Effect of Group Racial Composition on Weight Loss in African Americans

Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA.
Obesity (Impact Factor: 3.73). 03/2008; 16(2):306-10. DOI: 10.1038/oby.2007.49
Source: PubMed


We do not know how racial composition of a group influences behavior change for African Americans (AAs) in group-based weight loss programs. We tested the hypothesis that AA who participate in all AA weight loss intervention groups will lose more weight than AA who participate in mixed race groups.
This observational study was ancillary to Phase 1 of the Weight Loss Maintenance Study, a multi-center trial of strategies to maintain weight loss after a 20-week behavior modification program. Three of four centers recruited several all-AA intervention groups. Remaining groups were combinations of AA and non-AA participants. All participants received the same weight loss intervention. Change in weight was the primary outcome, comparing participants of all-AA groups with AA participants of mixed race groups conducted by the same AA interventionists. Secondary outcomes included measures of intervention adherence and behavior change.
Participants of all-AA groups (n = 271) were comparable to other AA participants (n = 106). The mean proportion of AA in mixed race groups was 56%. All-AA group participants had similar weight loss as those in mixed groups (-4.2 vs. -4.2 kg, P = 0.97). There were no differences between the groups in mean number of sessions attended or changes in dietary intake.
Significant weight loss was observed in both groups, with no effect of group composition on adherence or weight loss outcomes. Special logistics to accommodate all-AA groups may not be necessary. Despite varying instructional environments, AA appeared to respond positively to intervention messages with significant changes in dietary intake, physical activity (PA), and weight.

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Available from: Carmen Samuel-Hodge, Oct 03, 2014
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    • "This often meant delivering the intervention in existing ethnically appropriate locations (Lasco et al. 1989) or adapting locations to be appropriate , for example, to respect the group's gender values (e.g., by employing for some South Asian populations only female lifeguards for women-only swimming sessions) (Kousar, Burns, and Lewandowski 2008). The delivery also considered appropriate activities; the population's preferred methods of communication and learning (Andrews et al. 2007; Utz et al. 2008); the preferred format of individual or group sessions (Boltri et al. 2008) to encourage social support (Yanek et al. 2001); and the preference of an exclusive (single ethnic group) or open (mixed ethnic groups) intervention environment (Ard et al. 2008). This forty-six-item Typology of Adaptation Approaches is presented in more detail, and with definitions, in table 2. The adaptations identified in the 107 studies are summarized in appendix 3. "
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    ABSTRACT: Adapting behavior change interventions to meet the needs of racial and ethnic minority populations has the potential to enhance their effectiveness in the target populations. But because there is little guidance on how best to undertake these adaptations, work in this field has proceeded without any firm foundations. In this article, we present our Tool Kit of Adaptation Approaches as a framework for policymakers, practitioners, and researchers interested in delivering behavior change interventions to ethnically diverse, underserved populations in the United Kingdom. We undertook a mixed-method program of research on interventions for smoking cessation, increasing physical activity, and promoting healthy eating that had been adapted to improve salience and acceptability for African-, Chinese-, and South Asian-origin minority populations. This program included a systematic review (reported using PRISMA criteria), qualitative interviews, and a realist synthesis of data. We compiled a richly informative data set of 161 publications and twenty-six interviews detailing the adaptation of behavior change interventions and the contexts in which they were undertaken. On the basis of these data, we developed our Tool Kit of Adaptation Approaches, which contains (1) a forty-six-item Typology of Adaptation Approaches; (2) a Pathway to Adaptation, which shows how to use the Typology to create a generic behavior change intervention; and (3) RESET, a decision tool that provides practical guidance on which adaptations to use in different contexts. Our Tool Kit of Adaptation Approaches provides the first evidence-derived suite of materials to support the development, design, implementation, and reporting of health behavior change interventions for minority groups. The Tool Kit now needs prospective, empirical evaluation in a range of intervention and population settings.
    Milbank Quarterly 12/2013; 91(4):811-51. DOI:10.1111/1468-0009.12034 · 3.38 Impact Factor
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    • "Four studies investigated a single adaptation. One study [25] investigated whether group composition (ethnically mixed versus homogenous groups) in a group intervention influenced weight loss among African Americans (surface-structure adaptation) and found no difference between the groups. Fitzgibbon et al. [28] evaluated incorporation of faith in a weight loss intervention. "
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    ABSTRACT: The importance of cultural adaptations in behavioral interventions targeting ethnic minorities in high-income societies is widely recognized. Little is known, however, about the effectiveness of specific cultural adaptations in such interventions. To systematically review the effectiveness of specific cultural adaptations in interventions that target smoking cessation, diet, and/or physical activity and to explore features of such adaptations that may account for their effectiveness. Systematic review using MEDLINE, PsycINFO, Embase, and the Cochrane Central Register of Controlled Trials registers (1997-2009). Inclusion criteria: a) effectiveness study of a lifestyle intervention targeted to ethnic minority populations living in a high income society; b) interventions included cultural adaptations and a control group that was exposed to the intervention without the cultural adaptation under study; c) primary outcome measures included smoking cessation, diet, or physical activity. Out of 44904 hits, we identified 17 studies, all conducted in the United States. In five studies, specific cultural adaptations had a statistically significant effect on primary outcomes. The remaining studies showed no significant effects on primary outcomes, but some presented trends favorable for cultural adaptations. We observed that interventions incorporating a package of cultural adaptations, cultural adaptations that implied higher intensity and those incorporating family values were more likely to report statistically significant effects. Adaptations in smoking cessation interventions seem to be more effective than adaptations in interventions aimed at diet and physical activity. This review indicates that culturally targeted behavioral interventions may be more effective if cultural adaptations are implemented as a package of adaptations, the adaptation includes family level, and where the adaptation results in a higher intensity of the intervention. More systematic experiments are needed in which the aim is to gain insight in the best mix of cultural adaptations among diverse populations in various settings, particularly outside the US.
    PLoS ONE 10/2013; 8(10):e73373. DOI:10.1371/journal.pone.0073373 · 3.23 Impact Factor
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    • "However, it is hard to discern what specific cultural adaptations or combination of adaptations are most useful [71]. What researchers consider to be “salient” cultural adaptations is often derived from qualitative studies [85–87], based on community input [88], based on researcher perception of sociocultural perspectives of AAs, or, informal participant and community leader conversations [89]. For example, AA women have cited inclusion of spirituality as a culturally salient adaptation to promote weight control [90]. "
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    ABSTRACT: We performed a systematic review of the behavioral lifestyle intervention trials conducted in the United States published between 1990 and 2011 that included a maintenance phase of at least six months, to identify intervention features that promote weight loss maintenance in African American women. Seventeen studies met the inclusion criteria. Generally, African American women lost less weight during the intensive weight loss phase and maintained a lower % of their weight loss compared to Caucasian women. The majority of studies failed to describe the specific strategies used in the delivery of the maintenance intervention, adherence to those strategies, and did not incorporate a maintenance phase process evaluation making it difficult to identify intervention characteristics associated with better weight loss maintenance. However, the inclusion of cultural adaptations, particularly in studies with a mixed ethnicity/race sample, resulted in less % weight regain for African American women. Studies with a formal maintenance intervention and weight management as the primary intervention focus reported more positive weight maintenance outcomes for African American women. Nonetheless, our results present both the difficulty in weight loss and maintenance experienced by African American women in behavioral lifestyle interventions.
    Journal of obesity 04/2013; 2013:437369. DOI:10.1155/2013/437369
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