Obesity and the metabolic syndrome in African American women

Health behavior and perceptions among African American women with metabolic syndrome

Background

Metabolic syndrome is a cluster of different risk factors (abdominal obesity, insulin resistance, high blood pressure, and high cholesterol) that predispose to the development of cardiovascular diseases. African American women (AAW) are easily predisposed to metabolic syndrome due to higher levels of insulin resistance. Various sociodemographic factors further contribute to higher prevalence.

Aim

This study evaluates the current prevalence of metabolic syndrome in AAW and identifies the related sociodemographic risk factors.

Methods

The study utilized 2007–11 National Health and Nutrition Examination Survey (NHANES) data sets from the Centers for Disease Control (CDC). The sample was divided into two groups: AAW with and without metabolic syndrome. Sociodemographic, physical examination, laboratory parameters, and health perceptions were compared between the two groups.

Results

Out of the available sample of 30,442 individuals, 1918 (6.4%) met the inclusion criteria (AAW, age>20, non-pregnant women). The prevalence of metabolic syndrome was 47%. Older age, lower education level, low socioeconomic status, unmarried status, low physical activity level, and smoking were associated with higher prevalence of metabolic syndrome (p<0.001). The prevalence of borderline hypertension, hypertension, diabetes, stroke, and cardiovascular diseases was significantly higher in AAW with metabolic syndrome (p<0.001).

Conclusion

In spite of the focus on prevention of cardiovascular risk factors and elimination of ethnic and gender disparities, metabolic syndrome is still widely prevalent in AAW and poses a threat to the goals of Healthy People 2020.

Perceptions of physical activity and motivational interviewing among rural African-American women with type 2 diabetes

PURPOSE

Motivational interviewing (MI), a patient-centered behavioral counseling style, is a common behavioral intervention strategy. Because intervention outcomes are highly dependent on patient responsiveness to intervention strategy, we evaluated MI perceptions among rural African American women with type 2 diabetes before a physical activity intervention.

METHODS

Four moderator-led focus groups were conducted with patients aged 21-50 years who had never participated in a MI intervention and who receive diabetes care in a rural community health center. Patients were asked to share their perceptions of an MI consultation after viewing a DVD-based example. They were also asked to discuss their physical activity perceptions and readiness. A comprehensive content analysis based on grounded theory was performed by two raters in order to identify main themes.

MAIN FINDINGS

Although patients (n = 31) had an appreciation for physical activity benefits and high levels of physical activity readiness, themes related to physical activity barriers and lack of motivation were pervasive. Patients regarded the MI consultation as an effective health communication but the patient-centeredness of the approach was negatively perceived. Compared with MI, patients agreed that more traditional paternalistic approaches (i.e., physician-led interactions) were more representative of "good counseling" and more familiar to them. Patients shared deeply about personal experiences and provided words of encouragement to one another.

CONCLUSION

Physical activity interventions including rural African-American women should include activities that focus on barrier management and increasing motivation. MI might be an appropriate behavioral counseling model when added to a more traditional cognitive-behavioral physical activity intervention that is group-based and tailored to patients' communication preferences and the clinical setting.