Abstract B041: Community-health worker delivered weight loss and maintenance intervention for rural African American adults
Authors: Yeary Karen , Cornell Carol , Moore Page , Gauss C. Heath , Prewitt Elaine , Turner Jerome 
Published: September 2020

Abstract
Introduction: Excess body weight is a critical modifiable risk factor for numerous cancers and one of the top public health problems in the country. Unfortunately, underserved groups bear a disproportionate burden, with African Americans having the highest rates of obesity. Behavioral weight loss interventions have been recommended by several governmental agencies to treat obesity and improve cancer risk, control, and survivorship. However, health care provider shortages in underserved areas have resulted in access gaps. Community Health Workers (CHWs), trusted community members, have filled these gaps and been successful in changing health behaviors (e.g. dietary intake, screening), associated with weight loss or cancer, but have not been thoroughly engaged to deliver evidence-based behavioral weight loss interventions. To increase reach among the underserved, community-based weight loss and maintenance interventions are critical. Methods: Building on a 10+ year partnership between community and academic researchers, an evidence-based behavioral weight loss program was adapted for African Americans of faith to create a group-based, CHW-delivered weight loss and maintenance intervention. With the intention of recruiting two CHWs per church, a total of 61 CHWs were recruited and underwent 28 hours of training over 4-6 weeks to deliver the intervention. A total of 31 churches were randomized to a Weight Loss Only arm (16 core lessons) or a Weight Loss + Maintenance arm (16 core + 12 maintenance lessons) in this cluster randomized controlled trial (n=440). Actual weight and height (BMI—body mass index), dietary behaviors, and physical activity were assessed at 0, 6, 12, and 18 months. Linear mixed models and fit by restricted maximum likelihood were implemented using SAS 9.2. All analyses were conducted with the intention-to-treat principle. Results: The intervention produced significant weight loss from baseline to 6-months (-2.47 (-3.13, -1.80)), with 23.7% of all participants losing at least 5% of their body weight. Among those with clinically significant weight loss (≥5%) at 6 months, there was a statistical trend of lower weight regain in the Weight Loss + Maintenance at 12 months. Participants in the Weight Loss + Maintenance arm also reported higher levels of physical activity at 12 months. There were no significant differences between arms at 18 months. Discussion: The intervention produced significant weight loss from baseline to 6-months on par with other evidence-based weight loss interventions for African Americans, including adaptations that utilized health professionals. Compared to health-care professionals, CHWs may be a more cost-effective way to deliver evidence-based behavioral weight loss interventions. Engagement of institutional infrastructures already in place in communities, such as churches, may be a feasible way to sustainably implement and disseminate evidence-based weight loss interventions for those not reached by traditional healthcare institutions
Citation Format: Karen Yeary, Carol Cornell, Page Moore, C. Heath Gauss, Elaine Prewitt, Jerome Turner. Community-health worker delivered weight loss and maintenance intervention for rural African American adults [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B041.