Testing the efficacy of evidence-based community strategies in support of weight-loss program among overweight AA women in the Deep South Principal Investigator: Dr. Monika Baskin Obesity has been implicated as a cancer risk factor. Residents ofthe Deep South, of whom about 1/3 are AA, are at particular risk. Rates of overweight and obesity among AA women in Alabama and Mississippi are among the highest in the nation. Through the CBPR process, members of our community network have consistently identified nutrition and physical activity as priority areas for program activities;however, they note significant environmental barriers to healthy eating and active living (e.g., limited availability of health affordable food and access to safe and convenient opportunities for physical activity). In direct response to this feedback and in light of promising evidence ofthe success of multilevel (individual, environment/policy) approaches to achieving and sustaining weight loss;the proposed study seeks to answer the research question: Do evidence-based community strategies supporting weight loss in addition to an evidence-based individual weight-loss program result in greater improvements in weight status among overweight AA women residing in rural communities in the Deep South? To date, there are no published studies of multilevel weight loss inten/entions for black women residing in rural communities. Using a two-group clustered randomized design, 400 black women residing in one of eight demographically-similar rural communities in the Black Belt of Alabama and Mississippi Delta (4 sites per state), will receive one of two interventions: 30-month behavioral weight loss intervention (Group 1) or 30-month behavioral weight loss intervention plus supportive community strategies (Group 2). Group 2 communities will be provided funds and technical assistance to implement strategies promoting weight management. All communities will participate in the evidence-based behavioral intervention delivered by local DSN project staff and Community Health Advisors as Research Partners (CHARPs). Change in body weight (primary outcome) and other clinical indicators such as waist circumference, blood pressure, glucose, and lipids (secondary outcomes) will be assessed at multiple periods to determine intervention efficacy. DSN investigators in collaboration with local DSN staff and CHARPs will develop and disseminate methods, results, and lessons learned from the study to community stakeholders and the scientific community Racial and ethnic minorities and socioeconomically disadvantaged populations experience a greater cancer burden(1) These same groups are disproportionately impacted by a myriad of co-morbid conditions including type 2 diabetes, hypertension, and cardiovascular disease(1-3) Obesity, believed in large part to be the result of positive energy balance, has been implicated as a risk factor for cancer and other conditions. This study extends a 9-year academic-community partnership (Deep South Network for Cancer Control) between UAB and communities throughout Alabama and Mississippi to reduce or eliminate cancer health disparities between African Americans and whites. Through the CBPR process, community members have consistently identified healthy eating and physical activity as priority areas for intervention in DSN counties. Community-based nutrition and physical activity interventions aimed at individual behavior change were included in the currently funded DSNCC;however, similarto other published work, these programs have had modest success with our target population. Our participating community members communicated to us the challenges with sustained behavior change in the face of communities that are not supportive of healthy eating and active living. In addition, responses from >300 attendees at our annual CNP meeting who were asked about next steps in our partnership, suggested more concerted effort to improve the built environment to promote healthy lifestyles (including weight loss) to reduce cancer risk. Multilevel (individual, environment/policy) approaches have shown promise in achieving and sustaining weight loss(4,5) among a sample of predominately white children. To date, there are no published studies of multilevel weight-loss interventions for AA women in rural communities. The proposed study will evaluate the efficacy of a comprehensive, evidence-based, and culturally relevant intervention including the behavioral weight-loss program from the Weight Loss Maintenance (WLM) trial (6,7) and community strategies to prevent obesity(8) on weight loss among overweight AA women in the Deep South.
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