A comparison of the 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults to clinical outcomes of a Promotora-Led Mi Corazon Mi Comunidad intervention among Hispanics

Obesity is a serious and costly condition, causing a higher prevalence of chronic diseases and having an average medical cost of $1,430 higher than non-overweight patients (Finkelstein, Trogdon, Cohen, & Dietz, 2009). With more than two thirds of U.S. adults suffering from overweight or obesity, health organizations have recognized the disease as a threat to the well-being of the nation. In 2013, the American Health Association (AHA) and the American College of Cardiology (ACC) among other stakeholders developed a set of guidelines and recommendations for primary health providers in order to reduce overweight, obesity and concomitant conditions (Jensen et al., 2014). The evidence-based guidelines suggest the elements of weight loss lifestyle interventions that have been proven to result in clinically meaningful health benefits for patients. Nevertheless, the guidelines also report the gaps in evidence, such as the need to understand and improve the efficiency of on-site lifestyle interventions on key populations including racial/ethnic groups. The overall goal of this study was to assess weight and blood pressure changes of Hispanic adult participants who engaged in a Promotora-Led Mi Corazon Mi Comunidad (PLMM) intervention. A total of 753 participants were initially enrolled in the intervention conducted from 2009 – 2013 in El Paso, Texas. The 2013 AHA/ACC/TOS Guideline was used as a reference to assess weight and blood pressure changes between pre- and post-intervention. The specific aims of the study were: 1) to identify participants who upon enrollment met 2013 AHA/ACC/TOS Guideline cut-off points for overweight and obesity; 2) to identify participants who in addition to meeting the overweight and obesity criteria, also met the cut-off points for waist circumference in the 2013 AHA/ACC/TOS Guideline (n=500); 3) to determine the proportion of female and male participants who achieved 3, 5 and 10 percent weight reduction milestones consistent with recommendations from the 2013 AHA/ACC/TOS Guideline after the 4-month intervention, and 4) to determine blood pressure changes in female and male participants who completed the PLMM intervention (n=285). Results from secondary data analyses indicated that 57% of eligible participants were retained after the 4-month intervention. The 285 participants that completed the intervention achieved an average weight loss of 1.48% ±3.33. The median weight loss of 1.31±3.3 kg was statistically significant (p=0.001), which represents a 0.5±1.29 kg/m2 (p=0.001) decrease in overall BMI measurements. In addition, there was a statistically significant reduction of 3.32 ± 6.38 cm (p=0.001) in waist circumference, a measurement strongly associated with cardiovascular health risk. Diastolic and systolic blood pressure were also reduced by 0.59 and 0.84 mmHg respectively among the selected sample of participants. A total of 28% of the 285 selected participants that completed the PLMM achieved a body weight loss of 3% or more, which according to the 2013 AHA/ACC/TOS Guideline will produce clinically meaningful health benefits. In conclusion, the 4-month intervention led by Community Health Workers/Promotores de Salud proved to be an efficient method to reduce overweight and obesity among Hispanic adults living in El Paso, TX. The inclusion of an individualized diet component and increase in the intervention time to 6 months or more could further improve the health benefits achieved by the PLMM intervention