Running head: OBESITY IN AFRICAN AMERICAN WOMEN

ESSAY GRADE: 96/100 = A Olivia: Congratulations on writing an excellent intervention paper! The only aspect of this assignment that you missed was to include specific health disparity rates. The paper was insightful and a pleasure to read! I have enjoyed having you in two courses and I wish you every success in your future endeavors! I look forward to interacting with you as a graduate student in the College of Public Health! Best Regards, Dr. Stedman-Smith

Interventions Addressing the Disproportionate Effect of Obesity on African American Women in the United States

Olivia Hartman Kent State University

Running head: OBESITY IN AFRICAN AMERICAN WOMEN

The obesity epidemic in America disproportionately affects African American women ages 20 and older. Obesity is a label for a range of weight that is greater than what is generally considered healthy for a given height. The United States Centers for Disease Control and Prevention define obesity in adults as having a body mass index (BMI) of 30 or higher. BMI is a number calculated from a persons height and weight to provide an indicator of that persons body fat. This number is used to screen for weight categories that are at particular risk of health problems, such as cardiovascular disease (CDC, 2011). However, BMI is not a direct measure of body fatness, and because it is calculated by weight, it includes both muscle and fat. Increased muscularity may cause an individual to have a BMI indicating that they are obese, when really they are not. The National Heart, Lung, and Blood Institute recommends considering the individuals waist circumference as well. This is because abdominal fat predicts an individuals risk for obesityrelated diseases (CDC, 2011). (Excellent information!) Healthy People 2020 asserts a specific goal to promote health and reduce chronic disease risk through the consumption of healthful diets and achievement and maintenance of healthy body weights (United States Department of Health and Human Services [DHHS], 2011). Diet and body weight are directly related to an individuals health status, so maintaining a healthy BMI helps individuals reduce their risks for heart disease, high blood pressure, dyslipidemia, type 2 diabetes, osteoarthritis, certain cancers, and

Running head: OBESITY IN AFRICAN AMERICAN WOMEN

premature death (CDC, 2011). The prevalence of obesity among black women in America is higher than it is in most other subgroups, and morbidity and mortality from diseases associated with obesity are higher among black women than white women (Ogden, 2009). (Need specific rates here) This data depicts the scope of the obesity problem burdening African American women. A wide variety of interventions and prevention programs have been implemented in order to address the obesity epidemic in the United States. Selective preventive measures can be defined as those targeting populations at greatest risk, and are of particular importance when attempting to reduce obesity among African American women (Bonnie & OConnell, 2004). One example of a selective preventive measure is the LIFE Project, designed to reduce obesity in rural African American women. This population is particularly vulnerable to obesity and obesity-related diseases because they have considerably fewer community resources to address weight loss
(Parker, Coles, Logan, & Davis, 2010).

The LIFE project was developed as a response to community members expressed need for a weight-loss intervention program providing nutrition and physical activity education. In order to incorporate community members concerns into the design of the program as fully as possible, community members were involved from the inception of the intervention. Reducing the risk of obesity and the development of chronic conditions such as diabetes and hypertension were major concerns, especially among the African

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American women (Parker, Coles, Logan, & Davis, 2010). They identified churches to be an easily accessible, familiar, and comfortable institution for implementation of programs. Accordingly, the LIFE project is a church based educational weight loss program for obese African American women ages 2464. The program lasted ten weeks, and participants lived in rural areas of South Carolina that had little access to weight loss programs (Parker, Coles,
Logan, & Davis, 2010).

The LIFE project curriculum focuses on the 3Ds: dietary practices, daily physical activities, and discussions with health care providers. Given the research findings about the positive features of spiritual components of weight-loss programs and the influence of the church in African American rural life, spiritual and non-spiritual versions of the curriculum were presented (Parker, Coles, Logan, & Davis, 2010). Non-spiritual sessions included content pertaining to the 3Ds, while spiritual sessions added appropriate biblical scriptures. The curriculum in both versions included nutritional and physical activity information, and both groups achieved reductions in weight and systolic blood pressure. The LIFE project also found that social interaction through the group process was an extremely important component, perhaps as important as the curricular content (Parker, Coles, Logan, & Davis, 2010). Socioeconomic deprivation is associated with an increased likelihood of engaging in detrimental health-related behaviors, such as poor nutrition and physical inactivity, and the odds of obesity are 25% higher for

Running head: OBESITY IN AFRICAN AMERICAN WOMEN

persons of low adult socioeconomic status rather than high (James, FowlerBrown, Raghunathan, & Van Hoewyk , 2006). Research has found that African Americans and other minorities are more likely to have low socioeconomic status than whites (Duncan, Kalil & Ziol, 2008). Interventions to address weight management for low-income, obese African American women have been implemented in the primary care setting to reduce barriers in weight management that this population faces. One particular primary care intervention provided 90 minutes of physician-delivered weight management instruction over 6 months. Participants included 144 obese or overweight African American women ages 18-65 who were recruited from the office of their primary care physician (Martin et al., 2006). The instruction was tailored based on the individuals need, and combined culturally sensitive diet recommendations that were individualized to personal food preferences. This helps reduce barriers such as increased food preparation time, obtaining or preparing novel food, or the use of unappetizing foods. Necessity of low-cost alternatives for diet and physical activity were also taken into consideration (Martin et al., 2006). Accessing weight management resources through primary care physicians reduces barriers associated with accessing new treatment settings, and allows an ongoing system of support, follow-up, and motivation. The physician provided oral recommendations and handouts summarizing the focus of each visit. A study of this intervention found that 79% of

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intervention participants lost weight by month six, in comparison to only 47% of those receiving standard care (Martin et al., 2006). Both of these interventions can be considered successful because participants from both programs experienced statistically significant weight loss (Martin et al., 2006; Parker, Coles, Logan, & Davis, 2010). These programs also included components related to both healthy diet and adequate physical activity, which is important. Programs focusing on diet or physical activity alone are incomplete and will not be as successful in producing results (Glanz, Rimer & Viswanath, 2008). Both interventions promote ease of access for weight-loss services. The LIFE project was implemented in the church because community members identified this as an ideal setting. However, a limitation of this program is that it only lasts 10 weeks, which is a relatively short amount of time to instill life-long behavioral changes. Primary care prevention is ongoing and more convenient. Primary care weight management interventions have the best promise to reduce obesity among African American women for a number of reasons. Because primary care physicians are already utilized, access to care is less of an issue. Also, implementations of weight management actions are individualized, and primary care physicians are an important source of health risk advice (Martin et al., 2006). This type of intervention is both timeefficient and cost-effective. However, for extremely difficult cases, participation in another weight maintenance program in addition to receiving services from a persons primary care physician may be necessary.

Running head: OBESITY IN AFRICAN AMERICAN WOMEN

In order to decrease the disproportionate suffering due to obesity that African American women experience, many barriers must be overcome. Lower levels of education and resources are holding this demographic group back from making positive changes in their health behaviors and health status. Access to health care, which is affected by socio-economic status, also needs to be addressed. (This is very important, since for those who do not have access to healthcare, the physician intervention is not accessible. Also, nurse clinicians, nurse practitioners, and physician assistants may be more cost effective for administering the primary care intervention than physicians, since they are paid lower wages.) Proper diet, fruit and vegetable consumption, and physical activity are all very important components of maintaining a healthy weight. These behavioral factors are affected by ones access to resources over their life course. Lack of transportation to grocery stores with healthy food options, inexpensive foods being the less healthy ones, and unsafe neighborhoods where physical activities can be dangerous are all factors that can and do affect an individuals health behaviors (James, Fowler-Brown, Raghunathan, & Van Hoewyk , 2006). These factors are particularly important to consider in the case of African American women, because they are disproportionately affected by poverty and obesity (Parker, Coles, Logan, & Davis, 2010). To enhance the effectiveness of future interventions, the Social Ecological Model should be utilized. This model proposes that there are many factors affecting behaviors on various different levels. Levels of influence

Running head: OBESITY IN AFRICAN AMERICAN WOMEN

include the individual, family, community, and policy. The Social Ecological Model asserts that the simultaneous implementation of interventions acting on these different levels of influence will create a much larger impact than focusing on just one (Glanz, Rimer & Viswanath, 2008). (Excellent). For instance, individualized programs such as the LIFE project are of great value. On a community level, the creation of parks and bike paths support physical activity. Policies that discourage an obesogenic environment, such as the ban of artificial trans fat in schools and food service establishments, will further promote healthy weight behaviors. Obesity, especially in African American women, is a complex and multi-factoral public health problem, and the necessity of simultaneous prevention and intervention programs operating on all levels of influence and in various settings is apparent. (Olivia, I am glad that you added the importance of including the built environment beyond the two approaches that you profiled as interventions.)

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References Bonnie, R.J., & OConnell, M.E. (Eds.). (2004). Reducing underage drinking: A collective responsibility. Washington, DC: The National Academies Press.

Duncan, G.J., Kalil, A., Ziol, K. (2008). Economic costs of early childhood poverty. Partnership for Americas Economic Success, 4, 1-33.

Glanz, K., Rimer, B.K., & Viswanath, K. (2008). Health behavior and health education: Theory, research, and practice. San Francisco, CA: Jossey-Bass.

James, S.A., Fowler-Brown, A., Raghunathan, T.E., & Van Hoewyk, J. (2006). Life-course Socioeconomic position and obesity in African American women: the Pitt County study. American Journal of Public Health, 96 (3), 554-559.

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Ogden, C.L. (2009). Disparities in obesity prevalence in the United States: black women at Risk. The American Journal of Clinical Nutrition, 89, 1001-1002.

Parker, V.G., Coles, C., Logan, B.L., & Davis, L. (2010). The LIFE project: a community-based weight loss intervention program for rural African American women. Family Community Health, 33(2), 133-143.

United States Centers for Disease Control and Prevention. (2011). About BMI for adults. Retrieved from http://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/ index.html #Interpreted

U.S. Department of Health and Human Services. (2011). Nutrition and weight status. Retrieved from http://www.healthypeople.gov/2020/topicsobjectives2020 /overview.aspx?topicId=29

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