Utilizing the Church and Church Members for Conducting Weight Loss Programs

Obesity rates in the United States have dramatically increased over the last two decades, making overweight and obesity one of the most pressing public health problems facing the nation today. In 1999, an estimated 61 percent of U.S. adults were overweight. While this problem is nearly universal, occurring in both genders and across all races, ethnic, and age groups, disparities do exist. For example, rates of overweight and obesity are higher among women of racial and ethnic minority populations than among non-Hispanic White women. Culturally appropriate interventions are needed to address these disparities, as well as to help bring down the overall rates of overweight and obesity and their attendant health risks.

The intervention is designed to promote dietary change and physical activity through the church as a potential strategy for promoting weight loss among African Americans. The program includes both individual and group treatment formats. Participants in the group format meet with health educators for 6 months, once a month, for lessons and group discussions. Lesson plans include: (1) introduction, (2) ideal body weight and maintaining healthy weight, (3) diet and exercise, energy intake versus energy expenditure, (4) limiting fat and salt intake, (5) food groups: eating a variety of foods, and (6) choosing a diet with plenty of fruits, vegetables, and grain products. Participants in the individual intervention format meet with a health educator 15 times over 6 months, keep a food diary, and receive a computerized dietary assessment. In addition to the lessons covered in the group intervention, individuals also receive the following lessons: (1) record-keeping: food and exercise diary, (2) developing individual weight loss, caloric, and exercise goals, (3) modification of dietary and exercise habits, (4) conducting self-assessment and developing an individual plan, (5) social support of behavior change, (6) review of change and cognitive restructuring, (7) stress management, (8) relapse prevention, and (9) program evaluation.

The program takes 6 months to complete.  Lay health educators must be recruited from the same local church where the program is being implemented and then be intensively trained for 2 days in the study protocol, motivational interviewing, behavior modification, and dietary assessment. Church members must also be recruited as program participants.

The intervention is designed for implementation within a local church setting for adults. It is culturally tailored for its target population of African Americans. However, the program could be implemented through any adult social organization and could be tailored for multiple cultures.

The intervention is designed for a church setting, but could be implemented through other organizations that offer convenient program participation and information dissemination.

Health educators are required to conduct the intervention at the church site.  The programmatic material required is the Intervention Guide, a program protocol that includes the following components: 1) Program description for professionals, 2) Lifestyle Balance Lessons, 3) Lifestyle Balance Participant Notebooks, and 3) Questionnaires.  These health education materials are available at the Pennington Center.  The dietary assessment software is to be used for the individual treatment approach and is not part of the Group intervention.

The intervention was pilot-tested with a convenience sample of 40 African American members (37 women, 3 men) of a church in Baton Rouge, Louisiana. The pilot test did not include a no-treatment comparison condition. Investigators recruited health educators and participants using flyers, posters, and personal communication with church leaders. Each of the lay health educators received a stipend for implementing the program throughout the 6-month period while participants each received a $100 incentive for participating in the study. Results of the study showed that 6 months after enrollment:
 

• Results did not differ significantly between the individual and group conditions.

• Participants lost an average of 3.3 kilograms.

• Participants lost an average of 0.5 percent of body fat.

 
 
 
 

• Participants in both groups decreased physical inactivity and reported both positive and negative changes in quality of life, but the changes between baseline and 6 months post-enrollment were not statistically significant.