Weight Loss Maintenance in African American Women: A Systematic Review of the Behavioral Lifestyle Intervention Literature

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.

Weight Loss Intervention Efficacy Among Black Women

“…3,5,19 The participant numbers ranged from 16 to 2,921. 3,5,19 The systematic review by Osei-Assibey and Boachie 20 gave no specific details about the participants and did not specify the number of studies that included men. It was done in the United Kingdom; however, all the studies reviewed were performed in the US.…”

“…3,19 One systematic review focused on interventions that promoted weight loss maintenance in black women. 5 One systemic review studied diet and lifestyle interventions that promoted weight loss and reduced cardiovascular risk in blacks. 20 Fitzgibbon et al 3 performed the highest quality and most detailed systematic review.…”

“…Black women lost less weight than white women and had challenges with weight loss maintenance. 5 Among 11 studies of black women reviewed, the mean weight loss ranged from 0.5 to 4.6 kg. 3 Tussing-Humphreys et al 5 found a wider weight loss range of 0.5 to 8.5 kg.…”

“…4 Treatment of obesity includes diet, physical activity, and behavior change education; however, specific and effective ways to treat individuals with obesity in a primary care setting are still unclear. 5 It is important to determine what interventions and treatment options specifically work in high-risk populations, such as black women. Previous research has shown that black women enrolled in weight loss intervention studies are usually compared with white women and typically lose less weight and are also underrepresented.…”

“…Previous research has shown that black women enrolled in weight loss intervention studies are usually compared with white women and typically lose less weight and are also underrepresented. 3,5,6 The purpose of this evidence-based review was to determine if participation of black women in weight loss interventions led to successful weight loss compared with usual care or control groups. The usual care of obesity treatment delivered by a provider in a primary care setting is usually one on one, verbal, and brief.…”