What was the research about?
Obesity is more common among Latino men than other men in the United States. Programs that help people learn how to change behaviors, like eating healthy and being physically active, may help with weight loss. But these programs are often based on research with non-Latino White women.
In this study, the research team compared two programs to help Latino men lose weight:
- The HOMBRE program. This program was culturally adapted for Latino men. The program provided men with a scale, an activity tracker, and an app to track food intake. Then, over 12 weekly sessions, men received information about fitness, healthy eating, and obesity. Men chose between in-person, online, or self-led support. For in-person and online support, a bilingual health coach led meetings and gave feedback to each man, then had monthly calls for eight months. In the self-led option, patients received reminders to watch the videos, use the devices, and contact the coach weekly for 12 weeks and then monthly for eight months.
- An online self-led program. In this program, men viewed an online self-led video course for 12 weeks. They received health coach support on request for up to one year.
What were the results?
After 18 months, the two programs didn’t differ in the percentage of men who had lost 5 percent of their starting weight. In each program, men lost about 2 kilograms (4.4 pounds). The two programs also didn’t differ in:
- Blood pressure
- Waist size
- Types of foods eaten and physical activity
- Weight-related health problems
- Quality of life, depression symptoms, or how well they slept
At six months, men in HOMBRE had lost an average of 1.3 kilograms (2.9 pounds) more than men in the online self-led program. At 12 months, they had lost 1.1 kilograms (2.4 pounds) more. Also, among men in HOMBRE, some results showed that men who chose group meetings lost more weight than men who chose the self-led option. But the research team don’t know for sure that this was true.
Who was in the study?
The study included 424 Latino men with overweight or obesity and one or more risk factors for heart disease, like diabetes or high cholesterol. Among patients, 53 percent had a college degree or higher, and 60 percent had annual household incomes over $100,000. The average age was 47. All received care from one of 14 primary care clinics in California.
What did the research team do?
The research team assigned men by chance to one of the two programs. The team measured weight, waist size, and blood pressure when the study started and 18 months later. Patients completed surveys by phone at 6 and 12 months and in person at 18 months.
Patients, primary care providers, and medical directors helped design the study.
What were the limits of the study?
People in the study had high education and income levels. Results may differ for Latino men from other backgrounds.
Future research could look at other ways to help Latino men maintain weight loss.
How can people use the results?
Primary care clinics can use the results when considering weight loss programs for Latino men.
To compare the effectiveness of HOMBRE, a lifestyle coach-facilitated program with a choice of three delivery options, versus a minimal intensity self-guided program in sustaining weight loss among Latino men with overweight or obesity
|Design||Randomized controlled trial|
|Population||424 Latino men with BMI ≥27 and 1 or more cardiometabolic risk factors from 1 of 14 primary care clinics in California|
|Timeframe||18-month follow-up for primary outcome|
Latino men have the highest prevalence of obesity among men in the United States. Behavioral lifestyle weight-loss interventions may help, but evidence on these interventions comes from research conducted with non-Latino White women. This randomized controlled trial compared the effect of the HOMBRE intervention versus a minimal intensity intervention on sustaining weight loss among Latino men.
Researchers randomized participants to the HOMBRE or minimal intensity interventions. Culturally adapted for Latino men, HOMBRE included 12 weekly sessions about how to adopt and sustain a healthy lifestyle. Participants received a digital scale, a wearable activity tracker, and an app to track dietary intake. Participants chose to participate via in-person group meetings, online group meetings, or an independent self-guided online course. For the in-person and online group options, a bilingual health coach led the meetings, provided individualized feedback, and called patients monthly about goal progress for eight months after the meetings. In the self-guided option, participants received standardized messages weekly for 12 weeks and then monthly for eight months, with reminders to watch the videos, self-monitor, and contact the coach if needed.
In the minimal intensity intervention, participants viewed the 12-week self-guided video course and received coach support on request for up to 12 months.
The study included 424 Latino men with a body mass index (BMI) greater than or equal to 27 and one or more cardiometabolic risk factors. Among participants, 53% had a college degree or higher, and 60% had annual household incomes over $100,000. The average age was 47, and the average BMI was 33. All received care from primary care providers at one of 14 clinics in California.
Researchers measured participant weight, waist circumference, and blood pressure at baseline and 18 months. Participants completed surveys about other outcomes via phone at 6 and 12 months and in person at 18 months.
Patients, primary care providers, and medical directors helped design the study.
At 18 months, men in the HOMBRE and minimal intensity interventions did not differ significantly in any study outcomes. In each intervention, men lost about 2 kilograms.
In exploratory analyses, compared with the minimal intensity intervention, men in HOMBRE had an average of 1.3 kilograms and 1.1 kilograms more weight loss after 6 (p=0.02) and 12 (p=0.03) months. Among men in HOMBRE, those who chose in-person and online group options lost significantly more weight at all follow-up time points than men who chose the self-guided option (all p<0.05).
Participants had high education and income levels. Results may differ for Latino men from other backgrounds.
Conclusions and Relevance
In this study, a culturally tailored intervention did not result in a higher proportion of Latino men sustaining weight loss than a minimal intensity intervention.
Future Research Needs
Future research could explore other ways to maintain weight loss in Latino men.
Final Research Report
View this project's final research report.
Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.
The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments.
Peer reviewers commented and the researchers made changes or provided responses. Those comments and responses included the following:
- The reviewers found the report to be a thorough description of a well-conducted study.
- The reviewers noted that the patient advisory board was made up of people who were able to invest a lot of hours to the project, and therefore was likely limited to people with more resources and that could afford to devote that much time to the study. They asked whether the patient advisory board accurately reflected the study participants. The researchers explained that they recruited advisory board members the same way they recruited study participants but acknowledged that individuals with multiple jobs and difficult work schedules might have found the time investment to be unmanageable. The researchers also stated that they tried to accommodate broad advisory board participation by having the meetings in the evening and offering different options for engaging in the intervention.
- The reviewers asked the researchers to consider whether the study results were dampened by common behavioral research problems like people entering research studies being more motivated to change their behavior, or at least trying to appear more engaged. The researchers acknowledged that these factors could be an issue that would affect the generalizability of their results.
- The reviewers asked about the engagement of primary care providers in the study, and whether the primary care providers treating study participants were aware of the study. The researchers described how they involved primary care providers at the beginning to introduce the study and also to give providers a chance to remove people from the contact lists if the clinicians felt a patient would not be appropriate for the study. The researchers acknowledged that they did not involve the primary care provider otherwise in the study, and that strengthening the collaboration with the provider would be worth testing in the future.
Conflict of Interest Disclosures
Study Registration Information
^Palo Alto Medical Foundation Research Institute was the original organization associated with this project.
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