Weight Management for the African American Family

2. Weight Management for the African American Family Adrienne D. Mims, M.D. MPH From the Heart Church Ministry July 18, 2004

3. Learning Objectives • The epidemic of obesity • Health effects of being overweight • What is a healthy lifestyle for maintaining optimum weight • Understand what works for weight management in African Americans • Developing your personal plan of next steps

4. Total Body Weight Energy Balance Calories Consumed Calories Expended

5. Body Mass Index (BMI) • New way to determine appropriate weight • Uses weight and height in calculation • Determines amount of excess fat tissue • Appropriate for adults over age 20 • Not used during pregnancy • May not be helpful in those who are more muscular

6. Body Mass Index Percentile BMI% • Used to assess weight in children • Calculated on growth charts specific for age and sex • Above 85% is at risk for overweight • Above 95% is overweight

7. Category Underweight Normal Overweight Obesity I II Severe III (extreme) BMI score < 18.5 18.5-24.9 25.0-29.9 30.0-34.9 35.0-39.9 >40 Body Mass Index (BMI)

8. Obesity* Trends Among U.S. AdultsBRFSS, 1991 (*BMI 30, or ~ 30 lbs overweight for 5’4” person) No Data <10% 10%-14% 15-19% 20-24% 25% 4

9. Obesity* Trends Among U.S. AdultsBRFSS, 1997 (*BMI 30, or ~ 30 lbs overweight for 5’4” person) 10%-14% 15-19% 20-24% 25% 7

10. 10%-14% 15-19% 20-24% 25% Obesity* Trends Among U.S. AdultsBRFSS, 1999 (*BMI 30, or ~ 30 lbs overweight for 5’4” person) 8

11. Obesity* Trends Among U.S. AdultsBRFSS, 2001 (*BMI 30, or ~ 30 lbs overweight for 5’4” person) 10%-14% 15-19% 20-24% 25% 9

12. Increases in Disease from Obesity • Heart disease 360% • Diabetes 3,930% • High Blood Pressure 260% • Arthritis 400% • Death from cancer 80% NHANES, JAMA; October 9, 2002; 282: 1723-1727

13. What are the causes of the epidemic?

14. What are the causes of the epidemic? • Eating more calories (300/day) • Mostly as carbohydrates • Bread • French fries • Snacks • Deserts • Less physical activity • Computers • Television/videos

15. Increasing portion sizes (1955 to 2001) • McDonalds Fries • from 2.3 to 6.9 oz • 200 to 610 calories • Coca-Cola • from 6.5 oz to 20 oz • 86 to 230 calories • Snickers • from 1.1 oz to 3.7 oz • 130 to 505 calories • from 416 to 1,345 calories 600 500 400 300 1955 200 2001 100 0 fries McD's Snickers Coca-Cola Nutrition Action Healthletter 2001

16. Total Body Weight Increases Energy Balance Calories Consumed Food tastes good Calories Expended Exercise is hard work

17. “We are unable to under-eat sufficiently to compensate for being inactive.” Shiriki Kumanyiki Current Drug Therapies 2; 2001: 353-370

19. Children and Overweight • Children are all sizes • Less physically active than the past • Unhealthy foods at school • TV pressures for unhealthy foods and snacks • Being overweight can lead to diseases • Diabetes • High blood pressure • High cholesterol

20. Children and Overweight • Better to grow into weight than diet • Provide lots of love and attention • Encourage daily physical activity • Limit TV viewing and video games • Be active as a family

22. Healthy eating for children • Never withhold food as punishment or use as a reward • Don’t try to force children to eat • Serve smaller amounts of fish, lean meats and chicken • Serve fruit as snacks • Limit sodas and fruit drinks

24. African American Women and Obesity • 48% of African American Women are overweight or obese • Major weight gain occurs in first few years of marriage • 47% of women gain excessive weight with pregnancy • 36% of women in with a normal weight are trying to gain weight • they often felt tired and believed that loosing weight would give them energy

25. African American Women and Weight Loss Habits • More likely to use liquid meals and diet pills • Engage in weight loss methods for short time periods • Generally eat only 1 fruit and 2 vegetables daily • Women unsuccessful with weight loss labeled foods as “good” or “bad”;

26. Exercise and Weight Loss • Only 50% try increasing physical activity to loose weight • Reasons for not exercising: • Having hair care issues • No adult role models who exercise • Time constraints • Don’t like to sweat • Motivations to exercise • Loose or control weight • Increase energy • Reduce stress • Quality time with family

28. What Works for Weight Loss inAfrican Americans • Most successful programs are church based • Weekly group sessions combining • Exercise • Dietary changes • Motivational counseling • Programs range from 8;14;16;32 weeks • Most sessions were 1.5 to 2 hours

30. What Works for Weight Loss in African Americans • Cultural adaptations • location and format of exercise sessions • lower cost • culturally sensitive recipes • addressing attitudes about exercise • including family in the weight loss effort

31. Impact of Weight Loss Programs • Weight loss and weight maintenance highly correlated to session attendance • Improvements in weight, BMI, total cholesterol, blood pressure, waist circumference, energy expenditure • Decrease in emotional eating

32. Healthy Lifestyles for the Family • Daily prayer and meditation • Exercise 30 to 60 minutes daily • Eat meals together as a family • Eat a diet with a variety of foods • 2-4 fruits daily • 3-5 vegetables • Three meals and 2 healthy snacks • Whole grain cereals and beans • Limit TV/video games to 2 hours

34. Make Your Plan Today • Set a realistic goal • Include one for exercise and one for healthy eating • Set a start date • Pray on your plan Begin your lifetime to better health