Telling overweight women to stay at their current weight was more effective than asking them to lose weight, according to a Duke study out today.
The study focused on nearly 200 overweight 25- to 44-year-old black women who received care from community health centers in North Carolina that serve predominately poor patients. Overweight is defined as body mass index, or BMI, of 25 to 29. Obese is BMI of 30 or higher.
One group was given the typical standard of care from their primary doctors, including suggestions to lose weight and healthy lifestyle. The women in the other group were encouraged to prevent weight gain and were provided individual goals for diet using registered dietitians along with a YMCA membership and physical activity goals.
At 12 months, more than half of those encouraged to lose weight actually gained weight, whereas only one-third of the other group did.
“This study demonstrates that weight maintenance is easier to achieve than weight loss,” says Dr. Fatima Cody Stanford, an obesity medicine and nutrition fellow at Massachusetts General Hospital and Harvard Medical School. “However, this is true in persons of all ethnic backgrounds, not just those of African descent.”
Historically, weight loss programs are not as effective among black women compared to white women and men, says Gary Bennett, lead author of the study and director of obesity prevention at Duke University. Therefore, he says, his findings are promising.
“There’s not the same social pressure for black women to lose weight in the black community,” he explains. “If 80 percent of the black female population is overweight, then that’s normal. So, being normal weight is abnormal.”
Stanford agrees. “Black women have higher weight misperception and more satisfaction with heavier weight than other groups. Even thought the women in the study were all classified as overweight or Class I obese, they were happy with maintaining their size than might be seen in a comparable group of Caucasian women.”
These perceptions, according to both, are the reason why the typical weight loss tactics may be less effective among black women. Instead of talking about health or weight loss, for example, Bennett says that his team used messages such as “getting Michelle Obama arms.”
A 2012 survey by the Washington Post and Kaiser Family Foundation found that despite having an overall higher self-esteem than white women, 65 percent of overweight or obese black women still felt that their weight had a negative effect on their health.
“I don’t particularly think it is harmful to tell overweight women not to lose weight, but I do think that it might be interpreted as a deceptive practice as it could lead to worse health outcomes,” says Stanford. “I believe that health care providers should inform patients of their weight status (whether normal, overweight, or obese) and provide guidance of how to achieve and maintain a healthy weight.”
Bennett says that for those who are overweight and do not yet have health problems, weight maintenance is a promising tactic.Bl
“At the same body mass index of 31 to 32, the black woman is less likely to have early mortality, hypertension, cardiovascular mortality or high cholesterol than the white women,” Bennett says.
This suggests that letting black women remain overweight may not be as detrimental as previously thought.
“Black women do tend to have lower levels of certain chronic diseases at higher weight classes than persons of other ethnic backgrounds,” Stanford says.
Constance Brown-Riggs, registered dietitian and national spokesperson for the Academy of Nutrition and Dietetics, says that this study also points out the limitations of primary care doctors to address nutrition and weight loss.
“It validates the need for registered dietitians in facilitating behavior change strategies that can lead to weight loss or maintenance,” she explains. “Primary care doctors just don’t have the time or resources to adequately address the myriad of factors involved in moving an individual towards successful weight loss or maintenance.”
Brown-Riggs, who is also author of The African American Guide To Living Well With Diabetes and Eating Soulfully and Healthfully with Diabetes, adds: “The ‘cookie cutter’ approach will not help individuals work through barriers such as purchasing and preparing healthier foods or incorporating physical activity into their day.”
Bennett says that his team plans to reexamine the weight gain or loss at the 18-month mark and consider these interventions as a first-line treatment intervention.
“We’re also going to look at this in men. Black men have a similar pattern of lower health risks with obesity. But, once men enter their mid to late 30s, they gain a lot of weight. We’re going to look at this strategy,” he says.
Dr. Tyeese Gaines is a physician-journalist with over 10 years of print and broadcast experience, now serving as health editor for MSNBC’s theGrio.com. Dr. Ty is a practicing emergency medicine physician in New Jersey and clinical instructor of emergency medicine at Yale School of Medicine. Follow her on twitter at @doctorty.