Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA.
Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA.
Obesity (Silver Spring). 2024 Mar;32(3):476-485. doi: 10.1002/oby.23936. Epub 2023 Dec 6.
Studies have consistently shown that African American individuals lose less weight in response to behavioral interventions, but the mechanisms leading to this result have been understudied.
Data were derived from the PROmoting Successful Weight Loss in Primary CarE in Louisiana (PROPEL) study, which was a cluster-randomized, two-arm trial conducted in primary care clinics. In the PROPEL trial, African American individuals lost less weight compared with patients who belonged to other racial groups after 24 months. In the current study, counterfactual mediation analyses among 445 patients in the intervention arm of PROPEL were used to determine which variables mediated the relationship between race and weight loss. The mediators included treatment engagement, psychosocial, and lifestyle factors.
At 6 months, daily weighing mediated 33% (p = 0.008) of the racial differences in weight loss. At 24 months, session attendance and daily weighing mediated 35% (p = 0.027) and 66% (p = 0.005) of the racial differences in weight loss, respectively. None of the psychosocial or lifestyle variables mediated the race-weight loss association.
Strategies specifically targeting engagement, such as improving session attendance and self-weighing behaviors, among African American individuals are needed to support more equitable weight losses over extended time periods.
研究一致表明，非洲裔美国人在行为干预方面的减肥效果较差，但导致这一结果的机制仍研究不足。
数据来自路易斯安那州促进初级保健中成功减肥的项目（PROPEL）研究，这是一项在初级保健诊所进行的集群随机、双臂试验。在 PROPEL 试验中，与属于其他种族群体的患者相比，非洲裔美国人在 24 个月后体重减轻较少。在当前的研究中，PROPEL 干预组的 445 名患者进行了反事实中介分析，以确定哪些变量在种族与体重减轻之间的关系中起中介作用。这些中介因素包括治疗参与、心理社会和生活方式因素。
在 6 个月时，每日称重解释了体重减轻的种族差异的 33%（p=0.008）。在 24 个月时，出席会议次数和每日称重分别解释了体重减轻的种族差异的 35%（p=0.027）和 66%（p=0.005）。心理社会和生活方式变量均未中介种族与体重减轻的关联。
需要针对参与度制定专门策略，例如提高非洲裔美国人的会议出席率和自我称重行为，以支持在较长时间内实现更公平的体重减轻。
