Changes in Weight and Physical Function for Older African American Women in National, Peer-Led, Community-Based Weight Loss Program

2.摘要 老年非裔美国人(AA)女性肥胖和虚弱的患病率最高。在学术上，专家上- 领导干预，肥胖、虚弱、年长的人都减轻了体重，改善了他们的身体功能。然而， 由于人员成本高，而且全国范围内没有基础设施，这些措施的大规模实施 干预是不切实际的。长期目标是消除肥胖和虚弱的健康差距 上了年纪的戒酒协会女性。该提案的总体目标是确定低成本、基于社区的 同龄人领导的减肥计划，建立了关于肥胖、身体机能和医疗保健的国家基础设施 老年再生障碍性贫血妇女的利用情况。要治疗老年AA女性的肥胖和虚弱，测试减肥是至关重要的 干预1)有初步的益处证据；2)老年再生障碍性贫血妇女可以接受；3)负担得起；以及 4)可以广泛传播。明智地减轻体重(TOPS)是一个全国性的，非营利性的，以社区为基础的， 符合这些标准的同行主导的减肥计划。首先，申请人的回溯性数据库分析 TOPS显示了两个重要的结果：1)续签年度会员的参与者失去并保持 长达7年的显著减肥(SWL)；和2)与年轻女性相比，老年女性 更有可能实现SWL。其次，申请者在一年中为年长的AA女性开设了三个TOPS章节 成功的先导性研究。尽管这项研究于2012年结束，但其中一个章节在近6年后仍在进行中。 第三，TOPS价格实惠；每年只需92美元。最后，TOPS有一个全国性的基础设施，包括 在所有50个州。由于肥胖、虚弱、年长的人在学术上、专家主导的减肥干预中可以改善 他们的身体功能，中心假设是一个低成本的，基于社区的，由同龄人领导的减肥计划 使用国家基础设施可以提供SWL、改善的身体功能和更低的医疗保健利用率 AA妇女，这是一个服务不足的弱势群体。提出这项研究的理由是 学术的、专家主导的减肥干预措施分享了对成功减肥至关重要的组成部分；因此， TOPS也能带来类似的结果。将通过实现以下目标来检验中心假设 肥胖、虚弱、年长的AA女性：确定TOPS对体重变化和心血管疾病的影响 危险因素；2)身体功能和生活质量；3)医疗保健利用。这个项目具有创新性，因为 它使用“社区到学术界”的方法来治疗健康差距；我们的研究人群侧重于老年人 身体功能下降的AA女性；我们的结果集中在体重、身体功能和医疗保健上 利用；以及我们独特的研究环境。这项拟议的研究具有重要意义，因为确定真正的- TOPS计划的世界有效性及其对体重、身体功能和医疗保健利用率的影响 在再生障碍性贫血中，妇女可以对整个老年人口产生广泛的影响。因此，它有可能减少 所有老年人中的不利老年后果。

2. ABSTRACT Older African American (AA) women have the highest prevalence of both obesity and frailty. In academic, expert- led interventions, obese, frail, older individuals both lost weight and improved their physical function. However, because of high personnel costs and nonexistent nationwide infrastructure, large-scale implementation of these interventions is impractical. The long-term goals are to eliminate the health disparities of obesity and frailty in older AA women. This proposal’s overall objective is to determine the effects of a low-cost, community-based, peer-led weight loss program with a national infrastructure on obesity, physical function, and healthcare utilization in older AA women. To treat obesity and frailty in older AA women, it is critical to test a weight loss intervention that 1) has preliminary evidence of benefit; 2) is acceptable to older AA women; 3) is affordable; and 4) can be broadly disseminated. Take Off Pounds Sensibly (TOPS) is a national, nonprofit, community-based, peer-led weight loss program that meets these criteria. First, the applicant’s retrospective database analyses of TOPS showed two important results: 1) Participants who renew their annual membership lose and maintain significant weight loss (SWL) for up to 7 years; and 2) Compared to their younger counterparts, older women are more likely to achieve SWL. Second, the applicant started three TOPS chapters for older AA women in a successful pilot study. Though the study ended in 2012, one of the chapters is still active almost 6 years later. Third, TOPS is affordable; it only costs $92 annually. Finally, TOPS has a nationwide infrastructure with chapters in all 50 states. Since obese, frail, older individuals in academic, expert-led weight loss interventions can improve their physical function, the central hypothesis is that a low cost, community-based, peer-led weight loss program with a national infrastructure can provide SWL, improved physical function, and lower healthcare utilization for AA women, an underserved, vulnerable population. The rationale for the proposed research is that TOPS and academic, expert-led weight loss interventions share components critical to successful weight loss; therefore, TOPS can deliver similar outcomes. The central hypothesis will be tested by pursuing the following aims in obese, frail, older AA women: Determine the effect of TOPS on 1) weight change and cardiovascular disease risk factors; 2) physical function and quality of life; and 3) healthcare utilization. This project is innovative because it uses a “community to academia” approach to treat the health disparities; our study population focuses on older AA women with decreased physical function; our outcomes focus on weight, physical function, and healthcare utilization; and our unique study settings. The proposed research is significant because determining the real- world effectiveness of the TOPS program and its impact on weight, physical function, and healthcare utilization in AA women can have a widespread impact on the older population at large. Thus, it has the potential to reduce adverse geriatric outcomes among all older individuals.