From Our 2013 Archives
'Maintain, Don't Gain' May Work Best for Obese Black Women
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The finding stems from work with nearly 200 mildly obese young and middle-aged black residents of North Carolina, half of whom participated in a new yearlong food counseling and exercise program designed to maintain each patient's current body shape, rather than to shed pounds.
The bottom line: Although most of the women given standard weight-loss counseling continued to gain weight over the ensuing 18 months, those given maintenance counseling were much more likely to stabilize their weight.
"Black American women have some of the highest rates of obesity in the world," said study author Gary Bennett, director of the Duke University Obesity Prevention Program in Durham, N.C. "Frankly, 80 percent are overweight, which means that overweight has become the norm."
"Federal guidelines recommend that our primary-care physicians encourage all overweight patients to lose weight," Bennett said. "But black women may not necessarily want to lose weight, perhaps because they are less likely to value thinness as a cultural norm and have fewer social pressures to do so. What is clear is that we consistently see that black women do not do well when we try to deliver weight-loss treatment."
"Our focus was on weight stability," he said. "And we did not push the connection between health and weight. The goal was to help these women -- who are already slightly obese -- avoid further weight gains that, year after year, will give rise to all sorts of health complications down the road."
Bennett discussed his team's findings in the Aug. 26 issue of the journal JAMA Internal Medicine.
Study participants were recruited from six different North Carolina community health centers starting in 2009. All were between the ages of 25 and 44, all were deemed "class 1" (mildly) obese and the majority were on the lower rungs of the socioeconomic ladder.
Over the course of 12 months, roughly half were assigned randomly to receive the usual weight-loss counseling. The other half were enrolled in a highly individualized and flexible weight-stability-counseling program called Shape.
All Shape patients were given a YMCA membership. They also were encouraged to make slight food-consumption adjustments (no sugary drinks; more fruits and vegetables) that would result in a 200-calorie dip in daily consumption.
All the while, Shape patients were not told that the point of the program was to lose weight, but it was rather to feel better overall while keeping their current physique.
The result: By the one-year mark more than 62 percent of the Shape women had either maintained their initial weight (and body-mass index, a measure of body fat based on height and weight) or even shed some pounds, compared with about 45 percent of those receiving weight-loss counseling.
What's more, weight stability among the Shape participants was found to have continued through to the 18-month mark, six months after the program ended.
"What's important to know is that when black women are slightly overweight or obese, they don't actually have as many health risks as other groups," Bennett said. "We don't really know why, but they seem to have some sort of health advantage in that respect. At the same time, we also know that this advantage disappears over time as they continue to gain weight year after year, so if we don't prevent that [long-term] gain they will certainly come face-to-face with all sorts of cardiovascular issues, hypertension and diabetes."
"This preventive approach is very important," he added. "And certainly it may have benefits beyond black women alone. There are many people who are uninterested in weight loss or have been unsuccessful trying. For them, we now have a message that may work: Just don't gain anymore."
In an editorial published with the Duke study, former U.S. Surgeon General Dr. Regina Benjamin lent her support to the Shape program.
"As Surgeon General, my whole focus was on prevention," Benjamin said. "This innovative approach fits right into that because it shows that, even if you don't call it 'healthy,' a doctor can give me a healthy lifestyle prescription that I can actually live with and incorporate into my family, my daily life, my church life."
"It's also a positive new way of thinking about health that isn't about telling people that you can't do this and you can't do that," Benjamin said. "It doesn't focus on your dress size or what the scales say. It focuses on feeling better and the enjoyable aspects of healthy living by telling people that [they're] going to have a better outcome overall. You and your family are going to feel better and be happier. That's the reward."
SOURCES: Gary Bennett, Ph.D. director, Duke Obesity Prevention Program, and associate professor, department of psychology and neuroscience, Duke University, Durham, N.C.; Regina Benjamin, M.D., former U.S. Surgeon General, U.S. Department of Health and Human Services, Washington, D.C.; Aug. 26, 2013, JAMA Internal Medicine
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