The importance of community consultation and social support in adhering to an obesity reduction program: Results from the Healthy Weights Initiative

Abstract

Background: Few community-based obesity reduction programs have been evaluated. After 153 community consultations, the City of Moose Jaw, SK, Canada, decided to initiate a free comprehensive program. The initiative included 71 letters of support from the Mayor, every family physician, cardiologist, and internist in the city, and every relevant community group including the Heart and Stroke Foundation, the Canadian Cancer Society, and the Public Health Agency of Canada. Objective: To promote strong adherence while positively influencing a wide range of physical and mental health variables measured through objective assessment or validated surveys. Methods: The only inclusion criterion was that the individuals must be obese adults (body mass index > 30 kg/m2). Participants were requested to sign up with a “buddy” who was also obese and identify three family members or friends to sign a social support contract. During the initial 12 weeks, each individual received 60 group exercise sessions, 12 group cognitive behavioral therapy sessions, and 12 group dietary sessions with licensed professionals. During the second 12-week period, maintenance therapy included 12 group exercise sessions (24 weeks in total). Results: To date, 243 people have been referred with 229 starting. Among those who started, 183 completed the program (79.9%), while 15 quit for medical reasons and 31 quit for personal reasons. Mean objective reductions included the following: 31.0 lbs of body fat, 3.9% body fat, 2.9 in from the waist, 2.3 in from the hip, blood cholesterol by 0.5 mmol/L, systolic blood pressure by 5.9 mmHg, and diastolic blood pressure by 3.2 mmHg (all P < 0.000). There were no changes in blood sugar levels. There was also statistically significant differences in aerobic fitness, self-report health, quality of life measured by Short Form-36, and depressed mood measured by Beck Depression Inventory-II (all P < 0.000). Independent risk factors for not completing the program were not having a family member or friend sign a social support contract (odds ratio 2.91, 95% confidence interval 1.01–8.34, P=0.047) and lower education (odds ratio 2.90, 95% confidence interval 1.20–7.03, P=0.018). Conclusion: Comprehensive obesity reduction programs can be effective when there is extensive consultation at the community level and social support at the individual level.