title: Successful long-term weight loss among participants with diabetes receiving an intervention promoting an adapted Mediterranean-style dietary pattern: the Heart Healthy Lenoir Project.
abstract: OBJECTIVE
  To examine weight change by diabetes status among participants receiving a Mediterranean-style diet, physical activity, and weight loss intervention adapted for delivery in the southeastern USA, where rates of cardiovascular disease (CVD) are disproportionately high.
  
  
  METHODS
  The intervention included: Phase I (months 1-6), an individually tailored intervention promoting a Mediterranean-style dietary pattern and increased walking; Phase II (months 7-12), option of a 16-week weight loss intervention for those with BMI≥25 kg/m2offered as 16 weekly group sessions or 5 group sessions and 10 phone calls, or a lifestyle maintenance intervention; and Phase III (months 13-24), weight loss maintenance intervention for those losing ≥8 pounds with all others receiving a lifestyle maintenance intervention. Weight change was assessed at 6, 12, and 24-month follow-up.
  
  
  RESULTS
  Baseline characteristics (n=339): mean age 56, 77% female, 65% African-American, 124 (37%) with diabetes; mean weight 103 kg for those with diabetes and 95 kg for those without. Among participants with diabetes, average weight change was -1.2 kg (95% CI -2.1 to -0.4) at 6 months (n=92), -1.5 kg (95% CI -2.9 to -0.2) at 12 months (n=96), and -3.7 kg (95% CI -5.2 to -2.1) at 24 months (n=93). Among those without diabetes, weight change was -0.4 kg (95% CI -1.4 to 0.6) at 24 months (n=154).
  
  
  CONCLUSIONS
  Participants with diabetes experienced sustained weight loss at 24-month follow-up. High-risk US populations with diabetes may experience clinically important weight loss from this type of lifestyle intervention.
  
  
  BACKGROUND
  NCT01433484.
authors.affiliation: Ambulatory Care Physician, Durham VA Medical Center, Durham, North Carolina, USA.
authors.forename: Genevieve G R
authors.initials: GG
authors.lastname: Embree
authors.affiliation: Department of Nutrition, Center for Health Promotion and Disease Prevention, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA; Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, North Carolina, USA.
authors.forename: Carmen D
authors.initials: CD
authors.lastname: Samuel-Hodge
authors.affiliation: Center for Health Promotion and Disease Prevention, University of North Carolina , Chapel Hill, North Carolina , USA.
authors.forename: Larry F
authors.initials: LF
authors.lastname: Johnston
authors.affiliation: Center for Health Promotion and Disease Prevention, University of North Carolina , Chapel Hill, North Carolina , USA.
authors.forename: Beverly A
authors.initials: BA
authors.lastname: Garcia
authors.affiliation: Center for Health Promotion and Disease Prevention, University of North Carolina , Chapel Hill, North Carolina , USA.
authors.forename: Ziya
authors.initials: Z
authors.lastname: Gizlice
authors.affiliation: Department of Epidemiology , Gillings School of Global Public Health, University of North Carolina , Chapel Hill, North Carolina , USA.
authors.forename: Kelly R
authors.initials: KR
authors.lastname: Evenson
authors.affiliation: Division of General Medicine and Clinical Epidemiology , School of Medicine, University of North Carolina , Chapel Hill, North Carolina , USA.
authors.forename: Darren A
authors.initials: DA
authors.lastname: DeWalt
authors.affiliation: Department of Nutrition, Center for Health Promotion and Disease Prevention, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA; Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, North Carolina, USA.
authors.forename: Alice S
authors.initials: AS
authors.lastname: Ammerman
authors.affiliation: Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, North Carolina, USA; Division of General Medicine and Clinical Epidemiology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Keyserling
keywords: Dietary Intervention; Ethnic Disparities; Physical Activity Intervention(s); Weight Loss Program