Evaluation of a Community-Based Weight Management Program for Predominantly Severely Obese, Difficult-To-Reach, Inner-City Minority Adolescents

Abstract

Abstract:Background: Few interventions targeting severely obese minority youth have been implemented in community-based settings. We evaluate a 9-month multicomponent, community-based program for obese, inner-city adolescents.Methods: Of 5250 estimated eligible adolescents, 349 were recruited; they had a mean age of 15 -2 years, mean BMI %ile 98.9 -1.5, and comprised 52% African American and 44% Hispanic. Longitudinal trends of anthropometric measures were compared 1 year before enrollment (T -12), at baseline (T0) and after program completion (T9). Dietary and physical activity behaviors were compared at T0 and T9. Anthropometric changes were compared at T9 and 18 months (T18) in completers and noncompleters.Results: A majority of participants were severely obese (67%) and expressed low readiness to change behaviors (82%). For intervals T -12 to T0 versus T0 to T9, there were significant decreases in rates of gain in BMI (0.13 vs. 0.04, p < 0.01), BMI percentile (0.0002 vs. -0.0001, p < 0.01), percent overweight (0.001 vs. -0.001, p < 0.01), and BMI z-score (0.003 vs. -0.003, p < 0.01). Significant increases in vegetable and fruit consumption and in vigorous physical activity participation were observed. From T9 to T18, except for a significant increase in BMI (38.3 -7.4 vs. 39.0 -7.5, p < 0.01) in completers, all other anthropometric measures remained unchanged in completers and noncompleters.Conclusions: We demonstrate modest clinical improvements and increased healthy lifestyle behaviors in predominantly severely obese, difficult-to-reach, ethnic minority adolescents attending a community-based weight management program. The loss of clinical improvements 9 months after program completion implies that extending the duration of such a program may prevent long-term weight regain in severely obese adolescents.

Reach and representativeness of ethnic minority women in the Health Is Power Study: a longitudinal analysis

“…Among African American and Hispanic or Latina women in this sample, only about one in five of the women who were originally recruited were retained at the primary outcome measurement endpoint, which is consistent with other randomized controlled trials in the behavioral and clinical sciences [12,14,19,46,47]. Also, similar to other studies, most participants dropped out early in the process, owing likely to both the complexity of behavior change and the efficacy of strategies employed herein to encourage drop out early in the study [48][49][50][51].…”

“…Most studies report the number of people recruited, perhaps reporting recruitment ratios (number recruited/ number eligible or screened) [5,[18][19][20]. In contrast, very few studies report characteristics indicating the representativeness of the sample and whether the sample that was retained through completion of the study represented the sample that was recruited initially [21].…”

Health issues in Hispanic/Latino youth.

“…Despite efforts to resolve barriers (e.g. transportation) for participation in interventions, adolescent adherence and engagement in clinic-based programs remain low (Rieder et al, 2013). Furthermore, because of the serious consequences for adult health, youth who exhibit glucose dysregulation should receive behavioral or pharmacological interventions as recommended by the American Diabetes Association (“Type 2 diabetes in children and adolescents.…”

Paradoxically speaking about engagement in pediatric weight management

“…Compared with their peers, children who adhere to recommendations are also more likely to come from higher‐income families and have parents with higher levels of education . Studies that examined proxy measures of treatment adherence, including programme completion, motivation to make lifestyle changes, and perceived barriers and support, have reported that (i) non‐completers (vs. completers) are more likely to be heavier , older, of ethnic minority, and with a lower income and (ii) children with obesity (vs. less obese children) are less ready as well as perceive more barriers and less support to make healthy lifestyle changes . Taken together, these findings suggest that children who are less likely to adhere to dietary and physical activity guidelines are more affected by or at a higher risk of obesity.…”