Weighing In On African American Obesity

Weighing In On African American Obesity

Researchers look for clues in eliminating obesity-related disparities, particularly among Black women

By B. Denise Hawkins

Everybody is getting fatter. The poor are getting fatter, Gen Xers are getting fatter, African-American women and Hispanic men are getting fatter, and children too young to even have a category are really getting fatter. But for African-Americans and other people of color, the need to lose weight, adopt healthy diets and get fit, is more than a New Year’s resolution, it’s a matter of life and death.

While obesity has long been seen as a minority issue, the study of the disease among African Americans, Hispanics and American Indians has gotten little attention from researchers and scholars until recently.

“All of a sudden minorities have company from the general population,” says Dr. Shiriki K. Kumanyika, a professor of epidemiology at the University of Pennsylvania School of Medicine in Philadelphia. “The newfound attention to the problem can only benefit us all,” adds Kumanyika who for more than two decades has been weighing in on what the nation is eating and how weight and nutrition impact chronic diseases. She, like many researchers and scientists, have become increasingly alarmed by the rapidly rising number of Americans who are overweight or obese, but Kumanyika is one of the few scholars working on the management of obesity and the link to health disparities among African Americans.

In this special focus on obesity and weight gain, we learn about Kumanyika’s efforts to mentor and grow a new cadre of African-American researchers who are taking aim at addressing obesity and related issues in the Black community; we find out what a group of graduating seniors from an HBCU in the Mid-Atlantic region is telling nutritionist Dr. Susan M. Gross of Morgan State University in Baltimore about how they perceive their body size and weight and the health risk associated with looking good; and a new study, says Dr. Yvonne Bronner, researcher and director of the Public Health Program at Morgan State, gives hope to those who thought that they were lactose intolerant and touts the use of calcium-rich diets in weight and disease management.

BI: Your work and research is almost always cited when it comes to research on African American and Hispanic obesity. How would you quantify the level and quantity of research being done and effective interventions aimed at African Americans when it comes to obesity and its link to health disparities?

SK: The amount of research on African Americans and obesity and weight control is almost nonexistent. If you put it on a scale with the amount of research that has been done on obesity, you can’t even get a signal. There is a small amount of research being done on this area of research, even with the recent interest … there are probably less than 50 informative studies about how to prevent or treat obesity in African Americans and that includes African Americans who have been in studies with Whites and where comparisons were made on how the (weight-loss) program worked.

A lot of the literature suggests that either African Americans drop out of studies or they lose somewhat less weight or both. In literature reviews, I find even less information (on studies and clinical trials) done on the Latino population.

BI: For more than two decades you have devoted a substantial part of your research efforts to studying dietary change and weight-management strategies for the control of chronic diseases. What are some of the current projects and research efforts on which you are working?

SK: I’m working almost exclusively on obesity-related issues. I have a center funded by the National Center for Minority Health and Health Disparities at NIH (National Institutes of Health), which is under project EXPORT (Excellence in Partnerships for Community Outreach, Research on Health Disparities and Training). We are trying to stimulate new research on reducing obesity and obesity-related health disparities in inner-city communities primarily and ultimately in Latino communities. We are working with Cheney University. Cheney students are involved in projects, and we are awarding pilot grants to the faculty.

I am also halfway through a weight-control study called SHARE, which stands for Supporting Health Activity and Eating Right Everyday. What we are testing is social-support mechanisms or what’s the best way to provide social support in a weight-loss program for African Americans. I like to think of the program as a state-of-the-art behavioral intervention. The novelty of the program is that most participants were recruited along with one or two other family members or friends as support team members. Everyone comes to the first six months of weekly classes. The question is whether you get better overall weight loss if other people in your social network actually go through the program with you.

Then I am involved in a project funded by the Robert Wood Johnson Foundation. It is an evaluation of an online program developed by the National Black Women’s Health Imperative (formerly the National Black Women’s Health Project). The project, Walking for Wellness, is a concept that Billye Avery developed a long time ago. The idea behind it is that women walking in groups, talking with each other, and solving problems can become fit at the same time.

BI:  Through your research and work with community organizations, you have been able to tap into some of the major causes of weight gain and obesity, as well as barriers to weight loss among African-American women. Do you have plans to move these very important findings from the academic community to the very lucrative, but full field of commercial books, self-help tapes or national programs, on weight loss and obesity?

SK: No, not until I see something that works. I will be happy to move it into dissemination commercially or some other way, but the problem that I have had when people have approached me about doing books is that I haven’t really seen anything that works any better than what is already out there. There is a group, Slim Down Sisters, and their advice is very good, and they’ve written books.

The advice out there tends to be pretty much the same unless we can find some special leverage that is going to work better for Black women or that is going to help them to follow advice better [for losing weight]. That’s really what I am looking for because the advice is the same — you’ve got to exercise, be physically active on a regular basis, and you’ve got to change the way you eat. There is no getting around it.

I haven’t seen evidence that other methods work, like some of the herbal medicines and things that have ephedra in it, given the health profiles of Black women — high blood pressure and heart disease. People selling products that could have risks associated with them have a higher level of credibility in the Black community because they are alternatives and have more appeal than some products coming from the mainstream.

The mainstream weight-loss community has never really spoken to Black women that much. It has promoted a very slender image … it has never really been clear that its products and services were intended for Black women. So, when something comes along and it’s natural and has some other kind of aura associated with it, it may have credibility, but it may not be safe. I’m trying to find something that is safe, but that also has a special ring to it.

BI: Is there a correlation between being overweight and such factors as race, socio-economic status, education and geographic region?

SK: There is clearly a link between ethnicity and obesity because the prevalence in overweight and obesity is just so different. The differences in socio-economic status alone don’t explain the differences in prevalence, although when you look at people with very low incomes or education, there is much less of an ethnic difference than you would have in the middle-of-the-income range. In the high-income range, it is really hard to compare because none of the minority groups are in there and there are not enough to have in a data set if you look at wealth. College-educated Black women are still substantially heavier than college-educated White women. Obesity levels don’t decrease as much with increasing income levels among Black women as they do with White women. So, the effects of socio-economic status aren’t quite the same.

There are a lot of other factors that can be looked at to explain obesity and being overweight, like neighborhood. Even among African Americans there is a lot of residential segregation that affects this population. The services and foods, and physical activity opportunities, target marketing, advertising and other things thought of as environmental causes of obesity, are probably a lot more prevalent in communities where Black people live.

BI:  What about the role of culture in the prevalence of obesity and body perception?

SK: That has come out in literature among the survey data. If you look at how many people are trying to lose weight for example, comparing White women and Black women, you might see that there are equal proportions trying to lose weight. But then you adjust for actual weight levels; fewer of the Black women who are in the range where they are considered overweight or obese are trying to lose weight. In the White community, White women who are in the normal or healthy range are trying to lose weight. But in the Black community, there are more women who are overweight but who are not trying to lose weight. You have to adjust for weight levels.

Such data on Black women doesn’t mean that there is no interest in weight loss. Finding Black female recruits for weight-control studies is easy, but we have to look at where that interest in participating in a weight-control program fits in among the many other competing priorities that they face and how much weight they want to lose, what they are willing to do in order to lose it, and whether it is central to their self-image.

I think that a lot of the studies, even though there aren’t that many, but the ones that have been able to compare the results (weight loss) for Blacks and Whites tend to show that the weight losses are smaller and the drop-out rate is higher (among Black women). Black women may not be able to fit weight control into their lives in the same way (as White women). There are more female-headed households and more stuff happening in a lot of families. Many of our programs are designed for people who can come every week and get the whole course. People may come the first week and not come back again until the fourth week.

BI:   Are there gender differences in the self-perception of body size and body satisfaction when it comes to African-American men and women?

SK: The focus on Black women is partly because the rates of obesity among Black men are similar to the rates in other population groups.

BI:  What are the reasons most cited by African Americans to explain weight gain and obesity?

SK: People in the African-American community have different explanations for what causes weight, which makes starting a discussion in this community a challenge. For example, there are perceptions that generations of people who have been heavy is destiny, while there are people who want to lose weight or who plan to do that at some point, are not making all of the connections with their health risks. That’s why I think we need to really find more depth and increase the amount of research on this topic, especially research that involves investigators who have an African-American experience.

BI:  Where do we go from here? How should the Black community respond to the spate of almost weekly headlines on obesity and weight gain? Are Black children the new targets of obesity?

SK: I’m involved in a new study on weight-gain prevention and African-American girls. I was also on the Institute of Medicine Committee that released a study on obesity prevention and youth. One of the things I’m trying to do is take all of the recommendations in that report, which was sensitive to the fact that minority children are at a higher risk for obesity, and use them as a guide because it lays out a lot of the issues facing children.

Next steps will also include exploring how do considerations for weight control and obesity differ in the African-American community. We also need to determine what researchers need to know to proceed and do more community-partnered research to help determine what is really going on in the African-American community instead of continuing to put these programs in place that appear to be relatively superficial on the surface for people who can come out to take part in them.

While more community-based research and partnerships are needed to inform weight control and obesity interventions, finding ways to discuss these issues in the Black community has been challenging.



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