A community-based lifestyle and weight loss intervention promoting a Mediterranean-style diet pattern evaluated in the stroke belt of North Carolina: The Heart Healthy Lenoir Project

Thomas C. Keyserling, Carmen D. Samuel-Hodge, Stephanie Jilcott Pitts, Beverly A. Garcia, Larry F. Johnston, Ziya Gizlice, Cassandra L. Miller, Danielle F. Braxton, Kelly R. Evenson, Janice C. Smith, Gwen B. Davis, Emmanuelle L. Quenum, Nadya T.Majette Elliott, Myron D. Gross, Katrina E. Donahue, Jacqueline R. Halladay, Alice S. Ammerman

Research output: Contribution to journalArticlepeer-review

31 Scopus citations


Background: Because residents of the southeastern United States experience disproportionally high rates of cardiovascular disease (CVD), it is important to develop effective lifestyle interventions for this population. Methods: The primary objective was to develop and evaluate a dietary, physical activity (PA) and weight loss intervention for residents of the southeastern US. The intervention, given in eastern North Carolina, was evaluated in a 2 year prospective cohort study with an embedded randomized controlled trial (RCT) of a weight loss maintenance intervention. The intervention included: Phase I (months 1-6), individually-tailored intervention promoting a Mediterranean-style dietary pattern and increased walking; Phase II (months 7-12), option of a 16-week weight loss intervention for those with BMI ≥ 25 kg/m2 offered in 2 formats (16 weekly group sessions or 5 group sessions and 10 phone calls) or a lifestyle maintenance intervention; and Phase III (months 13-24), weight loss maintenance RCT for those losing ≥ 8 lb with all other participants receiving a lifestyle maintenance intervention. Change in diet and PA behaviors, CVD risk factors, and weight were assessed at 6, 12, and 24 month follow-up. Results: Baseline characteristics (N = 339) were: 260 (77 %) females, 219 (65 %) African Americans, mean age 56 years, and mean body mass index 36 kg/m2. In Phase I, among 251 (74 %) that returned for 6 month follow-up, there were substantial improvements in diet score (4.3 units [95 % CI 3.7 to 5.0]), walking (64 min/week [19 to 109]), and systolic blood pressure (-6.4 mmHg [-8.7 to -4.1]) that were generally maintained through 24 month follow-up. In Phase II, 138 (57 group only, 81 group/phone) chose the weight loss intervention and at 12 months, weight change was: -3.1 kg (-4.9 to -1.3) for group (N = 50) and -2.1 kg (-3.2 to -1.0) for group/phone combination (N = 75). In Phase III, 27 participants took part in the RCT. At 24 months, weight loss was -2.1 kg (-4.3 to 0.0) for group (N = 51) and -1.1 kg (-2.7 to 0.4) for combination (N = 72). Outcomes for African American and whites were similar. Conclusions: The intervention yielded substantial improvement in diet, PA, and blood pressure, but weight loss was modest. Trial registration: clinicaltrials.gov Identifier: NCT01433484

Original languageEnglish (US)
Article number732
JournalBMC public health
Issue number1
StatePublished - Aug 5 2016

Bibliographical note

Funding Information:
Funder: This research was supported by National Institutes of Health (NIH) grant 5P50 HL105184 to the University of North Carolina Center for Health Promotion and Disease Prevention (HPDP) with subcontract to the Brody School of Medicine, East Carolina University. Other support was provided by Centers for Disease Control and Prevention (CDC) cooperative agreement No. U48/DP001944 to HPDP (a CDC Prevention Research Center). Role of the Funder/Sponsor: The funding agencies had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Publisher Copyright:
© 2016 The Author(s).


  • Cardiovascular disease
  • Dietary intervention
  • Disparities
  • Lifestyle intervention
  • Low-income participants
  • Mediterranean diet
  • Prevention
  • Weight loss intervention


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