Addressing Intergenerational Obesity and Promoting Healthy Eating and Physical Activity Among Individuals Living with Diabetes in Appalachia Kentucky

Scope of Work (8/1/2025-11/14/2025) The University of Kentucky Research Foundation (Drs. Barr-Porter, Duncan, Harlow, and Norman-Burgdolf) will be responsible for finishing out the current grant, assisting with analysis and conceptualizing of data and findings, collaborating on dissemination of findings, and any publications following the work. Burden of type 2 diabetes and obesity in rural communities. Type 2 diabetes mellitus (T2DM) is a persistent public health condition with 34.1 million U.S. adults affected (Centers for Disease Control and Prevention, 2020). Moreover, geographic disparities exist with some population segments such as rural-dwelling Americans experience greater vulnerability to this condition. For instance, the prevalence of diagnosed T2DM is 17% higher in rural residents compared to their urban counterparts (Massey et al, 2010). The prevalence of T2DM in Kentucky’s rural Appalachian counties is 13.6%, compared to the overall state prevalence of 10.6% (Kentucky Cabinet for Family and Health Services, 2020). Moreover, in Kentucky, obesity rates are among the highest in the nation with approximately 36.5% of adults classified as obese, 13.3% diagnosed with type 2 diabetes, 40.9% with hypertension, 37.9% with high cholesterol, while only 15.3% meet physical activity recommendations, and 4.7% meet fruit and vegetable consumption recommendations (America’s Health Rankings, 2020). The burden of T2DM and obesity is evident across the lifespan. As obesity prevalence continues to increase in American population, increased attention is also given to younger generations. Approximately 24% of adolescent ages 10 to 17 are classified as obese in Kentucky, placing the state number 1 in youth obesity (State of Childhood Obesity, 2020). Approximately 24% of adolescent ages 10 to 17 are classified as obese in Kentucky, placing the state number 1 in youth obesity (State of Childhood Obesity, 2020).The increased prevalence of obesity can be associated with youth-onset T2DM indicated by a 95.3% increase from 2001 to 2017 (Lawrence et al, 2021). Moreover, the prevalence of T2DM increases with age and an estimated 25% of older adults (≥ 65 years) have T2DM (Kirkman et al, 2012). The increased prevalence in T2DM among older adults is consistent with the increased prevalence of T2DM where an estimated one-third of older adults are obese (Kritchevsky, 2018). Intergenerational households are prevalent and can be used to promote health in rural Appalachia communities. With an estimated 5.9 million intergenerational families (e.g., grandparents, parents, grandchildren ≤18 years; America’s Fact Finder, 2017), it is imperative that we understand how this family structure impacts the health of its members. This type of family unit is particularly of interest in rural Appalachia since families provide influence cultural health beliefs and health behaviors. In addition to intergenerational households, families in rural Appalachia live on the same piece of land called hollows—land between two mountains. Family-centered behaviors (Fiese et al, 2015; Demir & Bektas, 2017) have long-standing been shown to have positive, health-promoting benefits on nutrition and health outcomes (Schor, 1995). Thus, tailoring an intervention that mitigate social environment factors that hinder proper nutrition and physical activity. Importance of healthy eating/nutrition and physical activity to improve T2DM outcomes and risk. For those living with T2DM it is imperative the healthy eating/nutrition and physical activity are part of their routine (National Institute of Diabetes and Digestive and Kidney Diseases [NIDDK], 2016). These two components of T2DM self-care in addition to prescribed medications, are instrumental in managing glycemic levels, blood pressure, and cholesterol; lose weight; and reduce the risk of T2DM related complications (NIDDK, 2016). For those who may be at risk for diabetes or have prediabetes, healthy eating/nutrition and physical activities are also key to reducing the risk of progression to T2DM. Therefore, the specific aims for this study are as follows: Aim 1: Use social network analysis to describe (a) community assets (e.g., access to healthy eating and ways to participate in physical activity) and (b) intergenerational links to obesity and diabetes (e.g., parent, sibling, child). Aim 2: Develop a tailored household-specific nutrition and physical activity plan. Aim 3: Determine the preliminary effectiveness of a tailored nutrition and physical activity for those living within the household. H3a: Participants (overweight/obese individuals living with diabetes) will have a clinically meaning change in hemoglobin A1c (≥ 0.5%) and weight (≥ -6%) H3b: Members of the households will have improved in glycemic control and anthropometric indicators of being overweight/obese.