Results of a faith-based weight loss intervention for black women

Obesity is a risk factor for a variety of chronic diseases. Although weight loss may reduce these risks, weight loss programs designed for black women have yielded mixed results. Studies suggest that religion/spirituality is a prominent component of black culture. Given this, the inclusion of religion/spirituality as an active component of a weight loss program may enhance the benefits of the program. The role of religion/spirituality, however, has not been specifically tested as a mechanism that enhances the weight loss process. This paper presents the results of "Faith on the Move," a randomized pilot study of a faith-based weight loss program for black women. The goals of the study were to estimate the effects of a 12-week culturally tailored, faith-based weight loss intervention on weight loss, dietary fat consumption and physical activity. The culturally tailored, faith-based weight loss intervention was compared to a culturally tailored weight loss intervention with no active faith component. Fifty-nine overweight/obese black women were randomized to one of the two interventions. Although the results were not statistically significant, the effect size suggests that the addition of the faith component improved results. These promising preliminary results will need to be tested in an adequately powered trial.     

The effect of a church-based breast cancer screening education program on mammography rates among African-American women

This study examines the effectiveness of breast cancer screening education programs on mammography rates among African-American women 40 years of age and over. We conducted two types of educational programs in community settings, primarily in African-American churches. Three-month follow-up interviews were used to determine whether women who participated in programming were more likely to get a mammogram if they had not had a mammogram in the last year. Our results demonstrate that the educational programs significantly increased the likelihood of getting a mammogram when compared to a control group that received no educational programming. Further, we found that the programs were effective for motivating breast cancer screening in housing projects as well as in the churches, and that the effectiveness of the programs remained even when we controlled for socioeconomic status, depression, and age.     

Emotional eating is associated with weight loss success among adults enrolled in a weight loss program

To examine associations between decreased emotional eating and weight loss success; and whether participation in a behavioral weight loss intervention was associated with a greater reduction in emotional eating over time compared to usual care. Secondary data analysis of a randomized controlled trial conducted at two university medical centers with 227 overweight adults with diabetes. Logistic and standard regression analyses examined associations between emotional eating change and weight loss success (i.e., weight loss of ≥7 % of body weight and decrease in BMI). After 6 months of intervention, decreased emotional eating was associated with greater odds of weight loss success (p = .05). The odds of weight loss success for subjects with decreased emotional eating at 12 months were 1.70 times higher than for subjects with increased emotional eating. No differences in change in emotional eating were found between subjects in the behavioral weight loss intervention and usual care. Strategies to reduce emotional eating may be useful to promote greater weight loss among overweight adults with diabetes.     

Culturally-sensitive weight loss program produces significant reduction in weight, blood pressure, and cholesterol in eight weeks

Dietary and behavioral needs of special populations are rarely considered in traditional weight loss programs. This study assessed the impact of culturally-sensitive modifications to the Duke University Rice Diet weight loss program for African-American dieters. The study was a randomized modified cross-over study in which volunteers received either early or delayed weight loss intervention. Final outcomes were measured at 8 weeks. At the onset of the study, there were 56 African American participants, however, only 44 (79%) completed the study. The eight-week intervention was a modified 1000-calorie/day version of the Rice Diet. Modifications to the program included decreased cost, culturally-sensitive recipes, addressing attitudes about exercise, and including family members in weight loss efforts. Average weight loss for subjects completing the program was 14.8 pounds (SD = 6.8 pounds). BMI decreased from 37.8 kg/m2 to 35.3 kg/m2 (p < 0.01). Total cholesterol levels decreased from 199.2 mg/dL to 185.4 mg/dL (p < 0.01); systolic and diastolic blood pressure decreased by 4.3 mmHg (p < 0.01) and 2.4 mmHg (p < 0.05), respectively. The control group showed no significant change in any outcome measures. We found that diet programs can be successfully tailored to incorporate the needs of African-Americans. Most importantly, these dietary program changes can lead to significant improvement in clinical parameters. Additional studies are necessary to determine the permanence of these short-term changes.     

John Henryism and blood pressure differences among black men

A community probability sample of southern, working-class, black men (N=132)between 17 and 60 years of age was administered a scale to measure the degree to which they felt they could control their environment through hard work and determination. Since the legend of John Henry—the famous, black steeldriver of American folklore—can be understood as a cultural statement about how black Americans must often attempt to control behavioral Stressors through hard work and determination, items for the scale were developed to reflect the theme of John Henryism. It was hypothesized that men scoring below the median on education but above the median on John Henryism would have higher blood pressures than any other group. The data were in line with the prediction, in that men who scored low on education and high on John Henryism had significantly higher diastolic blood pressures than men who scored above the median on both measures. Study findings are discussed in terms of the meaning that education and John Henryism may have for raising or lowering autonomic arousal when individuals encounter behavioral Stressors in everyday life. Preliminary construct validity evidence for the John Henryism Scale is also presented.This research was made possible by a grant from the Robert Wood Johnson Foundation (5938), Biomedical Research Support Funds (2 S07 RR05450-20), and a Research Career Development Award (K04 HL01011) to Sherman A. James from the National Heart, Lung and Blood Institute.     

Body fat distribution patterns and blood pressure in black and white women

The prevalence of obesity and being overweight and the distribution of body fat in relation to blood pressure were assessed in a college population of 181 black and white US women and 124 black Nigerian women. The mean ages ranged from 18.6 to 22.4 years. Twenty-nine percent of black US women were overweight and 12.9% were obese; whereas 13.6% of white US women were overweight and 2.3% were obese. Only 18.6% of Nigerians were overweight and 1.6% were obese. More upper body fat was found among the black US women and Nigerians than among white US women. There was no significant correlation between body fat distribution and blood pressure among Nigerians. In general, among US blacks and whites, there were positive associations among body mass index, waist-hip girth measurements, and blood pressure, particularly for systolic blood pressure.     

Randomized trial of a phone- and web-based weight loss program for women at elevated breast cancer risk: the HELP study

Excess weight and physical inactivity are modifiable risk factors for breast cancer. Behavioral intervention is particularly important among women with an elevated risk profile. This trial tested an intervention that trained women to use a self-monitoring website to increase activity and lose weight. Women with BMI ≥27.5 kg/m² at elevated breast cancer risk were randomized to the intervention (N = 71) or usual care (N = 34). The intervention group received telephone-based coaching and used web-based self-monitoring tools. At 6 months, significant weight loss was observed in the intervention group (4.7 % loss from starting weight; SD = 4.7 %) relative to usual care (0.4 % gain; SD = 3.0 %) (p < 0.0001). By 12 months, the intervention group had lost 3.7 % of weight (SD = 5.4 %), compared to 1.3 % (SD = 4.2) for usual care (p = 0.003). At 12 months, accelerometer-measured moderate-to-vigorous physical activity increased by 12 min/day (SD = 24) compared to no change in usual care (p = 0.04. In summary, this web- and phone-based approach produced modest but significant improvements in weight and physical activity for women at elevated breast cancer risk.     

Motivational interviewing fails to improve outcomes of a behavioral weight loss program for obese African American women: a pilot randomized trial

Compared to other racial/ethnic groups, African American (AA) women are more likely to be obese but less likely to participate in weight loss interventions or to successfully lose weight. Sustained motivation for weight loss may be especially difficult for AA women due to socioeconomic and cultural factors. The purpose of this study was to examine whether the addition of motivational interviewing (MI) to a culturally-targeted behavioral weight loss program for AA women improved adherence to the program, diet and physical activity behaviors, and weight loss outcomes. Forty-four obese (mean BMI = 39.4, SD = 7.1) AA women were randomized to receive a 16-week behavioral weight loss program plus four MI sessions, or the same behavioral weight loss program plus four health education (HE; attention control) sessions. Results showed that participants in both MI and HE conditions lost a significant amount of weight, reduced their energy intake and percent calories from fat, and increased their fruit and vegetable consumption (ps < .05). However, adherence to the behavioral weight loss program and changes in diet, physical activity, and weight did not differ across MI and HE conditions. Future research is warranted to determine the subpopulations with which MI is most effective.     

Executive function in weight loss and weight loss maintenance: a conceptual review and novel neuropsychological model of weight control

Weight loss maintenance is a complex, multifaceted process that presents a significant challenge for most individuals who lose weight. A growing body of literature indicates a strong relationship between cognitive dysfunction and excessive body weight, and suggests that a subset of high-order cognitive processes known as executive functions (EF) likely play an important role in weight management. Recent reviews cover neuropsychological correlates of weight status yet fail to address the role of executive function in the central dilemma of successful weight loss maintenance. In this paper, we provide an overview of the existing literature examining executive functions as they relate to weight status and initial weight loss. Further, we propose a novel conceptual model of the relationships between EF, initial weight loss, and weight loss maintenance, mapping specific executive functions onto strategies known to be associated with both phases of the weight control process. Implications for the development of more efficacious weight loss maintenance interventions are discussed.     

John Henryism and blood pressure differences among black men. II. The role of occupational stressors

In this study, the effects of psychosocial job stressors on the resting blood pressure (BP) of 112 black male workers were examined. The subjects resided in a rural, poor, predominantly black community in eastern North Carolina. The job stressors included unemployment, lack of job security, lack of job success, the perception that wages earned were too low for the work performed (and inhibited anger about unfair wages), and the perception that being black had hindered chances for achieving job success. The effect-modifying influence of on-the-job social support, and John Henryism, on several of these relationships was also examined. For systolic blood pressure, a main effect was observed for job security, and an interaction effect was observed for employment status and time of day of interview. For diastolic blood pressure, significant interactions were observed for job success and John Henryism, and for job success and the perception that being black had hindered chances for achieving job success. These findings further clarify under what conditions John Henryism may be associated with higher BPs in this sample of black men. These findings also shed light on the emotional pathways through which selected job stressors may influence resting BPs in these men.This research was supported by a grant from the Robert Wood Johnson Foundation (5938) and by a Research Career Development Award (K04 HL01011) to Sherman A. James from the National Heart, Lung and Blood Institute. The authors thank Stan Kasl, Edward Wagner, and Laurence Watkins for critiquing an earlier version of this paper and Lesa McPherson and Sue Hartnett for their invaluable technical assistance.     

Relationship among self-esteem,internal-external locus of control,and weight change after participation in a weight reduction program

This report covers 15 to 47 months of follow-up study of 66 obese women who participated in a 10-week weight reduction program. Subjects were divided into three self-esteem groups and into two groups of “internal” and “external” subjects. The average weight regain during the follow-up period was 3.1 kg, although all subjects remained below their pretreatment weight. The higher the self-esteem score, the lower the average weight regain during follow-up (1.7 kg, 2.6 kg, and 3.5 kg, respectively). For internals the average weight regain was 1.8 kg and for externals 3.4 kg. Implications are discussed, and suggestions for improved weight reduction programs are presented.     

Developing weight loss interventions for African-American women: elements of successful models

This review examines published reports of weight-loss interventions targeted to overweight African-American women and identifies specific factors that may account for the variability in observed outcomes. The review will identify program elements that have been associated with weight loss in obese African-American women, describe behavior modification elements of weight loss programs, and provide a list of "lessons learned" that may be useful in planning future weight-loss intervention programs for this target population.     

Beyond controlling blood pressure in the black patient: metabolic considerations.

Hypertension is highly prevalent among African Americans, who are also more likely than whites to develop end-organ complications of hypertension. Traditional diuretic-based stepcare therapy has successfully reduced such complications of hypertension as stroke, congestive heart failure, and premature death in all populations tested. Prevention of coronary deaths has been less successful. Potentially adverse metabolic effects of thiazide diuretics and some beta-blockers may partially explain the less successful cardiac outcomes. Use of antihypertensive agents lacking adverse metabolic effects but still achieving effective blood pressure control could improve cardiac outcomes while maintaining the benefits achieved with older forms of therapy. Achievement of improved cardiac outcomes is now one of the principal goals of hypertension research and treatment.     

Psychotherapy and black women: a survey

A survey of black and white psychiatrists on the subject of nonpsychotic black female patients in psychotherapy yielded 93 usable responses. Among the findings are a profile of the average black woman in psychotherapy, responses to questions on clinical and therapeutic issues, and the role of racism as reported by the psychiatrists.     

Effect of weight loss without salt restriction on the reduction of blood pressure in overweight hypertensive patients.

Overweight patients with uncomplicated essential hypertension were followed up biweekly for six months: 24 not receiving antihypertensive-drug therapy (Group I) and 83 on regular but inadequate (despite drug manipulation) antihypertensive-drug therapy (Group II). All patients in Group I and 57 randomly selected patients from group II (IIa) participated in a weight-reduction program. The remaining 26 from Group II (IIb) did not receive a dietary program. Salt intake was in the normal range in all three groups. All patients on the dietary program lost at least 3 kg (mean, 10.5 kg), and all but two showed a meaningful reduction in blood pressure; 75 per cent of Group I and 61 per cent of Group IIa returned to normal blood pressure. The weight and blood-pressure reductions were highly significant (P less than 0.001), were present in both sexes and all ages, and were directly associated. In Group IIb, no significant change in blood pressure or weight occurred (P greater than 0.30).     

Smoking cessation, obesity and weight concerns in black women: a call to action for culturally competent interventions

Approximately 20.8% of black women and 23.1% of white women smoke, and significantly more blacks (37.4%) than whites (22.4%) are obese. Although the average amount of weight gain after quitting smoking is 6-8 lbs for women, blacks tend to gain substantially more weight. This large increase in postcessation weight gain in blacks may further augment the health risks that blacks face in conjunction with obesity. Interventions that promote smoking cessation, while simultaneously reducing weight concerns or weight gain has been proposed as a strategy to help weight-concerned women quit smoking. However, these studies have included primarily white samples and no studies have examined the feasibility or effectiveness of smoking-cessation and weight-control interventions for black women smokers. This review describes the literature on smoking, obesity/weight control and weight concerns in smokers, with a particular attention to black women smokers. A call to action to develop comprehensive and culturally competent smoking-cessation and obesity/weight-control interventions for black women is emphasized due to their high rates of smoking, obesity and postcessation weight gain.     

A comparison of weight control and weight control plus body image therapy for obese men and women

Participants were 65 obese men and women who were randomly assigned to either weight control or weight control plus cognitive behavioral body image therapy. Both conditions showed clinically significant improvements in body image at posttreatment and 1-year follow-up. Adding body image therapy to weight control did not result in greater psychological improvements and did not result in better maintenance of body image change when participants regained weight after treatment. Weight loss and maintenance were equivalent between groups. Adding body image therapy did not improve or detract from weight loss. Although body image therapy has been shown to be effective in obese persons, it appears that a well-rounded cognitive-behavioral weight control program is effective as well.