Steps Ahead: A Randomized Trial to Reduce Unhealthy Weight Gain in the Lower Mississippi Delta

Objective: The Lower Mississippi Delta (LMD) region of the United States is characterized by high levels of obesity and physical inactivity. The objective was to test the effectiveness of adapting the 2010 Dietary Guidelines for Americans (DG), with and without a physical activity (PA) component, for attenuating weight gain. Methods: Overall, 121 white and African- American adults (35-64 years; body mass index 25-34.9 kg m 2) were randomized to a DG only group (n 5 61) or a DG 1 PA group (n 5 60). Both groups received a 12week dietary education and behavior change intervention. The DG 1 PA group also received PA education and a pedometer. Changes in weight (kg), % weight, and waist circumference (WC; cm) were determined. Analyses considered all completers (n 5 99) and those who engaged with 80% of the intervention (n 5 83). General linear models compared mean changes between groups after adjustment for baseline values, race, and sex. Results: Weight, % weight, and WC significantly decreased from baseline to follow-up in both groups (p < 0.05; unadjusted values). Adjusted analysis showed a main effect of group for weight (p 5 0.041) and % weight (p 5 0.047) in the completers analysis, and WC (p 5 0.046) in the 80% attendance analysis, with the DG 1 PA group improving weight-related outcomes more. Conclusions: Low-burden behavioral interventions could be effective strategies in attenuating unhealthy weight gain in the LMD.