By Alvin Tran
Get active. Eat Smart. Eat your colors. And eat breakfast.
These were the four themes guiding participants in “Live Well, Be Well,” a diabetes prevention program in the San Francisco Bay Area for underserved communities.
The researchers recruited over 230 adults at risk for diabetes from Berkeley, Oakland, and Richmond. They were randomized, and half received a series of phone-based, lifestyle counseling sessions. The other half, the control group, was offered counseling after one year.
Participants chose from the four themes to guide their sessions, says UCSF Associate Professor of Medicine and lead author of the study, Dr. Alka Kanaya, M.D.
“We wanted to basically see which [theme participants felt] most interested in and the one they felt were most feasible for them to make a change. We really did want to pound home the message about healthy diet, eating correct portion sizes, [and] making smart choices when you’re eating food.”
Trained health educators from Berkeley’s Division of Public Health guided these phone-based sessions and helped participants create goals for diet and exercise. After six months, the counseling sessions stopped.
At six and twelve months, researchers collected a combination of physical characteristics related to diabetes risk. Those included the participants’ weight and cholesterol levels, and behavioral risk factors such as food intake and physical activity.
“We looked at a broad variety of risk factors all associated with diabetes,” Kanaya explained. “[We were] looking at a conglomerate of various outcomes.”
The results, published in the American Journal of Public Health, were primarily positive. Those who received six months of counseling had significant changes. “We saw that people who were assigned to the telephone counseling intervention actually did achieve more significant weight-loss than the group that was in the waitlist control,” said Kanaya.
She said those who received phone counseling also consumed more fruits and vegetables and fewer grams of fat per day.
But at twelve months, many of the lifestyle changes did not persist. “But that’s real life,” Kanaya explained. “People, when they make changes, they make them in the first six months of most trials. Having them sustain the change can be more difficult.”
Kate Clayton, Chief of Health Promotion at Berkeley’s Division of Public Health, is optimistic. “It’s something that’s relatively cost-effective for us as a health department to deliver phone-based counseling as opposed to in-person [counseling],” she said.
Berkeley’s Division of Public Health was unable to prolong Live Well, Be Well because of the lack of funding for the program. “The Department of Public Health really felt strongly that they were providing good service not knowing how the data would stack up in the end. Unfortunately, they could only do the telephone counseling until their funding ran out for it,” Kanaya said.
Clayton said while Live Well, Be Well is currently not a formal program, there is a lot to learn from the study.
“One of our real goals for both UCSF and the Berkeley Public Health Department was to really recruit African Americans, Latinos, and folks from lower socioeconomic status and with less education,” Clayton said. “We were successful in that. We are really happy to have a study that shows that an intervention can work with those populations because they have a lot of challenges.”
Clayton said she plans to use the results to apply for more funds next year to bring Live Well, Be Well back to the community, and encourage other public health departments to use a similar model.