For patients with obesity seeking weight loss, federal authorities recommend either calorie restriction of standard food choices/calorie counting (CC) or adopting the MyPlate (MyP) distillation of the Dietary Guidelines for Americans. MyP recommends increasing fruit and vegetable consumption, making half of grain choices whole grain, replacing sugary drinks with water, limiting sodium intake, and restricting empty calorie intake. Comparing the effectiveness of these 2 approaches in low-income patients to reduce excess body fat long-term is innovative.
Conduct a comparative effectiveness trial of the CC and MyP approaches. Primary patient-centered hypothesis: The MyP approach to weight loss will yield greater satiety (indicators: feeling hungry, meal satisfaction, feeling full). Primary medical hypothesis: Both approaches will yield similar reductions in body fat (indicators: weight, waist circumference) at 12-month follow-up. Secondary hypotheses: Mental health, satisfaction with program, and quality of life (QOL) will increase more in MyP participants than in CC participants. Systolic blood pressure will decrease more in MyP participants.
A total of 261 study participants were randomly assigned to the CC (n = 130) or MyP (n = 131) conditions. For the 6-month intervention phase, all participants had the opportunity to participate in two 1-hour home health education sessions, two 1-hour group education sessions, and seven 20-minute telephone coaching sessions. Additionally, MyP participants were invited to attend two 1-hour cooking demonstrations. Trained bilingual community health workers delivered the interventions. The study population was predominantly low-income Latino and African American patients recruited from a federally qualified health center in Long Beach, California. They were 95% female, 86% Latino, 8% African American, and 4% White. The mean participant age was 41 years. Assessment periods were baseline, 6-month follow-up, and 12-month follow-up. Assessments included questionnaire measures, anthropometry, and food frequency questionnaires. Intervention sessions and assessments were conducted in English or Spanish, depending on participant preference. Key outcome analyses involved random intercept mixed-effects modeling of repeated measures across the 3 assessments.
Study retention was 77% at 12-month follow-up. The MyP and CC conditions both yielded improved satiety on 2 measures; only the CC condition yielded reduced hunger, contrary to prediction. Both conditions yielded reduced waist circumference for overall sample and for female and Latino participant subgroups but neither condition yielded significant weight loss. MyP yielded reduced systolic blood pressure at 6 months but not at 12-month follow-up; CC participants experienced no change in blood pressure. Both conditions yielded improvements in mental health, health-related QOL, and satisfaction with their respective weight loss program.
Both intervention approaches yielded beneficial changes in satiety, QOL, and reduction in excess body fat. Patient satisfaction with the program was high in both conditions. For a predominantly low-income, Latino patient population, the simpler MyP approach to reducing excess body fat may be as efficacious as the more complex traditional calorie restriction approach to reducing excess body fat.
Many participants missed ≥5 intervention sessions, which diminished intervention impact. Acculturation was an important moderating influence on outcomes, with the least-acculturated participants experiencing less intervention benefit than more acculturated participants.
