Influence of Neighborhood Socioeconomic Deprivation on Effectiveness of an Intensive Lifestyle Intervention.

Abstract

Objective: To assess the influence of neighborhood socioeconomic deprivation on the effectiveness of an intensive lifestyle intervention (ILI) in the Look AHEAD trial.

Research design and methods: Look AHEAD randomized adults with overweight/obesity and type 2 diabetes to ILI for weight loss, or Diabetes Support and Education (DSE). We linked participant data from four study sites to the 2000 United States Census to generate a neighborhood socioeconomic deprivation score. We analyzed the effect of neighborhood deprivation in tertiles on various clinical outcomes including weight and HbA1c changes over 4 years using a mixed-effects linear model with random intercept and an interaction term between deprivation tertile and study arm over 4 years.

Results: Among 1213 participants at baseline, the mean age was 60 years, 41% were male, and 65% identified as White, 26% as Black, and 4% as Hispanic. Most participants had a college degree (84%) and reported an annual income over $40,000 (75%). The deprivation score ranged from -12.04 to -2.61 in the most deprived tertile and 2.01 to 18.69 in the least deprived tertile (the lower the score, the higher the deprivation). There were no statistically significant treatment differences by deprivation score in weight or HbA1c changes over the 4-year period.

Conclusions: In this clinical trial population, an intensive lifestyle intervention was equally effective across levels of neighborhood socioeconomic deprivation. However, these findings may not extend to individuals with the lowest income and educational attainment who are not typically represented in clinical trials and for whom more research is needed.