Robert O. Powell, MS, ACSMCES

1
Comparing Perceived Health with Weight and
Metabolic Parameters in Participants from a
Modified Diabetes Prevention Program
Robert O. Powell, MS, ACSM-CES powellro_at_upmc.edu M
iriam C. Seidel, MS, RD, LDN Gretchen A. Piatt,
PhD, MPH, CHES
2
Background

• Overweight and obesity correlates with type 2
  diabetes and other aspects of the Metabolic
  Syndrome (MetSyn)
• Two-thirds of the United States is considered
  overweight or obese
• Interventions (DPP) focusing on health risk
  reduction through Weight Loss and Physical
  Activity are necessary
• Many participants struggle or regain following
  intervention
• Perceived Health and Success

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Objective

• Determine whether overweight/ obese individuals
  with Metabolic Syndrome still perceive their
  health as good
• Determine whether this population was less
  successful with weight loss following the Group
  Lifestyle Balance Program

4
Study Setting

• 11 underserved urban neighborhoods adjacent to
  Pittsburgh, PA
• Local hospital was the hub for the study
• Neighborhoods are victim to industrial downsizing
• High prevalence of chronic disease with lack of
  health care

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Recruitment

• Community based screenings
• - Ongoing from 5/25/05- 11/02/07
• Flyers to churches, community partnerships, MD
  offices, local store fronts, hospital, etc.
• Word of mouth
• - Past Participants

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Screening Measures

• Height and Weight
• - portable stadiometer
• - digital scale
• BMI
• Waist Circumference
• Blood Pressure
• Fasting blood draw
• - Hospital phlebotomist

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Eligibility

• BMI gt 25 and
• Metabolic Syndrome (NCEP ATP III)
• Involves at least 3 of 5 parameters
• - WC gt 40(in) men gt 35(in) women
• - Elevated BP gt 130 SBP/ 85 DBP(mmHg)
• - Elevated TG gt 150(ml/dl)
• - Abnormal FBG gt 100 lt 126(ml/dl) (ADA,2005)
• - Abnormal HDLc lt 40(ml/dl) men lt 50(ml/dl)
  women

The Expert Committee on the Diagnosis and
Classification of Diabetes Mellitus Follow-up
report on the diagnosis of diabetes mellitus.
Diabetes Care 263160-3167, 2003
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Intervention

• 12 week Group Lifestyle Balance Program (adapted
  from DPP)
• 60- 90 minute sessions
• Healthy Eating, Physical Activity, Behavior
  Change strategies
• Facilitators Exercise Specialist, Dietitian
• Support Lay Health Coaches

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Study Design and Participation
Screening Population n 635
Eligible n 205
Not Eligible n 430
Consented to Intervention n 107
Withdrew n 13
Assessed at 3 month n 84
Withdrew n 2
Assessed at 6 month n 64
Withdrew n 7
Assessed at 12 month n 39
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Intervention Assessments

• Measured at baseline, 3, 6, and 12 months
• Bodyweight (also weekly during intervention)
• - using a calibrated digital scale
• Waist Circumference, BMI, Blood Pressure
• Fasting blood work
• - glucose, blood lipids
• Demographics Questionnaire
• Health Assessment
• - Healthy Days Questionnaire

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Baseline Demographic Characteristics (n 107)
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Baseline Clinical Characteristics (n 107)
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Weight Loss at 3 months (n84)
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MetSyn Improvements at 3 months (n84)
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Assessment of Health Status

• Self administered perceived health status
• Would you say that your health is?
• Excellent
• Very Good
• Good
• Fair
• Poor
• Dont know/ Unsure
• derived from CDC BRFSS Questionnaire.
• Health Status Section

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Perceived Health at Baseline (n107)
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Differences in Characteristics (n107)
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Perceived GOOD Health and Successful Weight Loss
at 3 months
P.13
GLBP goal gt 7 Weight loss
19
Perceived GOOD Health and MetSyn Improvements at
3 months
P0.09
GLBP goal Reduce gt 1 MetSyn component
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Perceived GOOD Health and Sustained Weight Loss

• Of those who reported their health as good at
  baseline, 66.7 sustained a gt5 weight loss at 6
  months, p0.14
• Of those who reported their health as good at
  baseline, 50 sustained a gt5 weight loss at 12
  months, p0.58

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Limitations

• Volunteer Bias
• Fasting blood work required
• Small sample size
• Health status assessment is subjective
• Generalized Good vs. Not Good responses
• Incomplete data on diet and exercise behaviors to
  compare with outcomes

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Conclusion

• A GLBP can be effective within an underserved
  urban community for improving weight and MetSyn
  parameters
• Participants may not perceive their weight or
  their metabolic risks factors as a threat to
  their health
• This perception may initiate a barrier to
  successful weight loss following intervention

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Future Considerations

• Recognize the social/ cultural perceptions of
  good health as a barrier to success
• Promote functional health as a motivational tool
  within interventions (metabolic risk alone may
  not be enough)

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Thank You

• Study Staff
• Exercise Specialist- Robert Powell, MS, ACSM-CES
• Dietitian (PI)- Mim Seidel, MS, RD, LDN
• Epidemiologist- Gretchen Piatt, PhD, MPH, CHES
• Lay Health Coaches- Rhonda Lee and Helen Tomasic
• This research was sponsored by funding from the
  United States Air Force administered by the U.S.
  Army Medical Research Acquisition Activity, Fort
  Detrick, Maryland, Award Number W81XWH-04-2-003
  Review of material does not imply Department of
  the Air Force endorsement of factual accuracy or
  opinion.

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Perceived Health with Weight and MetSyn at 3
months (n 84)
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Weight Loss and MetSyn Improvements at 3 months

• 5 weight loss 47.1 (n41)
• 7 weight loss 26.4 (n23)
• Stayed the same or reduced at least one component
  of MetSyn 78.4 (n87)
• Reduced at least one component of MetSyn 54.1
  (n60)
• Reduced at least two components of MetSyn 33.3
  (n37)