Feasibility Testing of the Health4LIFE Weight Loss Intervention for Primary School Educators Living with Overweight/Obesity Employed at Public Schools in Low-Income Settings in Cape Town and South Africa: A Mixed Methods Study

Abstract

Given the high prevalence of overweight and obesity amongst educators, this study investigated the feasibility of the 16-week Health4LIFE weight loss intervention for primary school educators living with overweight/obesity in low-income settings in Cape Town, South Africa. The research comprised two sub-studies, a pilot randomised controlled trial testing the intervention (10 intervention, <i>n</i> = 79 and 10 control schools, <i>n</i> = 58), and an investigation of the perceptions of participating educators and principals. Feasibility outcomes included reach, applicability, acceptability, implementation integrity, and a hypothesis-generating signal of effect on lifestyle factors and weight. The intervention consisted of a wellness day, weight loss manual, and text messages. Results indicated acceptable reach, with positive feedback on intervention components from principals and educators. Implementation was largely successful, though three schools dropped out due to scheduling issues. Barriers included interruption of teaching time and busy school schedules. The intervention group (<i>n</i> = 42) showed favourable shifts in belief patterns, stages of change, and lifestyle behaviours, with a trend towards weight loss. Control group (<i>n</i> = 43) changes were limited to dietary intake. The triangulation of results supported the intervention's feasibility in terms of primary and secondary outcomes. Recommendations for enhancement include adding in-person follow-up sessions and an app-based element to potentially increase impact on lifestyle indicators and weight loss.