Evaluation of a Behavioral Intervention With Multiple Components Among Low-Income and Uninsured Adults With Obesity and Diabetes

Am J Health Promot. 2018 Feb;32(2):409-422. doi: 10.1177/0890117117696250. Epub 2017 Mar 9.


Purpose: To examine the effects of a community-based behavioral intervention with multiple components on health outcomes among low-income and uninsured adults who were obese and had diabetes and treated in a "real-world" setting.

Design: A longitudinal design with a retrospective comparison group was used to examine the ability of a health promotion program to improve body mass index (BMI) and hemoglobin A1c (HbA1c) among 87 treatment group and 62 comparison group participants.

Setting: Urban/metropolitan city in the United States.

Intervention: A community-based behavioral intervention with 3 components including health-coach visits, registered dietitian visits, and exercise consultations delivered over 12 months.

Measures: Biometric measurements were collected at baseline, 3, 6, 9, 12, and 18 months, whereas self-reported measurements were collected at baseline, 6 months, and 12 months.

Analysis: Linear mixed models with participant-level random intercepts were fitted for BMI and HbA1c.

Results: The treatment group demonstrated reductions in BMI (percentage change = -2.1%, P < .001) and HbA1c (-0.6%, P < .001) as well as improvement in diabetes knowledge (+5.4%, P = .025), whereas the comparison group did not show any improvements in biometric measures. Dietitian visits were the most effective treatment component to reduce HbA1c (coefficient = -0.08, P = .025).

Conclusion: Multiple component behavioral intervention in community settings, particularly when delivered by registered dietitians, shows promise to combat the dual epidemic of obesity and diabetes among low-income and uninsured patients.

Keywords: behavioral intervention with multiple components; body mass index; exercise consultations; hbA1c; health promotion; health-coach visit; registered dietitian visit; twin epidemic of diabetes and obesity; vulnerable populations.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Behavior Therapy / organization & administration*
  • Blood Pressure
  • Body Mass Index
  • Body Weights and Measures
  • Community-Based Participatory Research
  • Diabetes Mellitus, Type 2 / psychology
  • Diabetes Mellitus, Type 2 / therapy*
  • Female
  • Glycated Hemoglobin
  • Health Knowledge, Attitudes, Practice
  • Health Promotion / organization & administration
  • Health Status
  • Humans
  • Lipids / blood
  • Longitudinal Studies
  • Male
  • Medically Uninsured*
  • Mental Health
  • Middle Aged
  • Nutritionists / organization & administration*
  • Obesity / psychology
  • Obesity / therapy*
  • Retrospective Studies
  • Socioeconomic Factors
  • United States


  • Glycated Hemoglobin A
  • Lipids