Evaluation of a Community-led nutrition and Lifestyle program for weight loss and metabolic Health

INTERVENTION: The Hope for Health (HfH) lifestyle program. A holistic initiative combining traditional indigenous practices with modern approaches to health nutrition and lifestyle. Specifically, the program is divided into two parts: 1. A traditional 2‐week retreat, taking people out of their home environment to stay in natural bush land, and providing culturally and linguistically effective two‐way education that targets gaps in understanding of nutrition and health. The retreat involves nutrition and health education, training in lifestyle skills, exercise, cooking and stress management. This program (Hope for Health) is a readily available program delivered by Why Warriors Org Ltd. 2. Support and Mentoring (3.5 months) includes individual case management and regular activities, provided for 14 weeks after the retreat. Participants receive support to tackle other systemic barriers that directly affect their ability to instigate lifestyle changes, such as choosing healthy food options at the store, dealing with difficulties in storing fresh produce at home, overcoming poor sleep and family stress from substance abuse and overcrowding, and seeking assistance for gambling. Importantly, dietary advice, home cooking demonstrations (usually conducted outside the house), and fitness activities are open for all household members, with the aim of imparting new knowledge and skills to a broader community. The support and mentoring will be delivered by the local members of Hope for Health team in conjunction with Miwatj Health and The Arnhem Land Progress Aboriginal Corporation nutritionists. At least weekly activities (health coach appointments) will be organised, determined through a participatory process, emphasising opportunities for peer‐support discussion (yarning) CONDITION: Diet and Nutrition ‐ Obesity Overweight ;Obesity; ; Overweight ; Obesity PRIMARY OUTCOME: Weight loss of at least 5% in a proportion of participants assessed by trained personnel using a validated weighing scale. [Baseline and 4 months post commencement of the intervention.] INCLUSION CRITERIA: 1. Adults greater than or equal to 18 years of age to less than or equal to 65 years of age 2. Body mass index (BMI) greater than or equal to 25 kg/m2 3. Residents of Elcho Island 4. Expressed interest and agreed to undertake the Hope for Health program 5. Not expected to leave the Island for more than 2 weeks in the 4 months after enrolment 6. Provided a signed and dated informed consent form SECONDARY OUTCOME: Blood pressure and aortic stiffness measured using the SphygmoCor XCEL by two trained personnel. [Baseline and 4 months post commencement of the intervention.] Body mass index will be calculated using hight and weight measured using standardised measuring scales and stadiometer. [Baseline and 4 months post commencement of the intervention.] Clinical Blood Biomarkers blood count, plasma insulin, cholesterol and lipid profile and sensitive markers of inflammation measured using venous blood and fasting glucose and HbA1c measured using finger pick blood test. [Baseline and 4 months post commencement of the intervention.] Dietary intake measured using the Menzies Remote Short‐item Dietary Assessment Tool, 24‐hour dietary recall and the food insecurity experience scale questionnaire. [Baseline and 4 months post commencement of the intervention.] Physical activity measured using the Physical activity and sitting questions using in National Aboriginal and Torres strait Islander Health Survey and seven day objective measurement using wrist worn ActiGraph Link activity monitors. [Baseline and 4 months post commencement of the intervention.] Quality of life measured using the Strong Souls Tool. [Baseline and 4 months post commencement of the intervention.] Risk of obstructive sleep apnea assessed using the STOP BANG questionnaire [Baseline and 4 months post commencement of the intervention.] Waist circumference measured by two trained personnel using a standardised measuring tape. [Baseline and 4 months post commencement of the intervention.] Weight assessed by two trained personnel measured using standardised measuring scales. [Baseline and 4 months post commencement of the intervention.]