The Effectiveness of Two Community-Based Weight Loss Strategies among Obese, Low-Income US Latinos

Abstract Background Latino immigrants have high rates of obesity and face barriers to weight loss. Objective To evaluate the effectiveness of a case-management (CM) intervention with and without community health workers (CHWs) for weight loss. Design This was a 2-year, randomized controlled trial comparing two interventions with each other and with usual care (UC). Participants/setting Eligible participants included Latinos with a body mass index of 30 to 60 and one or more heart disease risk factors. The 207 participants recruited during 2009-2010 had a mean age of 47 years and were mostly women (77%). At 24 months, 86% of the sample was assessed. Intervention The CM+CHW (n=82) and CM (n=84) interventions were compared with each other and with UC (n=41). Both included an intensive 12-month phase followed by 12 months of maintenance. The CM+CHW group received home visits. Main outcome measures Weight change at 24 months. Statistical analyses Generalized estimating equations using intent-to-treat. Results At 6 months, mean weight loss in the CM+CHW arm was −2.1 kg (95% CI −2.8 to −1.3) or −2% of baseline weight (95% CI −1% to −2%) compared with −1.6 kg (95% CI −2.4 to −0.7; % weight change, −2%, −1%, and −3%) in CM and −0.9 kg (95% CI −1.8 to 0.1; % weight change, −1%, 0%, and −2%) in UC. By 12 and 24 months, differences narrowed and CM+CHW was no longer statistically distinct. Men achieved greater weight loss than women in all groups at each time point ( P