Programs

Culturally specific weight loss programs show promise



So many Americans — nearly half, according to one study — gained weight in the first year of the COVID pandemic that a new phrase emerged: “Quarantine 19.”

But several dozen Somali and Latino participants in a Mayo Clinic study in Rochester did the opposite: they lost weight. And improved their blood pressure, ate more vegetables and exercised more. The study, published in March, looked at immigrants living in southeast Minnesota who were mentored by someone from their respective ethnic groups.

This unexpected success sparked a larger study of how small, culturally similar groups can promote positive weight loss outcomes. Mayo Clinic researchers are currently recruiting participants for a new 450-person trial. They plan to launch the project in June in collaboration with the University of Minnesota and the National Institutes of Health.

“It was so successful because most people gained weight during the pandemic; these are such impressive results,” said lead author Dr. Mark Wieland, a Mayo Clinic physician who focuses his research on community strategies to promote health equity. “If this succeeds in a more rigorous study, then we can start an evidence-based intervention.”

Participants lost an average of 2% of their body weight over 12 weeks. Also surprising and impressive, according to the researchers, no one gave up despite the pandemic hitting just after the 39 participants began meeting in small groups. The pilot study was designed and started before the pandemic, so the researchers assumed the study would end in spring 2020 with the rest of life.

Luz Molina, who helped lead the Latino groups, recalled the reaction of the study’s principal investigators. “When COVID came, they just said, ‘So should we stop here?’ ” she says. “And I was like, ‘No, no; they want to continue! They’re very motivated, so we have to do something. ”

The groups therefore moved away from streaming content and moved to less structured goal-setting and motivation-focused discussion groups.

The researchers divided the participants into four groups – two for Somali and Spanish speakers. They met via Facebook and text. (“I don’t think I knew Zoom existed then,” Molina said, explaining that it was so early in the pandemic that the video site hadn’t yet become a basic meeting place.) Soon, messages were flying in Spanish and Somali. .

“One participant said, ‘I ran the stairs between the first and second floors while I was doing laundry, and I burned 200 calories!’ “said Molina. “And some people have sent in pictures of vegetables they’ve never seen before.”

Somali participants were equally enthusiastic, said Yahye Ahmed, who helped lead the Somali groups. He offered attendees suggestions for safe places to walk during the early days of the pandemic, when gathering outside for exercise was frowned upon. Top suggestions included the mall early in the morning when most people were sleeping.

“We give examples, but we let the community share ideas, so it’s not like we’re telling them what to do,” Molina said.

Last success for the partnership

The study is part of a larger research network that partners with southeastern Minnesota communities of color that the Mayo Clinic created in 2004, called the Rochester Healthy Community Partnership. Much of the success of projects under this umbrella stems from the trust between researchers and communities of color that has been built over the years, Wieland said.

Community liaisons like Yahye and Molina, called community health promoters, played a key role in participants’ success, the study found.

“Speaking the same language and being able to understand each other, you see, is the greatest

Thing,” said one of the participants, whose name was redacted in the study. “When someone knows your lifestyle, your community, your language, then they understand your culture.”

Community leaders made sure to tailor each group according to cultural norms, Yahye said.

“Each community knows what is best for that community,” he said.

“You come from a warm climate that’s huge on organic, freshly prepared foods. And then you come to America, and everything changes – you have processed foods, high sugar intake, less activity. The only time you walk is if it’s for exercise. With us, it’s part of life.

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For example, the Somali participants split into groups according to gender. “Women are more comfortable with women saying things they wouldn’t say in the presence of a man,” Yahye said.

In some ways, the pandemic may have provided more incentive to meet virtually, Yahye and Molina said, because people could not gather in person at the mosque or other locations.

“People were able to share their life experiences and how they dealt with things,” Yahye said. “They talked about eating habits and worried about less exercise…and shared ideas to encourage each other to reach their goals and complete the commitment they made before the pandemic.”

Immigration linked to weight gain

Immigrants often arrive in Minnesota with a healthier weight than the general population, the researchers noted, but most gain weight within the first 10 years. Another study conducted by Wieland showed that diabetes rates for the Somali population near Rochester are double those of non-Somali patients. Latinos are 17% more likely to be diagnosed with type 2 diabetes than whites, according to the Centers for Disease Control and Prevention.

The reasons for weight gain among immigrants are not fully understood, Wieland said. Immigrants have a less physical lifestyle in the United States and generally adopt poorer diets.

“It pushes you into an unhealthy environment; it’s not that people make bad choices,” he said.

In Somalia, Yahye said, you can often eat more “and get away with it,” because of all the movement incorporated into everyday life. Meals were also cooked fresh and eaten in one sitting, he said, while leftovers here go in the fridge and are easily accessible.

“You come from a hot weather climate that’s huge on organic, freshly prepared food,” Yahye said. “And then you come to America, and everything changes — you have processed foods, high sugar intake, less activity. The only time you walk is if it’s for exercise. With us, it’s part of life.

Molina accepted.

“When we come to this country, we change our diet and sometimes we don’t know what to eat, which is good,” she said. “On TV they show you these good pizzas and lots of burgers; if you buy it with fries it’s cheaper than if you buy a salad. Sometimes you can even buy two for the price of one.

The next phase is based on the “train the trainer” model

Some of the pilot study participants are tapped as leaders of the new study. Wieland said the study’s model can be replicated by other groups, from nonprofits to public health departments.

“It’s exciting to think about it,” he said.

In the pilot study, Yahye said, information about weight loss trickled down from participants to community members who weren’t involved, broadening its impact.

“We hope we can continue to build on this success,” he said. “The goal is for children to benefit from all these things that we put in place.”