Obesity is a compelling public health problem in the US, with over 6o96 of adults either overweight or obese. The obesity epidemic disproportionately affects specific racial/ethnic groups, notably African Americans, as well as populations in the Southern US, in rural regions and those of low socioeconomic status. It is intertwined with the diabetes epidemic and elevates risk for other chronic diseases, and thus is a priority condition targeted to remediate racial/ethnic health disparities. Obesity is strongly rooted in lifestyle behaviors, which are amenable to change, as demonstrated by the Diabetes Prevention Program (DPP) Lifestyle intervention that effectively produced weight loss and delayed onset of type 2 diabetes among highrisk individuals. The DPP Lifestyle intervention was successful across all age and ethnic groups, however it was delivered by health professionals and targeted highly motivated volunteers. To realize the full benefit of the DPP Lifestyle Intervention, translation to real world settings is needed, recognizing the need to identify cost-effective delivery modes. Community Health Workers (CHWs) may be a viable option in this respect, however data are not available on the DPP Lifestyle intervention delivered by CHWs. The overall goal of this 5-year randomized, controlled trial is to examine the efficacy and cost effectiveness of CHWs in delivering the DPP Lifestyle Intervention to overweight adults in rural, predominantly African American communities in the Arkansas Delta. We propose to randomize individuals (N=2so) to receive the DPP Lifestyle intervention delivered by Community Coaches (CHWs), delivered by health professionals (Professional Coaches) or to an assessment-only control. Primary aims are: (i) to determine 6-month weight loss among participants in the Community Coach condition compared to controls; (2) compare efficacy of Community Coaches at achieving weight loss maintenance over 12 months compared with Professional Coaches; and (3) determine cost effectiveness at 18 months of Lifestyle Intervention delivered by Community Coaches compared with Professional Coaches. Secondary outcomes include physical activity, diet behavior, quality of life, treatment satisfaction and process data to measure intervention delivery and fidelity. The project seeks to translate the DPP Lifestyle intervention and contribute information necessary to inform efforts to reduce racial and ethnic health disparities in rural, underserved communities by ameliorating obesity in this high risk group.
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