Rethink standard weight-loss treatments to improve obesity outcomes for Black women
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Black women remain underrepresented in weight-loss intervention studies and typically lose less weight compared with white women, but tailored interventions and engagement strategies can increase chances of success, according to a speaker.
CDC data show Black women have the highest obesity prevalence in the United States compared with other groups and are the only race and sex subgroup with an obesity prevalence greater than 50% of the overall population, Loneke Blackman Carr, PhD, RD, assistant professor in the department of nutritional sciences at the University of Connecticut Institute for Collaboration on Health, Intervention and Policy, said during a presentation at ObesityWeek 2021. About 57% of Black women are living with obesity, and by 2030, severe obesity will increase particularly among women and among non-Hispanic Black adults, Blackman Carr said.
“With Black women sitting at the intersection of both of these identities, they are certainly at a special point of concern as we see that severe obesity will increase,” Blackman Carr said. “There is a historic present but also a future need to focus on obesity solutions for treatments, and hopefully also prevention, to abate this trend.”
Creating tailored interventions
Lifestyle change through behavioral modifications, as shown in trials like Look AHEAD and the Diabetes Control and Complications Trial, are efficacious; however, there are differences in effectiveness by race and sex. Diversity among trial participants is also low, Blackman Carr said.
“Much of the work we do as behavioral intervention scholars is predicated on the success we have seen in those efficacy trials, but there is a difference in weight loss, particularly when it concerns Black women,” Blackman Carr said.
Apart from tightly controlled randomized controlled trials for weight loss, Black women consistently lose less weight — about 2% to 3% total weight loss — compared with white women across intervention studies, Blackman Carr said.
“We know our goal is to reach clinical significance of 5% to 10% [weight loss]; however, Black women are only losing a small amount, and we are not reaching that goal that we know confers the health benefits we hope to achieve through weight loss,” Blackman Carr said.
As an alternative, weight-gain prevention as a treatment modality could abate continued weight gain and stem obesity trends among Black women, Blackman Carr said. She cautioned that more evidence on weight-gain prevention is still needed.
“Weight-gain prevention has a relatable and digestible message for Black women,” Blackman Carr said. “This focus on keeping your same weight, or weight stability, is particularly salient for this group. We know this because aesthetic, cultural values do have a preference toward curvier, shapelier frames. The goal is not always to become slim.”
Future directions for success
The contextual or lived experiences of Black women are often not considered in behavioral weight-control approaches, Blackman Carr said. Alternatives to cognitive behavioral therapy, such as acceptance-based behavioral treatment, have been associated with above-average weight loss and could increase engagement among Black women in particular, Blackman Carr said.
Researchers should also examine other less-used techniques, such as social comparison, to accompany the typical tools of self-regulation, social support and self-monitoring. Building interventions that can use digital modalities, especially smartphones, could provide a relevant pathway to engage Black women in weight-control interventions.
Additionally, racism and racialized experiences should be measured and assessed among trial participants, even if such factors seem irrelevant to a study, Blackman Carr said.
“We need to understand that gap in disparity and why Black vs. white women are not losing as much weight. What is taking place within that lived experience?” Blackman Carr said. “Just understanding these variables — where people live, what their environment contains — can help us engage in the behaviors we promote.”
‘Recruit and retain’ Black women
Black women continue to be underrepresented in most trials, particularly in the weight-gain prevention space, Blackman Carr said. Trialists and researchers must recruit and retain Black women to support the statistical analyses needed to learn more about which treatments work, she said.
“It is important to learn not just what might be in the way, but what facilitates behavior change, too,” Blackman Carr said.
To increase diversity in studies, the makeup of professional team and staff should reflect the population that is recruited.
“Is our staff diverse? Do we have folks creating the intervention connected with the community they represent?” Blackman Carr said. “That is how we can make a difference in recruitment and retention. Being engaged will be a helpful and relevant strategy for having Black women in studies.”
Any intervention must also consider the lived experiences and cultural needs of Black women for success, she said.
“By continuing to innovate in this space as we have, while needing to make further strides, we can achieve weight loss that is at least clinically significant as a common standard for Black women. That is our goal,” Blackman Carr said.
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Blackman Carr L. Reducing disparities in obesity prevalence, and obesity prevention and treatment intervention outcomes in Black women. Presented at: ObesityWeek; Nov. 1-5, 2021 (virtual meeting).
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