title: Effectiveness of a community-directed 'healthy lifestyle' program in a remote Australian aboriginal community.
abstract: OBJECTIVE
  To assess the sustainability and effectiveness of a community-directed program for primary and secondary prevention of obesity, diabetes and cardiovascular disease in an Aboriginal community in north-west Western Australia.
  
  
  METHODS
  Evaluation of health outcomes (body mass index, glucose tolerance, and plasma insulin and triglyceride concentrations) in a cohort of high-risk individuals (n = 49, followed over two years) and cross-sectional community samples (n = 200 at baseline, 185 at two-year and 132 at four-year follow-ups), process (interventions and their implementation) and impact (diet and exercise behaviour).
  
  
  RESULTS
  For the high-risk cohort, involvement in diet and/or exercise strategies was associated with protection from increases in plasma glucose and triglycerides seen in a comparison group; however, sustained weight loss was not achieved. At the community level, significant reductions were observed in fasting insulin concentration but no change in prevalence of diabetes, overweight or obesity. Weight gain remained a problem among younger people. Sustainable improvements were observed for dietary intake and level of physical activity. These changes were related to supportive policies implemented by the community council and store management.
  
  
  CONCLUSIONS
  Community control and ownership enabled embedding and sustainability of program, in association with social environmental policy changes and long-term improvements in important risk factors for chronic disease.
  
  
  CONCLUSIONS
  Developmental initiatives facilitating planning, implementation and ownership of interventions by community members and organisations can be a feasible and effective way to achieve sustainable improvements in health behaviours and selected health outcomes among Aboriginal people.
authors.affiliation: Monash University, Centre for Population Health and Nutrition, Monash Medical Centre, Victoria. kevin.rowley@med.monash.edu.au
authors.forename: K G
authors.initials: KG
authors.lastname: Rowley
authors.forename: M
authors.initials: M
authors.lastname: Daniel
authors.forename: K
authors.initials: K
authors.lastname: Skinner
authors.forename: M
authors.initials: M
authors.lastname: Skinner
authors.forename: G A
authors.initials: GA
authors.lastname: White
authors.forename: K
authors.initials: K
authors.lastname: O'Dea
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000208:ethnology / Q000517:prevention & control*; D003153:Community Health Services / Q000458:organization & administration*; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000208:ethnology / Q000517:prevention & control*; D005260:Female; D006293:Health Promotion / Q000458:organization & administration*; D006306:Health Surveys; D006801:Humans; D008019:Life Style / Q000208:ethnology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000175:diagnosis / Q000208:ethnology / Q000517:prevention & control*; D015397:Program Evaluation; D019035:Rural Health Services / Q000458:organization & administration*; D014904:Western Australia / Q000453:epidemiology