Weight loss in obese Mexican Americans treated for 1-year with orlistat and lifestyle modification

Abstract

OBJECTIVE:To evaluate the effectiveness of a culturally appropriate lifestyle intervention combined with orlistat in producing weight loss with obese Mexican-American women. SUBJECTS: Mexican-American women (N ¼ 108), aged 21-65 y, with a body mass index (BMI) Z27 kg/m 2 were randomized to 1 y of treatment with orlistat and a culturally tailored lifestyle modification intervention (OLM; n ¼ 56) or a wait-list control group (WLC; n ¼ 52). DESIGN: A randomized, controlled, open-label 12-month study. Orlistat was dosed at 120 mg, three times per day. The OLM intervention included behavior modification, a low-fat (r30% of total daily calories) diet, and moderate physical activity (Z150 min/week). MEASUREMENT: Primary outcomes included changes in body weight (kg), BMI, waist circumference, blood pressure, glucose, and lipids. RESULTS: A total of 72 (37 OLM, 35 WLC) and 66 participants (32 OLM, 34 WLC) completed the 6-and 12-month follow-ups, respectively. Repeated-measures ANOVA demonstrated a significant time  treatment interaction (Wilks' l ¼ 12.61; Po0.001), indicating that OLM-treated patients achieved significant weight loss relative to the WLC group during the study (mean percentage weight loss7s.e.m.; À8.1%71.2 vs À1.6%70.7 at 6 months and À8.8%71.5 vs À0.2%71.0 at 12 months, respectively). OLM-treated patients also experienced significant reductions in waist circumference, low-density-lipoprotein, and total cholesterol. CONCLUSIONS: This study demonstrates the effectiveness of an intervention combining orlistat and lifestyle modification with Mexican-American women, a population with substantial risk for obesity. International Journal of Obesity (2003) 27, 1486-1493. doi:10.1038/sj.ijo.0802439Keywords: Mexican American; women; orlistat; culturally appropriate Mexican Americans in the United States are at increased risk for overweight and obesity and tend to develop obesity at an earlier age than non-Hispanics. 1-4 Currently, among Mexican-American women and men, the prevalence of overweight or obesity (body mass index (BMI) Z25 kg/m 2 ) is 71.9 and 74.7%, respectively. 5 The prevalence of abdominal obesity (ie, waist circumference 488 cm for women and 4102 cm for men) is 62.7% for Mexican-American women and 30.6% for Mexican-American men. 6 Mexican Americans are also predisposed to develop more atherogenic patterns of body fat distribution. 7,8 Early weight gain and centralized and upper body fat have been associated with the onset of diabetes in Mexican Americans. 9 For example, Mexican Americans with centralized obesity are at significantly greater risk for low HDL-C, high total cholesterol, and high blood glucose than nonobese individuals or those with nonabdominal obesity. 8 In addition, 50% of Mexican-American adults 35 y or older either have diabetes themselves or have a first-degree relative with diabetes. 10 Modest weight loss can have a beneficial effect on cardiovascular disease and diabetes risk factors. 1,[11][12][13][14] It is likely that Mexican Americans, and other minority groups, would also ...

Anatomy of Culturally Sensitive Interventions Promoting Nutrition and Exercise in Hispanics: A Critical Examination of Existing Literature

“…The theory most frequently used to guide the interventions was the social learning theory (41.2%; Fitzgibbon, Stolley, Dyer, VanHorn, & KauferChristoffel, 2002; Poston et al, 2001; Rosal et al, 2005; Staten et al, 2004; Trevino et al, 2004; Vazquez, Millen, Bissett, Levenson, & Chipkin, 1998). Other theories or frameworks used were the social support framework (Avila & Hovell, 1994; Castro et al, 1995; Poston et al, 2001, 2003), a peer health worker model (Castro et al, 1995; Staten et al, 2004), self-change behavioral modification strategies (Avila & Hovell, 1994), a systems perspective (Castro et al, 1995), a self-determination theory and transtheoretical model (Fitzgibbon et al, 2002), a patient–provider communication model (Staten et al, 2004), a community organization framework (Thompson, Coronado, Chen, & Islas, 2006), socioecological theory (Trevino et al, 2004), social marketing and the Precede-Proceed Model (Wechsler, Basch, Zybert, & Shea, 1998), and a patient-centered counseling model (Rosal et al, 2005). …”

“…However, authors used a varied terminology to describe the cultural qualification of the intervention: culturally appropriate (Elder et al, 2006; Poston et al, 2001, 2003; Thompson et al, 2006), culture specific (Elshaw, Young, Saunders, McGurn, & Lopez, 1994; Fitzgibbon, Stolley, Avellone, Sugerman, & Chavez, 1996; Rosal et al, 2005; Vazquez et al, 1998), or culturally focused (Castro et al, 1995). …”

“…Additional deep-structure components included the literacy level of participants (39%), use of social support and networks (29%), and incorporation of Hispanic cultural values in intervention design or implementation (29%). Hispanic values considered in the interventions included familism (Castro et al, 1995; Cousins et al, 1992; Fitzgibbon et al, 1996, 2003, 2006; Poston et al, 2003; Rosal et al, 2005; Trevino et al, 2004; Vazquez et al, 1998; Wechsler et al, 1998); trust, or confianza (Castro et al, 1995; Fitzgibbon et al, 2002); the need to establish smooth relationships, or simpatia (Fitzgibbon et al, 2003); and fatalism, or lack of empowerment (Vazquez et al, 1998). …”

Long-term outcomes from a multiple-risk-factor diabetes trial for Latinas: ¡Viva Bien!

“…Brown, Garcia, Kouzekanani, and Hanis [61] reported a 12-month retention rate of 90% in their study involving a culturally competent lifestyle intervention targeting Mexican- Americans with type 2 diabetes. Poston et al [62] reported a 12-month retention rate of 66% in a study of 108 Mexican-American women testing a culturally tailored lifestyle modification intervention.…”

Tu Salud, ¡ Si Cuenta! : Exposure to a community-wide campaign and its associations with physical activity and fruit and vegetable consumption among individuals of Mexican descent

“…However, addressing lifestyle changes to prevent obesity and related diseases among ethnic minority populations remains a challenge (Corsino, et al, 2012; Faucher & Mobley, 2010; Lindberg, et al, 2012; Ockene et al, 2011; Poston et al, 2003; Rosal et al, 2011; Vincent, 2009). The Centers for Disease Control and Prevention, National Cancer Institute, and other national agencies have registries and searchable databases of evidence-based interventions (EBIs) to support their wide-spread dissemination and implementation and reach ethnic minority populations with the best approaches to addressing chronic diseases and other leading causes of mortality and morbidity (NREPP, 2015).…”