Abstract
Objective: Churches are frequently used to reach Black adults to effect weight loss. However, there has been no recent review, to our knowledge, inclusive of solely Black adults in church settings. We sought to comprehensively examine the methodological approaches and weight-loss outcomes of church-based weight-loss lifestyle interventions conducted among Black adults to provide insights on literature gaps and offer suggestions for future research. Methods: Google Scholar, PubMed, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) were searched for trials conducted in churches that reported weight outcomes at any time point. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guided manuscript development. Results: A total of 15 studies (N = 2285) from 2007 to 2023 met inclusion criteria, and 33% were high-quality randomized trials. The majority were pilot studies (60%) conducted in the Southern United States. Most reported significant postintervention weight loss. The follow-up time points varied from 2 to 12 months. Methodological approaches included the following: cultural adaptations (93%); theory-guided (93%); delivered by community health workers (80%); and delivered in person in a group format (100%). Only one study offered individual-level attention beyond texts/emails. Most participants were well-educated female individuals. Conclusions: Weight-loss interventions among Black church settings effect statistically significant weight loss, albeit in a small way. Limitations include pilot studies and small samples. More rigorously designed studies are warranted.
| Original language | English |
|---|---|
| Pages (from-to) | 2060-2076 |
| Number of pages | 17 |
| Journal | Obesity |
| Volume | 32 |
| Issue number | 11 |
| DOIs | |
| State | Published - Nov 2024 |
Bibliographical note
Publisher Copyright:© 2024 The Author(s). Obesity published by Wiley Periodicals LLC on behalf of The Obesity Society.
Funding
To determine the quality of the selected studies, two reviewers (Lovoria B. Williams and Bassema Abu Farsakh) used the Cochrane Risk of Bias Scale [44] to independently assess the quality of the randomized trials [45–48] and the two-group quasi-trials [49–51], as shown in Table 2. Moreover, the reviewers used the National Institutes of Health quality assessment tool for before-after studies [52] to assess the quality of the single-group quasi-trials [41, 53–58], as shown in Table 3. We adhered to the PRISMA guidelines to report study selection and identification [59]. Abbreviations: H, high risk of bias; L, low risk of bias. Note: 0 = no, 1 = yes. Abbreviations: N/A, not applicable; NIH, National Institutes of Health. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guided manuscript development. We established the methods and inclusion criteria a priori and conducted electronic database searches in December 2023. A university librarian assisted in the refinement of the search syntax. To identify weight-loss lifestyle change interventions and/or DPP translation studies conducted in African American/Black churches, we searched Google Scholar, PubMed, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases for articles published between 2007 and 2023. The following search terms were used: “faith-based”; “church-based”; “church”; “diabetes prevention”; “diabetes prevention program”; “adults”; “lifestyle intervention”; “weight loss”; “weight reduction”; “weight management”; “intervention”; “African American”; “Blacks”; and “community based.” See Table 1 for the search terms applied in each database. We limited the search to peer-reviewed scientific journals written in English. Abbreviations: AB, abstract; CINAHL, Cumulative Index to Nursing and Allied Health Literature; MH, major heading; TI, Title. Inclusion criteria determined a priori included the following: 1) lifestyle change interventions with faith-based scope/recruitment setting and intervention delivery of the study; 2) enrolled African American/Black adult samples; 3) weight-loss aim that reported pre- and postintervention weight or body mass index (BMI); and 4) interventions that focused on weight maintenance if initial weight-loss outcomes were reported. Because of the proliferation of DPP translation studies to community sites after 2007, we conducted our search from 2007 to 2023. Exclusion criteria included solely qualitative methodologies, literature reviews, samples that included individuals other than Black or African American individuals, settings other than churches [35], duplicate samples [36, 37], or studies that included diverse samples and did not report a subanalysis of the Black adults [38] or that aimed at weight maintenance rather than weight loss [39]. The preliminary search identified 25,007 articles. Figure 1 provides the PRISMA flowchart. After filters were applied, 581 articles remained. After applying the inclusion criteria and excluding irrelevant articles or those that did not meet the inclusion criteria, three authors (Lovoria B. Williams, Bassema Abu Farsakh, and Zainab S. Almogheer) independently reviewed the articles' full text and rated each on a scale of 1 to 3 to assess the extent the study met the inclusion criteria. A rating of 1 indicated that the study did not meet the inclusion criteria, 2 indicated uncertainty (unclear whether it met all four inclusion criteria), and 3 indicated that the study met the inclusion and exclusion criteria. The three authors then compared their rating scores of the selected articles, and those scoring less than 3 were discussed and discrepancies were resolved. This process resulted in the exclusion of additional articles for reasons such as focus on blood pressure reduction [40] rather than weight loss and research protocol without results [41–43], which left 15 articles that met our inclusion criteria. Using a standardized evidence table form, two authors (Lovoria B. Williams and Bassema Abu Farsakh) extracted data from each trial. Each conducted an independent review of the articles and tabulated the selected articles based on their purpose/hypothesis(es), design, primary and secondary outcome measures, adopted theory/model (if any), interventionists' background and training, participants' characteristics and retention rate, description and length of the intervention, delivery method, cultural adaptation approaches, level of intervention (i.e., group vs. individualized), and weight/BMI change. To determine the quality of the selected studies, two reviewers (Lovoria B. Williams and Bassema Abu Farsakh) used the Cochrane Risk of Bias Scale [44] to independently assess the quality of the randomized trials [45–48] and the two-group quasi-trials [49–51], as shown in Table 2. Moreover, the reviewers used the National Institutes of Health quality assessment tool for before-after studies [52] to assess the quality of the single-group quasi-trials [41, 53–58], as shown in Table 3. We adhered to the PRISMA guidelines to report study selection and identification [59]. Abbreviations: H, high risk of bias; L, low risk of bias. Note: 0 = no, 1 = yes. Abbreviations: N/A, not applicable; NIH, National Institutes of Health.
| Funders | Funder number |
|---|---|
| National Institutes of Health (NIH) | |
| Preferred Reporting Items for Systematic Reviews and Meta-analyses | |
| CINAHL | 41–43 |
ASJC Scopus subject areas
- Medicine (miscellaneous)
- Endocrinology, Diabetes and Metabolism
- Endocrinology
- Nutrition and Dietetics
