Self-reported weight loss practices among African American and Hispanic adults in the United States

Impact of refitted race-free eGFR formula on obesity pharmacotherapy options

OBJECTIVE

Recent changes to the Chronic Kidney Disease Epidemiology Collaboration estimated glomerular filtration rate (eGFR) formula (2021 CKD-EPI) removed race from the 2009 formula, increasing the number of Black people classified as having CKD, but these changes may impact eligibility and/or dosing for antiobesity medications. This study estimated the number of people with obesity nationwide who might have pharmacotherapy options impacted by the new formula.

METHODS

Using National Health and Nutrition Examination Survey (NHANES) cohort study data, the number of people eligible for antiobesity medication was estimated, and the number who would require a dosage reduction or would no longer be eligible for specific medications based on the new eGFR formula was also estimated.

RESULTS

Among 16,412,571 Black and 109,654,751 non-Black people eligible for antiobesity medication, 911,336 (6.1%) Black and 6,925,492 (6.6%) non-Black people had ≥CKD stage 3 by the 2009 CKD-EPI formula. Applying the 2021 CKD-EPI formula, 1,260,969 (8.5%) Black people and 4,989,919 (4.7%) non-Black people had ≥CKD stage 3. For medications requiring renal adjustment, the number of Black people who would require a lower dose or be precluded from using a medication increased by 24.7% to 50.2%.

CONCLUSIONS

These findings highlight the importance of measuring-rather than estimating-GFR in Black people with CKD when considering many antiobesity pharmacotherapy options.

Relative and Cumulative Effects of Hypertension Self-Care Behaviors on Blood Pressure

New recommendations for hypertension (HTN) diagnosis and treatment highlight the role of self-care activities in managing blood pressure (BP). This cross-sectional study investigated the predictive validity of the Hypertension Self-Care Activity Level Effects (H-SCALE) measure and examined the relative and cumulative effects of HTN self-care adherence on BP. We pooled baseline data from three studies ( N = 79), resulting in a gender and racially balanced sample. Partial correlations determined the relative effects of individual self-care behaviors on BP. We modeled the relationship between adherence to self-care behaviors and BP control using logistic regression. Physical activity had the greatest correlation with systolic BP. Adherence to each additional self-care behavior increased the odds of systolic BP control by 88% (95% confidence interval (CI) = [1.20, 2.96]) and diastolic BP control by 74% (95% CI = [1.10, 2.75]). Results provide further evidence that the H-SCALE is a valid assessment tool and should be adopted by clinicians to aid in improving BP management.

Racial/Ethnic Differences in Weight-Loss Strategies among US Adults: National Health and Nutrition Examination Survey 2007-2012

BACKGROUND

Dieting, exercising, and seeking professional help have been associated with intentional weight loss among adults.

OBJECTIVE

This study examined the use of diet (eg, ate less, ate less fat, or switched to low-calorie foods), exercise, diet and exercise, and professional help (eg, weight-loss program or prescribed diet pills) for weight loss among non-Hispanic whites, Mexican Americans, and non-Hispanic blacks.

DESIGN

Cross-sectional data from the 2007-2012 National Health and Nutrition Examination Survey were used.

PARTICIPANTS

Males and females (n=9,046) aged 20 to 65 years were included.

MAIN OUTCOME MEASURE

The weight history questionnaire assessed weight-loss attempts and use of weight-loss strategies in the past year.

STATISTICAL ANALYSES PERFORMED

Multivariate logistic regression models were used to estimate associations of race/ethnicity with strategies to lose weight. Models controlled for age, sex, education, and body mass index. In fully adjusted models, interactions of race/ethnicity by sex were tested.

RESULTS

Lower proportions of Mexican Americans (35%) and non-Hispanic blacks (35%) than non-Hispanic whites (39%) reported trying to lose weight. Among those who tried to lose weight, non-Hispanic blacks were less likely than non-Hispanic whites to use diet (odds ratio [OR] 0.78, 95% CI 0.67 to 0.90) or exercise (OR 0.83, 95% CI 0.70 to 0.99) for weight loss. Mexican Americans (OR 0.71, 95% CI 0.53 to 0.95) and non-Hispanic blacks (OR 0.71, 95% CI 0.52 to 0.95) were also less likely than non-Hispanic whites to use professional help for weight loss. The relationships between race/ethnicity and weight-loss strategy were stronger for females than males.

CONCLUSIONS

Targeted efforts are needed to address racial/ethnic disparities in weight-loss attempts and use of recommended strategies especially among females.

Weight Loss Pharmacotherapy: Brief Summary of the Clinical Literature and Comments on Racial Differences

The disparity in obesity rates between White, Black, and Hispanic individuals, especially women, is striking. Moreover, at any given body mass index or abdominal girth, incident diabetes is greater in Black, Hispanic and other racial-ethnic minorities than Whites. In addition to the growing health burden, the total costs of obesity in 2030 could exceed $500 billion (USD). Weight loss of 5%-15% from baseline can be attained with anti-obesity pharmacotherapy approved for long-term use in combination with lifestyle change. Weight loss of ≥ 5% is associated with medical benefits including reduction of incident diabetes and cardiovascular risk. While medical weight loss after one year or more in the US population is better than previously seen in many clinical trials, >60% of adults fail to sustain a 5% weight loss. Drug therapies approved for long-term weight loss may permit even more subjects to sustain healthful weight reduction.

Weight-loss strategies used by baby boomer men: a mixed methods approach

BACKGROUND

Baby Boomer men (those born in 1946-1964) are becoming obese at an earlier age compared to previous generations. The present study aimed to identify weight-loss strategies used by Baby Boomer men, to determine whether those strategies varied by weight status and to explore their dieting experiences.

METHODS

The study used a cross-sectional survey of 211 men and 20 in-depth interviews.

RESULTS

Men had a mean (SD) body mass index (BMI) of 29.35 (5.07) kg m(-2), with 82% being overweight or obese. Fifty-six percent were currently trying to lose weight. Healthy weight-loss strategies included reducing portions, increasing physical activity, cutting back on fried foods, cutting back on sweets, cutting back on alcohol, using meal replacement drinks/bars and joining a weight-loss programme. Unhealthy strategies included skipping meals and using over-the-counter 'diet pills'. Men who reduced portions, skipped meals, cut back on sweets, joined a weight-loss programme and used diet pills had significantly higher BMIs than men who said they did not (P < 0.05 for all). Interviews revealed that older men struggle to lose weight, 'I've been struggling for the last 2-3 years'. 'The last time I really tried to lose weight I stayed on the diet for just a day or two'. Wives were considered essential to their weight management success.

CONCLUSIONS

Men used a do-it-yourself weight-loss approach using both healthy and unhealthy strategies. Obese men were more likely to use unhealthy practices than overweight men.

Health literacy issues surrounding weight management among African American women: a mixed methods study

BACKGROUND

Individuals with limited health literacy (LHL) have poorer health outcomes and have difficulty understanding and complying with recommendations to maintain a healthy lifestyle. The present study examined the association between health literacy (HL) and sources of dieting information, the weight-loss methods used and the information needed to manage weight among African American women.

METHODS

This mixed method study included seven focus groups and a survey of 413 African American women. Binary logistic regression analyses were performed to examine the association between HL category and sources of dieting information, weight-loss methods and information needed to lose weight. Thematic analysis was used to analyse focus group data.

RESULTS

Women with LHL were significantly more likely to have a higher body mass index (BMI) than those with AHL (P < 0.05). Compared to respondents with LHL, those with adequate health literacy (AHL) are more likely to rely on information obtained from the Internet (P < 0.001), although they are less likely to rely on information obtained from the television (P < 0.05). They also are significantly more likely to participate in physical activity to lose weight (P ≤ 0.002). In addition, women with AHL were significantly less likely to want information on portion control (P = 0.002). Major qualitative themes were the importance of television and the Internet as major sources of health information, the use of healthy and unhealthy weight-loss methods, and being overwhelmed by the plethora of dieting information.

CONCLUSIONS

HL may affect BMI among AA women, where they access dieting information and the types of information needed to manage their weight.

Factors related to weight loss attempt among Dominican immigrants

To assess weight loss attempt among a Latino immigrant population from the Dominican Republic we analyzed data on 585 overweight and obese Dominicans from a cross-sectional survey using Chi-square statistics, Student's t-tests, and logistic regression models. We found 58% of the overweight and obese tried to lose weight. Female gender (OR 2.28, CI 1.53-3.39), overweight perception (OR 2.37, CI 1.57-3.60) and weight loss advice from health professionals (OR 1.90, CI 1.24-2.91) were strongly associated with weight loss attempt. Individuals with diabetes were more likely to receive advice to lose weight (OR 2.58, CI 1.18-5.63; yet, they were more satisfied with their weight (40.5 vs. 27.8%, p < 0.021), and no difference in their weight loss attempt (p = 0.849) was detected compared to individuals without diabetes. We conclude a significant proportion of overweight and obese Dominican immigrants do not attempt to lose weight. Overweight perception and, except among individuals with diabetes, weight loss advice were strong inducements to weight loss attempt.

Weight loss strategies used by African American women: possible implications for tailored messages

BACKGROUND

African American women have the highest rates of obesity in the USA. They are less likely to participate in weight loss programmes and are less successful in their weight loss attempts. The present study aimed to identify weight loss strategies used by African American women and to determine whether those strategies varied by weight status. The study also examined the emotional issues that lead to compulsive overeating and identified the types of information that African American women need to help manage their weight.

METHODS

A self-administered survey was completed by 413 adult African American women in 2009. Participants were weighed and measured by a member of the research team.

RESULTS

Based on body mass index classification, 43% of women were obese, 25% were overweight, 30% were normal weight and 2% were underweight. Sixty percent had tried to lose weight in the past 12 months. Weight loss practices included: cutting back on fried foods (53%), cutting back on sweets (51%) and increasing physical activity, skipping meals (22%), fasting (17%), and using diet pills (7%). Obese women were significantly more likely to fast and use diet pills than overweight women (P < 0.001). Obese women also were significantly more likely to say they wanted information on how to choose a weight loss programme (P < 0.001), manage stress (P < 0.001) and increase self-esteem (P < 0.001).

CONCLUSIONS

Our findings suggest that weight loss messages and programmes may need to be specifically developed for obese women compared to overweight and normal weight women who just need to 'lose a few pounds'.