The Effects of Adding Waist Circumference Monitoring to a Modified Version of the Diabetes Prevention Program's Lifestyle Balance Intervention on Overall Weight Loss
Tukov, Magdalene Shuser
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There is a world-wide obesity epidemic and in the United States, ethnic minorities are disproportionately affected. Data on effective interventions and simple self-monitoring modalities for obesity management in primary care settings are limited. The purpose of this study was to determine the effects of adding waist circumference (WC) monitoring to a modified version of the Diabetes Prevention Program's Lifestyle Balance Intervention on overall weight loss among obese subjects attending an inner city primary care clinic and to identify predictors of weight loss in this population. We conducted a 2-arm 12 week randomized controlled trial (RCT) based on a modified version of the Diabetes Prevention Program (DPP). A total of 42 obese subjects were randomly assigned to one of two treatments: modified DPP alone (DPP alone) or modified DPP plus WC monitoring (DPP+WC). The main outcome was change in weight between groups from baseline to week 12. The sample was 88% female, 91% African American, and mean age was 48.3±12 years. A pre-post evaluation with both groups combined showed a -2.2kg decrease in weight (t=-2.9, Paired t-test <0.05), -4.3cm decrease in WC (t=-4.3, Paired t-test <0.05) and a 0.8kg/m2 decrease in BMI (t=-3.4, Paired t-test <0.05) from baseline to week 12. The mean change in weight from baseline to week 12 among the DPP alone participants was -2.3kg and -1.2kg in the DPP+WC group but these changes were not statistically significant. Controlling for duration of follow-up, there was no significant main effect of the intervention on weight loss at 12-weeks (F (1, 20) =0.11, P>0.05). Logistic regression models for weight loss and dropout found that duration of follow-up (weeks) was the only significant positive predictor of weight loss (OR=1.4, 95% CI 1.1 to 1.8) while eating self-efficacy at baseline was the only significant predictor of attrition (OR 2.2, 95% CI 1.2 to 4.2). Our results support the notion that small changes in weight occur with short term medium intensity interventions. Individualized face-to-face counseling and management visits positively predict weight loss. High baseline eating self-efficacy score is associated with increased risk of attrition. Therefore evaluating these factors at baseline and intervening on them prior to implementing weight loss interventions will improve retention and weight loss success.