Community-Based Strategies to Reduce Cardiometabolic Disease in the Deep South

PROJECT SUMMARY/ABSTRACT Nearly 3 out of 4 adults in the United States (US) live with overweight or obesity, with the highest rates observed in rural areas and among individuals facing persistent barriers to preventive care. Obesity is associated with cardiometabolic diseases like diabetes, heart disease and stroke, well as multiple cancers. Over the past decade, trends in obesity have been generally stable for men, but increased significantly among women. Women living in rural settings have higher rates of obesity compared to their peers in urban settings. Evidence-based interventions (EBIs) that promote weight loss, healthier diet and physical activity are effective at slowing the conversion of pre-diabetes mellitus (pre-DM) and hypertension (HTN) to diabetes and heart failure, respectively. However, these interventions are often underutilized by populations at highest risk, including women living in the rural Deep South. The mission of the Deep South Center to Reduce Disparities in Chronic Diseases is to develop a regional research center focused on the prevention, treatment and management of cardiometabolic diseases among populations who suffer disproportionately from these conditions in Alabama, Mississippi, and Louisiana. Consistent with the Center’s theme (applying a precision public health approach across the care continuum to reduce the burden of cardiometabolic disease), this study leverages two EBIs led by our team that have been previously tested for the study population and achieved clinically-relevant weight loss and other clinical outcomes (group-based weight loss intervention) along with improvements in diet and physical activity (individual gardening intervention). Combining these EBIs addresses multiple domains (behavioral, personal environment, sociocultural) and levels (individual, interpersonal, community) of influence on risk factors for obesity and other cardiometabolic diseases prevalent in the Deep South. These interventions, delivered by local lay staff and non-academic partners, have a high potential for sustainability; however, there is a need to further evaluate the external validity and implementation-related barriers and facilitators to maximize reach, adoption and implementation. We will employ a pragmatic, multilevel, cluster-randomized, type 1 hybrid effectiveness-implementation trial. A total of 264 women (age >30 years) with overweight or obesity and Pre-DM or HTN from 12 rural counties (6 Alabama, 6 Mississippi) will receive either the combined group weight loss intervention (Journey to Better Health; JTBH) plus individual gardening intervention (Harvest for Health; H4H) or the JTBH alone. The specific aims are to compare interventions on: (1) primary outcomes related to implementation effectiveness (reach, adoption, maintenance of health behaviors), (2) secondary outcomes on clinical effectiveness, and (3) cost effectiveness. Findings will inform our long-term goal of widely disseminating and sustaining multi-level interventions to reduce the multiple chronic disease burden in the Deep South.