Project Summary SANOS (SAlud y Nutrición para todOS) (Health and Nutrition for All) addresses the obesity crisis among Hispanics, the largest, fastest growing U.S. minority and immigrant group at 53 million, 17% of the total U.S. population. Mexicans are the largest U.S. Hispanic population; nearly two-thirds of Hispanics originate from Mexico. Obesity and its associated health consequences disproportionately affect minority populations; Hispanics, and particularly Mexican Americans, are among the highest risk groups. 78.3% of U.S. Mexican women and 81.9% of U.S. Mexican men are overweight or obese, compared to 60.9% of non-Hispanic White women and 73.2% of non-Hispanic White men. Obesity is a shared risk for both cardiovascular disease (and its risk factors) and cancer. While there is much evidence on effective multicomponent lifestyle interventions in non-minority populations (e.g. Diabetes Prevention Program and Action for Health in Diabetes (Look AHEAD)), these programs are considered too expensive and burdensome to be widely disseminated. There is a paucity of data on how to optimize such approaches for hard-to-reach communities such as Hispanic immigrants. Most weight-loss interventions have been less successful with ethnic minorities, including Hispanics. There is a pressing need to design optimized lifestyle interventions for minority populations, particularly in accessible community settings, that reduce participant burden and costs but retain essential intervention components for meaningful weight loss. SANOS is the first study to use the Multiphase Optimization Strategy (MOST), an innovative methodological framework, to address this gap. Ventanillas de Salud (VDS; Health Windows) is a bi-national collaborative program between the Mexican government and over 400 non-profit and private agencies, working to increase access to health care and promote healthy lifestyle choices among low-income U.S. Latinos. In 2016, the VDS purchased a mobile van, outfitting the vehicle with space to provide consular services and to conduct health screenings (“VDS Mobile”) in NYC neighborhoods with large Mexican populations. SANOS components were developed from a pilot program at the NY VDS; in this application we propose testing these components at VDS Mobile to reach the most marginalized. The overall objective of SANOS is to use MOST to design, for the first time, an optimized version of a scalable, culturally and linguistically tailored diet and lifestyle intervention for U.S. Mexicans. In the proposed research we will identify which of 4 obesity intervention components contribute most to decreasing weight by 5% from baseline (primary outcome) among overweight or obese individuals at 6 months post-intake. Components include: i) Initial in- person individual diet and exercise counseling; ii) Thrice weekly diet and exercise text messages; iii) Weekly telephone support; and iv) Self-monitoring tools. Secondary outcomes include improvements in BMI, waist circumference, HgbA1c, cholesterol, blood pressure, and diet and exercise behavior. We will also estimate the cost and incremental cost-effectiveness of the intervention components.

Project Narrative SANOS is the first to apply an innovative methodological framework, the Multiphase Optimization Strategy (MOST), to optimize a diet and lifestyle intervention addressing obesity, hence cardiovascular disease (CVD) and cancer risk, adapted for and delivered in tandem with, a mobile program with great reach into the underserved U.S. Mexican population. Evidence generated from this study has tremendous potential to lead to the dissemination of an optimized lifestyle intervention to the multiple Ventanillas de Salud (VDS) Mobile sites as well as to other institutions and organizations serving Hispanic and other large, vulnerable, hard-to-reach populations throughout the U.S., through community-embedded sites (e.g. churches, community-based organizations, schools, etc.), to address obesity and significantly reduce CVD and cancer risk.