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- 通过干预措施，肥胖、体弱、老年人的体重减轻，身体机能改善。然而，在这方面， 由于高昂的人力成本和不存在全国性的基础设施， 干预不切实际。长期目标是消除肥胖和虚弱的健康差距， 老年戒酒会女性该提案的总体目标是确定一个低成本、以社区为基础、 同伴主导的减肥计划，在肥胖、身体功能和医疗保健方面建立国家基础设施 老年AA妇女的使用。为了治疗老年AA女性的肥胖和虚弱， 干预措施：1）有初步证据证明有益; 2）老年AA妇女可接受; 3）负担得起;以及 4)可以广泛传播。明智地减掉体重（TOPS）是一个全国性的、非营利的、以社区为基础的， 同伴主导的减肥计划，符合这些标准。首先，申请人的回顾性数据库分析， TOPS显示了两个重要的结果：1）更新年度会员的参与者失去和保持 显着的体重减轻（SWL）长达7年;和2）与年轻的同行相比，老年妇女 更有可能达到SWL。第二，申请人开始三个TOPS章为老年AA妇女在一个 成功的试点研究。虽然这项研究在2012年结束，但其中一个章节在近6年后仍然活跃。 第三，TOPS是负担得起的;它每年只需92美元。最后，TOPS有一个全国性的基础设施， 在所有50个州。由于肥胖，体弱，老年人在学术，专家主导的减肥干预措施可以改善 他们的身体功能，中心假设是，一个低成本，以社区为基础，同行为主导的减肥计划， 国家基础设施可以提供SWL，改善身体功能，降低医疗保健利用率， AA妇女，一个得不到充分服务的弱势群体。拟议研究的理由是，TOPS和 学术，专家主导的减肥干预措施共享成功减肥的关键组成部分;因此， TOPS可以提供类似的结果。中心假设将通过追求以下目标来检验， 肥胖、虚弱、老年AA女性：确定TOPS对1）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。该项目具有创新性，因为 它使用“社区到学术界”的方法来处理健康差异;我们的研究人群集中在老年人， 身体功能下降的AA女性;我们的结果侧重于体重、身体功能和医疗保健 利用率;以及我们独特的研究环境。这项研究的意义在于确定真实的- TOPS计划的全球有效性及其对体重、身体功能和医疗保健利用的影响 在AA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 所有老年人的不良老年结局。

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.