A Controlled Evaluation of Staging Dietary Patterns to Reduce the Risk of Diabetes in African-American Women

Wendy Auslander, PHD, Debra Haire-Joshu, PHD, Cheryl Houston, PHD, RD, Chaie-Won Rhee, MSW, James Herbert Williams, PHD


Diabetes Care. 2002;25(5) 

In This Article

Abstract and Introduction

Objective. This study evaluated the 3-month follow-up data of the Eat Well, Live Well Nutrition Program, a culturally specific, peer-led dietary change program designed to reduce the risk of type 2 diabetes in low-income African-American women. This peer-led program was delivered in the community and was tailored to the participants’ stage of change for individual dietary patterns. We report the results of the 3-month intervention and the extent to which dietary changes and other key outcomes were maintained at a 3-month follow-up assessment.
Research Design and Methods. Using an experimental control group design, 294 overweight African-American women (ages 25–55 years), recruited in collaboration with a neighborhood organization, completed pre- and posttest and 3-month follow-up interviews of dietary behaviors, knowledge, attitudes, fat intake, and weight.
Results. Significant reductions were found in fat intake among women in the treatment condition when compared with women in the control group; these reductions were maintained at 3-month follow-up assessment. Likewise, significant changes in dietary patterns were reported after the study and were maintained, except for one dietary pattern (replacement).
Conclusions. This model of health promotion, which individually tailors dietary patterns through staging and use of peer educators, has the potential for decreasing fat intake and increasing and maintaining specific low-fat dietary patterns among overweight African-American women at risk for diabetes.

The prevention of type 2 diabetes among African-American women is critical because of the high rates of diabetes-related mortality and morbidity in this population. Among African-American women, diabetes is considered epidemic; the rate is 11.8% among women >\= 20 years of age, and 25% among women >55 years of age. This is nearly twice the rate of Caucasian women [1]. In addition, African-Americans experience higher rates of diabetes-related complications than Caucasians, such as eye disease, kidney failure, and lower extremity amputations. For example, the frequency of diabetic retinopathy is 40–50% higher, and end-stage renal disease is four times more likely among African- Americans than Caucasians. Moreover, the overall mortality rate among African-American women is 40% higher compared with their Caucasian counterparts [2].

One explanation for the higher rates of diabetes in this population is the higher amount of dietary fat consumed by AfricanAmericans when compared with Caucasians [3,4]. Dietary patterns have been examined as a major risk factor contributing to type 2 diabetes. For example, in their description of the lifestyle risk factors for type 2 diabetes, Rewers and Hamman [5] indicated that higher dietary fat intake was associated with a higher risk of diabetes, even after adjusting for obesity, age, sex, ethnicity, fat distribution, and fasting insulin levels. Moreover, recent nutrition-related recommendations for diabetes prevention have indicated that reducing intake of total and saturated fat, independent of total calories, may reduce the risk of diabetes [6]. This result may be explained by the adverse impact that dietary fat has on insulin sensitivity [6]. Thus, changing dietary patterns to reduce fat intake may be important for reducing the risk of diabetes.

To address this challenge, a community-based dietary change program, the Eat Well, Live Well Nutrition Program (EWLW), was delivered to African-American women at risk for diabetes. Its primary focus was to reduce dietary fat intake and increase low-fat dietary patterns by tailoring the intervention to participants’ readiness to make changes in their diet. Although weight reduction was encouraged, healthy eating through lowering fat in the diet was the major emphasis for recruitment and program content.

Few dietary change programs use participants’ readiness to change as a method for individually tailoring program content. The stages of change theory, which guided the delivery of the EWLW program, asserts that change is a dynamic process occurring over these distinct stages [7]: 1) precontemplation, the stage at which the person is unaware of the risk of their behavior or aware but unwilling to consider changing a given behavior in the foreseeable future; 2) contemplation, the stage that begins when the individual is thinking about changing a behavior, but is not taking active steps to change; 3) preparation, the stage during which the individual is making definite plans to change a given behavior; 4) action, the stage during which the individual initiates the behavior change by actively modifying habits or environment; and 5) maintenance, the stage during which the individual is sustaining the behavior change and preventing relapse. Individuals may cycle through the stages several times before they maintain a change in behavior [8]. This theory has been used to assess and guide intervention programs for a variety of health behaviors, such as smoking cessation [9], exercise [10], and weight control [11]. Although recently this theory has been used in cross-sectional studies to predict dietary fat intake among African-American women [12], only a few studies, such as the one by Greene and Rossi [13], have used this theory for intervention in dietary change, and none has staged specific dietary patterns in an attempt to tailor program content among African-American women.

The purpose of this study was to evaluate the extent to which African-American women who participated in the EWLW reduced and maintained lower dietary fat intake in a 3-month follow-up period.


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