PILI at Work a 5-Year Controlled Intervention Trial: Testing DVD Versus Group Delivery of a Weight-Loss Maintenance Intervention in Native Hawaiian- Serving Worksites
PILI at Work a 5-Year Controlled Intervention Trial: Testing DVD Versus Group Delivery of a Weight-Loss Maintenance Intervention in Native Hawaiian- Serving Worksites
The PILI @ Work project is a 5 year randomized control trial to adapt a weight loss program
 for the employees of Native Hawaiian-serving organizations in Hawai'i. The study has two
 specific aims:

 Specific Aim 1: To adapt and implement a weight loss and weight loss maintenance program in
 Native Hawaiian-serving organizations, working with employee representatives to determine how
 the intervention can be best implemented with employees at the worksites. Specific Aim 2:
 Among employees participating in the program, to test whether weight loss maintenance program
 in DVD format is as effective as the weight loss maintenance program in a group face to face
 format in maintaining weight loss for employees who complete weight loss program.

 The investigators hypothesize that the PILI @ Work interventions can be effectively adapted
 and implemented in a worksite settings with active participation by employees and employers.
 The investigators also hypothesize that overweight (BMI ≥ 25) and obese (BMI ≥ 30) employees
 who complete weight loss portion of the intervention, and are randomized to received the
 weight loss maintenance intervention via DVD will have similar success at maintaining weight
 loss compared to those randomized to PILI Maintenance in group meetings or settings. The
 investigators hypothesize that will will also be true for physical functioning,blood
 pressure, daily self-weighing, low to moderate fat and low calorie diets, and daily physical
 activity.
Effective and culturally relevant interventions are needed to curb the rising tide of
 overweight and obesity. This study adapts an evidence-based weight loss intervention for use
 in Native Hawaiian-serving organizations in Hawai'i, using a community-based participatory
 research (CBPR) approach. Findings from our two previous NIH-funded projects help to inform
 this proposed research: 1) The Designing Healthy Worksites (DHW) Project and 2) the PILI
 Lifestyle Intervention (PILI), developed by the PILI 'Ohana (family) Project: Partnerships to
 Overcome Obesity Disparities in Hawai'i.

 The DHW Project engaged with eight Native Hawaiian-serving organizations to obtain data on 1)
 existing worksite policies that support and/or promote health and well-being of employees and
 2) the perspectives and ideas of employees and employers around creating a healthy workplace.
 DHW participants expressed enthusiasm for health promotion programs at the worksite,
 especially weight-loss programs.

 The PILI 'Ohana Project adapted an evidence-based lifestyle intervention for use with Native
 Hawaiians and Pacific Islanders who sought care at community health clinics and/or were
 members of civic groups. The PILI Lifestyle Intervention (PILI) has two phases-PILI Weight
 Loss and PILI Maintenance. Both PILI Wt Loss and PILI Maintenance were designed for deliver
 to community-based groups. In pilot testing, all participants participating in PILI Wt Loss
 and realized significant weight loss after 3 months. Participants then were randomized into
 PILI Maintenance or standard behavioral treatment (SBT); those in PILI Maintenance performed
 better than those in SBT. PILI Wt Loss and PILI Maintenance were improved based on feedback
 from the pilot. Because of reported time constraints by pilot participants, a DVD version of
 PILI Maintenance was developed that people could use instead of attending group sessions. In
 a subsequent community-based study of PILI (funded by NIH-NCMHD and now underway),
 non-worksite participants are being randomized into a face-to-face or DVD delivery of PILI
 Maintenance after completion of PILI Wt Loss.

 Our specific aims and hypotheses for its application in worksites are as follows:

 Specific Aim 1: To adapt and implement PILI Wt Loss and PILI Maintenance in Native
 Hawaiian-serving organizations, working with employee representatives to determine how the
 intervention can be best implemented with employees in worksites (PILI Wt Loss and PILI
 Maintenance together will be called PILI@Work).

 Primary hypothesis: A community-tested, evidence-based intervention for obesity reduction and
 weight-loss maintenance can be effectively adapted and implemented in worksite settings with
 active participation by employees and employers.

 Specific Aim 2: Among employees participating in PILI@Work, to test whether PILI Maintenance
 in DVD format is as effective as PILI Maintenance in Group in maintaining weight loss for
 employees who complete PILI Wt Loss.

 Primary hypothesis: Overweight (BMI ≥ 25) and obese (BMI ≥ 30) employees who complete PILI Wt
 Loss will have successful weight loss outcomes, and those randomized to PILI Maintenance in
 DVD will have similar success at maintaining weight loss compared to those randomized to PILI
 Maintenance in group meetings or settings. Successful weight loss maintenance will be
 measured as a ≥ 3% mean weight change.

 Secondary hypothesis: Employees participating in PILI Maintenance in DVD and those in PILI
 Maintenance in Group will show similar maintenance of, or improvements in, physical
 functioning, blood pressure, daily self-weighing, low to moderate fat and low calorie diets,
 and daily physical activity.
Inclusion Criteria:

 -  persons of any self-reported ethnicity

 -  age 18 years or older

 -  overweight or obese as defined as (BMI) ≥ 25 for Caucasians, NHs, or PIs and > 23 for
 those with Asian ancestry

 -  willing and able to follow a healthy eating and physical activity regimen that could
 include 150 minutes of brisk walking per week (or equivalent) and caloric intake
 control

 Exclusion Criteria:

 -  prognosed survival < 6 months

 -  planning to terminate employment during the intervention study period (12 months)

 -  pregnancy

 -  any dietary or exercise restrictions that would prevent an individual from fully
 participating in the intervention protocol (e.g., end-stage renal disease on a renal
 diet)

 -  any co-morbid condition (physical and mental disabilities) that would prevent the
 individual from participating in the intervention protocol (e.g., severe arthritis,
 hemi-paresis, major psychiatric illness, eating disorder)