Title : Evaluation of a nutrition and health education program on components of metabolic health on women from under-resourced South African communities
Overconsumption of sugar, refined carbohydrates, and poor-quality fats, increases the risk for developing chronic diseases. While poverty is an important barrier to health and education for both men and women, it tends to yield a higher burden in women. There is evidence that low-carbohydrate high-fat (LCHF) diets can improve metabolic health in well-controlled clinical trials. However, one cannot assume that the same nutritional advice will translate to residents of underserved communities. Eat Better South Africa (EBSA) runs nutrition education programs for women to prevent or manage metabolic conditions. The aim was to evaluate EBSA’s effectiveness for changing dietary behaviour and improving metabolic health. This was a cross-sectional mixed method project. Qualitative methods consisted of focus group discussions and in-depth interviews with previous EBSA participants, naïve EBSA participants, EBSA team members, and health practitioners. Quantitative methods consisted of behaviour factors, diet and physical activity assessment and metabolic blood markers to assess changes before, after and 6-monhts after the program. Thematic analysis was conducted using NVivo 12. Descriptive and statistical analysis was done using Stata 16 and Jamovi. Women experienced improvements in dietary behaviours and biomarkers related to inflammation, lipids, and glycaemic profiles. Participants’ waist circumference, weight, blood pressure, triglycerides and HbA1c were significantly reduced, and those changes were sustained six months after. Women’s carbohydrate intake was significantly reduced, and their health markers improved despite a slight increase in sedentary behaviour. Most women found that the EBSA diet made them feel less hungry, more energetic and they felt that their health had improved. Women felt that some health practitioners were not supportive of the diet, but that they became more positive after observing the related health outcomes. Health practitioners’ approaches to LCHF diets seemed to be supportive but not advocating. Most participants followed EBSA’s dietary recommendations and experienced health improvements as a result. Follow up data at six months suggested that those changes could be sustainable. In the absence of long-term evidence, existing data suggest that it is a potentially effective treatment to adopt a LCHF diet as an option for patients to manage and prevent chronic disease in under-resourced communities.
What will audience learn from your presentation?
- Participants seemed to have adhered to a LCHF diet during the intervention. Overall, the EBSA program showed an improvement in the women’s health parameters such as blood pressures, body measurements and blood markers, however, they did not change their physical activity or sleep patterns during the intervention. Regarding the follow-up testing, weight was the only variable that continued improving. It is important to mention that no variables returned to baseline and some markers remained significantly improved when compared to baseline.
- One challenge identified by the majority of the women was the lack of advocacy and support from health practitioners, which lead to conducting a qualitative study with medical doctors, nurses and dietitians to explore their opinions about EBSA and LCHF diets. Community assessments should be included as part of the evaluation process of any kind of intervention are essential. Social environmental factors have a significant impact on the women’s lives, which is reflected in the physical activity and blood pressure data.
- To change the paradigm of diet-related disease, an ecological model is needed. As a result, the context or environment is considered to be an integral part when trying to understand and work with communities and the individuals living there. Ecological means that there are multiple levels or layers of issues that need to be considered, including the individual, family, neighbourhood, community and policies at the national level. When health professionals or researchers attempt to determine why individuals behave in a certain way, they apply behavioural theories. Behaviour is influenced by various factors, such as the individual’s relationships with others, community, job, school and the laws that the government has put in place. One behavioural theory that encompasses all of these factors is the social-ecological model.
- Health practitioners’ approach to LCHF diets seemed to be supportive but not advocating. Indeed, because LCHF diets are popular in South Africa, health practitioners are likely to be approached by a patient whose acquaintance has had success with restricting refined carbohydrate and simple sugars. Although, currently, some international food guidelines endorse LCHF diets, there is still a considerable amount of confusion and lack of knowledge regarding this diet. In the absence of long-term evidence, existing data suggest that it is a potentially effective treatment to adopt a LCHF diet as an option for patients with diet-related chronic diseases. This may be an important aspect to include in training of health professionals, particularly contextualized to lived experience of their patients.
- Taken as a whole, the study findings indicate that this community-based, LCHF dietary support program was both acceptable and feasible for the participants. Moreover, the results show that the intervention design was appropriate for this population group, and the medium of delivery was effective. Further investigation is required into adherence over a longer time frame and acceptability and adherence issues with other population groups. It is well known that, by changing their health behaviours to more positive models, women can influence the dietary behaviours of family members and those around them. They are, therefore, a key population group to consider when designing sustainable behavioural community nutrition education interventions, one outcome of which may be sustained weight loss.