Translating Lifestyle Programs for Diabetes Prevention inSouth Asian Communities

Translating Lifestyle Programs for Diabetes Prevention in South Asian Communities South Asians, people from the Indian subcontinent, are at increased risk for developing diabetes. Translating successful diabetes prevention programs to create culturally appropriate lifestyle interventions for South Asian populations worldwide is a prudent method for preventing diabetes in this population. The aims of this dissertation are to understand the determinants of lifestyle behaviors and excess weight and evaluate the ability of a culturally tailored lifestyle intervention to improve anthropometric measures related to diabetes risk in the South Asian population. This dissertation describes research using data from two different studies which seek to plan, implement, and evaluate lifestyle programs for diabetes prevention in South Asian populations: the formative research phase of the US-based South Asian Health and Prevention Education (SHAPE) study and cross-sectional and longitudinal data from the Diabetes Community Lifestyle Improvement Program (D-CLIP) in Chennai, India. A thematic analysis of verbatim transcripts from seventeen focus group discussions conducted with US South Asians showed that immigration to the US and gender expectations, particularly the desire to ensure the comfort and happiness of family members, were barriers to healthy lifestyle behaviors. Conversely, family can also be a motivator and a source of social support for healthy lifestyles. A cross-sectional analysis of D-CLIP screening data (N=1,281) assessed the relationship between factors associated with healthy weight maintenance (fruit and vegetable intake, weekly exercise, weight loss history, and weight loss and exercise self-efficacy) and BMI and waist circumference. Weekly fruit consumption, past weight loss experience, and weight loss self-efficacy, along with gender, age, and marital status, explained 13.7% and 25.8% of the variation in BMI and waist circumference, respectively, in this population. Finally, changes in BMI, weight, and waist circumference during the first six months of the D-CLIP randomized controlled intervention trial were compared in intervention (n=294) and control (n=304) participants. Intervention participants showed significantly greater reductions (p<0.0001 for all) in weight, BMI, and waist circumference (2.86 kg, 1.05 kg/m2, and 3.72 cm) compared to controls (0.73 kg, 0.31 kg/m2, and 1.58 cm). Based on the results of this research, recommendations for diabetes prevention in South Asian populations are proposed.