Patient Profile
Participants in the English language class were primarily African American and ranged from young adults to great grandmothers. A majority of the participants were middle-aged or older and lived alone, while some were raising their grandchildren. Many participants were on disability as a result of their weight related comorbidities and spent much of their time alone at home.
Participants in the Spanish language class were more likely to be living in families. Most of them were women with husbands and younger children. A majority were recent immigrants from Mexico or Central America. Although this group was also overweight and had related diseases such as hypertension and diabetes, they were less likely to be as obese as participants in the English language group.

The Class Curriculum
The curriculum of the Take Charge class was created to reflect the wholistic approach taken by Family Medicine towards patient needs and it emphasized the role of biopsychosocial factors in health. The course curriculum consisted of diet education, fitness exercise, and empowerment and motivational activities. Medical issues related to obesity, such as the relationship between fat and heart disease, were taught by the physician instructor during class discussions. The physician instructor also addressed individual health questions of patients and referred them to their primary care physicians for follow-up as needed.

Participants were instructed to follow a very low-fat, high fiber vegetarian diet, restricting daily fat intake to about 20 grams. The content of the diet education included cooking demonstrations and samples, healthy food displays, and information on shopping, reading labels, and calculating fat and fiber gram intake.

The class devoted time to low impact aerobic exercise, stretching, deep breathing, and meditation relaxation. Empowerment activities designed to enhance self-esteem, raise consciousness, motivate behavior change, and provide support were also regular curriculum features. Active peer support was delivered through group “go-rounds” and a “listening exercise.” The focus of the go-rounds was to provide each person time to share with the group and learn about others. The one-on-one listening exercise allowed participants to explore thoughts and feelings with a partner who practiced listening without offering advice. To expand this peer support beyond the classroom, participants were encouraged early in the program to exchange contact information and set up walking dates. As the class progressed, exercises like identifying “10 things I want to do in this lifetime” were incorporated into the Take Charge curriculum to address the deeper motivational needs of participants, especially those on disability who had been out of work for several years. The instructors felt that participants found lifestyle change easier when they were occupied with other lifetime goals and were busy with activities that satisfied them and kept their minds off food.