; RCT, randomized controlled trial.



Two newsletters on health topics unrelated to weight loss

Brief individual in-person counselling visit every 4 months with primary care provider

Duration: 12 weeks

Duration: 6 months

Two individual in-person sessions + monthly newsletters with healthy lifestyle topics and community resources LSI with 12 behavioural education modules (self-study manual) + 4 individual in-person counselling visits

Duration: 6 months

Duration: 4 months

Enhanced usual care: 2 individual in-person sessions

Two newsletters on health topics unrelated to weight loss

Duration: 6 months

Duration: 6 months Follow-up: 12 and 18 months

Attention control: 24 group session + 2 individual in-person health education sessions (during weight loss) None

Weight loss intervention duration and follow-up (where applicable)†

Comparison or controlgroup(s)

African Americans and DPP translations C. D. Samuel-Hodge et al.

*DPP reference for AAs.

Two-group parallel RCT

217 women with BMI 27–50 and type 2 diabetes (39% AA) Treatment group (n = 109; n = 43 AA) Attention control group (n = 108; n = 41 AA)

West et al., 2007 (39)

Study design

Study population

Author, publication year

Table 1 Continued

112

obesity reviews

© 2014 World Obesity

© 2014 World Obesity

Church (semi-urban, AA church)

Dodani et al., 2009, 2010 (23,24)

Church (rural, middle Georgia)

Community (urban)

Kumanyika et al., 2009 (25)

Boltri et al., 2011 (20)

Church (AA Baptist church in Georgia)

Boltri et al., 2008 (21)

Not reported

University

West et al., 2008 (8) (The DPP study)

100% AA study samples Befort et al., 2008 (19)

Intervention setting

Author, publication year

Trained volunteer (medical or psychology background)

Trained church minister (nurses)

Trained health professional (mostly nutrition or exercise science, graduate-level)

Trained health professional

Trained health professional

Trained health professional

Interventionist

Table 2 DPP translations among AA men and women: intervention characteristics

8–16 h

Total contacts: 16-lesson core curriculum (delivered over 6-month period) Format: individual in-person contact (30–60 min per contact) Frequency: weekly

Total contacts: 12 12 weekly group in-person contacts (60 min per contact)

Weight loss goal: not reported Dietary approach: not reported† Physical activity: not reported† Behavioural: not reported† Other components: introductory prayer

Weight loss goal: 5% Dietary approach: calorie-restricted, low-fat diet Physical activity: 150 min per week Behavioural: goal setting, motivational interviews, problem solving, self-monitoring Other components: Spiritual themes and Biblical scriptures incorporated in content; introductory and closing prayer

6-week: 6–9 h 16-week: 16–24 h

12 h

Total contacts: 24 24 weekly group in-person contacts (90 min per contact)

Total contacts: 6 or 16 6-week programme: 6 weekly group in-person contacts (60–90 min/contact) 16-week programme: 16 weekly group in-person contacts (60–90 min/contact)

36 h

Total contacts: 16 16 weekly group in-person contacts (60–90 min/ contact)

Weight loss goal: not reported† Dietary approach: not reported† Physical activity: not reported† Behavioural: not reported† Other components: introductory prayer Weight loss goal: 5–10% Dietary approach: 1200–1800 kcal d−1 Physical activity: ≥180 min per week Behavioural: self-monitoring Other components: social support, relaxation activity

16–24 h

Total contacts: 16 16 weekly group in-person contacts (90 min per contact)

24 h

Estimated total dose*

Intervention treatment during weight loss phase

Weight loss goal: 7% Dietary approach: decreased energy intake by 500–1000 kcal d−1, with goal of 25% kcal from fat, 5–9 svg d−1 fruits and vegetables Physical activity: ≥150 min per week Behavioural: goal setting, self-monitoring Other components: Motivational interviews

Weight loss goal: 7% Dietary approach: reduction of dietary fat to 25% of calories Physical activity: ≥150 min of brisk walking/week Behavioural: goal setting, motivational interviews, problem solving, self-monitoring (weight, food intake, physical activity)

Intervention components

obesity reviews African Americans and DPP translations C. D. Samuel-Hodge et al. 113

15 (Suppl. 4), 107–124, October 2014

15 (Suppl. 4), 107–124, October 2014

Primary care (rural)

Primary care (urban)

University (Birmingham, AL)

Community (rural)

Cramer et al., 2007 (27)

West et al., 2007 (39)

Perri et al., 2008 (34); Rickel et al., 2011 (35)

Church (rural, lower Mississippi delta)

Yeary et al., 2011 (26)

Mixed study samples Mayer-Davis et al., 2004 (33)

Intervention setting

Author, publication year

Table 2 Continued

Not available

Total contacts: 27 24 weekly group in-person contacts (duration not reported) + 3 individual in-person contacts (45 min per contact for motivational interviews)

Total contacts: 24 24 weekly group in-person contacts (duration not reported)

Weight loss goal: not reported Dietary approach: caloric restriction (1200–1500 kcal d−1), fat intake goal of 33–42 g d−1 Physical activity: ≥150 min per week Behavioural: goal setting, problem solving, self-monitoring and other topics (stimulus control, social support, cognitive restructuring, relapse prevention) Other components: motivational interviews Weight loss goal: not reported Dietary approach: low-calorie (1,200 kcal d−1) Physical activity: ≥210 min per week Behavioural: goal setting, self-monitoring

Not available

Not available

Weight loss goal: 7% Dietary approach: reducing fat intake Physical activity: ≥150 min per week Behavioural: goal setting, motivational interviews, relapse prevention, self- monitoring

Total contacts: 15 8 monthly individual in-person contacts (duration not reported) + 7 biweekly individual phone contacts (duration not reported)

24 h

Total contacts: 16 16 weekly group in-person contacts (90 min per contact)

26 h

Estimated total dose*

Intervention treatment during weight loss phase

Total contacts: 26§ Months 1–4: 3 weekly group in-person contacts (60 min per contact) + 1 weekly individual in-person contact (duration not reported) Months 5–6: 4 biweekly group in-person contacts (60 min per contact) Months 6–12: 6 monthly group in-person contacts (60 min per contact)

Weight loss goal: 10%‡ Dietary approach: 25% kcal from fat, energy intake goals added as needed Physical activity: ≥150 min per week Behavioural: goal setting, problem solving, self-monitoring Other components: Information on diabetes care added in content

Weight loss goal: 7% Dietary approach: DPP dietary goals (25% calories from fat) Physical activity: 150 min per week Behavioural: goal setting, problem solving, self-monitoring Other components: Scriptures and Bible studies incorporated into content; plus added spiritual goal of spending time with God (15 min d−1)

Intervention components

African Americans and DPP translations C. D. Samuel-Hodge et al.

Trained health professional (cooperative extension family and consumer sciences agents or individuals with bachelor’s or master’s degree in nutrition, exercise science or psychology)

Trained health professional (behaviourist, nutritionist, exercise physiologist or diabetes educator)

Trained health professional (nurse case managers)

Trained health professional (nutritionists)

Trained lay health advisors (community members, mostly current or retired teachers)

Interventionist

114

obesity reviews

© 2014 World Obesity

© 2014 World Obesity Trained health professional (primary care nurse practitioners)

Primary care

Community

Primary care

Primary care (urban)

Health departments

Whittemore et al., 2009 (40)

Katula et al., 2011 (30)

Hess et al., 2012 (28)

Kumanyika et al., 2012 (32)

Samuel-Hodge et al., 2012, 2013 (36,37)

Weight loss goal: 5%** Dietary approach: focus on fat and cholesterol quality, increased fruit and vegetable intake, decreased energy intake to achieve 1–2 lb per week loss Physical activity: ≥150 min per week Behavioural: goal setting, motivational interviews, problem solving, self- monitoring

Weight loss goal: 5–10% Dietary approach: US dietary guidelines, with reductions in fat and other sources of calories Physical activity: ≥150 min per week Behavioural: not reported

Weight loss goal: not reported Dietary approach: Time-calorie displacement Physical activity: 150 min per week Behavioural: goal setting, self- monitoring

Weight loss goal: 5–7% Dietary approach: decreased caloric intake (1,200–1,800 kcal d−1) Physical activity: ≥180 min per week Behavioural: goal setting, problem solving

Weight loss goal: 5–7% Dietary approach: not reported† Physical activity: ≥150 min per week Behavioural: goal setting, motivational interviews, problem solving, self-monitoring

Weight loss goal: 5% Dietary approach: 30 + ITT analysis or attrition < 20%. only sample. sample. §Non-randomized controlled trials (during the weight loss phase). ¶Completers only outcome analysis. **Weight loss outcomes not reported. †AA

‡Mixed

AA, African American; DPP, Diabetes Prevention Program; ITT, intention-to-treat.

Figure 2 Weight loss comparisons for AA participants.

15 (Suppl. 4), 107–124, October 2014

© 2014 World Obesity

obesity reviews

African Americans and DPP translations C. D. Samuel-Hodge et al. 119

three (43%) were randomized controlled trials. Two studies limited inclusion to persons with impaired glucose metabolism (diagnosed prediabetes) (20,21) and one excluded persons with diagnosed diabetes (23). Study samples included mostly women (70% to 100%), and reported weight loss phase durations of 12 weeks to 6 months, most commonly 16 weeks. Among the 10 studies with mixed samples (27–40), the proportion of African American participants ranged from 14% to 82% (20–169 participants); one study reported 100% minority (primarily African American) participants (27). In contrast to the studies with only African American samples, 90% of the mixed sample studies were randomized controlled trials, with much larger study samples (range of 58 to 301 participants). Study durations were also longer, ranging from 12 weeks to 12 months, with 6 months as the most common. Similar to the studies with 100% African American participants, mixed sample studies included mostly women (58% to 100%), and focused primarily on overweight/obesity as the main risk factor for inclusion. Only one study limited inclusion to adults with prediabetes (30), and three studies limited their samples to patients with diagnosed diabetes (27,33,39). Among the seven studies with 100% African American samples, most (n = 4) were conducted in church settings, both rural and urban (Table 2). All interventions were delivered as group-based interventions, with or without additional individual sessions, and facilitated by trained interventionists (primarily health professionals). The adaptations to the original DPP content and delivery format varied primarily in the number of contacts and duration. The number of intervention contacts ranged from 6 to 24 (with 12 or 16 sessions being most common), delivered weekly over 3 to 6 months. Total intervention dose ranged from 6 to 36 contact hours among studies with only African American participants. Components added to the DPP content included motivational interviewing (19), stress management (22) or social support (25). Adaptations made to the DPP content in the four church-based studies included adding prayer, Bible study or goals to spend time with God daily (20,21,23,26). In the 10 studies with mixed samples, six (60%) were conducted in healthcare settings (five in primary care practices). In nine of the 10 studies, trained health professionals delivered the interventions; the other used trained community health workers. Unlike the studies with 100% African Americans, intervention delivery varied greatly, with some studies using individual contacts only and others group sessions; both face-to-face and telephone contacts were used. Numbers of intervention contacts ranged from 13 to 27, with contacts occurring weekly to monthly, both across and within interventions. Total intervention dose also varied from 2 to 32 contact hours estimated, based on available data from only 50% of studies. Content adapta© 2014 World Obesity

tions included use of a medication algorithm to help patients with their diabetes medication management (27), an electronic incentive programme (28) and motivational interviewing sessions (39).

Study outcomes Tables 3 and 4 summarize sample characteristics, intervention attendance, study attrition and weight outcomes for the 17 reviewed studies and the original DPP reference. Combined, the mean age of study participants was between 43.7 to 60.3 years, and BMI ranged from a mean of 31.6 to 39.8 kg m−2 (mean of 36 kg m−2 in 100% African American studies and 36.5 kg m−2 in mixed samples). In studies with 100% African American samples, socioeconomic status (e.g. income or education) was reported in only five of the seven studies. Only two classified participants as low- or lower-income (19,26). Among studies with mixed samples, nine reported either income or education. Only three described their samples as low- or lower-income (33,36,38). In comparing these DPP translations with the reference programme, we examined attendance and attrition as well as the primary outcome of weight loss. For the attendance outcome, the DPP and mixed sample rates for attendance and attrition are for all study participants, not African American or minority participants only. In addition, DPP used an individual delivery format, whereas the DPP translations were primarily group-based. Among the DPP translations with only African American participants, reported session attendance (n = 6 studies) ranged from 33% to 69%. In the mixed sample studies, only three of the 10 studies reported mean attendance rates. While almost all studies reported attendance for completing a certain number of contacts, not reporting the average attendance made comparisons across interventions difficult. Among studies reporting attendance for the total sample, attendance ranged from 50% to 72%, slightly higher than the rates in studies with only African American participants and lower than the overall 95% reported for individual contacts in DPP. Compared with the 7% attrition rate reported in DPP, the five DPP translations with only African Americans reported attrition rates of 12% to 41% compared with 3% to 34% in studies with mixed samples. Only two of the 17 studies had attrition rates less than or equal to that in DPP, and six studies reported attrition rates of 20% or higher. Although attrition rates varied greatly, they appeared to be related not to intervention duration or study design, but to intervention setting. The three studies conducted in primary care and urban settings reported the highest attrition rates (25,28,32). To adjust for missing weight loss values, four of the seven studies (57%) with only African American participants used some form of imputation (e.g. 15 (Suppl. 4), 107–124, October 2014

120 African Americans and DPP translations C. D. Samuel-Hodge et al.

last or baseline observations carried forward) to assign final weight values when missing; imputations were also used in 60% of mixed sample studies. All other studies analysed only data from those who returned for follow-up assessment at the end of the weight loss phase. Table 3 shows comparisons with the weight loss outcomes among African American lifestyle intervention participants in the DPP trial (−5.8 kg for men and women combined); 34% lost at least 7% of initial body weight. Where reported, we also noted outcomes for the proportion of participants who lost at least 5% and 7% of their initial body weight. Weight loss outcomes of −1.7 to −4.1 kg (mean −3.0 kg) were reported by studies that had only African American participants, with percent of initial body weight lost averaging −3.2% (Tables 3 and 4). Only two of the seven studies reported weight loss for participants who lost at least 5% or 7% of initial body weight. On average, 37% lost at least 5% of initial body weight (n = 2 studies, range of 27.7% to 48%) (23,25). In one study, 26% lost at least 7% of initial body weight (23). For studies with mixed samples, we report weight loss in both the total sample and for the African American subgroup (where available). For the total sample, absolute weight change ranged from a mean of −8.8 kg to +0.9 kg, with an overall average change of −2.9 kg (n = 9 studies). This corresponded to an overall average weight loss of −2.9% (range −9.0% to +0.9%; n = 10 studies). For the African American subgroups, total weight changes (reported in six studies) ranged from −6.8 kg to +0.9 kg with an overall average weight loss of −2.6 kg, and percent weight loss of −6.9% to +0.7% (mean −2.6%). As in the studies with only African American participants, only a few studies reported weight loss in terms of losing at least 5% or 7% of initial body weight. Where reported (n = 4 studies), 22.5% to 34% of all participants lost at least 5% of initial body weight (8% to 25.9% for African American participants). Only three studies reported ≥7% losses of initial body weight. In these, only 14% to 16.7% of all participants and 0% to 11.9% of African American participants met that criterion.

Summary findings – all studies Table 4 summarizes key characteristics and outcomes for the 17 studies. Compared with DPP, the seven DPP translations with only African American participants included, on average, a slightly younger population, and a larger proportion of women. Among studies with mixed samples, the average participant was slightly older (52.2 years), but the proportion of women was similar to studies with only African American participants. Intervention doses varied widely in both categories of studies because of the wide range in intervention duration. The larger intervention 15 (Suppl. 4), 107–124, October 2014

obesity reviews

doses are likely due to the use of group-based formats, which are often longer than individual contacts used in DPP. For short-term weight loss outcomes, we calculated a weight loss rate (kg per month) based on mean weight loss and duration of the weight loss phase (Table 4 and Fig. 2). For example, the original DPP trial reported a mean weight loss of 5.8 kg for African Americans over 6 months. The weight loss rate was: −0.8 kg per 6 months or −0.97 kg per month (rounded to −1.0 kg per month). All translational studies combined had an average weight loss of about half the weight loss for African Americans in DPP (−2.8 vs. −5.8 kg). As expected, interventions with greater intensity and planned total dose (Table 3) had better weight loss outcomes than those with smaller doses (e.g. 3 h or less). When weight loss was expressed as a monthly rate (to account for different intervention durations), the DPP translations with only African Americans had results more comparable with DPP – an average weight loss of −0.7 kg per month (range −0.4 to −1.2 kg per month) compared with −0.8 kg per month for women and −1.0 kg per month overall. In the mixed sample studies, the average weight loss for African Americans was even less (−0.5 kg per month; range −1.1 to +0.2 kg per month), which is about half of the rate in the original DPP study. Figure 2 depicts reported weight loss and calculated weight loss per month rate for the African American subgroup in each study, relative to the DPP weight loss outcomes for African American participants. Studies were divided into two categories, with the higher-quality studies defined as randomized controlled trials with a sample size of ≥30 and either intention-to-treat analysis or attrition ≤20%. Among these high-quality studies, the mean weight loss and monthly rate (n = 5 studies) remain about the same as in all studies (−2.8 kg and −0.6 kg per month, respectively). This analysis excludes all but one of the smaller studies (22) with only African American participants. Here, we also excluded results from the weight loss phase of the Treatment of Obesity in Underserved Rural Settings (TOURS) study. We did this because of the study design during the weight loss phase and the fact that weight outcomes were analysed only for those who completed the study (34,35), even though that study reported the best weight loss outcomes overall and for African American women (even greater than DPP outcomes). We then examined weight loss outcomes in African Americans within samples limited to participants with diagnosed prediabetes or diabetes only, versus those with broader inclusion criteria. From the three studies that included participants diagnosed with prediabetes, only two small, non-randomized clinical trials reported weight loss among African Americans of −1.7 and −3.4 kg over 4 months (estimated −0.6 kg per month) (20,21). Three mixed sample studies included only participants © 2014 World Obesity

obesity reviews

African Americans and DPP translations C. D. Samuel-Hodge et al. 121

with diagnosed diabetes (27,33,39). Of these, only one reported weight loss outcomes of −3 kg over 6 months in African Americans (rate of −0.5 kg per month) (39).

Discussion Ten years after publication of the DPP results, only a few published studies have translated the DPP intervention among African Americans, who are particularly at high risk for both obesity and diabetes. Among the studies reviewed, the samples were generally small, especially in those with only African American participants. Most of these studies had fewer than 45 participants; only one had over 300 participants (25). A similar pattern also emerged in the mixed sample studies. Moreover, men, younger adults and people of lower socioeconomic status were underrepresented in these studies. In general, then, our results are likely most applicable for slightly older African American women. The weight loss effectiveness findings for African Americans can be summarized as such (i) overall, the DPP translations showed a much lower level of weight loss effectiveness – about half of that reported in DPP immediately post-intervention; (ii) for studies with African Americans only, the overall weight loss expressed as a monthly rate was slightly lower than the DPP rate for African American women, with an even lower overall rate among mixed population studies and (iii) with only a few higherquality studies published, aside from intervention dose, it is difficult to identify features of translated interventions that may be influencing weight loss effectiveness. While in general, translations of an efficacy study such as the DPP are expected to be less effective, for African American women, what was observed in DPP may be the best we can expect for this subgroup with this particular intervention approach. Expecting lower levels of weight loss effectiveness in DPP translations also assumes that the DPP approach is the best and most appropriate for all subgroups. Recent reviews of behavioural lifestyle interventions for weight loss show that in these studies, the average rate of weight loss is about 0.4 to 0.5 kg per week (11,12). The weight loss outcomes for African Americans in DPP (about 0.3 kg per week) and in these translational studies (0.1 to 0.2 kg per week) suggest that additional enhancements are needed to optimize outcomes for African Americans. In the studies we reviewed here, samples with only African Americans fared slightly better in mean weight loss (absolute and monthly rate) than African Americans in the mixed population studies. This finding is contrary to the report of Ard et al. (41), where group racial composition did not appear to affect weight loss outcomes for African Americans. If, however, the focus shifts from group composition to attendance or frequent contacts (factors known to impact weight loss outcomes) (42), a different picture © 2014 World Obesity

emerges. Excluding three studies with individual contacts and the lowest total dose (28,32,40), the average weight loss for African American participants in studies with mixed samples versus African Americans only was −3.8 versus −2.9 kg, respectively. Where reported, the mixed samples had slightly higher attendance rates (62%, n = 3 studies) than African Americans only (56%, n = 5 studies). More generally, the 59% average attendance in these DPP translations (range of 33% to 72%) was lower than the 66% average (range of 35% to 93%) reported by Fitzgibbon et al. in their review of weight loss interventions among African Americans (43). These average attendance rates are even lower than the 76% average rate (range of 57% to 96%) reported in a different review of DPP translations by Whittemore (5), and may partly explain the suboptimal weight loss outcomes in African American participants. Beyond intervention intensity and the average dose received by participants (as measured by attendance), there may be other important factors to target for weight loss interventions among African Americans and mainly older women. Among higher-quality studies (e.g. studies with random group assignment, larger samples and intention-totreat analysis or low attrition) with reported weight loss outcomes for African Americans (22,25,34–37,39), interventions that targeted support from family and friends (25) and stress relief (22) showed promise. In the SHARE study, weight loss was highest in the group where family/friends actively participated in the weight loss intervention and when family members in the pair lost more weight (>5% body weight) (25). In the study by Cox et al., augmenting DPP with a stress management component (relaxation techniques, behavioural and cognitive strategies) benefited participants with moderate to high levels of perceived stress (22). This focus on stress as a potential mediator in weight loss outcomes has been noted elsewhere (5). Other process factors such as training staff for intervention implementation may also influence outcome effectiveness. For example, Perri et al. reported extensive staff training (over 70 h) (34), while Samuel-Hodge et al. provided 26 h of training to health department intervention staff (37).

Limitations A number of limitations, related to the review process and studies included, should be considered when interpreting the findings of this review. Our findings are limited by the cut-off date for study inclusion (new studies may have been published subsequently), and our definition of a DPP translation (e.g. excluding interventions shorter than 3 months). Still further limitations apply to the studies themselves. Because of our focus on weight loss effectiveness in African Americans, we retained studies with very small samples, single-group design and inadequate plans for addressing 15 (Suppl. 4), 107–124, October 2014

122 African Americans and DPP translations C. D. Samuel-Hodge et al.

missing outcome data. These inclusions undoubtedly introduce bias in the reported weight loss outcomes and our estimates of effectiveness. Many of these limitations have been reported in other DPP translation and weight loss intervention reviews (5,43). In particular, the studies with only African American participants were more likely to have smaller samples, and a single-group design. The small, non-randomized clinical trials we included may have been designed as pilot studies, conducted to generate preliminary data for larger trials. If so, then a non-randomized clinical trial design would be much more feasible, less costly and easier to introduce and explain to potential participants during recruitment. An additional limitation was that the comparison groups all received treatment comparable with the treatment group among the studies with only African American participants, and even in the randomized clinical trials. These study designs may have been dictated mostly by efforts to provide a socially (and ethically) acceptable comparison group in a high-risk population. Moreover, when testing a treatment of known effectiveness, a standard control group may be less necessary, especially when the focus is not only effectiveness but also processes of implementation and factors such as reach, adoption and maintenance (44). Other limitations include inadequate descriptions of samples and outcomes by race/ethnicity, failure to report outcomes specific to achievement of weight loss goals (e.g. losing 5% or 7% of initial weight), mean attendance rates and duration of intervention contacts. Estimating the intervention dose (both dose delivered and dose received) and the proportion of participants meeting the study weight loss goals allowed us to better compare studies. Clinically meaningful weight loss, or successful lifestyle obesity treatment, is often defined as weight loss of at least 5% (11,12). When the proportion of participants losing at least this amount of weight is not reported along with the mean weight loss, it is harder to determine the degree of treatment success, or the influence, if any, of outliers on the mean weight loss reported.

Implications and conclusions More effective, evidence-based interventions for weight loss among African American women are needed. Even in the high-resourced DPP intervention, African American women had the lowest weight loss outcomes (3). If this result is influenced by social and cultural processes (45), then finding solutions to this challenge requires an ecological approach. The expanded obesity research paradigm developed by the African American Collaborative Obesity Research Network provides such a model with relevant contextual variables (45). This model suggests that factors relevant to obesity in African Americans include, e.g. the media and marketing environment, women as heads of 15 (Suppl. 4), 107–124, October 2014

obesity reviews

households, social networks that provide norm-setting and support in communities and mechanisms to cope with chronic stresses (particularly those that involve food and physical activity). As these contextual factors are better elucidated, interventions should emerge with greater potential for outcome improvements. These new ecological approaches should include relevant theoretical models and behavioural and cognitive strategies. Another line of research could focus on identifying the magnitude of health benefits realized at lower levels of weight loss effectiveness, especially for African American women. If health benefits are more sensitive to how the weight loss is achieved (e.g. the combination of dietary, psychosocial and physical activity components), rather than how much weight is lost, our approaches to risk reduction could be improved. The suboptimal weight loss effectiveness of DPP translations among African American adults, particularly women, signals the need for not only more research that includes other at-risk African American subgroups (e.g. men and younger adults of lower socioeconomic status) but also argues for enhancements to the existing evidencebased interventions. Such enhancements should be informed by high-quality research to identify relevant social factors that mediate intervention effects on weight loss outcomes in African Americans.

Acknowledgement This research was supported in part by a Robert Wood Johnson Foundation grant to the African American Collaborative Obesity Research Network (AACORN). The content is the responsibility of the authors and does not necessarily represent the views of the Robert Wood Johnson Foundation.

Conflict of interest statement No conflict of interest was declared.

References 1. The Diabetes Prevention Program Research Group. The Diabetes Prevention Program (DPP): description of lifestyle intervention. Diabetes Care 2002; 25: 2165–2171. 2. The Diabetes Prevention Program Research Group. Achieving weight and activity goals among Diabetes Prevention Program lifestyle participants. Obes Res 2004; 12: 1426–1434. 3. The Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002; 346: 393–403. 4. Ali M, Echouffo-Tcheugui J, Williamson D. How effective were lifestyle interventions in real-world settings that were modeled on the Diabetes Prevention Program? Health Aff 2012; 31: 67–75. 5. Whittemore R. A systematic review of the translational research on the diabetes prevention program. Transl Behav Med 2011; 1: 480–491.

© 2014 World Obesity

obesity reviews

African Americans and DPP translations C. D. Samuel-Hodge et al. 123

6. Jackson L. Translating the Diabetes Prevention Program into practice: a review of community interventions. Diabetes Educ 2009; 35: 309–320. 7. Laws R, St George A, Rychetnik L, Bauman A. Diabetes prevention research: a systematic review of external validity in lifestyle interventions. Am J Prev Med 2012; 43: 205–214. 8. West DS, Elaine Prewitt T, Bursac Z, Felix HC. Weight loss of black, white, and Hispanic men and women in the diabetes prevention program. Obesity (Silver Spring) 2008; 16: 1413–1420. 9. Liberati A, Altman DG, Tetzlaff J et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 2009; 339: b2700. 10. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009; 6: e1000097. 11. Butryn M, Webb V, Wadden T. Behavioral treatment of obesity. Psychiatr Clin North Am 2011; 34: 841–859. 12. Wadden TA, Crerand CE, Brock J. Behavioral treatment of obesity. Psychiatr Clin North Am 2005; 28: 151–170. 13. Verhagen A, de Vet H, de Bie R, Boers M, van den Brandt P. The art of quality assessment of RCTs included in systematic reviews. J Clin Epidemiol 2001; 54: 651–654. 14. Oxman AD. Checklists for review articles. BMJ 1994; 309: 648–651. 15. Jadad AR, Moore RA, Carroll D et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 1996; 17: 1–12. 16. Moher D, Jadad AR, Nichol G, Penman M, Tugwell P, Walsh S. Assessing the quality of randomized controlled trials: an annotated bibliography of scales and checklists. Control Clin Trials 1995; 16: 62–73. 17. Verhagen A, de Vet H, De Bie R et al. The Delphi list: a criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus. J Clin Epidemiol 1998; 51: 1235–1241. 18. Wayne P, Kiel D, Krebs D et al. The effects of Tai Chi on bone mineral density in postmenopausal women: a systematic review. Arch Phys Med Rehabil 2007; 88: 673–680. 19. Befort C, Nollen N, Ellerbeck E, Sullivan D, Thomas J, Ahluwalia J. Motivational interviewing fails to improve outcomes of a behavioral weight loss program for obese African American women: a pilot randomized trial. J Behav Med 2008; 31: 367–377. 20. Boltri JM, Davis-Smith M, Okosun IS, Seale JP, Foster B. Translation of the National Institutes of Health Diabetes Prevention Program in African American churches. J Natl Med Assoc 2011; 103: 194–202. 21. Boltri JM, Davis-Smith YM, Seale JP, Shellenberger S, Okosun IS, Cornelius ME. Diabetes prevention in a faith-based setting: results of translational research. J Public Health Manag Pract 2008; 14: 29–32. 22. Cox T, Krukowski R, Love S et al. Stress managementaugmented behavioral weight loss intervention for African American women: a pilot, randomized controlled trial. Health Educ Behav 2012; 40: 78–87. 23. Dodani S, Fields J. Implementation of the fit body and soul, a church-based life style program for diabetes prevention in highrisk African Americans: a feasibility study. Diabetes Educ 2010; 36: 465–472. 24. Dodani S, Kramer M, Williams L, Crawford S, Kriska A. Fit body and soul: a church-based behavioral lifestyle program for diabetes prevention in African Americans. Ethn Dis 2009; 19: 135–141.

© 2014 World Obesity

25. Kumanyika S, Wadden T, Shults J et al. Trial of family and friend support for weight loss in African American adults. Arch Intern Med 2009; 169: 1795–1804. 26. Yeary KH, Cornell CE, Turner J et al. Feasibility of an evidence-based weight loss intervention for a faith-based, rural, African American population. Prev Chronic Dis 2011; 8: A146. 27. Cramer J, Sibley R, Bartlett D, Kahn L, Loffredo L. An adaptation of the diabetes prevention program for use with high-risk, minority patients with type 2 diabetes. Diabetes Educ 2007; 33: 503–508. 28. Hess M, Vance D, McKie P, Burton L, Ard J, Klapow J. Evaluating the feasibility and impact of interactive telephone technology and incentives when combined with a behavioral intervention for weight loss: a pilot study. Nursing (Auckl) 2012; 2: 33–43. 29. Katula J, Vitolins M, Rosenberger E et al. Healthy Living Partnerships to Prevent Diabetes (HELP PD): design and methods. Contemp Clin Trials 2010; 31: 71–81. 30. Katula J, Vitolins M, Rosenberger E et al. 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. 31. Kumanyika S, Fassbender J, Phipps E et al. Design, recruitment and start up of a primary care weight loss trial targeting African American and Hispanic adults. Contemp Clin Trials 2011; 32: 215–224. 32. Kumanyika S, Fassbender J, Sarwer D et al. One-year results of the Think Health! study of weight management in primary care practices. Obesity (Silver Spring) 2012; 20: 1249–1257. 33. Mayer-Davis EJ, D’Antonio AM, Smith SM et al. Pounds Off With Empowerment (POWER): a clinical trial of weight management strategies for black and white adults with diabetes who live in medically underserved rural communities. Am J Public Health 2004; 94: 1736–1742. 34. Perri MG, Limacher MC, Durning PE et al. Extended-care programs for weight management in rural communities: the Treatment of Obesity in Underserved Rural Settings (TOURS) randomized trial. Arch Intern Med 2008; 168: 2347–2354. 35. Rickel KA, Milsom VA, Ross KM, Hoover VJ, Peterson ND, Perri MG. Differential response of African American and Caucasian women to extended-care programs for obesity management. Ethn Dis 2011; 21: 170–175. 36. Samuel-Hodge C, Garcia B, Johnston L et al. Translation of a behavioral weight loss intervention for mid-life, low-income women in local health departments. Obesity (Silver Spring) 2013; 21: 1764–1773. 37. Samuel-Hodge C, Garcia B, Johnston L et al. Rationale, design, and sample characteristics of a practical randomized trial to assess a weight loss intervention for low-income women: the Weight-Wise II Program. Contemp Clin Trials 2012; 33: 93–103. 38. Samuel-Hodge C, Johnston L, Gizlice Z et al. Randomized trial of a behavioral weight loss intervention for low-income women: the Weight Wise Program. Obesity (Silver Spring) 2009; 17: 1891–1899. 39. West DS, DiLillo V, Bursac Z, Gore SA, Greene PG. Motivational interviewing improves weight loss in women with type 2 diabetes. Diabetes Care 2007; 30: 1081–1087. 40. Whittemore R, Melkus G, Wagner J, Dziura J, Northrup V, Grey M. Translating the Diabetes Prevention Program to primary care: a pilot study. Nurs Res 2009; 58: 2–12. 41. Ard JD, Kumanyika S, Stevens VJ et al. Effect of group racial composition on weight loss in African Americans. Obesity 2008; 16: 306–310. 42. Artinian N, Fletcher G, Mozaffarian D et al. Interventions to promote physical activity and dietary lifestyle changes for car-

15 (Suppl. 4), 107–124, October 2014

124 African Americans and DPP translations C. D. Samuel-Hodge et al.

diovascular risk factor reduction in adults: a scientific statement from the American Heart Association. Circulation 2010; 122: 406–441. 43. Fitzgibbon M, Tussing-Humphreys L, Porter J, Martin I, Odoms-Young A, Sharp L. Weight loss and African-American women: a systematic review of the behavioural weight loss intervention literature. Obes Rev 2012; 13: 193–213.

15 (Suppl. 4), 107–124, October 2014

obesity reviews

44. Glasgow RE, Klesges LM, Dzewaltowski DA, Bull SS, Estabrooks P. The future of health behavior change research: what is needed to improve translation of research into health promotion practice? Ann Behav Med 2004; 27: 3–12. 45. Kumanyika S, Whitt-Glover M, Gary T et al. Expanding the obesity research paradigm to reach African American communities. Prev Chronic Dis 2007; 4: A112.

© 2014 World Obesity

Effectiveness of Diabetes Prevention Program translations among African Americans.

The Diabetes Prevention Program (DPP) demonstrated risk reduction for incident diabetes through weight loss among all participants, including African ...
236KB Sizes 0 Downloads 8 Views