Study Suggests Alternate Method of Encouraging Fitness in Black Women

Duke University, with a unique concern for Black women’s health, recently completed a study that I’m eager to discuss:

Programs aimed at helping obese black women lose weight have not had the same success as programs for black men and white men and women.

But new research from Duke University has found that a successful alternative could be a “maintain, don’t gain” approach.

The study, which appears in the Aug. 26 issue of JAMA Internal Medicine, compared changes in weight and risk for diabetes, heart disease or stroke among 194 premenopausal black women, aged 25-44. They were recruited from Piedmont Health’s six nonprofit community health centers in a multi-county area of central North Carolina, which serves predominantly poor patients.

For the study, half of the participants — 97 women — were randomly placed in a primary care-based intervention program called Shape, while the other 97 received usual care from their physicians, generally weight-loss counseling.

The intervention program used software built by Duke researchers that personalized the intervention for each woman. Each woman received an individualized set of behavior-change goals for diet and physical activity. They tracked how well they were doing each week via automated phone calls, and had a personal health coach and a gym membership.

After 12 months, the intervention group stabilized their weight, while participants in the usual care group continued to gain weight. Sixty-two percent of intervention participants were at or below their weight at the onset of the program, compared to 45 percent of usual-care participants. After 18 months, intervention participants still maintained their weight while the usual care group continued to gain weight.

“Many people go to great lengths to lose weight when their doctor recommends it. They may try a series of diets or join a gym or undergo really complex medical regimens. The complexity of these treatments can make it difficult for many to lose a sufficient amount of weight,” said lead author Gary Bennett, an associate professor of psychology and neuroscience and global health at Duke who studies obesity prevention.

“Our approach was different. We simply asked our patients to maintain their weight,” Bennett said. “By maintaining their current weight, these patients can reduce their likelihood of experiencing health problems later on in life.”

The study, funded by a grant from the National Institute for Diabetes and Digestive and Kidney Diseases, cited other research showing that overweight and slightly obese premenopausal black women face far lower risks for many chronic diseases than do obese whites and other racial groups.

But by ages 40-59, black women have more than twice the prevalence of class 2 (moderate) obesity and three times the rate of class 3 (extreme) obesity than white women, the study said. This combination of rapid premenopausal weight gain and extreme obesity contributes to disproportionate chronic disease risk among black women, researchers said.

Preventing weight gain could reduce the odds of developing a host of health problems, such as high blood pressure, high cholesterol diabetes, cardiovascular disease, stroke and some cancers, the authors said.

A “maintain, don’t gain” approach could be particularly effective for this group for the following reasons:

— Compared to white women, black women are typically more satisfied with their weight and face fewer social pressures to lose weight, Bennett said. Consequently, they may be particularly receptive to intervention messages about maintaining their weight.

— Preventing weight gain is less intense than trying to lose it, so this approach could be achieved more easily.

“It’s true that there are some health risks for these overweight and slightly obese women,” Bennett said. “However, these health risks increase dramatically as women continue to gain weight, usually 2 to 4 pounds, year after year.”

“We could reduce these health risks if women simply maintained their current weight,” Bennett said. “Fortunately, it’s much easier to maintain weight than it is to lose it. We think this ‘maintain, don’t gain’ approach can help some women reduce their risk of obesity-related chronic disease.” [source]

As always, I have a few points to make:

1) Before I can even get into specific questions about the efficacy of the study, doesn’t this:

The intervention program used software built by Duke researchers that personalized the intervention for each woman. Each woman received an individualized set of behavior-change goals for diet and physical activity. They tracked how well they were doing each week via automated phone calls, and had a personal health coach and a gym membership.

sound like, I don’t know… quality health care? Discussion of your current state, individualized advice regarding change, follow-ups, providing additional resources?

Sigh.

Honestly, the basic inequalities in the resources given to both parties pretty much renders this study, on its face, a little unfair – comparing any person who’s given a full stable of resources to someone who has to wing it on their own… doesn’t make much sense. As we’ve talked about countless times before… primary care physicians don’t know much about weight loss at all.

I’m especially curious about the fact that they were given “personal health coaches.” What were some examples of the advice these coaches were giving their clients?

2) I want to ask about the language of “maintain, don’t gain.” What kind of words do you have to use in order to get that message across, as opposed to a message of “you must lose weight?” Think about it – to tell someone to simply maintain what they have and avoid gaining (while giving them adequate tools to do so), you’re not putting them down as they are in their current state. You’re not using punitive language to describe them now.

To tell someone to maintain what they currently have, you have to – in some way – imply that what they currently have is okay. (And, by “okay,” I don’t mean “okay as opposed to great,” I mean “okay” as in “acceptable.”) It doesn’t speak to a space of trying to devalue them as they are now, and I think that’s important.

Compare this study to this poll:

[…] a recent survey conducted by The Washington Post and the Kaiser Family Foundation that focused on African American women. The poll found that although black women are heavier than their white counterparts, they report having appreciably higher levels of self-esteem. Although 41 percent of average-sized or thin white women report having high self-esteem, that figure was 66 percent among black women considered by government standards to be overweight or obese.

Excerpted from News: Fat Black Women Have The Audacity To Think Highly Of Themselves | A Black Girl’s Guide To Weight Loss