PROPEL: Food insecurity moderates effectiveness of weight loss intervention
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Food insecurity appeared to reduce the effectiveness of a high-intensity, lifestyle-based behavioral weight loss intervention, researchers wrote in Annals of Internal Medicine
“Our previous research shows that individuals with food insecurity are more likely to have greater body weight and body fat,” Candice A. Myers, PhD, an associate professor of research from the Pennington Biomedical Research Center at Louisiana State University, told Healio Primary Care. “We wanted to understand how this association worked in the context of an obesity treatment program to investigate if being food insecure had any effect on weight loss.”
The researchers analyzed data from clinics participating in Promoting Successful Weight Loss in Primary Care in Louisiana (PROPEL), a 2-year, cluster-randomized, two-group pragmatic trial conducted at 18 primary care clinics. The clinics were randomized in a 1:1 ratio to provide an intensive lifestyle intervention (ILI) or usual care (UC). A total of 803 patients (84% women) with BMIs ranging from 32.2 kg/m2 to 42.8 kg/m2 and weight ranging from 84.5 kg to 120.6 kg participated in the study.
The ILI group (n = 452) met with trained health professionals embedded in the clinics for in-person sessions every week for the first 6 months, followed by in-person sessions once per month. According to a previously published paper, the UC group (n = 351) received newsletters containing information on health, financial and family-related topics and health awareness events in their community.
“The PROPEL cohort was characterized by a number of health disparity factors,” Myers said. “Food insecurity was prevalent among PROPEL patients, with 31% reporting food insecurity. The PROPEL cohort was also largely African American at over 67%. Further, over 26% reported receiving Medicaid and over 65% reported an annual income less than $40,000.”
Myers and colleagues wrote that after 2 years, the ILI cohort lost more weight than the UC cohort, regardless of food security status. The ILI seemed to be less effective among food-insecure patients. The mean absolute weight difference between the ILI and UC cohorts was 5.2 kg (95% CI, 3.7-6.8) among the 556 food-secure patients and 2.7 kg (95% CI, 0.7-4.8) among the 247 food-insecure patients (mean absolute between-groups difference = 2.5 kg; 95% CI, 0.2-4.8).
“Food insecurity affects how people eat and what they eat,” Myers said. “It may be more difficult to obtain a healthy weight if people do not have consistent access to healthy food. Food insecurity can also influence a range of psychological factors, such as decision making, stress and anxiety, further complicating the ability to be healthy.”
She added that ascertaining patients’ food security status may help health care professionals customize obesity treatment plans.
The researchers concluded that the study “holds implications for physicians and health care practitioners working to address the growing obesity epidemic among U.S. adults,” particularly women and underrepresented groups.
“If we want to address growing obesity rates in these populations, physicians and health care practitioners should be aware of how food insecurity and obesity intersect in these population groups,” Myers said. “These patients are at greater risk of poor health and may require specialized attention to improve health outcomes.
The researchers’ next steps will be to identify factors that “contributed to blunted weight loss in food-insecure patients,” Myers said, adding that doing so could help facilitate weight loss among patients with food insecurity.
Reference:
Katzmarzyk PT, et al. Contemp Clin Trials. 2018;doi:10.1016/j.cct.2018.02.002.
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Diana L. Malkin-Washeim, PhD, MPH, RDN, CDCES, CD-N
In truth, multiple things come to mind when I read this study. There was no description or definition of what the "usual care" intervention was or the “intensive lifestyle intervention.” There is quite a bit of research as to why folks who are food insecure happen to be overweight and/or obese secondary to a maladaptive eating behavior — this was not addressed in the research.
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