Working With Black Women to Tailor Weight-Loss Programs

For many black women, big is beautiful, and size is not only a cultural norm, but also an asset, say researchers from University of North Texas in Fort Worth. But African American women are nearly twice as likely to develop diabetes and more than twice as likely to develop end-stage kidney disease or die of complications of diabetes than are white women. They also have a higher prevalence of being overweight or obese.

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However, focusing on weight loss to reduce rates of chronic disease, disability, and premature death may be the wrong tack, the researchers say; weight-loss programs often don’t work well for black women. Even those programs that may have been tailored to the black woman through culturally appropriate artwork and language, African American media outlets, and “meaningful themes” (such as family and spirituality) tend not to produce sustainable results. Most programs aim for participants to lose 5% to 10% of body mass (or roughly 9 to 18 lb for a 185-lb woman) to reduce cardiovascular risk. On average, the researchers say, black women lose 4 to 10 lb—and they typically regain as much as 33% of the weight lost within the year.

The answer, the researchers say, is to not use body mass index (BMI) as a guide. Body mass index is a poor proxy, they say, for general health and health behaviors because it fails to account for differences in body composition, fitness levels, and nutritional differences that predict health and longevity. “BMI itself,” the researchers note, “as a measure of health is of limited value.” According to an analysis of National Health and Nutrition Examination Surveys data, using BMI to predict cardiometabolic risk misclassifies nearly 75 million U.S. adults.

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The researchers suggest a collaborative approach may help: community-based participatory research. A key feature is bringing in the women as partners in research so that their subjective experiences inform the programs. The researchers cite a study in which the collaborative team ultimately “shifted its focus” from using weight loss alone as a metric to what they labeled as “a common-sense approach” more focused on physical activity and nutritional goals perceived by participants as relevant and valuable.