Groceries Plus Multi-Component Lifestyle Intervention for Adults with Hypertension and Type 2 Diabetes Residing in Urban Food Deserts

Decades of research have demonstrated that diabetes and hypertension disproportionately affect individuals with limited financial resources and Black and Hispanic populations in the U.S. Such individuals often reside in communities with limited availability of healthy foods (‘food deserts’) and the overabundance of unhealthy foods (‘food swamps’) which likely contributes to the prevalence of these health conditions. The Dietary Approaches to Stop Hypertension (DASH) eating pattern lowers blood pressure and reduces cardiovascular disease risks with especially prominent effects in Black Americans. However, its uptake has been limited in low-resourced communities due to factors such as limited access to grocery stores, higher prices of healthy foods, and knowledge gaps concerning healthful eating. Food-is-Medicine interventions use healthy, food-based interventions to help prevent and manage chronic diet-related diseases. In trials conducted in the general population, lifestyle interventions have been demonstrated effective for lowering hemoglobin A1c (HbA1c) and blood pressure. Targeted interventions promoting dietary modifications and weight management for persons in low-resourced communities are needed to advance cardiometabolic health. The Overarching Aim of this proposal is to pilot-test a 2-arm, 6-month tailored groceries plus lifestyle (dietary + weight management) intervention compared to self-guided groceries for adults with hypertension and type 2 diabetes residing in Healthy Food Priority Areas (‘food deserts’) in Baltimore--a population at very high risk for adverse cardiometabolic health outcomes. Our long-term objective is to establish a translatable and safe approach for a Food-is-Medicine strategy for adults living in low-resourced communities that will subsequently be tested in a full-scale trial. Our Specific Aims are: 1) To determine the feasibility of recruiting and retaining participants, assess the acceptability and adherence to the interventions, and obtain feedback through quantitative and qualitative approaches. 2) To conduct a pilot 2-arm randomized clinical trial that compares the effects of a coach-guided grocery plus concurrent lifestyle intervention focused on diet and weight management and a comparison intervention, on dietary quality, HbA1c, blood pressure, and other cardio-renal risk factors. 3) To conduct exploratory analyses related to: a) the effects of the intervention in subgroups; and b) the effects of potential mediator variables. 4)To develop a plan with community partners and other stakeholders to pursue a full-scale trial. Strengths of this proposal include a focus on adults with multiple cardiometabolic conditions living in low-resourced communities; a robust dietary and lifestyle intervention program; an experienced, highly collaborative team of investigators, and an established community advisory board.