Presentation (CTI)

OBJECTIVES: Services provided by trained laypersons, e.g. community health workers (CHWs), are more accessible to hard-to-reach populations and may provide better outcomes in adaptive interventions. In an open-label, sequential multiple assignment randomised trial, we evaluated the impact on obesity prognosis using CHW intervention as enhanced weight management support compared to standard professional care in housing-insecure obese Chinese adults in Hong Kong (HK).
METHODS: Chinese adults (aged 18 years or above) were randomised to receive support from either a nurse or dietitian. At 6 months, participants who failed to achieve 5% weight loss were classified as non-responders. Non-responders were randomised to receive either enhanced CHW service or maintain regular nurse or dietitian care until 9 months follow-up. Body weight was used to measure obesity prognosis. Multivariate mixed-effects models, using family cluster as a fixed-effect term, were used to evaluate the effectiveness of enhanced CHW intervention after adjusting for age of the non-responders.
RESULTS: This preliminary investigation included 153 obese individuals (mean age [SD] = 49.0 [11.5], 53.6% female) recruited between 25th June 2023 and 14th April 2025 through a community screening programme. Among them, 94 (61.4%) were classified as non-responders at 6-month follow-up. Loss-to-follow-up rate was 15.8%. Regression showed that enhanced CHW intervention could further reduce body weight at 9 months compared to maintained professional care, with a statistically significant effect (mean difference [MD]: -0.135kg, p<0.05). There were no significant differences in 9-month body weight between participants receiving nurse or dietitian care at the beginning of the trial.
CONCLUSIONS: CHW intervention could be an effective enhancement intervention for participants not responding to routine weight loss intervention provided by professionals.