The impact of a community-led program promoting weight loss and healthy living in Aboriginal communities: the New South Wales Knockout Health Challenge

Abstract

BackgroundAboriginal people in Australia experience significant health burden from chronic disease. There has been limited research to identify effective healthy lifestyle programs to address risk factors for chronic disease among Aboriginal people.MethodsThe Knockout Health Challenge is a community-led healthy lifestyle program for Aboriginal communities across New South Wales, Australia. An evaluation of the 2013 Knockout Health Challenge was undertaken. Participants’ self-reported physical activity and diet were measured at four time points - at the start and end of the Challenge (via paper form), and 5 and 9 months after the Challenge (via telephone survey). Participants’ weight was measured objectively at the start and end of the Challenge, and self-reported (via telephone survey) 5 and 9 months after the Challenge. Changes in body composition, physical activity and diet between time points were analysed using linear mixed models. As part of the telephone survey participants were also asked to identify other impacts of the Challenge; these were analysed descriptively (quantitative items) and thematically (qualitative items).ResultsA total of 586 people registered in 22 teams to participate in the Challenge. The mean weight at the start was 98.54kg (SD 22.4), and 94% of participants were overweight or obese. Among participants who provided data at all four time points (n=122), the mean weight loss from the start to the end of the Challenge was 2.3kg (95%CI -3.0 to -1.9, p<0.001), and from the start to 9 months after the Challenge was 2.3kg (95%CI -3.3 to -1.3, p<0.001). Body mass index decreased by an average of 0.9kg/m2 (95%CI -1.0 to -0.7, p<0.001) from the start to the end of the Challenge, and 0.8kg/m2 (95%CI -1.2 to -0.4, p<0.001) 9 months after. At the end of the Challenge, participants reported they were more physically active and had increased fruit and vegetable consumption compared with the start of the Challenge, and identified a range of other positive impacts.ConclusionsThe Challenge was effective in reducing weight and promoting healthy lifestyles among Aboriginal people across New South Wales, and has potential to contribute to closing the health gap between Aboriginal and non-Aboriginal people.

Weight change among repeat participants of an Aboriginal community-based weight loss program

“…Males comprise an equal proportion of the overweight/obese Aboriginal population [49]. They may be less likely to lose weight in the KHC [35] and have lower participation and probability of repeating than females, but our results indicate they are no more likely than females to regain lost weight. Similarly, the observed gender difference in weight regain disappeared with participation cycles in the American program [11] and a recent systematic review found participant demographics were not associated with weight loss maintenance [22].…”

“…(Contests lengths and dates can be found in the additional file, supplemental Table 1). The program has been described in detail elsewhere [35]; briefly, teams of 20 or more persons compete to lose weight through PA and healthy eating. Participants may enrol as a member of a team at the beginning of any contest and teams selfdetermine their activities to support healthy lifestyle behaviours.…”

Participant profile and impacts of an Aboriginal healthy lifestyle and weight loss challenge over four years 2012–2015

“…Only 25 reported any evaluation data, few are publicly available and not all include health outcomes 12 . Of the three including weight‐related outcomes, only one was evaluated and showed significant reductions in waist circumference, weight and BMI, and significant increases in intake of vegetables and of fruit 16 . Together, these results suggest that effects of community‐based PA interventions with Aboriginal Australians can result in modest but significant changes in risk profiles, but more evaluations are needed to build the evidence base.…”

“…Community engagement is further strengthened through Challenge Town Committees 20 comprising volunteers across local government, health services and land councils who support and promote the Challenge in their local area. Further details are provided in the Supplementary Materials and elsewhere 16 . An initial evaluation in 2013 showed significant reductions in waist circumference, weight and BMI and significant increases in intake of vegetables and of fruit at the end of the KHC 16 …”

“…Further details are provided in the Supplementary Materials and elsewhere 16 . An initial evaluation in 2013 showed significant reductions in waist circumference, weight and BMI and significant increases in intake of vegetables and of fruit at the end of the KHC 16 …”