The prevalence of obesity among Black women has reached epidemic proportions. Some researchers have suggested that the body images of Black females may contribute to their high risk for obesity by inhibiting motivation for weight control. While a number of empirical studies have examined the body images of Black females, findings are complex and at times, inconsistent. For example, some studies show that Black females consider overweight bodies more attractive, while other studies show that Black females prefer normal-weight bodies. Divergent findings may be due, in part, to the multidimensional nature of body image. Inconsistencies may also be due to differences between the Black females sampled. Methodological problems, including the use of measures that have been validated among Black females, the use of various weight-for-height standards, and the inconsistent analyses of or lack of physiological data, also may contribute to conflicting results. This review addresses the complexity of body image findings among a heterogeneous Black female population and the relationship between their body images and obesity risk. Implications for effective obesity treatment programs and suggestions for improvements in future body image studies are also discussed.

UCCESS IN THE CONTROL OF THEheart failure epidemic has come from advances in understanding effective, evidence-based medical therapies. 1 Challenges remain, however, in the delivery of these therapies to patients. Patient nonadherence to heart failure drugs ranges from 30% to 60% and nonadherence to lifestyle recommendations from 50% to 80%, with higher rates occurring in more socioeconomically disadvantaged subgroups. 2 To meet the challenge of delivering evidence-based therapies to patients with heart failure, research has turned to the evaluation of disease management, remote monitoring, and patient self-management programs. [3][4][5][6][7][8] Disease management programs extend medical care in the outpatient setting but keep patients in a passive role and, as For editorial comment see p 1383.

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Background Heart failure (HF) is increasing in prevalence and associated with prolonged morbidity, repeat hospitalizations, and high costs. Drug therapies and lifestyle changes can reduce hospitalizations, but non-adherence is high, ranging from 30–80%. There is an urgent need to identify cost-effective ways to improve adherence and reduce hospitalizations. Trial Design HART evaluated the benefit of patient self-management (SM) skills training in combination with HF education, over HF education alone, on the composite endpoints of death/HF hospitalizations and death/all-cause hospitalizations in patients with mild to moderate systolic or diastolic dysfunction. Secondary endpoints included progression of HF, quality of life, adherence to drug and lifestyle regimens, and psychosocial function. The HART cohort was comprised of 902 patients including 47% women, 40% minorities, and 23% with diastolic dysfunction. After a baseline exam, patients were randomized to SM or education control, received 18 treatment contacts over one year, annual follow-ups, and 3-month phone calls to assess primary endpoints. SM treatment was conducted in small groups and aimed to activate the patient to implement HF education through training in problem-solving and 5 SM skills. The education control received HF education in the mail followed by a phone call to check comprehension. Conclusions The significance of HART lies in its ability to determine the clinical value of activating the patient to collaborate in his/her care. Support for the trial hypotheses would encourage interdisciplinary HF treatment, drawing on an evidence base not only from medicine but also from the behavioral sciences.

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