Study participants motivated each other to try new vegetables. Credit: Sam Harper | MPR News

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So many Americans–nearly half, according to one study–gained weight during the first year of the COVID pandemic that a new phrase popped up: the “Quarantine 19.” 

But several dozen Somali and Latino participants in a Mayo Clinic study in Rochester did the opposite: They lost weight. And improved their blood pressure, and ate more vegetables, and exercised more. The study, published in March, looked at immigrants living in southeast Minnesota who were guided by someone from their respective ethnic groups.

The unexpected success story has prompted a larger study of how small, culturally similar groups can promote positive outcomes related to weight loss. Mayo Clinic researchers are currently recruiting participants for a new 450-person trial. They expect to launch the project in June in collaboration with the University of Minnesota and the National Institutes of Health.

“It was so successful because most people gained weight during the pandemic; these were such impressive results,” said lead author Dr. Mark Wieland, a Mayo Clinic physician who focuses his research on community-based strategies to promote health equity. “If this is successful in a more rigorous study, then we can start evidence-based intervention.” 

The participants lost an average of 2 percent of their body weight over 12 weeks. Also surprising and impressive, the researchers said, is that no one dropped out despite the fact that the pandemic hit just after the 39 participants started meeting in small groups. The pilot study had been designed and launched pre-pandemic, so researchers assumed the study would pause in the spring of 2020 along with the rest of life. 

Luz Molina, who helped lead the Latino groups, remembered the reaction of the study’s principal investigators. “When COVID hit, they just said, ‘So should we stop here?’ ” she said. “And I was like, ‘No, no; they want to continue! They are very motivated, so we have to do something.’ ”

So the groups gave up on the content delivery, and moved to less-structured goal-setting and discussion-based groups that focused on motivation. 

The researchers divided the participants into four groups–two each for Somali and Spanish speakers. They met via Facebook and text message. (“I don’t think I knew Zoom existed then,” Molina said, explaining that it was so early in the pandemic that the video site hadn’t yet become a staple meeting venue.) Soon, messages were flying in Spanish and Somali. 

“One participant said, ‘I ran stairs between the first and second floors while doing laundry, and I burned 200 calories!’ ” Molina said. “And some people sent pictures of vegetables they had never seen before.”

The Somali participants were equally enthusiastic, said Yahye Ahmed, who helped lead the Somali groups. He offered participants suggestions for safe places to walk during the early days of the pandemic, when gathering outside to exercise was frowned upon. Top suggestions included the mall early in the morning when most people are asleep.

“We give examples, but we let the community share ideas, so it’s not like we’re telling them what to do,” Molina said.

Latest success for partnership

The study is part of a broader network of research that partners with communities of color in southeast Minnesota that the Mayo Clinic established in 2004, called the Rochester Healthy Community Partnership. Much of the success of projects under that umbrella stems from trust between researchers and communities of color that has been established over years, Wieland said.

Community liaisons like Yahye and Molina, called community-based health promoters, were key in the participants’ success, the study said. 

“Speaking the same language and being able to understand us―you see that is the biggest

Thing,” said one of the participants, whose name was redacted in the study. “When someone knows your lifestyle, your community, your language, then they understand your culture.” 

The community leaders made sure to tailor each group according to cultural norms, Yahye said.

“Each community knows what is best for that community,” he said. 

“You’re coming from a climate of warm weather that’s huge on organic food, freshly made. And then you come to America, and everything switches–you have processed foods, high intake of sugar, less activity. The only time you’re walking is if it’s for exercising. Back home it’s a part of life.”

yahye ahmed

For example, the Somali participants broke into groups by gender. “The females are more comfortable with females saying things they would not say with a male present,” Yahye said. 

In some ways, the pandemic may have provided more incentive for meeting virtually, Yahye and Molina said, since people weren’t able to gather in person at the mosque or other spots.

“People were able to share their life experiences and how they were dealing with things,” Yahye said. “They talked about eating habits and worrying about less exercising … and sharing ideas to encourage themselves to still accomplish their goals and finish the commitment they made prior to the pandemic.”

Immigration tied to weight gain

Immigrants often arrive in Minnesota at a healthier weight than the general population, the researchers noted, but most gain weight in the first 10 years. Another study led by Wieland showed that rates of diabetes for the Somali population near Rochester are double that of non-Somali patients. Latino people are 17 percent more likely to be diagnosed with Type 2 diabetes than white people, according to the Centers for Disease Control and Prevention

The reasons for weight gain among immigrants aren’t completely understood, Wieland said. Immigrants have a less physical lifestyle in the United States and also typically adopt a poorer diet. 

“It pushes you into an unhealthy environment; it’s not that people are making poor choices,” he said. 

In Somalia, Yahye said, you could often eat more “and just get away with it,” because of all the movement incorporated into everyday life. Meals were also cooked fresh and consumed in one sitting, he said, while leftovers here go into the fridge and are easily accessible. 

“You’re coming from a climate of warm weather that’s huge on organic food, freshly made,” Yahye said. “And then you come to America, and everything switches–you have processed foods, high intake of sugar, less activity. The only time you’re walking is if it’s for exercising. Back home it’s a part of life.”

Molina agreed.

“When we come to this country we change our diets and sometimes we don’t know what to eat, what is good,” she said. “On TV they are showing you those good pizzas and many burgers; if you buy this with French fries, it’s less expensive than if you buy a salad. Sometimes you can even buy two for the price of one.” 

Next phase relies on “train the trainer” model

Some of the participants in the pilot study are being tapped as leaders for the new study. Wieland said the study’s model can be replicated by other groups, from nonprofits to public health departments.

“It’s exciting to think about,” he said.

In the pilot study, Yahye said, weight loss information trickled down from the participants to community members who weren’t involved, expanding its impact. 

“We hope we can keep on building with this success,” he said. “The goal is that the children benefit from all these things we put in place.”