Weight Loss Experiences of African American Women

Weight Loss Experiences of African American Women

Kathryn M Kolasa PhD, RD, LDNBrody School of Medicine at East

Carolina UniversityFebruary 9, 2007

Weight Loss Experiences of African American Women

Kathryn M Kolasa PhD, RD, LDNBrody School of Medicine at East

Carolina UniversityFebruary 9, 2007

At the end of the sessionparticipants 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

* (Reminder: Normal BMI is 18.5 to 24.9.)

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

Kolasa


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


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


http://www.nationalacademies.org/iom.fnb

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

Child 2-3 1,000 1,000-1,400 1,000-1,400

Female 4-89-13

14-1819-3031-50

51+

1,2001,6001,8002,0001,8001,600

1,400-1,6001,600-2,000

2,0002,000-2,200

2,0001,800

1,400-1,8001,800-2,200

2,4002,4002,200

2,000-2,200

Male 4-89-13

14-1819-3031-50

51+

1,4001,8002,2002,4002,2002,000

1,400-1,6001,800-2,2002,400-2,8002,600-2,8002,400-2,6002,200-2,400

1,600-2,2002,000-2,6002,800-3,200

3,0002,800-3,0002,400-2,800

From Dietary Guidelines for Americans 2005. Available at http://www.health.gov/dietaryguidelines/dga2005/document/pdf/dga2005.pdf Kolasa


http://www.health.gov/dietaryguidelines/dga2005/document/pdf/dga2005.pdf

Changes in Medical Risk Factors,By Percentage of Body Weight Lost

5%-10% 11%-15% 16%-20% >20% (n = 651) (n = 623) (n = 501) (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

An example of medical value of weight loss…

Kolasa


BMI > 30, or ~ 30 lbs. overweight for 5'4" person

2005

2005By 2058, everyone in US will be obese

if rates rise at same pace they have over the last several years

In one survey”67% Americanssay tried to diet to lose weightat least once in last 5 years. 66% saidthey failed

Kolasa


By definition most AA in ENC are overweight/obese

0%

10%

20%

30%

40%

50%

60%

Underwt Normwt Overwt Obese

WhiteAf Amer

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


All have watched Oprah and her weight

Is the African AmericanExperience 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


• 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


African American Women’s Weight Loss Experience cont’d

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

Kolasa


How is this same/different for AA women?

Stages of Change for Weight Loss

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

Stages of change

From Hawkins, 2001

Stages of Change for Weight Loss

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

Stages of change

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


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


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


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


See Success Storieswww.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 ChurchConcord, 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


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


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


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


Kolasa


http://www.hsph.harvard.edu/sisterstogether/

Can orderPhoto copyReproducibleMasters

[email protected]

1-877-946-4627

Fit and FabulousAs you Mature

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


What to Do?

• How can we educate, especially women with limited resources?

• What cultural adaptations are needed?

Kolasa


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


What to Do?

• Frame physical activity as a social activity

• Cooking demonstrations. Don’t cut out but alter food preparation

Kolasa


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

activelife, 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


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


What opportunities do we have in eastern North Carolina

References1. 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


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


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


http://win.niddk.nih.gov/publications/mature.htm

http://www.modep.buffalo.edu/assets/docs/healthy_down_home_cookin.pdf

Documents

Weight Loss Experiences of African American Women