The effectiveness of leader women intervention on obesity control in women living in A rural area

Objective: The aim of this study is to reduce BMI, body fat rate and fat weight and to provide weight loss on overweight and obese women, by regulating nutrition and increasing physical activity through peer facilitators (leader women). Material and Method: This study is a quasi-experimental study conducted on overweight and obese women aged 18-64 years between April 2018 and April 2019 and in a rural Family Physician Center (FPC) in Manisa province. The intervention method used is the 'Leader Woman' model, a special form of a model known as "training with peer leader" in the literature. Eleven of the women who participated in the intervention were identified as the leader women (n: 12, a woman not overweight or obese) and each leader woman formed her own target group. 137 of 322 women (42.5%) who were determined to be overweight or obese at the baseline study, agreed to participate to the intervention. Each women filled in and signed the ethical informed consent forms before intervention. Those who accepted to participate to the intervention, 86.9% could only be reached for interim (3rd month) antropometric assessment; 78.1% could complete the six-month target of the intervention. At the beginning of the intervention, study team educated leader women on obesity, diet and exercise in two and a half days sessions. The leader women were expected to transfer this education to their target women via engaged meetings at places where relevant in the town. All women were administered: the initial assessment questionnaire; physical activity assessment (via IPAQ); depressive mood assessment (via HADS) and the assessment of attitude to obese people (via ATOP). Also, women's height, waist and hip circumference were measured; Bioelectric Impedance Analysis (BIA) method was used for body analysis. Diet and change lists were given and pedometer was distributed to each women. Body analysis, waist and hip circumference measurements,also IPAQ and HADS depression sub-dimension were repeated at the end of the third and sixth months of intervention. Periodic data collection forms were distributed to the target women (healthy lifestyle forms) and the leading women (monthly monitoring forms). In analytical statistics Chi-square test, Fisher's exact test, McNemar test, Paired t test, Wilcoxon signed rank test; Repeated measures of variance, Friedman test, Mann Whitney U test, Kruskal-Wallis variance analysis and Bonferroni test in Post-hoc comparisons were used. Linear and logistic regression models was applied to multivariate comparisons. Results: The mean weight, waist circumference decreased respectively as 1.25 kg, 1.01 cm at the end of the 3rd month of intervention; and 1.13 kg, 1.30 cm at the end of the 6th month of intervention (p<0.05). The decrease of body fat weight is 1.73kg; body fat ratio is 1.76%; trunk fat weight is 0.69 kg; trunk fat ratio is 1.46% and the increase of body muscle weight is 0.47 kg (p<0.05). The percentage of the BMI category of women improved 8.4% in the 3rd month and 11.2% in the 6th month measurements. At the end of the intervention (6th month), 19.6% women lost weight, 5.0% and over. The number of women with a risk of depression decreased significantly during the intervention (p<0.05). The mean physical activity (MET) score of women increased significantly in the first period of intervention, but this increase could not be sustained over the whole period. Having health insurance, higher education and positive attitude towards obesity were the effective variables in intervention success in multivariate analysis (p <0.05). Conclusion: This community-based peer-led obesity intervention can generally be regarded as a successful intervention, but further interventions are needed to find a solution for the problem of sustanability. Priorities can be given to those who has positive attitude to obesity in the community based obesity intervention programs. Keywords: obesity, obesity prevention and control, women's health, peer