Weight Loss and Disease Outcomes, Research Paper Example

Literature Review

This literature review will examine evidence related to the connection between weight and type two diabetes, as well as clinical and behavioral interventions related to managing diabetes in the general population. In addition to studies that target the general population, there will also be descriptive, clinical, and qualitative studies based on understanding the increasing rate of incidence in African-American women.

Clinical Information Regarding Weight Loss and Disease Outcomes

There were a total of two studies that focused on the description of obesity and diabetes in the population, as well as identifying potential risk factors for outcomes. Barnes (2011) provides a general overview relating to the relationship between obesity and diabetes and the efficacy of screening in disease prevention. Barnes cites that obesity is a leading risk factor for type two diabetes and cardiovascular disease, particularly among individuals with a BMI that exceeds 35 (Barnes, 2011). In order to help decrease the burden of disease in the population, screening for obesity is advocated, in particular, screening for BMI levels. Finally, Barnes cites the key notion of weight loss as a means to reduce obesity and diabetes in the population by citing results from the Diabetes Prevention Program (DPP) and Look Ahead where individuals that lost weight had a lower risk for type two diabetes (Barnes, 2011).

Tilghman (2003) provides a specific overview regarding diabetes and obesity in the African-American community. Tilghman notes that the number of obese African-American women is nearly 80% higher than that of men; the prevalence rate of obese women in the African-American community is nearly twice of that European Americans (Tilghman, 2003). Obesity, as a main risk factor in diabetes has also led to an increased risk for diabetes among African-American women. Finally, Tighman, based on existing clinical evidence, describes how nurses should use preventative measures in order to help patients including implementing weight management interventions and assessing a patient’s health status in order to identify pertinent risk factors for diabetes (Tilghman, 2003).

Behavioral Interventions (Quantitative) Related to Type Two Diabetes

Spencer et al. (2011) assessed a culturally based, socio ecological intervention based on the tenets of empowerment theory in minority women. The authors conducted a randomized, control delay study among African-Americans and Latino women in Detroit. Subjects in the study had access to REACH Detroit, a community health organization that provided healthy eating demonstrations, physical fitness, and a weekly community farmers’ market. The community health practitioners at REACH were trained to engage with the subjects using a culturally sensitive, socio ecological intervention based on increasing motivation and results. The study ultimately found that the intervention group’s average decrease in HbA1C levels were .8% greater than the control group, a statistically significant difference (Spencer, 2011). Overall, the study introduced new techniques in how to help reduce the burden and incidence of type two diabetes in a traditionally underserved population (Spencer et al., 2011).

Egede et al. (2010) implement a randomized study design in order to evaluate the efficacy of diabetes knowledge and related information in high-risk African-Americans with poorly controlled hemoglobin. This study’s design is innovative in that, rather than simply assessing the impact of one intervention on the population, it employs a 2*2 factorial design that focuses on the individual use and combination of potential interventions in four different arms: 1) Telephone-delivered diabetes knowledge information; 2) telephone-delivered motivation behavioral skills training; 3) combined telephone-delivered diabetes knowledge/ information and motivation behavioral skills; 4) usual care. African-American individuals were allocated into the four different arms of the study. After baseline and intervention data was collected, the authors used a covariance analysis to understand the results. There were no results presented in the paper because it was an initial discussion of the study’s design and intention.

Delahanty and Nathan (2008) explore the results and implications of the Diabetes Prevention Plan (DPP) and Look AHEAD (Action for Health in Diabetes). The DPP was a clinical randomized trial assessing whether interventions aimed at reducing body mass and increasing exercise would delay or prevent the onset of type two diabetes in a high-risk population (Delahanty & Nathan, 2008). The Look AHEAD clinical trial allocated subjects into two different arms: 1) an arm that focused on weight loss and exercise as a means to controlling diabetes; 2) information and help sessions allowing individuals to learn more regarding diabetes. The Look Ahead program, however, also set more ambitious goals for individuals in the weight loss arms that included specific goals for weight loss. Results of the DPP study were highly encouraging: the intervention arm experienced a 58% lower cumulative incidence compared to the placebo group (Deahanty & Nathan, 2008). The DPP also established weight loss as the main mechanism that led to a lower incidence of diabetes with physical activity playing a supportive role in keeping the weight off. The results of the DPP study allowed the Look AHEAD study to focus on different outcomes- in particular the DPP study will focus more on outcomes related to cardiovascular disease. Because the Look AHEAD study has not ended yet, there are no results to report regarding the study.

Krishnan et al. (2011) sharpens the analytical lens to focus on the issues of weight and diabetes in the African-American community. In particular, while the association between general obesity and type two diabetes is well established, the adiposity of fat, particularly around the abdomen, has not been extensively researched (Krishnan et al., 2011). The study used existing data from the Black Women Health Study, an ongoing prospective cohort study of African-American women from 21 to 69 years of age, through questionnaires. The total sample size was 59,064 African-American followed-up over an eight year period 1995-2003. The outcome of interest was self-reported type two diabetes. Using Cox proportional regression, the study found an increasing risk of diabetes with increasing BMI levels (Krishnan et al. 2010). The most overweight women had a 23 times the risk of developing diabetes as women who were not classified as overweight- abdominal adiposity was also deemed a predictor of type two diabetes, although not as strong as BMI. The study is important in understanding a new measure to help the incidence of diabetes in the African-American population. While BMI has long been considered an important measure in understanding obesity, in women with lower BMI, excessive abdominal fat may also be a predictor of diabetes.

Steinhardt et al. (2009) explore the impact of a Diabetes Coaching Program (DCP) on African American women with diabetes. The DCP consisted of a four week curriculum based on resilience education and the management of diabetes; after the curriculum, there were 8 biweekly support group meetings (Steinhardt et al., 2009). The study focused on analyzing the pre- and post-test difference in variables related to psychosocial process, proximal, and distal outcomes. Overall, the study found there was a significant difference in measures related to diabetes management and hemoglobin and cholesterol levels. Coaching was deemed a success, upon further testing, and might be a key tool in helping individuals to manage diabetes.

Behavioral Interventions (Qualitative) Related to Type Two Diabetes

While a predominance of the other studies focus on results from quantitative, clinical interventions, Liburd (2003) adopts qualitative methods in order to ask an important question: What is the ritual importance of eating in the lives of African-American women? Liburd hopes to understand more regarding the eating patterns of African American woman as a key pathway to understand why they are seemingly at risk more than other ethnic groups. In order to explore the topic, Liburd interviews 23 women between the ages of 21-80. The qualitative interviews revealed several themes important in understanding the role of food in the lives of African-American women: African-American women eat because it is a remnant of slavery in which eating was one of only a handful of activities where they had private control; cooking, and by extension eating, was also cited as a means by which many African-American women form and codify their identity. The study’s conclusions are useful in understanding why African-American women may have certain problems with interventions merely aimed at losing weight without implementing psycho social interventions that attempt to support identities during the difficult time period.

Miller et al. (2003) explore how behavioral interventions aiming at building up the self-esteem of weight loss participants. The study focused on using motivational interviewing (MI) techniques among rural African American women with type two diabetes ranging from 21 to 50 years old. The sample size for the study was 31 women. The main intervention was a focus group that explored participants’ attitudes toward concepts such as “physical activity” and “exercise”; after a brief discussion in the focus group, a short DVD segment discussing physical activity perceptions and readiness among the women using motivational interviewing was stressed. After the intervention, interlocutors used grounded theory in a focus group setting to analyze potential changes in the attitudes of participants (Miller et al., 2003). Overall, the study found that the MI intervention, in isolation, was not received positively by the study participants, some of who replied that the messages would be more effective in a traditional setting between doctor and patient rather than alone.

Similar to other studies, Wagner et al. 2011 explored how factors not typically related to health (such as racism) are related to outcomes in diabetes. In order to assess this relationship, the authors administered four focus groups , led by two moderators, that assessed how individuals defined racism, how individuals explored to the effects of racism, and the relationship between racism and other stressors in life (Wagner et al, 2011). The study interviewed 28 African American women from the ages of 18-80 years old. After the focus groups completed, coders used grounded theory to analyze the results. Overall, participants said that although racism was a stressor, it seemed to fade over time as other stressors emerged as more important. Indeed, for many participants, managing diabetes had replaced diabetes as a key source of stress (Wagner, 2011). There was also a linkage cited between how racism might induce feelings that led to deleterious life habits (eating, poor self-image) that increased their risk for diabetes.

References:

Spencer, M., Rosland, A., Kieffer, E., Sinco, B., Valerio, M., Palmisano, G., Anderson, M., Guzman, R., & Heisler, M. (2011). Effectiveness of a Community Health Worker Intervention Among African American and Latino Adults With Type 2 Diabetes: A Randomized Controlled Trial. American Journal of Public Health, 101(12), 2253-2260. doi: 10.2105/AJPH.2010.300106

Egede, L., Strom, J., Durlaski, V., Mauldin, P., & Moran, W. (2010). Rationale and Design: Telephone-Delivered Behavioral Skills Interventions for African Americans with Type 2 Diabetes. Trials, 11, 35-45. doi: 10.1186/1745-6215-11-35

Delahanty, L., Nathan, D. (2008). Implications of the Diabetes Prevention Program (DPP) and Look AHEAD Clinical Trials for Lifestyle Interventions. J American Diet Association, 108, 66-72. doi: 10.1016/j.jada.2008.01.026

Liburd, L. (2003). Food, Identity, and African-American Women with Type 2 Diabetes: An Anthropological Perspective. Diabetes Spectrum, 16(3), 160-165. doi: 10.2337/diaspect.16.3.160

Tilghman, J. (2003). Obesity and Diabetes in African American Women. Association of Black Nursing Faculty, Retrieved from http://findarticles.com/p/articles/mi_m0MJT/is_3_14/ai_103380683/?tag=content;col1

Miller, S., Marolen, K., & Beech, B. (2010). Perceptions of Physical Activity and Motivational Interviewing Among Rural African-American Women with Type 2 Diabetes. Women’s Health Issues, 20(1), 43-49. doi: 10.1016/j.whi.2009.09.004

Barnes, A. (2011). The Epidemic of Obesity and Diabetes. Texas Heart Institute Journal, 38(2), 142-144. Retrieved fron http://web.ebscohost.com.ezp.waldenulibrary.org/ehost/pdfviewer/pdfviewer?sid=44bee858-827b-4df5-a3a8-7a5b9a946cc8%40sessionmgr114&vid=39&hid=112

Krishnan, S., Rosenburg, L., Djousse, L., Cupples, A., & Palmer, J. (2007). Overall and Central Obesity and Risk of Type 2 Diabetes in U.S. Black Women. 15, 1860-1866. doi: 10.1038/oby.2007.220

Steinhardt, M., Mamerow, M., Brown, S., Jolly, C. (2009). A Resilience Intervention in African American Adults with Type 2 Diabetes: A Pilot Study of Efficacy. Diabetes Educator, 35(2), 274-284. doi: 10.1177/0145721708329698

Wagner, J., Osborn, C. Mendenhall, E, & Tennen, H. (2011). Beliefs About Racism and Health Among African American Women with Diabetes: A Qualitative Study. National Medical Association, 103(3), 224-232. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3082367/