The Medical journal of Australia · 2025
Improving cardiometabolic risk factors in Aboriginal and Torres Strait Islander people in northeast Arnhem Land: single arm trial of a co-designed dietary and lifestyle program.
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Dissanayake Hasthi Uw, Gurruwiwi George, Dhurrkay J, Tynan Josh C, Braat Sabine, Harrap Benjamin, Trudgen Tim, Hanieh Sarah, Clark Bronwyn, Spencer Michaela, Christie Michael, Tonkin Emma, Armstrong Emily, Harrison Leonard C, Wentworth John M, Brimblecombe Julie K, Biggs Beverley-Ann
Аннотация
OBJECTIVE: To evaluate the impact of a 4-month dietary and lifestyle program co-designed and led by Aboriginal and Torres Strait Islander people on weight and metabolic markers, diet, and physical activity in overweight and obese adults in a remote Indigenous community.
STUDY DESIGN: Single arm, pre-post intervention study.
SETTING, PARTICIPANTS: Adult residents (18-65 years) of a remote Northern Territory community with body mass index (BMI) values of at least 25 kg/m2 or waist circumferences exceeding 94 cm (men) or 80 cm (women).
INTERVENTION: Hope for Health, a culturally sensitive 4-month program supporting self-managed health improvement based on dietary and lifestyle change, 1 August to 30 November 2022.
MAIN OUTCOME MEASURES: Weight loss of at least 5%; changes in BMI, waist circumference, other metabolic markers (blood pressure, biomarkers of metabolic health and inflammation), diet, and physical activity; participant perceptions of the program.
RESULTS: We assessed outcomes for 55 participants who completed weight assessments at both baseline and program end (mean age, 42.5 years [standard deviation, 10.1 years]; 36 women [65%]). Forty participants lost and 15 gained weight; overall mean weight loss was 1.5 kg (95% confidence interval [CI], 0.5-2.4 kg), and ten participants (18%; 95% CI, 9-31%) achieved at least 5% weight reduction. The mean change in BMI (53 participants) was -0.60 kg/m2 (95% CI, -0.93 to -0.27 kg/m2), in waist circumference (53 participants) -3.2 cm (95% CI, -4.7 to -1.7 cm), and in low-density lipoprotein cholesterol level (37 participants) -0.28 mmol/L (95% CI, -0.47 to -0.08 mmol/L); the relative decline in the HbA1c level geometric mean (50 participants) was 11% (95% CI, 6-15%). The intake of breads and cereals (median change, -1.5 [95% CI, -2.0 to -1.0] serves/day) and sugar-sweetened beverages (-0.6 [95% CI, -1.4 to -0.1] serves/day) declined; the amount of moderate and vigorous physical activity increased by a median of 103 min/day (95% CI, 74-136 min/day; 19 participants). The program focus on integrating healthy bodies and networks of kin, healthy governance, vibrant language and ceremony, and a healthy environment were seen as central to its value and benefit.
CONCLUSIONS: Community appreciation of the program and the improvements in cardiometabolic risk factors are encouraging, providing an example of a culturally sensitive, co-designed initiative led by Indigenous people for reducing the prevalence of chronic disease in remote areas.
TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ACTRN12622000174785; prospective: 2 February 2022).
STUDY DESIGN: Single arm, pre-post intervention study.
SETTING, PARTICIPANTS: Adult residents (18-65 years) of a remote Northern Territory community with body mass index (BMI) values of at least 25 kg/m2 or waist circumferences exceeding 94 cm (men) or 80 cm (women).
INTERVENTION: Hope for Health, a culturally sensitive 4-month program supporting self-managed health improvement based on dietary and lifestyle change, 1 August to 30 November 2022.
MAIN OUTCOME MEASURES: Weight loss of at least 5%; changes in BMI, waist circumference, other metabolic markers (blood pressure, biomarkers of metabolic health and inflammation), diet, and physical activity; participant perceptions of the program.
RESULTS: We assessed outcomes for 55 participants who completed weight assessments at both baseline and program end (mean age, 42.5 years [standard deviation, 10.1 years]; 36 women [65%]). Forty participants lost and 15 gained weight; overall mean weight loss was 1.5 kg (95% confidence interval [CI], 0.5-2.4 kg), and ten participants (18%; 95% CI, 9-31%) achieved at least 5% weight reduction. The mean change in BMI (53 participants) was -0.60 kg/m2 (95% CI, -0.93 to -0.27 kg/m2), in waist circumference (53 participants) -3.2 cm (95% CI, -4.7 to -1.7 cm), and in low-density lipoprotein cholesterol level (37 participants) -0.28 mmol/L (95% CI, -0.47 to -0.08 mmol/L); the relative decline in the HbA1c level geometric mean (50 participants) was 11% (95% CI, 6-15%). The intake of breads and cereals (median change, -1.5 [95% CI, -2.0 to -1.0] serves/day) and sugar-sweetened beverages (-0.6 [95% CI, -1.4 to -0.1] serves/day) declined; the amount of moderate and vigorous physical activity increased by a median of 103 min/day (95% CI, 74-136 min/day; 19 participants). The program focus on integrating healthy bodies and networks of kin, healthy governance, vibrant language and ceremony, and a healthy environment were seen as central to its value and benefit.
CONCLUSIONS: Community appreciation of the program and the improvements in cardiometabolic risk factors are encouraging, providing an example of a culturally sensitive, co-designed initiative led by Indigenous people for reducing the prevalence of chronic disease in remote areas.
TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ACTRN12622000174785; prospective: 2 February 2022).