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Weight-Wise Intervention

Weight-Wise Intervention. Carmen D. Samuel-Hodge, PhD, MS, RD UNC-Chapel Hill, NC. September 6, 2007. Research Team & Partners. Carmen Samuel-Hodge, PhD, MS, RD Sara Lindsley (Interventionist) Kathy Bramble (Interventionist Assistant) Weight-Wise Volunteers Beverly Garcia, MPH

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Weight-Wise Intervention

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  1. Weight-Wise Intervention Carmen D. Samuel-Hodge, PhD, MS, RD UNC-Chapel Hill, NC September 6, 2007

  2. Research Team & Partners • Carmen Samuel-Hodge, PhD, MS, RD • Sara Lindsley (Interventionist) • Kathy Bramble (Interventionist Assistant) • Weight-Wise Volunteers • Beverly Garcia, MPH • Larry Johnston, MPH • Agna, Allyson and other UNC Support Staff • Trisha Hardy, MPH, RD • Thomas Keyserling, MD, MPH • Alice Ammerman, DrPH, RD • New Hanover Community Health Center • NC Department of Health & Human Services • Grace United Methodist Church • Centers for Disease Control and Prevention

  3. Today’s Presentation • Description of Weight-Wise • Intervention • Study design • Women of Weight-Wise • Main Outcomes • Process Data • Weight Loss • Blood Pressure and Cholesterol

  4. Today’s Presentation • Maintenance Program • Program Description • Group 1 Results • Group 2 Results • Leader’s Guides for Weight-Wise • Description of Format • How to Use

  5. Weight-Wise Weight-Wise Program Weight Loss Program Maintenance Program

  6. Weight-Wise Weight-Wise Eligibility Women who are: • 40-64 years of age • BMI of 25-45 inclusive • Under-insured or uninsured • Eligible for the Breast and Cervical Cancer Control Program (BCCCP) • Willing to participate in WISEWOMAN

  7. Weight-Wise Weight Loss Approach • Moderate reduction in calories to promote 1 lb/week weight loss • Increase in moderate intensity physical activity -- 150 minutes/week • Dietary approach based on the DASH (Dietary Approaches to Stop Hypertension) Eating Plan • Study Goal for weight loss phase = 10 lbs (4.5 kg)

  8. Weight Loss Program • 16 weekly group sessions (2 hours each) • Session Components: • Group sharing and problem-solving • Weight control topic – nutrition, physical activity, or behavior change • Demonstration and practice opportunities (PA and Nutrition) • Move It (even-numbered sessions) • Taste It (odd-numbered sessions) • New Leaf Manual and group leader guides

  9. Weight-Wise Key Program Components • Monitoring of weight (weekly) • Motivational interviewing techniques and problem-solving focus • Self-awareness throughself-monitoring (food and physical activity) and feedback

  10. Weight-Wise Key Program Components • Social support through group interaction • Goal-setting and action planning • Incentives for attendance and self-monitoring

  11. Diaries – Got to Love ‘Em

  12. Feedback – Where am I Now? Weekly weight change graph Weekly food diaries Weekly physical activity minutes

  13. Wise Bucks Weight-Wise Incentives

  14. Wise Bucks Weight-Wise Incentives

  15. Choose A Bag for New Leaf!* * First session incentive

  16. Cilantro-in-a-Bucket Incentive* * Other weekly incentives: pedometer, spice-in-a-jar, stress ball and lotion, inspirational quotes (booklet), lunch bag, group photo

  17. Stress Combat Zone – An Incentive in the Making

  18. Let’s Walk Away the Pounds! A Popular ‘Move It’ Activity

  19. Participants Walking Away the Pounds! A Move It Activity

  20. Hip-Hop Dancing at My Age? A Move It Activity

  21. Taste It Recipes

  22. Baseline Screening – diet, physical activity, blood pressure, blood lipids, BMI, BIA, health history, psycho-social measures Randomize Participants N=143 Special Intervention N= 72 Delayed Intervention N= 71 Weight-Wise Study Flow Diagram

  23. Special Intervention (SI) N= 72 Delayed Intervention (DI) N= 71 16-week weight loss intervention (weekly group sessions) 2 Newsletters Weight Loss Phase F/U Measures/ Baseline for DI – diet, physical activity, blood pressure, blood lipids, BMI, BIA, health history, psycho-social measures Weight-Wise Study Flow Diagram

  24. SI-Eligible Participants Enter Maintenance Phase DI Participants enter Weight Loss Phase 16-week weight loss intervention 1-year Maintenance intervention (monthly contacts – phone + group sessions) Weight Loss F/U Measures Eligible Participants enter 1-year Maintenance Phase (all group sessions) 6-M Maintenance F/U Data MaintenanceF/U Measures Weight-Wise Study Flow Diagram Weight Loss Phase F/U Measures/ Baseline for DI

  25. Weight-Wise Women (N=143) Values are means unless otherwise indicated

  26. Weight, Blood Cholesterol & Blood Pressure N=143; Values are means unless otherwise indicated

  27. Risk Factors for CVD (N=143)

  28. Weight-Wise Main Outcomes

  29. Weight Loss Findings 1 • Assuming no change from baseline for participants who were missing a follow-up weight (intention-to-treat analysis): N=143

  30. Weight Loss Findings 2 • If only participants with a follow-up weight are included: N=126

  31. Blood Pressure & Cholesterol* * N=122; adjusted for baseline values and treatment group

  32. Process Data – Attendance, Physical Activity & Food Diaries

  33. Process Data Summary • Meannumber of sessions attended= 10 (SD = 6) • Median = 14 sessions attended • Average attendance of 65% • 67% attended 8 or more sessions • 79% of participants kept food records (4.7 days per week) and recorded PA minutes (173.6 minutes per week)

  34. Attendance (%) to Group Sessions

  35. Number of Sessions Attended

  36. Weekly Physical Activity Minutes

  37. Weekly Food Records

  38. Study Summary • Program participants lost on average 9.4 lbs (8.2 lbs. with imputation of missing weight data) or 4.8% of their body weight. • Program participants also significantly reduced their BP, and increased HDL-cholesterol. • 54% of intervention participants succeeded in losing at least 8 lbs. and were enrolled in a 12-month maintenance program. • There were no significant differences in weight loss by ethnicity • Session attendance and family support for physical activity were independent predictors of weight loss. • Follow-up rates were good (88%)

  39. What about Group 2?

  40. Success Summary – Group 2 • Lost on average6.5 pounds(most weight loss = 31 pounds) • Reduced SBP by 7.0mm Hgand diastolic BP by5.0 mm Hg • Total cholesterol was lowered 10.8 mg and HDL-cholesterol increased 2.1 mg • 30%(n=21) succeeded in losing at least 8 pounds and made it into the maintenance program

  41. Weight-Wise Success Stories 3 Weight-Wise success stories highlighted

  42. Weight-Wise Maintenance

  43. Group 1 Monthly group + phone contacts Content tailored to participant needs Standard components: Relapse prevention Enhancing motivation Building social support Group 2 Monthly group sessions Content tailored to participant needs Standard components: Relapse prevention Enhancing motivation Building social support 1-Year Maintenance Program

  44. Weight-Wise Did Women of Weight-Wise Keep the Weight Off?

  45. Early Maintenance Results • Of the 39 women in Group 1 who lost 8+ pounds … • 36 completed the 1-year maintenance programand half (18)kept at least 10 pounds (or 5% initial body weight) off • Of the 21 women in Group 2 who lost 8+ pounds … • 18 completed the 1-year maintenance programandhalf (9)kept at least 10 pounds off • Among the 126 women who completed Weight-Wise,29% (n=36) kept 10+ pounds off after 1 year.

  46. Weight-Wise Leader’s Guides

  47. Weight-Wise Leader’s Guides The Weight-Wise Leader’s Guides are: Detailed instructions to guide health practitioners in the facilitation of weekly group sessions in a 16-week weight loss program for low-income, midlife women.

  48. Weight-Wise Leader’s Guides • Content was adapted from intervention materials and strategies used in two successful programs designed for people with pre-diabetes and pre-hypertension: - Diabetes Prevention Program - PREMIER Program • Layout of the Leader’s Guides wasinformed by the NC WISEWOMAN Translation Team.

  49. Weight-Wise Leader’s Guides Manual includes: • Introduction to Weight-Wise (1st tab) • Supply Checklist • Other Materials • Resources • Sessions 1-16

  50. What’s in each Leader’s Guide? Session at a Glance: Overview of session’s content • Key behavioral strategies • Participant behavioral objectives • Process objectives and session content • List of handouts and other materials • Outline of topics and agenda

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