Home The "Study" Guide Study Suggests Alternate Method of Encouraging Fitness in Black Women

Study Suggests Alternate Method of Encouraging Fitness in Black Women

by Erika Nicole Kendall

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.

Happy Black woman holding scale

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.

If the results of this poll are to be believed for all Black women, isn’t it safe to assume that the shift in focus that comes with a “maintain, don’t gain” program also makes a huge difference?3) There’s also this:

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.

The language used here makes me think that the rate of chronic disease among white women remains consistent, while the rate among Black women remains low, then skyrockets as you approach menopause.

Any theories as to why this is?

I have to wonder, though – if we’re talking about the BMI chart and using that to identify size “appropriateness,” I can’t help but remind everyone:

12. The BMI was created before the slaves were freed.

No, seriously. And, if talking about slavery makes you somehow uncomfortable – probably not as uncomfortable as being a slave, but I digress – we don’t even have to talk about slaves. The BMI was created before World War I… before the sinking of the Titanic.

The BMI is older than the Klan.

It is older than the FBI, the USDA, and the Washington Monument. The BMI has been in existence longer than at least 20 of these United States have been members of the Union.

How many medical relics like this do we keep around and base public policy on, while remaining so unamended and unchecked?

13. In Keys’ study where he legitimized the BMI, he studied close to 7,500 men. Not women.

Any variances in the statistics that allowed (?!) for women to be included came well after Keys’ study, well after the BMI had been embraced as a standard. Women, and the varieties of ways in which our bodies differ from our male counterparts, were not given the opportunity to counter the metric to prove that maybe, just maybe, all bodies – regardless of gender – aren’t just “variations on a man’s body” and can’t be statistically valued as such.

4) If you get to a point where you can, at least, successfully maintain a weight, will it empower and encourage you to the point where you will take greater steps to lose more, if you choose?

Thoughts?

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10 comments

DW September 3, 2013 - 2:08 PM

I think the idea of maintain don’t gain could be a good starting point but not necessarily a full solution. I see that as a way to get a person started with changing habits so they can live a healthier lifestyle. I do not think it is a full solution since even with maintaining weight you can still have health issues over time if you are overweight.

Kami September 3, 2013 - 11:28 PM

Hopefully these health coaches are not pushing low calorie diets of 1200 calories are less and have nutritional knowledge. In the future maybe the medical community should get rid of the BMI. The medical community should use body fat.
Self love is important during the weight loss journey. Maintaining weight could be a good strategy by putting an emphasis on healthy choices of foods and fitness regimens. Then the pounds might be lost during those changes.

Lynn September 4, 2013 - 8:47 AM

I have a health coach with my job , it’s part of our “benefits”. If we call in 4 times a year and have a 30 min convo with a certified health coach they usually tell you their credentials they usually have some type of nutrition or exercise science or counseling background and you chat for about 30 mins about goals and things you can do to improve your health.
I think it’s a good idea they do kinda keep you on track but you have to hold yourself accountable as well. They are just there to motivate you and encourage you which is a good thing.

marie September 5, 2013 - 3:48 AM

I think this approach is real step forward. By focusing on maintaining the weight, you give women power over their own weight which was not the case before.
I would love an approach like that, as long as the health advices given by the coaches allow women to easily implement these advices on a daily basis.

cutiepie35 September 5, 2013 - 11:26 AM

I agree with dw its a great start. I have started to focus more on my health instead of my weight and I have started losing weight. For me clean eating and working out really works for me

LJ September 6, 2013 - 11:54 AM

Oooh, being a health coach is one of my dream jobs!

*floats on cloud 9* *back to reality*

This is pretty good, but I agree that the intervention is what we should be getting any dang way! I do love that the population was socioeconomically disadvantaged folks who are normally not included in obesity trials, but outside of the 12 month YMCA membership how did that provide something “extra” (that their $$ status may keep them away from on a regular basis); were vouchers to a local farmer’s market for fruits and vegetables not in the study budget?

Lenora B Pierce September 10, 2013 - 6:06 PM

Love this site!

Huddlestonkidsmom October 1, 2013 - 9:51 AM

I think the maintain, don’t gain is a healthy concept if you are already at a healthy weight, meaning you aren’t diabetic, hypertensive etc. Otherwise we are just kidding ourselves that losing weight shouldn’t be as much as a priority as maintaining it. There are way too many young women walking around with excessive body fat who think it’s ok, is any extra body fat ok, ever? I’m old and don’t want what I have which is why instead of trying to “maintain” my weight I’m working on losing some of it!

Terry O October 24, 2013 - 1:23 AM

I think the article was very informative. Duke provides a great deal of information on African American Women’s Health. I was part of Duke University’s Fibroid Study for African American Women in April where I underwent the Uterine Fibroid Embolization procedure to shrink 5 tumors that I had (or have). It has been 6 months. I have not had a follow-up, so I don’t know what the status is of my uterine tumors. I don’t know if they have shrunk or not. I will say that my symptoms appear to be decreased, such as heavy bleeding, but I still experience pain where my tumors are. Unfortunately, I have been unable able to get in contact with anyone over the Duke University Study department to have questions answered or to schedule a follow-up. It’s a little bit frustrating, but since I have no medical insurance and I’m still waiting on Obamacare, I have no choice but to sit and wait.

Kameron February 27, 2016 - 9:31 AM

This is my first time (I think) posting and before I do, I just wanted to say that I’m a family nurse practitioner serving a primarily black population in a low income, underserved, working poor neighborhood that is essentially a food desert.
1. I love your site and I routinely recommend it to my patients for encouragement. The ones who use it love the fact that someone who looks like them has been successful with weight loss/health/fitness and that there are progress photos and a story. It makes it feel more attainable for them.
2. I agree that weight maintenance rather than loss is a good goal, but only for those who are maybe moderately overweight. I see a lot of morbid obesity on a day to day basis and I would be remiss to encourage anyone to maintain that size for health reasons.
3. I’ve found greater success with talking to patients about the risks associated with being obese, family history of diseases like diabetes, high blood pressure, high cholesterol, heart attaches, strokes, etc, and overall health and FEELING better rather than just discussing pounds.
4. While I agree that most primary care providers are just not well versed in either nutrition or weight loss methods, they also don’t have the TIME to discuss these things in depth with patients. Luckily, because of where I work, I have more time with each patient to discuss with them their current eating habits, small changes they can make over time, HOW to plan out the meals for the week, grocery shopping tips, letting them know clean eating doesn’t mean all lettuce, carrots and bland chicken breasts, etc. I’ve found that a lot of my patients have been told to lose weight in the past and been given ZERO resources or guidance on how to do it. Therefore I now have meal plans, websites, and fitness tips all at the ready to equip my patients with the tools they need to make changes and for some of them, it’s really been working.

Sorry for the length. Thanks for being such a great resource!

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