A community-based lifestyle and weight loss intervention promoting a Mediterranean-style diet pattern evaluated in the stroke belt of North Carolina: the Heart Healthy Lenoir Project

Abstract

BackgroundBecause residents of the southeastern United States experience disproportionally high rates of cardiovascular disease (CVD), it is important to develop effective lifestyle interventions for this population.MethodsThe primary objective was to develop and evaluate a dietary, physical activity (PA) and weight loss intervention for residents of the southeastern US. The intervention, given in eastern North Carolina, was evaluated in a 2 year prospective cohort study with an embedded randomized controlled trial (RCT) of a weight loss maintenance intervention. The intervention included: Phase I (months 1–6), individually-tailored intervention promoting a Mediterranean-style dietary pattern and increased walking; Phase II (months 7–12), option of a 16-week weight loss intervention for those with BMI ≥ 25 kg/m2 offered in 2 formats (16 weekly group sessions or 5 group sessions and 10 phone calls) or a lifestyle maintenance intervention; and Phase III (months 13–24), weight loss maintenance RCT for those losing ≥ 8 lb with all other participants receiving a lifestyle maintenance intervention. Change in diet and PA behaviors, CVD risk factors, and weight were assessed at 6, 12, and 24 month follow-up.ResultsBaseline characteristics (N = 339) were: 260 (77 %) females, 219 (65 %) African Americans, mean age 56 years, and mean body mass index 36 kg/m2. In Phase I, among 251 (74 %) that returned for 6 month follow-up, there were substantial improvements in diet score (4.3 units [95 % CI 3.7 to 5.0]), walking (64 min/week [19 to 109]), and systolic blood pressure (−6.4 mmHg [−8.7 to −4.1]) that were generally maintained through 24 month follow-up. In Phase II, 138 (57 group only, 81 group/phone) chose the weight loss intervention and at 12 months, weight change was: −3.1 kg (−4.9 to −1.3) for group (N = 50) and −2.1 kg (−3.2 to −1.0) for group/phone combination (N = 75). In Phase III, 27 participants took part in the RCT. At 24 months, weight loss was −2.1 kg (−4.3 to 0.0) for group (N = 51) and −1.1 kg (−2.7 to 0.4) for combination (N = 72). Outcomes for African American and whites were similar.ConclusionsThe intervention yielded substantial improvement in diet, PA, and blood pressure, but weight loss was modest.Trial registrationclinicaltrials.gov Identifier: NCT01433484Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3370-9) contains supplementary material, which is available to authorized users.

Examining the Association between Intervention-Related Changes in Diet, Physical Activity, and Weight as Moderated by the Food and Physical Activity Environments among Rural, Southern Adults

“…18–21 However, in this study, the dietary content was modified to include a major focus on improving dietary fat as well as carbohydrate quality. 22, 23 The dietary recommendations were very similar to those advocated in the PREDIMED randomized trial intervention study; 16, 23–25 hence, the dietary intervention was called Med-South. (The Med-South dietary intervention materials can be found on the HHL Project website at: http://www.hearthealthylenoir.com/lifestyle-intervention-materials.)…”

“…16 The HHL lifestyle intervention study, one of three coordinated studies (lifestyle, high blood pressure, and genomics) was conducted as part of the overall HHL Project, a collaborative research effort designed to reduce CVD risk and disparities in risk in Lenoir County, as previously described. 16, 17 The study was approved by the [Blinded for Review] Institutional Review Board, with data collection beginning on September 20, 2011, and six-month data collection completed on April 27, 2012. Research staff screened potential participants (primarily by phone) to determine if they met eligibility criteria, as described previously.…”

“…Research staff screened potential participants (primarily by phone) to determine if they met eligibility criteria, as described previously. 16 If the participant met eligibility criteria, he/she was invited to an enrollment visit where written informed consent was first obtained, and then study-related questions were answered. 16 …”

“…Compared on baseline characteristics, those who did not return for follow-up measures were more likely to be male, white, younger, and of lower educational status. 16 …”

“…During Phase 1, the focus of this paper, the lifestyle intervention was given during 4 counseling sessions at monthly intervals with outcomes assessed at 6-month follow-up as previously described in detail in a prior publication. 16 The intervention content was culturally appropriate to the Southern diet and the lifestyle recommendations were individually-tailored to participants’ baseline lifestyle behaviors, as previously assessed in randomized trials. 18–21 However, in this study, the dietary content was modified to include a major focus on improving dietary fat as well as carbohydrate quality.…”