Family-Based Interventions to Promote Weight Management in Adults: Results From a Cluster Randomized Controlled Trial in India

Jeemon Panniyammakal; Antony Stanley; Sunaib Ismail; Thoniparambil R. Lekha; Sanjay Ganapathi; Sivadasanpillai Harikrishnan

doi:10.1370/afm.230632

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Figure 1.
The Trial Flow Diagram
CHD = coronary heart disease.
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Figure 2.
Population Average Between-Group Change in Body Mass Index in Intervention and Usual Care Groups
Note: Data was analyzed using a generalized estimating equations model adjusted for clustering at family level, age, sex, and educational status.
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Figure 3.
Population Average Between-Group Change in Waist Circumference in Intervention and Usual Care Groups
Note: Data was analyzed using a generalized estimating equations model adjusted for clustering at family level, age, sex, and educational status.

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Table 1.

Baseline Characteristics of the Study Population (N = 1,671)

Characteristics	Total	Usual care	Intervention
Families, No.	750	382	368
Participants, No.	1,671	846	825
Women, No. (%)	1,111 (66.5)	554 (65.5)	557 (67.5)
Age, mean (SD), y	40.8 (14.2)	40.6 (14.1)	42.0 (14.4)
Education attainment, mean (SD), y	13.3 (3.8)	13.5 (3.8)	13.2 (3.9)
Monthly family income >10,000 INR, No. (%)	817 (48.9)	432 (51.1)	385 (46.7)
Current smoking in men, No. (%)	44 (7.86)	23 (7.88)	21 (7.84)
Body weight, mean (SD), kg	65.4 (12.6)	65.3 (13.0)	65.5 (12.2)
Body mass index, mean (SD), kg/m²	25.6 (4.5)	25.5 (4.6)	25.7 (4.4)
Waist circumference, mean (SD), cm	89.3 (12.1)	89.5 (12.3)	89.1 (11.8)

INR = Indian rupee

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Table 2.

Changes in Anthropometric Measures

Measurement	Time points	Usual care^{^a} No., mean (SE)	Intervention^{^a} No., mean (SE)	Average change (95% CI) P value	ICC (95% CI)
Weight, kg	Baseline 1 year 2 years	846, 65.3 (0.48) 819, 66.1 (0.48) 822, 66.5 (0.49)	825, 65.5 (0.48) 796, 61.8 (0.48) 805, 62.6 (0.49)	−2.60 (− 3.95 to −1.26) P <.001	0.20 (0.13-0.25)
BMI, kg/m²	Baseline 1 year 2 years	846, 25.5 (0.18) 819, 25.9 (0.18) 822, 26.0 (0.18)	825, 25.7 (0.17) 796, 24.1 (0.17) 805, 24.4 (0.17)	− 1.06 (− 1.55 to −0.58) P <.001	0.19 (0.13-0.25)
Waist circumference, cm	Baseline 1 year 2 years	846, 89.5 (0.45) 819, 90.2 (0.42) 822, 90.4 (0.44)	825, 89.1 (0.46) 796, 89.1 (0.43) 805, 85.4 (0.42)	−4.17 (−5.38 to −2.96) P <.001	0.14 (0.09-0.22)

BMI = body mass index; ICC = intra-cluster correlation coefficient.
↵a After adjustment for clustering and baseline socio-economic characteristics.

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PLAIN-LANGUAGE SUMMARY

Original Research

Family-Based Lifestyle Intervention Improves Weight Management and Cardiovascular Health Among High-Risk Patients

Background and Goal:The PROgramme of Lifestyle Intervention in Families for Cardiovascular risk reduction (PROLIFIC) Study, conducted in India, aimed to assess whether a family-based approach to lifestyle interventions could improve weight management and obesity-related health outcomes among individuals with a family history of premature coronary heart disease.

Study Approach: In this cluster randomized controlled trial, families were randomly assigned to a family-based intervention group or a usual care group. The intervention group received structured lifestyle counseling from nonphysician health workers, who provided regular home visits, goal-setting, and peer group sessions focused on diet, physical activity, and cardiovascular health. The usual care group received one-time counseling and annual cardiovascular risk screenings but no ongoing interventions.

Main Results: 1,671 participants (1,111 women) from 750 families participated. After adjusting for family clustering and socio-economic factors, intervention participants experienced, on average, these improvements compared to the usual care group after two years:

2.61 kg greater reduction in weight (P < .001)

1.06 kg/m² greater reduction in BMI (P < .001)

4.17 cm greater reduction in waist circumference (P < .001)

Why It Matters: The findings demonstrate that a family-based approach to lifestyle interventions can significantly improve weight management and cardiovascular health among high-risk individuals. These interventions could have a substantial public health impact in preventing future diabetes and other noncommunicable disease conditions.

Family-Based Interventions to Promote Weight Management in Adults: Results From a Cluster Randomized Controlled Trial in India

Jeemon Panniyammakal, PhD, et al

Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India