title: Effects of a behavior-based weight management program delivered through a state cooperative extension and local public health department network, North Carolina, 2008-2009.
abstract: BACKGROUND
  Eat Smart, Move More, Weigh Less (ESMMWL) is an adult weight management program developed in response to North Carolina Obesity Plan recommendations to make weight management interventions accessible to underserved populations. ESMMWL was designed to be delivered through the North Carolina Cooperative Extension and North Carolina Division of Public Health. Program coursework included content on evidence-based eating and physical activity behaviors and incorporated mindful eating concepts. The objectives of this study were to describe participant changes in weight and behaviors and to document the effectiveness of the program.
  
  
  METHODS
  In this prospective pilot study, courses were delivered and data collected from January 2008 through June 2009. Instructors provided feedback about implementation. For participants, height, weight, and waist circumference were measured at baseline and completion. Participants completed a questionnaire about changes in their eating and physical activity behaviors, changes in their confidence to engage in weight management behaviors, and their satisfaction with the course.
  
  
  RESULTS
  Seventy-nine instructors delivered 101 ESMMWL courses in 48 North Carolina counties. Most of the 1,162 completers were white women. Approximately 83% reported moving toward or attaining their goal. The average weight loss was 8.4 lb. Approximately 92% reported an increase in confidence to eat healthfully, and 82% reported an increase in confidence to be physically active. Instructors made suggestions for program standardization.
  
  
  CONCLUSIONS
  This study demonstrated the effectiveness, diffusion, and implementation of a theoretically based weight management program through a state extension and local public health department network. Study of the sustainability of changes in eating and physical activity behaviors is needed.
authors.affiliation: East Carolina University Brody School of Medicine, 600 Moye Blvd., Greenville, NC 27834, USA.
authors.forename: Lauren MacKenzie
authors.initials: LM
authors.lastname: Whetstone
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Kolasa
authors.forename: Carolyn
authors.initials: C
authors.lastname: Dunn
authors.forename: K S U
authors.initials: KS
authors.lastname: Jayaratne
authors.forename: Sherée
authors.initials: S
authors.lastname: Vodicka
authors.forename: Lori
authors.initials: L
authors.lastname: Schneider
authors.forename: Cathy
authors.initials: C
authors.lastname: Thomas
authors.forename: Meg
authors.initials: M
authors.lastname: van Staveren
authors.forename: Surabhi
authors.initials: S
authors.lastname: Aggarwal
authors.forename: Carolyn
authors.initials: C
authors.lastname: Lackey
mesh_terms: D000328:Adult; D001521:Behavior Therapy / Q000379:methods*; D001835:Body Weight; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D009765:Obesity / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D010865:Pilot Projects; D011446:Prospective Studies; D011634:Public Health; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D015431:Weight Loss