The epidemic of obesity in the U.S. shows no signs of abating – presently, almost 70% of the adult U.S. population is either overweight or obese. Black women are disproportionately affected by the condition. Between 1976 and 2008, obesity among black women increased more than 60%[2, 3]. Nearly 60% of black women are obese, a rate that is twice that of non-Hispanic white women. Socioeconomic status and obesity are less strongly associated in black women than in other groups. Nevertheless, socioeconomic factors strongly pattern exposure to obesogenic environmental factors [4, 5], the adoption of obesogenic risk behaviors, the limited availability of weight management resources[7, 8], and the efficacy of obesity treatment strategies in the primary care setting.
Despite their vastly increased risk of obesity and associated chronic disease[10, 11], racial/ethnic minority and socioeconomically disadvantaged populations have been underrepresented in clinical trials of weight loss interventions. This is problematic because promoting weight loss among black women is a long-standing and vexing clinical challenge[12, 13]. Evidence-based obesity treatments are consistently less effective and absolute weight losses are generally smaller among black women, compared to other populations[10, 11, 14]. There is growing recognition that alternative clinical treatment strategies are necessary to contend with the challenge of obesity[14–17]. While it is undeniable that weight loss is the optimal treatment strategy for many obese individuals, weight gain prevention may have considerable clinical utility among overweight and some obese black women.
Weight gain prevention holds promise in reducing risk associated with cardiovascular diseases (CVD), type 2 diabetes, some cancers and perhaps premature mortality. Weight gain prevention may have particular benefits for blacks, who exhibit disproportionately greater rates of adulthood weight gain[20, 21] and extreme obesity , both of which increase obesity-associated chronic disease risk[22–24]. Relative to whites, black women have weaker associations of adiposity with cardiovascular risk factors[25–28] and mortality from cardiovascular disease[29, 30] and all causes. Thus, promoting weight stability within the overweight (BMI = 25-29.9 kg/m2) and lower levels of the Class 1 obesity ranges (BMI = 30-34.9 kg/m2) might be an appropriate chronic disease risk reduction strategy in black women, especially prior to menopause, when weight gains are particularly pronounced[31, 32].
Additionally, we suspect that weight gain prevention strategies may be more consistent with the sociocultural experiences of black women, compared to traditional weight loss approaches. While some opposing data exist, most studies have shown that black women are more tolerant of heavier body weights, as compared to white women. Blacks have a greater social acceptance of overweight, less body weight dissatisfaction, and higher body weight ideals than do whites[12, 33–40]. A number of studies have shown that overweight blacks are less likely to perceive themselves to be overweight, compared to whites and Hispanics[41–43]. Perceived body image and attractiveness are not as strongly linked with weight in black women, compared to white women. Moreover, a majority of blacks do not consider overweight to be unhealthy. Given that black women’s views about attractiveness and health are not closely associated with their weight status, weight loss messages[44–46] – which emphasize the importance of thinness – may have limited effectiveness among obese women. Intervention messages that emphasize weight gain prevention or enhancement of one’s current shape may have greater sociocultural relevance, thus enhancing participant receptivity[47, 48].
Given the challenges associated with promoting weight loss among black women, particularly in the primary care setting, alternative treatment strategies are necessary. Weight gain prevention among overweight and Class 1 obese individuals is one such approach, one that requires relatively low treatment intensity and might be more consistent with the sociocultural experiences of black women. We suspect that its lower intensity and greater consistency with sociocultural norms may heighten participant responsiveness, improve intervention engagement, and enhance intervention outcomes among black women.