"Weight Loss Maintenance in African American Women: A Systematic Review of the Behavioral Lifestyle Intervention Literature" Tussing-Humphreys, et. al, Journal of Obesity 2013;
A systematic review of literature is when the researchers have a set of specialized criteria when they run a specific literature search on a subject matter. So the subject matter for this SR was behavioral lifestyle intervention(s) and their search terms were with weight loss maintenance, long-term weight loss, weight regain, weight loss, dietary intervention, obesity, AA (African Americans), and black. Then as they go through their articles they are looking for specific criteria to include Randomized and non-randomized studies, English language, behavioral lifestyle interventions with a maintenance phase of at least six months and many more. A grand total of 505 articles were located and only 16 articles (with 17 studies because 1 article reported on 2 studies) were reviewed. This is a 31 page pdf and many of the pages are used to tell specifics about the study, interventions and results. I looked at a few and went towards the end to see their results, discussion and conclusion/future directions. The results sections gives very detailed information about what they observed in each of the 17 studies. Some of the take-a-ways of the discussion portion are as follows:
"AA women lost less weight during the intensive weight loss phase and maintained a lower % of their weight loss compared to Caucasian women in the the behavioral lifestyle interventions reviewed"
Their "most remarkable finding was that the majority of the 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 control."
"the active intervention phase does not lead to sufficient weight losses to warrant an active maintenance phase."
"Many individuals remain obese, even after one year of treatment and continue to desire to lose."
"Not surprising, inclusion of formal maintenance program was largely associated with lower % weight regain for both AA and Caucasian women."
"designing an intervention that places the priority on weight loss throughout the trial (i.e., from recruitment to implementation to maintenance phases) might improve weight outcomes."
Conclusions and Future Directions
"AA women struggle unduly with both weight loss and maintenance."
"In terms of biology, studies suggest that AA women have several metabolic and physiologic factors that may account for their difficulty with weight management."
The authors suggest that future studies should examine these biological factors within the context of weight loss/maintenance trials and test for racial/ethnic differences.
Also a look at the interconnectedness of the behavioral, sociocultural, environmental and biologic factors that lead to successful weight control in AA women is warranted.
Although I am African American and these studies can make you feel like a lost cause; I do not feel as though we are a lost cause. Until more biologic studies are done to prove that we do have all these restraints as suggested; I will continue to believe that most of the time our behaviors are an individual choice. Yes, there are socioeconomic factors that do impact some AA women's ability to sustain a healthy weight due to communities without Farmer's Markets or healthy choices at their local stores. The authors stated that the quantification of these factors' influence on weight control and identification of the optimum level for intervention within subgroups of the population pose a complex set of research questions for investigators.
I also came upon a little dust-up in the literature circa 2010. A frustrated investigator (MD psychiatrist) concluded that, "these findings lend further support to the notion that obesity is resistant to psychological methods of treatment, if anything other than a short-term perspective is taken. It is suggested that it is ethically questionable to claim that psychological treatments for obesity “work” in the absence of data on their longer-term effects." The investigator had conducted a randomized control trial with a 3-year follow-up on a new cognitive behavioral treatment for obesity. Well, it failed, most of the participants after 3 years had gained all the weight back. Hence, the frustration, well, Dr. Kelly Brownell of Yale, took them to task in an article entitled, "The humbling experience of treating obesity: should we persist or desist?" First of all I love the title because weight loss and maintenance is a humbling experience, period!!! Dr. Brownell in what I would call an oped piece, writes about obesity as the great humbler, 2 competing interpretations (1) the skeptical perspective and (2)the hard pragmatism perspective, positioning the treatment of obesity and constructive reconciliation. One of her concluding remarks was "what is missing is information on the natural history of people who do not receive treatment." She states it seems to have been better to have had the treatment than to not have had any treatment at all!! Agreed!!
I have 2 personal observations about this. 1)My sister never received any treatments or interventions and I have no idea what her doctors told her in 1974 after her second child was born by cesarean section but she steadily gained weight until she died in 1983.
2)I still feel guilty to this day because I have an obese niece that I did not help. She is 3 years older than my daughter and they were very close. It would have been just as easy for me to take her to Weight Watchers with my daughter but she didn't live with me and I thought it just would have been futile (there's more to this but I would rather not express publicly) and today she remains obese. My daughter and her cousin are no longer close, probably because of distance but mainly because of the 2 different lifestyles now. After reading Dr. Brownell's piece, taking my niece to WW probably could have helped her in the long run than having no interventions at all.
I know this is a very long post. Thank you for reading.
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