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Guidelines on Overweight and Obesity: Electronic Textbook
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A.4.

Annotated Bibliography of Studies Specifically Designed To Achieve Weight Reduction in Special Populations

The following annotations describe weight reduction studies in special populations or situations.  From the total number of studies identified in which minorities or other special populations were included, the studies listed below are those for which the treatment or intervention program included design features specifically geared to the needs of a minority population or other special population of interest. Thus, these studies provide examples of ways in which researchers or service practitioners have attempted to adapt conventional weight reduction approaches to the needs of diverse client groups.  The annotations highlight the published reports with respect to the setting and the nature of the program. Study results are not included because relatively few studies are randomized controlled trials, several are pilot studies or program descriptions, and many do not lend themselves to a clear evaluation of success rates. Boldface material indicates the particular population or situation studied.

Agurs-Collins TD, Kumanyika SK, TenHave TR, Adams-Campbell LL. A randomized controlled trial of weight reduction and exercise for diabetes management in older African American subjects. Diabetes Care 1997;20:1503-1511 (362).

A randomized controlled trial conducted at an urban hospital in Washington, DC. The intervention group was offered 12 weekly group sessions, 1 individual session, and 6 biweekly group sessions; the usual care group was offered one class and two informational mailings. Participants were recruited through various clinics and through community outreach, including announcements in newsletters and church bulletins, flyers distributed at clinics and churches, and presentations at community gatherings.  Program materials depicted African American individuals, families, and community settings and reflected language, social values, and situations relevant to older Americans or African Americans.  All guidance about foods and recipes was based on types of foods and flavorings characteristic in African American communities. Recipes were provided by participants and used in direct instruction. Ample time was allowed for the participants to discuss and work through dietary adherence issues unique to their social contexts (e.g., church meals).

Avila P, Hovell MF. Physical activity training for weight loss in Latinas: A controlled trial. Int J Obes 1994;18:476-482 (631).

A 10-week physical activity program designed for obese Latina women in San Diego, California. Volunteers were recruited through flyers that were distributed in a low-income community medical clinic, the local church, English as a Second Language classes, and the local grocery store. Sessions focused on self-change behavior, nutrition education, gaining support from a "buddy," and an exercise component.  The sessions were led by a bicultural, bilingual physician.

Cousins JH, Rubovits DS, Dunn JK, Reeves RS, Ramirez AG, Foreyt JP. Family versus individually-oriented intervention for weight loss in Mexican American women. Public Health Rep 1992;107(5):549-555 (632).

A study that compared three groups of obese Mexican American women in Texas, ages 18 to 45 years. Families were recruited through media promotion and local contacts within the community, primarily through churches and health agencies. The comparison group received a bilingual manual with information on nutrition, exercise, and behavioral principles for weight loss. The manual was designed to reflect the cultural values of the population. The comparison group also received a cookbook with recipes for fat-modified traditional Mexican American foods. The individual group received the same printed materials and attended weekly classes led by bilingual registered dietitians. Classes provided individual and group activities. The family group received the materials and attended classes that emphasized a family-oriented approach to making changes in eating habits and exercise behavior; spouses and children were invited. Family group members received a modified version of the manual with additional information on partner support and parenting skills to encourage family changes in eating and exercise behaviors. Spouses were encouraged to attend classes with the participants, and separate classes were held for preschool-age children.

Daniel EL. A multi-intervention weight management program for low-income rural women. J Am Diet Assoc 1989;89:1310-1311 (633).

A pilot weight management program involving low-income rural women who were enrolled in the Special Supplemental Food Program for Women, Infants and Children (WIC) and/or food stamp programs in rural western New York State. The program included five biweekly sessions that focused on nutrition, behavior modification, aerobic exercise, and stress management. Handouts were designed for low-literacy or non-English-speaking adults, and plastic food models were used to discuss serving sizes and portion control. Suggestions for healthful eating were based on WIC foods whenever possible. Exercise focused on aerobic dance because it can done at home with no special equipment or child care needed and can be adapted to almost any kind of music.

Domel SB, Alford BB, Cattlett HN, Gench BE. Weight control for black women. J Am Diet Assoc 1992;92(3):346-348 (634).

A program for black women with low educational levels at four literacy program sites in economically disadvantaged areas of Dallas, Texas. The program consisted of 11 weekly sessions taught by a registered dietitian and included nutrition education, behavior modification, active learner participation, and self-responsibility.  It stressed practical, lifelong methods for weight control. Materials were geared toward low-literacy participants; for example, a green traffic light was used for low-calorie foods, and a yellow traffic light was used for high-calorie foods. Shopping tips included ways to save money and decrease calories; audiocassettes included a radio show format with disk jockey, guest speaker, and "phoned-in" questions from listeners.

Domel SB, Alford BB, Cattlett HN, Rodriguez ML, Gench BE. A pilot weight control program for Hispanic women. J Am Diet Assoc 1992 Oct;92(10):1270-1 (635).

A 10-session pilot weight control program for Hispanic women in Dallas, Texas. Modifications to fit the Hispanic culture included adding appropriate ethnic foods and recipes, stressing the importance of health for the entire family, and reformatting some of the materials. To this end, some of the pamphlets were changed to a comic book format, and audiocassetes were changed from a radio show format to a dialog between two comadres. The program was taught in Spanish by a bilingual Hispanic dietitian at a local church. Handouts were available in English and Spanish. Participants were recruited through articles in Spanish and English newspapers, public service announcements on Spanish radio stations, church bulletins, and various flyers. A promotional event was also held at each site 1 week before the program began.

Fox RA, Haniotes H, Rotatori A. A streamlined weight loss program for moderately retarded adults in a sheltered workshop setting. Appl Res Ment Retard 1984;5(1):69-79 (636).

A 15-week behavioral weight loss program for obese, moderately retarded adults that included 10 weeks of treatment and 5 weeks of maintenance. The program was conducted in the sheltered workshop where all of the participants worked, and participants were given time off during the day to attend sessions. Picture materials were developed to facilitate the learning and practice of the behavioral weight loss strategies; no reading skills were required. All participants in the study lived with their parents, and all parents were instructed in the behavioral weight reduction techniques and the forms so that they could provide guidance and support to their child at home during the course of the program.  Daily homework assignments were given so that participants could practice behavioral strategies outside of the training setting. Bimonthly phone calls to the parents were made to discuss their child's progress and difficulties in implementing behavior techniques. To encourage attendance, at each session, participants were entered into a drawing to win small prizes, and awards were also given for each pound of weight lost. Follow-up was conducted for 1 year.

Glasgow RE, Toobert DJ, Hampson SE, Brown JE, Lewinsohn PM, Donnely J. Improving self-care among older patients with type 2 diabetes. The "Sixty-Something..." Study. Patient Educ Couns 1992;19:61-74 (482).

A 10-session, self-management training program designed for persons older than 60 years of age.  Recruitment was conducted through local diabetes care professionals, presentations, mailings, newsletters of local and State diabetes associations, presentations at health fairs, flyers distributed at grocery stores and pharmacies, and local television and radio advertising. The program was offered at no cost, and participants were provided glucose testing materials and a coupon for a pair of walking shoes. Sessions were held during daylight hours in well-known, accessible, and pleasant facilities that earlier focus group participants thought were most convenient. In response to focus group feedback, the program focused on dietary and exercise self-care behaviors.  The group was led by an interdisciplinary team of psychologists, a registered dietitian, certified exercise leaders, and other educators. Group meetings were kept small and focused on developing individualized plans to overcome barriers to adherence. Participants chose the specific self-care area on which they wished to focus. Follow-up was conducted for 6 months.

Heath GW, Wilson RH, Smith J, Leonard BE. Community-based exercise and weight control.  Diabetes risk reduction and glycemic control in Zuni Indians. Am J Clin Nutr 1991;53:1642S-1646S (637).

A 2-year exercise intervention in the Zuni Indian community in western New Mexico. Participants were recruited through personal invitation, recommendation from the medical staff, and a general community advertising campaign.  Community events such as foot races were offered throughout the year, supported by community agencies and local businesses. The program was coordinated by a health educator, two health education assistants, and 48 Zuni Indians who were trained in exercise and group leadership.

Kanders BS, Ullmann-Joy P, Foreyt JP, Heymsfield SB, Heber D, Elashoff RM, Ashley JM, Reeves RS, Blackburn GL. The black American lifestyle intervention (BALI): The design of a weight loss program for working-class African American women. J Am Diet Assoc 1994;94(3):310-312 (638).

A 10-week weight loss program for obese, low-income African-American women ages 40 to 64 years in Boston, New York, Houston, and Los Angeles. The program focused on diet, exercise, and behavior modification using information obtained from interviews of obese African American women concerning these issues. Participants were placed on a culturally appropriate, low-fat diet, including two free meal replacement shakes. Lactaid was provided to those participants who were lactose intolerant. Group sessions involving goal-setting, problem-solving, and role-playing were led by a female African-American nutritionist. All educational materials, recipes, and menu plans were reviewed by minority health professionals to ensure cultural appropriateness. 

Kumanyika SK, Brancato J, Brewer A, Carnaghi M, Doroshenko LH, Rosen R, Rosofsky W, Self MS.  Interventions in the Trials of Nonpharmacologic Intervention in the Elderly. Effective approaches to weight and sodium reduction among older adults.  Circulation 1996;94(8):I-690 (639).

The Trials of Nonpharmacologic Intervention in the Elderly (TONE) was a randomized comparison of weight reduction, sodium reduction, and combined weight/sodium reduction programs versus a no-treatment control group conducted in four university research centers located in Maryland, North Carolina, New Jersey, and Tennessee. Education and counseling addressed relevant nutrition knowledge and behavior change skills. Contacts were weekly for 4 months, biweekly for 4 months, and then monthly. The study addressed challenges that an older population faces, such as literacy limitations, and used oral and visual examples to explain new concepts; concrete, step-by-step instruction; limited use of complex sentences; and minimal need for abstract reasoning. Only a small amount of information was given at one time to prevent overload. Easy-to-read typeface was used, as well as generous use of graphics. Physical changes of aging (e.g., impaired hearing, vision, or memory and speed of absorbing new information) were addressed by using simultaneous oral and visual presentation and seating and room arrangements to accommodate those who wished to be close to the speaker.  Large typeface was used in all visual materials, and the room was arranged to avoid glare. Graphics and text references were chosen to depict older persons, and counseling was geared to build on previously learned nutrition practices, preferences, and food-related attitudes.

Kumanyika SK, Charleston JB. Lose weight and win: A church-based weight loss program for blood pressure control among black women. Patient Educ Couns 1992;19(1):19-32 (640).

A behaviorally oriented weight control program offering eight weekly diet counseling/exercise sessions. The program was a component of the Baltimore Church High Blood Pressure Program (CHBPP), which encompassed black churches in the Baltimore, Maryland, black community.  Recruitment was through CHBPP networks, including lay volunteers from each congregation who had also been trained as blood pressure measurement specialists. Advertisement of the program was by word of mouth as well as by presentations at meetings of the ministerial alliance. Announcements were also placed in church bulletins. The meetings were held on church property, often following other scheduled church activities such as choir practice. The group format emphasized an unrushed, supportive, relaxed environment and included a diet component led by a registered dietitian and an exercise component consisting of low-impact aerobics.

Lasco RA, Curry RH, Dickson VJ, Powers J, Menes S, Merritt RK. Participation rates, weight loss, and blood pressure changes among obese women in a nutrition-exercise program. Public Health Rep 1989;104(6):640-646.(641)

A 10-week exercise and nutrition intervention targeted to obese residents of a black urban community in Atlanta between the ages of 18 and 59 years. Free transportation and child care were provided to encourage participation. Classes on nutrition, community resources, and exercise were offered, including low-impact aerobic dance, water exercises, and walking. Home visits by a public health educator were planned to build family support and alleviate spousal concerns. Participants were asked to comment on the program, and their suggestions were incorporated into the special interest sessions. Participation was monitored, and absentees were called and encouraged to attend the next session. 

McNabb W, Quinn M, Kerver J, Cook S, Karrison T. The Pathways church-based weight loss program for urban African American women at risk for diabetes. Diabetes Care 1997;20:1518-1523.(642)

A randomized, 14-week, church-based weight loss program targeting urban, obese African American women. The program was developed using locally conducted focus groups with the target population and administered by trained lay facilitators recruited from urban churches.  Facilitators assisted participants in identifying and providing solutions for their dietary problems.  Aspects of the program included emphasizing weight loss for general well-being and health rather than improved physical appearance, achieving culturally appropriate body size, and using ethnic foods and food combinations.

McNabb WL, Quinn MT, Rosing L. Weight loss program for inner-city black women with non-insulin-dependent diabetes mellitus: PATHWAYS. J Am Diet Assoc 1993;93(1):75-77 (643).

An 18-week weight loss program, including 12 core weekly sessions that focused on nutrition information and behavior modification and 6 follow-up or "reinforcement" sessions that provided support and strategies for overcoming obstacles the women faced along the way. The program was designed to deal with the obstacles obese, inner-city black women face in trying to exercise and lose weight and was partly based on feedback from a sample of women who were interviewed before the study was designed. An expert panel composed of local minority health care professionals reviewed program materials, which were written at a low-literacy level. Participants were provided with information about foods, including ethnic and regional foods such as greens, salt pork, and ham hocks.

Mount MA, Kendrick OW, Draughon M, Stitt KR, Head D, Mount R. Group participation as a method to achieve weight loss and blood glucose control. J Nutr Educ 1991;23:25-29 (644).

A biweekly, 10-session nutrition, diabetes, and weight loss education program with 30 black adults in rural west Alabama. The program used self-help groups to assist participants with diabetes management by providing peer interaction and support. Groups were led by a public health nutritionist, nutrition graduate student, and a lay facilitator chosen from each group.  Topics included definition of diabetes, meal planning, diet modification to reduce complications, and weight control.

Mulrow C, Bailey S, Sönksen PH, Slavin B. Evaluation of an audiovisual diabetes education program. Negative results of a randomized trial of patients with non-insulin dependent diabetes mellitus. J Gen Intern Med 1987;2:215-219 (645).

A randomized, controlled trial conducted at a hospital in central London. The intervention focused on improving glucose and weight control in low-income, low-literacy obese patients with non-insulin dependent diabetes. The trial excluded those patients who were taking insulin and patients who were older than 70 years of age. Of the 120 patients recruited, 55 percent were female, and 49 percent were West Indian black. Patients within the intervention group participated in monthly group sessions that included materials specifically designed for diabetic patients with low literacy or monthly group sessions without low-literacy materials.  Low-literacy sessions used standardized audiovisual lessons and written materials and included common West Indian foods.

Pleas J. Long-term effects of a lifestyle-change obesity treatment program with minorities. J Natl Med Assoc 1988;80(7):747-752 (646).

A 12-week weight management program with lifestyle change as its central focus (n=12) located at a neighborhood YMCA. Recruiting was conducted through articles and announcements in local newspapers and church bulletins. The weekly sessions lasted 2 hours, with the first hour devoted to lectures on nutrition, behavioral change, and weight loss; the second hour involved exercise, which included endurance exercises and walking.

Shintani TT, Hughes CK, Beckham S, O'Connor HK. Obesity and cardiovascular risk intervention through the ad libitum feeding of traditional Hawaiian diet. Am J Clin Nutr 1991;53:1647S-1651S (647).

Under the premise that, historically, Native Hawaiians have been thin due to their traditional diet, a diet intervention for Native Hawaiians was conducted with traditional Hawaiian foods on the western coast of the island of Oahu. Recruitment was conducted through newspaper advertisements, articles, flyers, and a public presentation about the program.  The selection of food for the program consisted of foods available in Hawaii before Western contact, such as taro, poi, sweet potatoes, yams, breadfruit, greens, fruit, seaweed, fish, and chicken. Foods were prepared in the traditional manner. Breakfast was eaten together, and cultural or health education sessions were conducted during the group dinner session.

Sullivan J, Carter JP. A nutrition-physical fitness intervention program for low-income black parents. J Natl Med Assoc 1985;77(1):39-43 (648).

An 8-week intervention for obese, low-income black mothers (n=10) of children younger than 3 years was conducted at the Parent Child Development Center of the Urban League in New Orleans, Louisiana. Aerobic exercise with soul music was incorporated into the sessions because it was thought to appeal to the population and because dancing can be done safely in the home with no special equipment. Child care was provided for the mothers during the sessions.

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