Weight Loss Experiences of
African American Women
Kathryn M Kolasa PhD, RD, LDN
Brody School of Medicine at East
Carolina University
February 9, 2007
At the end of the session
participants will
• Describe weight loss experiences of AA
women as described in research literature
• List strategies that lead to a positive
weight loss experience for AA women
• Have brainstormed how weight
management experiences for AA women
in eastern NC might be improved
Kolasa
ECU Family Medicine 2007
Who is in this session?
What hope to learn?
Quick Reminder of Definition of Obesity (NIH)
and types of evidence based interventions
CLASS
BMI
DIET
EXERCISE
DRUG
SURGERY
Overweight +
2 risk factors
25.0-29.9 or ↑
girth
Y
Overweight +
co-morbidity
27.0-29.9
Y
Y
Obesity I
30.0-34.9
Y
Y
Obesity II
35.0-39.9
Y
Y
Y*
Obesity III
 40
Y
Y
Y
* (Reminder: Normal BMI is 18.5 to 24.9.)
Kolasa
ECU Family Medicine 2007
Steps in Obesity
Management- adults & children
•
•
•
•
•
•
•
Assess BMI and waist circumference
Consider treatable causes of obesity ( e.g. meds,
hypothyroidism, Cushing’s syndrome)
Assess co-morbidities (HTN, DM, sleep apnea, etc)
Determine if pt is ready and motivated to address wt
Assess current dietary and physical activity habits.
Have patient keep diary.
Negotiate dietary and physical activity changes, set
mutual, incremental goals (There is no one best diet for
everyone but there are safe and effective strategies)
Provide education (including Internet resources;)
possibly refer to Registered Dietitian for more
information.
(Based on NIH Obesity assessment and treatment guidelines.)
Kolasa
ECU Family Medicine 2007
No single best diet prevention/treatment. But
there are known nutrient needs that must be
met for long term health
• http://www.nationalacademies.org/iom.fnb
• Minimum Carbohydrate: 130g daily (45-65% of total
calories)
•
•
•
•
•
Fat: 20-35% of calories
Protein: 10-35% of calories
Dietary Fiber: 14 g/1,000 cal
1 Hour Physical Activity Daily (wt maintenance)
Added sugar should not exceed 25% of calories
(WHO says 10%)
Kolasa
ECU Family Medicine 2007
Estimated Caloric Requirements
To lose 1 pound of body fat per week, increase activity or
decrease calorie intake by 250-500 calories per day
Activity Level
Gender
Age (years)
Sedentary
Moderately
Active
Active
2-3
1,000
1,000-1,400
1,000-1,400
Female
4-8
9-13
14-18
19-30
31-50
51+
1,200
1,600
1,800
2,000
1,800
1,600
1,400-1,600
1,600-2,000
2,000
2,000-2,200
2,000
1,800
1,400-1,800
1,800-2,200
2,400
2,400
2,200
2,000-2,200
Male
4-8
9-13
14-18
19-30
31-50
51+
1,400
1,800
2,200
2,400
2,200
2,000
1,400-1,600
1,800-2,200
2,400-2,800
2,600-2,800
2,400-2,600
2,200-2,400
1,600-2,200
2,000-2,600
2,800-3,200
3,000
2,800-3,000
2,400-2,800
Child
From Dietary Guidelines for Americans 2005. Available at
http://www.health.gov/dietaryguidelines/dga2005/document/pdf/dga2005.pdf
Kolasa
ECU Family Medicine 2007
An example of medical value of weight loss…
Changes in Medical Risk Factors,
By Percentage of Body Weight Lost
5%-10%
(n = 651)
11%-15%
(n = 623)
16%-20%
(n = 501)
>20%
(n = 789)
Reduction in:
Total cholesterol
–8.1%
–12%
–13.2%
–22.5%
Triglycerides
–12.9%
–21.7%
–19.5%
–40.7%
Fasting blood glucose
–4%
–6.9%
–6.7%
–12.5%
Systolic BP (mm Hg)
–4
–6
–6
–12
Diastolic BP (mm Hg)
–3
–5
–5
–9
Source: HMR, 2007
Kolasa
ECU Family Medicine 2007
2005
By 2058, everyone in US will be obese
if rates rise at same pace they have over the last several years
In one survey”
67% Americans
say tried to diet
to lose weight
at least once
in last 5 years.
66% said
they failed
BMI > 30, or ~ 30 lbs. overweight for 5'4" person
2005
Kolasa
ECU Family Medicine 2007
By definition
most AA in ENC are overweight/obese
60%
50%
40%
White
Af Amer
30%
20%
10%
0%
Underwt
Normwt
Overwt
Obese
From Cummings et al. REACH study Hertford, Martin, Pitt and Duplin Counties, 2005.
The evidence says AA women need to work
toward a healthier weight
• Studies show AA women less likely than
white women to participate in weight loss
programs (ref 7)
– 28% vs 40% in one study
The dominant culture has laughed and cried with the
weight struggles of cartoon characters like Cathy
Kolasa
ECU Family Medicine 2007
All have watched Oprah and her weight
Is the African American
Experience different?
African American Women’s Weight
Loss Experience
• Less likely to participate in weight loss programs (28% vs 40% in
one study)
– Exercise for wt loss less (37% vs 48%)
• Even less as number of children go up
– More likely to use maladaptive behaviors (Ref 2)
• More likely if other friends, relatives use pills, laxatives
• Don’t report to doctor
• Less likely to be motivated by appearance than whites, but can be
motivated by clothes not fitting; want to “look good” in clothes
• Try losing weight by decreasing fried foods, decreasing sweets,
increasing exercise, skipping meals, fasting on water or juice, using
laxatives, using liquid meals, use diet pills, join a weight loss
program; rarely on medically prescribed low fat (Ref 6)
Kolasa
ECU Family Medicine 2007
African American Women’s Weight
Loss Experience cont’d
•
Less likely to have success than Caucasians in same program (Ref 7, 11)
– Reasons are largely unexplained
– AA cite less personal motivation at outset
– AA less likely to continue exercising
– AA more likely to be frustrated with insufficient results
•
Generates feelings of pain, desperation, frustration, boredom
•
Those who are successful report feeling better and having more energy
•
Those successful don’t have “good food” “bad food” concepts
Kolasa
ECU Family Medicine 2007
Americans trying to lose weight
who fail say it’s because
• 80% don’t exercise
• 59% blame
metabolism
• 45% splurge on
favorite foods
• 44% no self discipline
• 41% snack too much
• 33% overeat at meals
• 31% eat for emotions
• 30% eat too much
high fat food
• 28% don’t make good
choices at restaurants
• 19% only watch fat
intake and not
calories
• 14% only watch
calories but not fat
intake
How is this same/different for AA women?
Kolasa
ECU Family Medicine 2007
Stages of Change for Weight Loss
Stages of change
PC C
P
A
%
30
19
47
4
Do you believe you would have more energy if you lost weight?
58
82
98
80
Do you believe life would be less stressful if you lost weight?
23
48
66
60
Do you believe you would look better in clothes if you lost weight?
46
70
91
100
Do you believe you would feel better about yourself if you lost
weight?
44
78
87
80
Do you believe you would be healthier if you lost weight?
46
78
92
60
Mean pros scale score (SD)
1.8
1.5
1.0
1.3
From Hawkins, 2001
Stages of Change for Weight Loss
Stages of change
PC
C
P
A
p
%
30
17
47
4
I think the type of food that I eat affects my weight
60
85
88
60
0.006
To keep from gaining weight, I need to exercise
84
89
97
80
0.050
To keep from gaining weight, I need to watch what I eat
86
100
100
100
0.001
After I go off a diet, I always put back on the weight
40
63
69
60
0.006
The will of God affects my weight
26
15
10
40
0.16
Weight runs in my family and affects my weight
30
30
45
40
0.11
Other people think I should lose weight
14
26
48
0
0.012
My mother thinks I should lose weight
25
39
61
40
0.011
My doctor thinks I should lose weight
33
58
78
60
0.001
My friends think I should lose weight
5
18
36
0
0.004
My husband / boyfriend thinks I should lose weight
20
38
48
60
0.022
My sisters think I should lose weight
26
26
59
0
0.059
From Hawkins, 2001
6 Themes in Wt Loss Experience
•
•
•
•
•
•
Failure of weight maintenance
Use of psychological and spiritual approaches
Role of family influences and social expectations
Role of African American subculture
Method of affordability
Racial differences in weight loss methods
– From Ref 3
Kolasa
ECU Family Medicine 2007
1. Failure of Wt Maintenance
• Achieve modest short term wt loss
• Need weight maintenance strategies
incorporated into the program. “They don’t
teach you how to maintain”
– Local experience. Ask for maintenance
programs but then don’t commit. So, how do
we get people to stay in for more than 12
weeks?
Kolasa
ECU Family Medicine 2007
2. Psychological and spiritual
approaches
• Desire to have concerns remediated
through spiritual means
– Church based improved adherence (Ref 9)
•
•
•
•
•
Praying
Fasting
Detox and Cleansing
Exercise to gospel music
Begin group classes with prayer
Kolasa
ECU Family Medicine 2007
What to Do?
• Describe spiritual approaches
– What can churches do
• Increasing identity between counselors
and participants
– Successful losers as peer counselors
– Use only AA instructors (Ref 7)
– Use buddy system for relapse prevention (Ref
10)
Kolasa
ECU Family Medicine 2007
See Success Stories
www.eatsmartmovemorenc.com
• Board of Elder’s adopted
a policy statement
supporting healthier
eating among members
• Monthly fellowship
gathering designated for
healthy eating and PA
• New equipment
purchased
• Members encouraged to
bring fruits and
vegetables to covered
dish dinners
• Provided fruit snacks to
youth programs
• Health tips included in
congregational newsletter
• Work continuing today by
partnering with a
neighboring congregation
to hire a parish nurse
• Pastor critical
Grace Lutheran Church
Concord, NC
3. Family influences and societal
expectations
• Pressured by families to accept being overweight. “Big
Boned” “voluptuous”
• Many do not conceptualize overweight in negative terms
(Ref 1)
• What friends think is important (Ref 5)
• Some have negative body image views even though
culture appears to tolerate fatness
– Studies support larger woman but not obese
• Women move to “preparation” when BMI> 35 (Ref 5)
– Do not perceive health and social consequences of obesity
– Not accepting dominant culture’s definition of overweight to
guide weight loss methods (Ref 4)
Kolasa
ECU Family Medicine 2007
What to do
• Address ambivalence about weight
• Encourage parents to give positive
messages to children about weight and
physical activity and healthy eating
• Teach relationship between weight and
health
Kolasa
ECU Family Medicine 2007
4. AA subculture hinders weight
management
• Impact may vary among individuals
• “eating and sharing is a black thing”
• Support of sedentary lifestyles
– Fear sweating or bulking up; don’t want hair messed
up
• Settings: focus on food in social settings
including church, sorority
• Cultural food types (fried chicken, collard
greens, fatty snacks)
• Role of caregiver: use of fast food, “too tired to
exercise”
Kolasa
ECU Family Medicine 2007
What to Do
• Afro-centric principles: interdependence, spirituality,
connection to one’s ancestry, social support, importance
of family
• Take care of self so can take care of others
• Capitalize on social support
–
–
–
–
–
Enhances perceived control/self efficacy (Ref 10)
Pray for other participants
Rewards for group rather than individual goal meeting
Share a meal at sessions (Ref 7)
Include families/children
• Healthy food preparation in cultural and social gatherings
rather than changing food
– ESMM policy guidelines. www.eatsmartmovemorenc.com
– Cookbooks and brochures
Kolasa
ECU Family Medicine 2007
Can order
Photo copy
Reproducible
Masters
WIN@info.
Niddk.nih.gov
1-877-946-4627
Fit and Fabulous
As you Mature
http://www.hsph.harvard.edu/sisterstogether/
Kolasa
ECU Family Medicine 2007
Can we make messages materials/programs
more appealing to AA women?
• Do materials need to show AA women?
• How edit tips on eating better?
– Start day with breakfast
– Eat more fruits and vegetables
– Eat less meat
– Choose non fat milk, yogurt, cheese
– Choose whole grain more often
– Drink less soda, sweet tea or other drinks
Try lower fat versions of favorite
foods, instead of
• Fried chicken _______________
• Ham hocks, salt pork, fat back _________
• French fries_________________
5. Affordability
• May not have the $ that day to go to
weight watchers or programs
• Healthy food thought of as expensive
• Safe places to be physically active
Kolasa
ECU Family Medicine 2007
What to Do?
• How can we educate, especially women
with limited resources?
• What cultural adaptations are needed?
Kolasa
ECU Family Medicine 2007
6. Racial differences in ideal
weight loss methods
• Not interested in physical activity
– Need demonstrations (Ref 7)
• Emphasis on acceptable food
characteristics (texture, taste)
– Like less information and more demonstration
(Ref 7)
Kolasa
ECU Family Medicine 2007
What to Do?
• Frame physical activity as a social activity
• Cooking demonstrations. Don’t cut out but
alter food preparation
Kolasa
ECU Family Medicine 2007
Before you start to walk, do the
stretching exercises shown here.
Remember not to bounce when
you stretch. Perform slow
movements and stretch only as
far as you feel comfortable.
When you choose a
hairstyle for your active
life, consider:
- Natural hairstyles hold up to frequent shampoos.
- Short hair is easy to wash and wear.
- Short hair can be dried and styled quickly or slicked back with gel.
- Locks are easy to care for.
- Long hair can be pulled back for a new look.
- Blunt cuts or Bobs look great wrapped or curled and can stay styled after
workouts.
FEELING FIT 4 LOOKING FINE
Kolasa
ECU Family Medicine 2007
Other thoughts on how to address
these themes?
• Failure of weight maintenance
• Use of psychological and spiritual
approaches
• Role of family influences and social
expectations
• Role of African American subculture
• Method of affordability
• Racial differences in weight loss methods
Kolasa
ECU Family Medicine 2007
What opportunities do we have in
eastern North Carolina
References
1.
Black MM et al. Overweight adolescent AA mothers gain weight
in spite of intentions to lose weight. JADA. 2006;106:80-87.
2.
Breitkopf CR, Berenson AB. Correlates of weight loss behaviors
among low income African American, Caucasian, and Latina
Women. ACOG. 2004;103:231.
3.
Davis EM, Clark JM, Gary TL, Cooper LA. Racial and
socioeconomic differences in the weight-loss experiences of
obese women. AJPH. 2005;95:1539
4.
Gore SV. African American women’s perceptions of weight:
paradigm shift for advanced practice. Holist Nurs PRact.
1999;13:71-79.
5.
Hawkins DS et al. Stages of change and weight loss among rural
African American women. Obesity research.2001;9:59.
Kolasa
ECU Family Medicine 2007
6.
James DCS. Gender differences in body mass index and weight
loss strategies among African Americans. JASA. 2003;103:1360.
7.
Karanja N. Steps to soulful living: a weight loss program for AA
women. Enthnicity & disease. 2002;12:363-371.
8.
Newton RL Weight management in African American Women:
practical issues. Obesity Management. 2005;243.
9.
Sbrocco T. et al. Church based obesity treatment for AA women
improves adherence. Enthnicity & Dis. 2005;15:246.
10.
Wolfe WA A review: maximizing social support—a neglected
strategy for improving wt management with AA women. Ethnicity
& disease. 2004;14:212-218.
11.
Young DR, et al. Motivations for exercise and weight loss among
AA women. Ethnicity & Health 2001;6:227-245.
Kolasa
ECU Family Medicine 2007
Resources
•
http://win.niddk.nih.gov/publications/mature.htm. Fit and Fabulous as you
Mature.
•
http://www.modep.buffalo.edu/assets/docs/healthy_down_home_cookin.pdf.
Healthy Down Home Cookin
•
Heart-Healthy Home Cooking African American Style. National Institutes
of Health (NIH) Publication No. 97-3792, 1997. This pamphlet tells how to
prepare your favorite African American dishes in ways that will help protect
you and your family from heart disease and stroke, and includes 20 tested
recipes. Available from the NHLBI for $3.00; call (301) 592-8573 or (240)
629-3255 (TTY).
•
Down Home Healthy Cookin’. National Cancer Institute (NCI), reprinted
2000. This pamphlet features 12 recipes for traditional African-American
foods modified to be low in fat and high in fiber—but still tasty. Available free
from NCI; call 1-800-4-CANCER or 1-800-332-8615 (TTY).
Kolasa
ECU Family Medicine 2007