# Presentation: 444889

## MiDieta – Interactive Diet, Fitness & Weight Management Program for Hispanics

**MiDieta – Interactive Diet, Fitness & Weight Management Program for Hispanics**

## Learning Objectives

- To understand the potential of culturally and linguistically appropriate online diet applications for the weight management of Hispanics
- To introduce a RWJF randomized trial of MiDieta that will begin in 2006

## Disparities among outcomes 

**Disparities among outcomes **

**Notes:**
To start, I think it’s important to reemphasize that obesity and related conditions, specifically diabetes, are epidemic in the US , especially among the Hispanic population.

## Diet & Obesity – Culturally-driven & Tied to Key Chronic Conditions

**Overweight**
**& Obesity**

**Culture**

**Diet**

**Notes:**
Diet more than almost any other behavior is heavily influenced by culture and language.

## “Online” by race/ethnicity

- Pew Internet Study, 2004.

**Notes:**
Most people are under the misconception that Hispanics are not online; When, in reality, Hispanics are online at nearly the rate of non-Hispanic whites (as you can see 64% of non-Hispanic whites are online in comparison to 63% of Hispanics according to a 2004 Pew Internt Study); Also of note is that many of these Hispanics are accessing Spanish-language websites. UNFORTUNATELY, however, there still exists a digital divide between the African American population and these other two groups. (Similar trends for 2005).

## Hispanics use the Web for Health Information

**Young Hispanic adults are *****at *****least **_***twice as***__** **__***likely***_** to **_**use the Internet**_** to research ratings of **_**health plans**_** as Non-Hispanics**

*Solucient healthcare survey (October 2003)*

**Notes:**
The other very interesting trend among Hispanics is that they are using the internet for health. For example, in a 2003 study by Solucient, young Hispanic adults were twice as likely as non-Hispanics to use the internet to research ratings of hospitals and health plans.

## Schroeder et al. 2003“How Hispanics Use the Internet for Health”HispaniCare/CDC/Univision/Hospitals Study

**Diabetes****	****	****72%**
**Diabetis****	****	****16%**
**Dibetes****	**** ****	****  3%**
**Deabetes****	****  ****	****  3%**
**Diabete****	**** ****	****  2%**
**[n=18,274]**

**Educational Challenges**

**Notes:**
We know however that the Hispanics online have less formal education than non-Hispanics. For example, this is data from an ongoing study we’ve been doing with the CDC on how Hispanics utilize the internet for health. (I would be glad to send you this 50 page document later if you leave me your information, or it can be accessed from our website). According to this study we found that 64% of all Hispanics accessing the Health information on the internet have a maximum of a high school education or less: 28% misspelled “Diabetes”

## HispaniCare (a division of DrTango Inc)

_**Business Mission**_
- Provide U.S. healthcare organizations with linguistically- and culturally-appropriate:
**Communications, **
**Wellness, & **
**Marketing Solutions**
_**Social Mission**_
- Reduce health disparities** **

**Notes:**
Our organization is the leading developer of online....(see slide) . In addition we have a strong social mission to narrow the health disparities gap. WE  have built and maintained hundreds of Spanish language websites for leading healthcare companies like (those you see to the right)

## MiDieta/MyDietTM 

**Internet-based diet, fitness and weight-management application for Hispanics and other minority groups that is:**
**Personalized**
**Culturally and linguistically appropriate, and**
**Effective**
**Deliver the application through hospitals, managed care providers, and media companies**

**Notes:**
We have developed the leading online diet, fitness and weight management application for Hispanics that is: Personalized, culturally and linguistically appropriate and effective. Developed 5 years ago originally in Spanish...by Hispanics...for Hispanics. It is now available through many hospitals, MCOs and media companies and is used by more Hispanics than any other online diet and weight management program.

## The Team behind MyDiet

_**Dr. Dirk Schroeder**_**: EVP  **
**Professor International Nutrition – Emory University**
_**Dr. Frederick Trowbridge**_**: VP Wellness. **
**Former Director of the CDC’s Div. of Nutrition and Physical Activity**
_**Dr. Eleazar Lara**_**: VP of Health**
**Former Secretary of Health, Venezuela**
**President Society for Nutrition Research**
_**Nina Nazor**_**: Director of MyDiet **
**Diabetes Educator & Nutritionist**
**10+ Dietitians & Nutritionists**

**Notes:**
MiDieta was developed by experts of Hispanic diet and nutrition including: (hit highlights)

## PanHispanicFoods

**Development**
**Translated: **USDA database into Spanish
**Merged in: **Food Databases from *Mexico*, *Central America*, *South America*, *Spain*
**Added: **Processed and commercial foods from Mexico
**Required: **6 dietitians for 1 year

**Notes:**
A key feature of MiDieta is what we call “PanHispanicFoods”. When we started building Midieta we translated the USDA database into Spanish and we aggregated the food composition databases from 7 L. A. countries. WE then merged them together into what we call PanHispanicFood in 2001. We had dieticians in Mexico pulling foods off of grocery shelves and putting them into this PanHispanicFoods database. All in all, it took 6 dieticians 1 year to build.

## Culturally-appropriate, bilingual diet management

**MiDieta® - **
**Diet, Fitness Evaluation **
**Weekly online newsletter**
**Daily recipes, articles, tips**
**Personalized menu & fitness program**
**Access to bilingual nutritionists **

**Notes:**
MiDieta offers a variety of things including: daily tips, culturally appropriate Latina recipes, a personalized menu planner, a weight tracker, and a bilingual shopping list. “As some of our Hispanic/Latino customers have told us, they think in Spanish and shop in English.”

## Culturally

**Culturally**
**& Linguistically **
**Appropriate**
**Evaluation**

**Notes:**
Here is a screen-shot of our culturally appropriate diet evaluation for Hispanics. For example, we include Atole here, for which there is no good translation, but it is a grain based drink that is very common in Latin America. This provides an example of a culturally appropriate diet evaluation that really seems to resonate with the target audience.

## Bilingual personalized menu & fitness  plan based on:

-  Gender
-  BMI
-  Goals
-  Condition
-  Food
-   preferences

**Notes:**
After an individual has completed the evaluations, they will come to this page. Based on the users gender, height, weight, diet preferences and weight goals, he or she gets assigned to a specific caloric level that should be consumed per day, in addition to a personalized diet plan. (92% are women)

## Bilingual

**Bilingual**
**Multicultural**
**Interactive**

***DrTango Solutions***

***30***

**Notes:**
One of the most valued features of MiDieta is a bilingual E-newsletter called NutriNotas that we send to over 350,000 Hispanic households each week via email. 

## MyDiet

**Diet & Exercise Evaluation**

**Wellness Management **
**(Menu & Exercise Planner)**

**E-mail Newsletter (encourage change)**

**Food Shopping List**

**Notes:**
Organizations that license to use MiDieta can customized the program to the look and feel of their healthcare organization...because the goal is to drive people back to their website and not ours. In sum, we’re helping healthcare organizations evaluate their Hispanic constituency for diet and fitness. 

## MiDieta / MyDietTM

**10/99: ****	**** Design-“PanHispanicFoods”**
**1/01: ****	****Launch - Univision.com – 1.3 *****million***** hits 3****rd**** day!**
**5/02: ****	****1****st**** Hospital **
**12/02: ****	****“Back-translated” to English**
**9/03: ****	****1****st**** Health Plan**
**6/05: ****	****- 5 M+ Hispanic/Latinos access**
**	****	****- 375+K **_***online Hispanic Households***_*** *****get newsletter**
**	****	****- 300+K culturally-appropriate diet & fitness evaluations**
**	****	****- 100+K questions to our “Ask the Expert”**

**Notes:**
Most of note on this slide is that when we launched this application in partnership with Univision in 2001: On the 3rd day of operations we had 1.3 million hits

## BMI of MiDieta Users (n=106,259)

**Notes:**
Just to show some statistics from a sample of MiDieta users: approximately 87% of men and 73% of women in a sample taken from MiDieta users were either overweight or obese

## Dietary Consumption (n=119,310)

**Notes:**
Data extracted from the dietary evaluations show that while many have high fat intakes, many others have inadequate fruit and vegetable intakes 

## Exercise Level (n=119,310)

- Very Low = Sedentary
- Low = < 3 x  per week
- Moderate = Light 3x /w
- Mod-High = 30 m. 3x /w
- High = 30 m. 5x /w

*Percent*

**Notes:**
Data extracted from a sample of physical activity evaluations show that 78% of these individuals rated themselves as having low or very low activity levels.

## User Feedback

- ...Para mí es un placer estar recibiendo su servicio, ya que ahí he encontrado muchas opciones para cada tiempo de comida y, lo mejor de todo, es comida latina, ¡¡la que nosotros estamos acostumbrados a comer!! ¡Felicidades de mi parte y sigan adelante! –
-                                                          ***Melisa***
* *
- ...For me, it is a real pleasure to receive your service, because in it I’ve found many options for every meal, and the ***best thing of all, it’s Latin food, the food that we’re used to!!***  Congratulations, and keep up the good work! –
-                                                           ***Melisa***

**Notes:**
We’re constantly getting positive user feedback. For example...Melisa happens to enjoy the fact that we offer Latino foods

## MiDieta – Awards

**Top 20 “most innovative health promotion and disease prevention applications from around the Nation” **(HHS, Mar 2004)
**2-year Robert Wood Johnson Foundation Grant on the potential of eHealth for Hispanics **(Oct 2004)

**Notes:**
MiDieta has also won some awards, most notably in 2004, the Department of Health and Human Services named MiDieta as one of the TOP 20...

## Objective: Evaluate the ability of a culturally- and linguistically-appropriate, interactive diet & fitness portal (MiDieta) to lead to weight-loss among U.S. Hispanics.

**RWJF Health eTechnologies Study **

**Notes:**
The objective of the RWJF randomized trial is to:....

## Health e-Technologies Design

_**Design**_**: **
**	***** Formative Research (6 m)**
**	***** Randomized Trial (12 m)**
**	***** n = 500 among six groups per institution**
_**Subjects**_**: Overweight online Hispanics enrolled in managed care plans**
_**Collaborating Institutions**_**: Managed Care: **
**	****AtlantiCare of New Jersey; BCBS of Florida**

## Outcomes

_**Primary**_***: *****Weight-loss: **at 3, 6, & 12 months follow-up
_**Secondary**_:
** ****Anthropometry: **BMI, waist-to-hip ratio
** ****Diet:** intakes, patterns
** ****Physical Activity: **frequency, duration, intensity
** ****Patient-Provider Comm.:***** ***frequency, satisfaction
** ****Adherence: **compliance, frequency of utilization

## RWJF MiDieta Timeline

**Oct 04 – Mar 05: Set-Up & Hiring**
**May 05 – Dec 05: Formative Research**
**Jan 06 – Dec 06: Randomized Trial**
**Oct 06 – Mar  07: Analysis & Write-up**

**Notes:**
This is a quick overview of the RWJF project timeline. We are currently conducting some formative research to understand the dieting practices of US Hispanics and plan to conduct focus groups within the next couple of months. We then plan to start the study on Jan. 1 of 2006, in line with most people’s New Years resolutions. By March of 2007 we hope to be able to submit the final write-up for publication.

## MyDietTM / MiDietaTM Suite – Populations & Conditions

_**Current**_**:**
- General adult (age 15+)
- Overweight & Obese
- Pregnant
- Post-partum
- Post-partum (lactating)

_**Forthcoming**_
_**2006:**_
- Type II Diabetes
- Child Obesity
- Offline Version
- Hypertension

**Notes:**
Currently MiDieta is set up for adults, specifically those that are overweight or obese, in addition to pregnant and post-partum, lactating women. However, we do have several enhancements and additional versions that we hope to launch in 2006, including: ...

## MyDiet for Child Obesity

**Tremendous epidemic**
**Developing national project to adapt MiDieta/MyDiet for schools and institutions addressing child obesity**
**Funding: RWJF, NIH, Others**

**Notes:**
And lastly, as we all know, child obesity has become a tremendous epidemic.  We are currently developing a national project to adapt the MiDieta/MyDiet portal for school-based child obesity interventions with hopeful funding from the RWJF, the NIH and others.

## Hypothesized Pathways

**Notes:**
(RED = effect modifiers)