Understanding cultural influences on African-American women may be important in helping them achieve long-term weight loss, according to researchers from Rice University and Baylor College of Medicine (BCM).
Obesity has reached epidemic proportions in America, and the problem is particularly serious among African-American women. Federal statistics indicate that four in five African-American women are overweight or obese. Researchers from Rice and BCM surveyed African-American women who lost clinically significant amounts of weight — at least 10 percent of their starting weight — to understand what made them successful at maintaining the loss or, in some cases, what made them regain weight.
Descriptive results of the study are presented online in the Journal of General Internal Medicine and will be available in print later this year. Rachel Tolbert Kimbro, associate professor of sociology at Rice, co-authored the report.
“We have very little evidence on successful long-term weight loss in African-Americans,” said Ann Smith Barnes, BCM assistant professor of medicine at BCM and lead author of the report. “Interventions to address obesity and promote long-term weight maintenance in African-Americans have yielded modest results. Also existing weight-control registries of successful weight-loss maintainers have included very few African-American participants.”
The researchers surveyed 1,110 African-American women age 18 or older about weight, weight loss, weight-loss maintenance and regain. The women all had intentionally lost at least 10 percent of their body weight and had not undergone surgery for weight loss.
Weight-loss maintainers, regainers
The women were divided into two main groups: “maintainers” and “regainers.” Maintainers lost 10 percent or more of their weight and kept it off for at least a year. Regainers also lost at least 10 percent of their body weight but gained some of it back.
Maintainers lost an average of 23 percent of their body weight (approximately 50 pounds) and maintained the loss for an average of 5 years. They achieved their goal by limiting fat intake, eating breakfast, avoiding fast-food restaurants, engaging in moderate to high levels of physical activity and using a scale to regularly monitor their weight.
Kimbro and Barnes noted the majority of all survey respondents reported losing weight on their own through dietary changes and exercise rather than through a formal weight-loss program. And maintainers reported health concerns as their incentive to lose weight.
“We found it interesting that women who maintained their weight loss were less likely to have participated in these types of programs; rather, they were more likely to have decided to lose the weight on their own,” Kimbro said.
While conventional weight-loss practices — eating more healthfully and being more active — were key to all the women’s success, the researchers found cultural influences might affect whether they maintained their weight loss or regained weight.
Maintainers were more likely to say that religious faith was important in losing and maintaining weight, according to Kimbro. “The study identified the role of faith as a potentially important one for maintaining weight loss for African-American women, suggesting that faith communities can be a potentially important source of motivation and social support for weight loss and maintenance,” she said.
Hairstyle management was identified in focus groups as having an important influence on physical activity in African-American women. Relaxed hair is traditionally considered more time-consuming to manage and more negatively affected by sweating. Although this study did not demonstrate a clear difference in reported physical activity levels among women with natural versus relaxed hairstyles, the role of hair management on physical activity needs further exploration, the researchers said.
The survey also showed that some of the women intentionally gained back some of their weight because they felt they looked too skinny. “A healthy appearance can mean different things for individuals from differing cultural groups,” Barnes said.
Barnes acknowledged that although they had hoped to recruit a more diverse socio-demographic group, most women in the study were highly educated. It is difficult to extrapolate these conclusions to lower socio-economic groups, she said.
The findings of this study give clinicians, researchers and program planners more information about strategies to assist women similar to those surveyed in achieving meaningful weight loss. In addition, 73 percent of the survey respondents agreed to be a part of an African-American Weight Control Registry. The ability to continue to gather data on individuals who have successfully lost and maintained weight will add significantly to the understanding of long-term weight loss in this medically at-risk population.
The study was funded by a career development award from the National Institute of Diabetes and Digestive and Kidney Diseases, with partial funding from the James A. Baker III Health Economics Program.