麻豆传媒

Intensive lifestyle intervention is an effective weight loss strategy even for people without steady access to good nutrition, though perhaps not as effectively, a post-hoc analysis of a prospective study indicated.

Overall results in the study had found that individuals with obesity who underwent intensive lifestyle intervention lost on average more weight by 6 months and kept it off by 24 months than those in a usual-care arm, Candice Myers, PhD, of Pennington Biomedical Research Center in Baton Rouge, Louisiana, and colleagues reported in .

But participants lacking food security lost less with the intensive lifestyle intervention than those who were food secure.

Specifically, food-secure individuals with obesity on intensive lifestyle intervention lost 5.2 kg (11.5 lb, 95% CI 8.2-15 lb, P<0.001) more than usual-care food-secure individuals by month 24. On the other hand, food-insecure people lost only 2.7 kg (6.0 lb, 95% CI 1.5-10.6 lb, P<0.009) more weight by month 24 relative to usual care.

"Food insecurity is more prevalent in health-disparate groups, including women, racial and ethnic minorities, and low-income adults," Myers explained to 麻豆传媒. "If we want to address growing obesity rates in these populations, healthcare providers should be aware of the intersection of food insecurity and obesity in these population groups."

"Knowing their patients' food security status could help healthcare providers understand how to best approach their patients and tailor treatment plans," she suggested. The researchers also suggested that healthcare providers direct their patients who are food insecure to support services, such as food banks and pantries or federal nutrition assistance programs like SNAP, the Supplemental Nutrition Assistance Program.

The researchers recommended using a simple two-item questionnaire screener to identify patients for food insecurity at primary care visits.

"Screening for food insecurity can also identify patients who face barriers (such as poor nutrition and diet quality or reduced medication adherence) and medical complications (such as emergency department visits or hospitalizations) that can compromise chronic disease management," the team wrote.

Myers said she and her colleagues weren't necessarily surprised by these findings, as they expected to see that food insecurity would blunt weight loss response for these patients. Lack of consistent access to healthy food ultimately creates a barrier for people struggling to obtain a healthy weight, she said.

The study was designed as a post-hoc analysis of the 2-year PROPEL (Promoting Successful Weight Loss in Primary Care in Louisiana) trial, which included adults with obesity from 18 primary care clinics in Louisiana.

In total, 323 food-secure participants underwent lifestyle intervention compared with 233 food-secure adults randomized to usual care. There were also 129 food-insecure participants who underwent intensive lifestyle intervention compared with 118 food-insecure individuals who received usual care. All participants were ages 20 to 75 years old with a body mass index of 30 to 50.

The intensive lifestyle intervention included weekly in-person sessions for the initial 6 months led by trained health coaches. The goal was to achieve a 10% loss in body weight through a calorie-restricted diet plus exercise. After the first 6 months, sessions were held once a month. Usual care involved just the typical care provided by the patient's primary care team.

Patients were deemed food insecure if they answered yes to two or more questions on a six-item questionnaire, including whether they skipped meals or were left hungry because they couldn't afford enough food. Those who were food insecure tended to be female, have less education, and have a lower annual income, the researchers noted.

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