“If you bring a public health program to people where they live, you can get amazing results,” says Peter Katzmarzyk, Ph.D., a professor of pediatric obesity and diabetes at Pennington Biomedical Research Center, Louisiana State University. Specifically, bringing health programs into underserved communities can lead to strong engagement and positive changes in people’s health. Dr. Katzmarzyk is part of the NIGMS-funded Louisiana Clinical & Translational Science Center (LA CaTS), a collaboration between 10 academic, research, and health care delivery institutions that focuses on reducing health disparities in Louisiana.
Defining Health Disparities
Health disparities are health differences, on the basis of one or more health outcomes, that adversely affect disadvantaged populations. A health disparity population is one with a pattern of poorer health outcomes, seen in how many overall cases of disease exist, how common the disease is, how it affects quality of life, and how often it leads to death, compared with the general population.
These populations, as designated by the National Institute of Minority Health and Health Disparities (NIMHD), include:
- Black/African Americans
- American Indians/Alaska Natives
- Native Hawaiians/other Pacific Islanders
- People who are socioeconomically disadvantaged (determined by income, education, occupation, and housing)
- People living in rural communities
- Sexual and gender minorities
Many researchers are investigating ways to reduce health disparities. They’re focusing on topics such as the disparities’ underlying causes, the best ways to communicate with underserved groups, and the effectiveness of alternative health care delivery methods, like telehealth.
LA CaTS Addresses Health Disparities Head On
LA CaTS supports researchers as they gain the knowledge needed to reduce disparities in chronic health conditions such as obesity, high blood pressure, and diabetes, which exist in multiple underserved groups. The center accomplishes this through a variety of programs and resources. For example, the LA CaTS pilot grant program funds studies on health disparities run by early career investigators, and its community scholars program supports researchers working closely with underserved communities to better understand their needs and develop programs to address them.
LA CaTS also assists with analyzing data, finding sites for clinical trials, and making documents such as consent forms that are easier for trial participants to understand. Further, the center provides a range of mentoring and professional development opportunities.
Bringing a Weight-Loss Program to Local Clinics
One example of LA CaTS’ impact is a 2020 study that showed that a weight-loss program was highly effective in disadvantaged communities. The study, offered through primary care clinics across Louisiana, was “built on the backbone of LA CaTS,” according to Dr. Katzmarzyk, the lead author.
More than half of the study participants were African American, and many had low household incomes—categories that have a higher risk for obesity. The program helped participants set diet and exercise goals, and supported them through sessions led by health coaches. Diet-related goals included managing food portion sizes and limiting daily calorie intake to a personalized target. Exercise goals included increasing physical activity to 175 minutes a week.
After 2 years, people who participated in the program maintained about 5 percent weight loss, on average. “Anywhere between 3 and 5 percent weight loss is thought to be clinically significant. People derive a lot of health benefits from that,” says Dr. Katzmarzyk. He adds that many weight-loss programs lead to people losing weight initially, then gaining it back in a short amount of time, so it was encouraging to see participants’ weight loss sustained over 2 years. Funds provided by the Patient Centered Outcomes Research Institute, along with resources of LA CaTS, enabled the development and implementation of the intervention.
Dr. Katzmarzyk and other LA CaTS researchers are planning to offer the weight-loss program in additional communities to further evaluate and improve its effectiveness.
Reaching Diabetes Patients Through Churches
Another example of LA CaTS’ reach is a study in which researchers are implementing a church-based program designed to help African Americans who have or are at risk for diabetes manage their conditions and lose weight. A grant from LA CaTS’ community scholars program funds the study, and leading it is Robert L. Newton, Jr., Ph.D., an associate professor of physical activity and ethnic minority health at Pennington Biomedical Research Center, in partnership with a church in Baton Rouge. Dr. Newton worked closely with the church to develop the grant application, and together they continue to shape the study.
“Historically, the African American church has been important not just for spiritual health but for mental and physical health,” says Dr. Newton. “There are parts of that legacy that continue on today where many churches have a health ministry. A lot of health programs have been developed in African American churches, and we wanted to build on that.”
Church members trained on the specifics of the program will lead weekly meetings about diabetes management, and researchers will send encouraging text messages to participants on a regular basis. The trained church members will provide feedback to help tailor the text messages to their church community, and the messages will include reminders about exercising, improving diet, and taking medications.
Previously, Dr. Newton and colleagues brought a weight-loss program to eight local churches that similarly used a text message component. To build on the success of that program, Dr. Newton is working collaboratively with the churches to decide on the topic, create the intervention materials, and develop the text messages. This academic-community partnership is known as Community-Based Participatory Research. He says that church-based health programs have been shown to be effective in other contexts, as have text-message-based interventions. He hopes that combining the two will create a highly effective program for supporting African Americans with diabetes. After conducting an initial study at the church in Baton Rouge, Dr. Newton plans to extend the program to other locations to gain further insights.
For more information on health disparities and how the National Institutes of Health seeks to address them, visit the NIMHD website.