New Leaf: Adapting a Proven Weight Loss Intervention to Reduce Risk in Latina Immigrants

Andrea Cherrington, M.P.H., M.D.

Background: Diabetes is a morbid and costly disease that disproportionately affects Latinos. Obesity is a significant risk factor for diabetes, and weight loss has been shown to be the key factor in lifestyle interventions for diabetes prevention. A disproportionate percentage of Latina immigrants are overweight or obese as compared to non-Hispanic white women. Programs that have been successful in promoting behavior change among Latinas incorporate the women's cultural beliefs, attitudes, and behaviors in the design of their interventions. We propose to culturally adapt a proven weight loss program (New Leaf) and pilot test it among Latina immigrant women attending a local public hospital.

Methods:
Sample and Setting
44 Latina immigrants at least 19 years of age who are overweight or obese. To assure medical supervision, they will be referred by their providers at a local safety net hospital.  

Formative Assessment
Three focus groups (8 participants per group; N=24) with Latina immigrants who are overweight or obese will be conducted by an experienced moderator to identify current eating habits and levels of physical activity as well as barriers to change for these women. Women will also review New Leaf materials. Based on the results of the focus groups, the New Leaf program will be adapted. It will then be reviewed by two lay health promoters who participate in another UAB program (Sowing the Seeds of Health) to assess appropriateness of language and content.

Pilot Test
Once a final draft is obtained, the program will be pilot-tested among two groups of 10 participants (N=20). The sessions will be delivered by a trained, bilingual Lay Health Educator (LHE) selected by the research team. They will be held at a site that is convenient for the women. Participants will be asked for their feedback on format, content, etc.

Measures
Our primary outcomes are feasibility and acceptability of the intervention. A number of process measures will be implemented (e.g., quality assurance, satisfaction, etc). We will collect baseline demographic data from all of the women. Additionally, we will assess diet and exercise behaviors as well as BMI, blood pressure, blood glucose, and lipid levels before and after the program.

Future Directions:
Based on these results, we plan to develop a group-randomized controlled trial to test whether this theory-based, culturally adapted intervention can be used to achieve weight loss among Latina immigrants.