Effectiveness of a community-directed 'healthy lifestyle' program in a remote Australian Aboriginal community

Objective: To assess the sustainability and effectiveness of a community-di rected program for primary and secondary prevention of obesity, diabetes an d cardiovascular disease in an Aboriginal community in north-west Western A ustralia. Method: Evaluation of health outcomes (body mass index, glucose tolerance, and plasma insulin and triglyceride concentrations) in a cohort of high-ris k individuals (n=49, followed over two years) and cross-sectional community samples (n-200 at baseline, 185 at two-year and 132 at four-year follow-up s), process (interventions and their implementation) and impact (diet and e xercise behaviour). Results: For the high-risk cohort, involvement in diet and/or exercise stra tegies was associated with protection from increases in plasma glucose and triglycerides seen in a comparison group; however, sustained weight loss wa s not achieved. At the community level, significant reductions were observe d in fasting insulin concentration but no change in prevalence of diabetes, overweight or obesity. Weight gain remained a problem among younger people . Sustainable improvements were observed for dietary intake and level of ph ysical activity. These changes were related to supportive policies implemen ted by the community council and store management. Conclusions: Community control and ownership enabled embedding and sustaina bility of program, in association with social environmental policy changes and long-term improvements in important risk factors for chronic disease. Implications: Developmental initiatives facilitating planning, implementati on and ownership of interventions by community members and organisations ca n be a feasible and effective way to achieve sustainable improvements in he alth behaviours and selected health outcomes among Aboriginal people.