Long-term bodyweight and glucose management effects of the Microclinic Social Network Health Behavioral Program in Amman, Jordan: 2-year results
AUTHORS: Daniel E Zoughbie, Kathleen T Watson, Nancy Bui, Rami S Farraj, Marta R Prescott, Eric L Ding
BACKGROUND: Evidence shows that social network phenomena are major drivers of lifestyle risk factors that contribute to risks of obesity and diabetes. Since 2005, Microclinic International has pioneered the research and development of a novel social network “microclinic” model—a social network programme designed to propagate lifestyle change and leverage pre-existing social networks to improve health. We sought to assess the effectiveness of such a social network programme for sustaining long-term health.
METHODS: With the Microclinic Social Network Behavioral Health Program in Jordan, patients with diabetes or prediabetes were enrolled in the 4-month Microclinic International programme, with data collection at baseline, the end of the 4-month programme, 12 months, and 24 months after baseline (between March, 2010, and April, 2012). Social clusters of two to eight individuals participated together in a programme with weekly physical activity, nutrition, health education, and social activity sessions. Multi-level repeated measures regression estimated the long-term change in weight, body-mass index (BMI), and HbA1c during programme and follow-up.
FINDINGS: Of 315 participants with a full 2-years of follow-up, 262 (83·2%) completed the 4-month programme, 283 (89·8%) returned for the 12-month follow-up, and 216 (69·6%) for the 24-month follow-up. At completion of the 4-month programme, participants lost an average of 2·89 kg (–3·84 to –1·93; p<0·0001). At 1 year, participants, on average, sustained a weight reduction of –1·84 kg (–2·77 to –0·91; p<0·0001) from baseline, a –0·69 (–1·03 to –0·36) reduction in BMI, and –0·46% (–0·60 to –0·32; p<0·0001) sustained absolute reduction in HbA1c. 2 years from baseline, participants maintained an average weight loss of –1·60 kg (–2·67 to –0·54; p=0·003) from baseline, –0·43 (–0·82 to –0·05) reduction in BMI, and –0·97% (–1·12 to –0·81; p<0·0001) reduction in HbA1c. INTERPRETATION: Our results show that the Microclinic Social Network Behavioral Health Program was translated well into this cultural context and participants had long-term sustained benefits in bodyweight, BMI, and glucose control. FUNDING: BRIDGES. Copyright © Zoughbie et al. Open Access article distributed under the terms of CC BY. CONTRIBUTORS: ELD and MP did the statistical analysis. ELD wrote the Abstract with input from DEZ. DEZ and KTW designed the project; KTW, NB, DEZ, and ELD collected data; and RSF contributed guidance to study implementation. Authors have seen and approved the final version of the Abstract for publication. DECLARATION OF INTERESTS: We declare that we have no competing interests. ACKNOWLEDGEMENTS: This project was conducted in collaboration with the Jordan Royal Health Awareness Society and Jordanian Ministry of Health. The project was supported by BRIDGES, an International Diabetes Federation programme, which is is supported by an educational grant from Lilly Diabetes. We thank the International Diabetes Federation for their funding support, the Jordanian Ministry of Health, Royal Health Awareness Society for logistical support, and David Matthews of University of Oxford for project advice and guidance. Additional support for this research was provided by the Mulago Foundation and Horace W Goldsmith Foundation. DEZ and ELD were supported by a grant from the Robert Wood Johnson Foundation. ELD was also supported by grant from American Diabetes Association. http://www.thelancet.com/lancetgh
Published Online May 10, 2014
Microclinic International, San Francisco, CA, USA
(D E Zoughbie DPhil, K T Watson BA, N Bui MPH, M R Prescott PhD, E L Ding ScD);
Jordan Royal Health Awareness Society, Amman, Jordan
(R S Farraj MBBS); and
Harvard School of Public Health, Boston, MA, USA (E L Ding)
Correspondence to: Eric L Ding, Harvard School of Public Health, Boston, MA 02115, USA