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Weight Loss Experiences of African American Women

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Weight Loss Experiences of African American Women. Kathryn M Kolasa ... African American women's perceptions of weight: paradigm shift for advanced practice. ... – PowerPoint PPT presentation

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Title: Weight Loss Experiences of African American Women


1
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 University
  • February 9, 2007

Kathryn M Kolasa PhD, RD, LDNBrody School of
Medicine at East Carolina University February 9,
2007
2
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
3
Who is in this session?What hope to learn?
4
Quick Reminder of Definition of Obesity (NIH)and
types of evidence based interventions
(Reminder Normal BMI is 18.5 to 24.9.)
Kolasa ECU Family Medicine 2007
5
Steps in Obesity Management- adults children
  • Assess BMI and waist circumference
  • Consider treatable causes of obesity ( e.g.
    meds, hypothyroidism, Cushings 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 ECU Family Medicine 2007
6
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 ECU Family Medicine 2007
7
Estimated Caloric Requirements To lose 1 pound
of body fat per week, increase activity or
decrease calorie intake by 250-500 calories per
day
From Dietary Guidelines for Americans 2005.
Available at http//www.health.gov/dietaryguidelin
es/dga2005/document/pdf/dga2005.pdf
Kolasa ECU Family Medicine 2007
8
An example of medical value of weight loss
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
Kolasa ECU Family Medicine 2007
9
By 2058, everyone in US will be obese if rates
rise at same pace they have over the last several
years
2005
In one survey 67 Americans say tried to diet
to lose weight at least once in last 5 years.
66 said they failed
BMI 30, or 30 lbs. overweight for 5'4"
person 2005                                     
                                                  
                                                  
                                                  
                                                  
                                                  
                                                  
                                 
Kolasa ECU Family Medicine 2007
10
By definition most AA in ENC are overweight/obese
From Cummings et al. REACH study Hertford,
Martin, Pitt and Duplin Counties, 2005.
11
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

12
The dominant culture has laughed and cried with
the weight struggles of cartoon characters like
Cathy
Kolasa ECU Family Medicine 2007
13
All have watched Oprah and her weight
14
Is the African American Experience different?
15
African American Womens 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
  • Dont 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 ECU Family Medicine 2007
16
African American Womens Weight Loss Experience
contd
  • 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 dont have good food bad
    food concepts

Kolasa ECU Family Medicine 2007
17
Americans trying to lose weight who fail say its
because
  • 80 dont 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 dont make good choices at restaurants
  • 19 only watch fat intake and not calories
  • 14 only watch calories but not fat intake

How is this same/different for AA women?
Kolasa ECU Family Medicine 2007
18
Stages of Change for Weight Loss
Stages of change
From Hawkins, 2001
19
Stages of Change for Weight Loss
Stages of change
From Hawkins, 2001
20
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 ECU Family Medicine 2007
21
1. Failure of Wt Maintenance
  • Achieve modest short term wt loss
  • Need weight maintenance strategies incorporated
    into the program. They dont teach you how to
    maintain
  • Local experience. Ask for maintenance programs
    but then dont commit. So, how do we get people
    to stay in for more than 12 weeks?

Kolasa ECU Family Medicine 2007
22
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 ECU Family Medicine 2007
23
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 ECU Family Medicine 2007
24
See Success Storieswww.eatsmartmovemorenc.com
  • Board of Elders 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 Church Concord, NC
25
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 cultures definition of
    overweight to guide weight loss methods (Ref 4)

Kolasa ECU Family Medicine 2007
26
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 ECU Family Medicine 2007
27
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 dont 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 ECU Family Medicine 2007
28
What to Do
  • Afro-centric principles interdependence,
    spirituality, connection to ones 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.co
    m
  • Cookbooks and brochures

Kolasa ECU Family Medicine 2007
29
Can order Photo copy Reproducible Masters WIN_at_inf
o. Niddk.nih.gov 1-877-946-4627 Fit and
Fabulous As you Mature
http//www.hsph.harvard.edu/sisterstogether/
Kolasa ECU Family Medicine 2007
30
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

31
Try lower fat versions of favorite foods, instead
of
  • Fried chicken _______________
  • Ham hocks, salt pork, fat back _________
  • French fries_________________

32
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 ECU Family Medicine 2007
33
What to Do?
  • How can we educate, especially women with limited
    resources?
  • What cultural adaptations are needed?

Kolasa ECU Family Medicine 2007
34
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 ECU Family Medicine 2007
35
What to Do?
  • Frame physical activity as a social activity
  • Cooking demonstrations. Dont cut out but alter
    food preparation

Kolasa ECU Family Medicine 2007
36
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.
37
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 ECU Family Medicine 2007
38
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 ECU Family Medicine 2007
39
What opportunities do we have in eastern North
Carolina
40
References
  • Black MM et al. Overweight adolescent AA mothers
    gain weight in spite of intentions to lose
    weight. JADA. 200610680-87.
  • Breitkopf CR, Berenson AB. Correlates of weight
    loss behaviors among low income African American,
    Caucasian, and Latina Women. ACOG. 2004103231.
  • Davis EM, Clark JM, Gary TL, Cooper LA. Racial
    and socioeconomic differences in the weight-loss
    experiences of obese women. AJPH. 2005951539
  • Gore SV. African American womens perceptions of
    weight paradigm shift for advanced practice.
    Holist Nurs PRact. 19991371-79.
  • Hawkins DS et al. Stages of change and weight
    loss among rural African American women. Obesity
    research.2001959.

Kolasa ECU Family Medicine 2007
41
  • James DCS. Gender differences in body mass index
    and weight loss strategies among African
    Americans. JASA. 20031031360.
  • Karanja N. Steps to soulful living a weight
    loss program for AA women. Enthnicity disease.
    200212363-371.
  • Newton RL Weight management in African American
    Women practical issues. Obesity Management.
    2005243.
  • Sbrocco T. et al. Church based obesity treatment
    for AA women improves adherence. Enthnicity
    Dis. 200515246.
  • Wolfe WA A review maximizing social supporta
    neglected strategy for improving wt management
    with AA women. Ethnicity disease.
    200414212-218.
  • Young DR, et al. Motivations for exercise and
    weight loss among AA women. Ethnicity Health
    20016227-245.

Kolasa ECU Family Medicine 2007
42
Resources
  • http//win.niddk.nih.gov/publications/mature.htm.
    Fit and Fabulous as you Mature.
  • http//www.modep.buffalo.edu/assets/docs/healthy_d
    own_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 fiberbut still tasty. Available free
    from NCI call 1-800-4-CANCER or 1-800-332-8615
    (TTY).

Kolasa ECU Family Medicine 2007
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