The main goal of this study was to determine whether the LEAN Program, which emphasizes healthy lifestyle changes, was associated with significant weight loss for African-American and European-American female active-duty service members and to determine whether it was equally effective for both ethnic groups. The results of the study show that participation in the LEAN Program was associated with statistically significant weight loss for both African-American and European-American active-duty females. The mean weight loss for participants from both ethnic groups was 12.12 lbs, which falls within the 5-10% weight reduction range that is suggested by literature to assist individuals with lowering some health risks, including some types of cancers, cardiovascular diseases, and premature weight-related death.
Despite evidence that African-American females usually perform significantly less favorably in weight-loss programs, have lower metabolic rates,and that their REE (resting energy expenditure) decreases more rapidly when dieting than European-American females, the findings from this study identified no statistically significant difference between African-American and European-American females who presented for six-month follow-up. Although it would be assumed that the attrition rates between the two groups would be the same, this was not the case. There were significantly less African-American females that did not have six-month follow-up data than European-American females. For this study, those without six-month data, when the data was collected and analyzed, were considered drops-outs. Although the exact reasons why many of the participants did not have six-month data was unknown, the program LEAN staff was not informed of their absence, and the staff was not able to make contact with the participant.
Many of the participants did not provide six-month data because of deployment, pregnancy, military duty service reassignment, and because their military commitment was fulfilled and they relocated off the island of Oahu and communication was lost. It also appears that some individuals who enrolled in the LEAN program reduced the necessary amount of weight to be within military standards and discontinued LEAN program participation. It should be noted that a number of individuals without six-month data, at the time of the data collection and analysis, returned and resumed LEAN program participation. Because it is not clear why African-American females had significantly less six-month data than European-American females, it is particularly important that future LEIAN Program studies explore ways to reduce attrition rates, particularly among African-American females.
Perhaps incorporating topic lectures that address this specific area in Phase I of the LEAN program curriculum may reduce attrition rates, particularly among African-American females. Also, since factors that would contribute to attrition vary from individual to individual and from cohort to cohort, the group facilitator may explore possible reasons why group members may terminate the program prematurely and discuss strategies to address these issues.
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The primary limitation of this study is the absence of a control group, which prevents robust causal inference. Although the LEAN Program will likely be just as effective in the civilian population, the fact that the study was conducted in a military facility, with active-duty participants whose careers were in jeopardy from being overweight raises questions of generalizability. The selection process that is inherent in military recruiting also means that participants in this study were at one time more physically fit than the average civilian. It also bears mentioning that although the program was associated with significant weight loss at six months, it is not uncommon for initially successful individuals to experience weight gain six months after the end of a weight-loss regimen. A one- or two-year retrospective analysis would address these questions directly.
Despite the limitations of the study, the LEAN Program was shown to be effective for weight loss among European-American and African-American active-duty female service members who completed the program. Because the TAMC LEAN Program emphasizes making reasonable healthy lifestyle choices, such as low-intensity exercise, reading food labels, strategic meal preparation, reducing “emotional eating”, and relapse prevention strategies, and by only including individuals interested in joining an intensive program, it seems that the program could be effective for females within the general public. The benefits of the TAMC LEAN program were enhanced by the weekly follow-up visits that were positively correlated with weight loss. More frequent attendees may have gleaned more guidance, social support from their peers, and more reinforcement from the group leader, leading to increased treatment motivation and more favorable weight loss results.
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The favorable outcomes observed among African-American females who participated in the program may be influenced in part by the LEAN Program’s inclusion of some the guidelines suggested by Kumanyika & Morssink for adapting weight-loss programs to work effectively with diverse populations. These guidelines include making the program geographically accessible to the participants, integrating familiar resources, providing a supportive environment, avoiding the use of negative stereotypes, and promoting active involvement among the participants. These guidelines would also likely benefit females within the general public who are attempting weight loss. Lastly, it appears that LEAN Program’s staff, which is an ethnic- and gender-diverse group of providers, are respectful of others cultural foods choices and activity preferences. Such attributes have been shown to be essential in the treatment of obesity but especially with diverse populations like the U.S. military and the general American population.