A systematic review of weight loss, physical activity and dietary interventions involving African American men

Community Health Worker Interventions for Men: A Scoping Review Using the RE-AIM Framework

INTRODUCTION

Community health workers (CHWs) are health promotion specialists who are trusted members of the community served and have a close understanding of the community's needs and values. CHWs are a cost-effective and scalable workforce to promote health among men through tailored approaches. The purpose of the present review was to use the RE-AIM Framework to assess design, implementation, and outcomes of CHW-implemented health promotion efforts tailored for men to provide recommendations for future efforts.

METHODS

The protocol was pre-registered with PROSPERO. The primary inclusion criteria were that the interventions were (a) implemented at least partially by CHWs, (b) conducted only among men, and (c) designed to improve a health-related outcome. PubMed, EMBASE, PsycINFO, CINAHL, Web of Science, and Global Index Medicus were searched using a librarian-generated search strategy. In all, 1,437 articles were uploaded to Rayyan and two reviewers blindly reviewed each article for inclusion. A total of 24 articles met the inclusion criteria.

RESULTS

Most interventions (a) targeted men under 50 years, (b) were conducted among a subset of underserved men, (c) improved health outcomes, (d) community-based and informed, (e) atheoretical, and (f) had satisfactory retention rates. The roles and responsibilities of CHWs were varied. Attention was given to training of CHWs, but limited attention was given to how/if the CHWs were supervised.

DISCUSSION

CHW-implemented interventions can improve health outcomes among men. Opportunities exist to build on past interventions, such as addressing mental health and incorporating prosocial aspects of masculinity. The results have implications for designing similar interventions.

Tailor Made: A Pilot Virtual Weight Loss Intervention Individually Tailored for African American Men

This study tests the acceptability and feasibility of the first virtual weight loss study individually tailored for middle-aged African American men. Tailor Made is a 3-month randomized controlled pilot of a weight loss intervention that included 58 overweight or obese African American men (mean age of 50.4; SD = 7.9). Control group participants received a Fitbit activity tracker and Bluetooth-enabled scale and copies of the self-led Tailor Made curriculum. Intervention group participants received the same Fitbit, Bluetooth-enabled scale, and curriculum and also participated in weekly, 45-minute virtual small group, professional-led education sessions using the Tailor Made curriculum and received three SMS text messages weekly: (a) a message individually tailored on African American Manhood that links men's values, goals, and motivation to health-promoting behavior; (b) a goal-tracking message to monitor physical activity, healthier eating, and lifestyle changes; and (c) a reminder 24 hours before their session. Participation rates in weekly small group sessions, randomization, and attendance at the assessments suggest that Tailor Made was feasible and acceptable. Only among intervention group participants, we found a small and significant decrease in BMI between baseline and final. In addition, active minutes of physical activity decreased for the control group while active minutes for the intervention group remained steady throughout the intervention. In sum, we demonstrated that a virtual, individually tailored weight loss intervention is feasible and acceptable to African American men. Participants valued the convenience of a virtual intervention, but there were a number of ways we may be able to enhance the potential benefits of this approach.

Mighty Men: A Pilot Test of the Feasibility and Acceptability of a Faith-Based, Individually Tailored, Cluster-Randomized Weight Loss Trial for Middle-Aged and Older African American Men

Two in five African American men have obesity, but they are underrepresented in community-based weight loss interventions. This pilot effectiveness trial examines the acceptability and feasibility of the first weight loss study for African American men that includes randomization and individual tailoring. Using a community-based, cluster-randomized, longitudinal parallel group design, four churches were randomized to a control condition or a weight loss condition. Each church received physical activity equipment, a coordinator, and small group physical activity sessions. A total of 71 African American men (mean age: 58.5) enrolled and received a Fitbit, Bluetooth-enabled scale, a t-shirt, gift cards for participation, and 45 min of small group physical activity led by a certified personal trainer. Men in the weight loss condition also received 45 min of health education and individually tailored SMS text messages. Multiple metrics suggest that Mighty Men was feasible, yet the acceptability of the intervention components was mixed. Participants in both the weight loss and control conditions lost weight between zero and 6 months (p < .001), but body fat (p = .005) and visceral fat percentage (p = .001) of men in the weight loss condition decreased while men in the control condition did not (p < .05). An increase in physical activity was seen among men in the weight loss condition (p = .030) but not among men in the control condition (p < .05). It is acceptable and feasible to conduct a 6-month weight loss intervention with African American men that includes randomization and individually tailored text messages.

Passive recruitment reach of a lifestyle management program to address obesity in the deep south during the COVID-19 pandemic

Obesity is a significant public health concern, especially in the Deep South and in Mississippi where prevalence is among the worst in the nation paired, with other poor health outcomes and socioeconomic conditions. Lifestyle management programs that address modifiable risk factors, such as nutrition and physical activity, can be effective mitigation strategies to halt weight accumulation patterns and ameliorate metabolic risk factors for some populations. However, there is limited evidence regarding the implementation of effective practice models to address obesity risk in underserved and underrepresented populations, such as African Americans, and people in the stage of earlier adulthood. Furthermore, there is growing evidence supporting the impact of the COVID-19 pandemic on lifestyle management programs that should be considered in these populations. The purpose of this manuscript was to describe the development and telehealth implementation of a weight management program during the COVID-19 pandemic and provide a preliminary examination of recruitment strategies and baseline characteristics for enrolled participants. Passive recruitment (social media, web, email, and other media advertisements) resulted in 157 screening initiations, and 79 of those participants met the study inclusion criteria. Further, of the 79 eligible participants, 38 completed all study enrollment requirements and presented with metabolic abnormalities. The study findings add to the emerging body of evidence for how the pandemic may have impacted lifestyle management programs and is representative of an understudied and underrepresented population.

Predictors of Health-Related Quality of Life Among African American Men

African American men have the lowest life expectancy of any ethnic gender group in the USA. Furthermore, these men endorse having a lower health-related quality of life (HRQoL) than any other group. There have been recent calls from national organizations to improve HRQoL-a multidimensional indicator of health strongly associated with mortality and morbidity. Following these calls, there have been widespread efforts implemented to improve HRQoL among the US population, though no known effort has been implemented that is tailored to the unique experiences of African American men. Health promotion efforts that are not tailored to the unique preferences and experiences of these men are likely to produce limited results. Formative research conducted among African American men is needed in order to design and implement an effective HRQoL-promoting intervention for African American men. The present study constitutes such formative research and was conducted with a sample of 211 African American men. Hierarchical regressions were performed to understand the role of literature-derived predictors of HRQoL among these men. Results found that depression, stress, and physical activity were found to be significant predictors of HRQoL among these men. This is the first known study to examine predictors of HRQoL among African American men-a group that disproportionately experiences health disparities and low HRQoL, though for who few successful health promotions exist. The findings from this study have implications for those seeking to design and implement HRQoL-promoting interventions among African American men.

Better Together? A Pilot Study of Romantic Partner Influence on Exercise Adherence and Cardiometabolic Risk in African-American Couples

Background

African-Americans (AAs) have higher rates of inactivity, obesity, and cardiometabolic risk compared to other races/ethnicities. Romantic partners can positively influence health habits, yet whether or not couples have to exercise together in order to adopt regular exercise remains unclear. This study examined whether exercising together influences exercise adherence and cardiometabolic risk in AA couples.

Methods

Nine AA romantic couples (age 62.8 ± 7.7 years; body mass index 31.0 ± 4.4 kg/m²; 6105 ± 1689 average steps/day) completed a 12-week walking (≥ 30 min, 3 days/week) plus resistance training (RT; 2 days/week) pilot intervention. Couples were randomized to either exercise together (ET) or separately (ES). Waist and hip circumferences, iDXA-measured body composition, blood pressure, and blood biomarkers (glucose, hemoglobin A1c (HbA1c), total cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides, C-reactive protein, and fibrinogen) were assessed pre- and post-intervention. Independent-sample t tests and generalized linear mixed models, controlling for gender, were used to analyze data. Significance was accepted at P < 0.05.

Results

There were no significant group × time interactions for any outcome. However, ET trended toward more walking (86.5 ± 57.7 min/week) than ES (66.1 ± 31.7 min/week). There were also significant overall time effects for waist circumference (P < 0.001), body fat (P = 0.020), fat mass (P = 0.007), gynoid fat (P = 0.041), HbA1c (P = 0.020), and HDL (P = 0.047), where all variables decreased.

Conclusions

Trends showed exercising together may promote walking prescription adherence, although more research is needed in a larger sample. This intervention may also improve cardiometabolic risk factors in this population. These pilot data will inform the current investigators’ future exercise intervention research in AA adult dyads.

Revising Diabetes Programming for Black Men and Their Families

Type-2 diabetes has increased 160% for African American males in the United States. This two-part study's purpose was to apply social marketing theory to understand the Type-2 diabetes education needs of men in Iowa. Study One was a preference assessment of Type-2 diabetes education strategies. Four African American men participated in a series of four focus groups and indicated that they were interested in diabetes prevention programming with their families but not in having it labeled as diabetes education. Participating men would rather increase their physical activity as opposed to tracking their food intake. As a follow-up to this study, nine other African American males took part in Study Two, which used cooking demonstrations and recipe taste-testing with the men to examine their relationship to food in the context of managing their Type-2 diabetes. The findings of both studies, which provided insight into these African American men's lifestyle as related to their Type-2 diabetes, could be useful for nursing professionals who have a critical role in navigating cultural, gender, and family norms while developing care plans, offering patient education, and promoting quality of life.

Mighty men: A faith-based weight loss intervention to reduce cancer risk in African American men

According to the American Cancer Society's guidelines on nutrition and physical activity for cancer prevention, weight control, eating practices and physical activity are second only to tobacco use as modifiable determinants of cancer risk. However, no evidence-based interventions have been targeted to African American men or tailored to individual African American men's preferences, needs or identities. The goal of this chapter is to describe the rationale for the components, aims and setting of Mighty Men: A Faith-Based Weight Loss Intervention for African American Men. We begin by discussing the rationale for focusing on weight loss in the context of cancer prevention, and argue that obesity and obesogenic behaviors are important yet modifiable determinants of cancer risk. Next, we briefly review the scarce literature on interventions to promote healthy eating, physical activity and weight loss in our population of interest, and then discuss the rationale for conducting the intervention in faith- based organizations rather than other common settings for recruiting African American men. We conclude with a discussion of the conceptual foundations and components of Mighty Men, and discuss our focus and goals in the context of the larger literature in this area.

Weight Loss Experiences of African American, Hispanic, and Non-Hispanic White Men and Women with Type 2 Diabetes: The Look AHEAD Trial

OBJECTIVE

The aim of this study was to characterize weight loss, treatment engagement, and weight control strategies utilized by African American, Hispanic, and non-Hispanic white participants in the Action for Health in Diabetes (Look AHEAD) Intensive Lifestyle Intervention by racial/ethnic and sex subgroups.

METHODS

Weight losses at 1, 4, and 8 years among 2,361 adults with obesity and type 2 diabetes randomized to intervention (31% minority; 42% men) are reported by subgroup. Multivariable models within subgroups examine relative contributions of treatment engagement variables and self-reported weight control behaviors.

RESULTS

All subgroups averaged weight losses ≥ 5% in year 1 but experienced regain; losses ≥ 5% were sustained at year 8 by non-Hispanic white participants and minority women (but not men). Session attendance was high (≥ 86%) in year 1 and exceeded protocol-specified minimum levels into year 8. Individual session attendance had stronger associations with weight loss among Hispanic and African American participants than non-Hispanic white participants at 4 years (P = 0.04) and 8 years (P = 0.001). Daily self-weighing uptake was considerable in all subgroups and was a prominent factor associated with year 1 weight loss among African American men and women. Greater meal replacement use was strongly associated with poorer 1-year weight losses among African American women.

CONCLUSIONS

Experiences of minority men and women with diabetes in lifestyle interventions fill important gaps in the literature that can inform treatment delivery.

Correlates of Moderate-to-Vigorous Physical Activity and Exercise Motivation in Underserved African American Men

Effective interventions are needed to increase physical activity (PA) in African American men, but little is known about correlates of PA and exercise motivation in this population. Using an ecological approach that considers cognitive, social, and environmental factors, correlates of moderate-to-vigorous physical activity (MVPA) and exercise motivation in underserved African American men were examined. Greater exercise motivation, greater social support for exercise, and more favorable environmental perceptions were hypothesized to be associated with higher MVPA, and greater social support and environmental perceptions were hypothesized to be associated with higher exercise motivation. This secondary analysis used baseline data from the Positive Action for Today’s Health (PATH) trial. African American men (n = 166, aged 48 ± 15 years) completed surveys that assessed cognitive, social, and environmental factors theoretically relevant to MVPA. Accelerometers were used to obtain a 7-day estimate of MVPA. Hierarchical linear regression analyses showed that exercise motivation was positively associated with MVPA (B = 1.15, SE = .41, p = .006). Exercise attitudes (B = .16, SE = .07, p = .037), exercise self-concept (B = .28, SE = .06, p < .001), exercise support from friends (B = .12, SE = .06, p = .048), and places for walking and cycling (B = .13, SE = .06, p = .032) were positively associated with exercise motivation. Interventions that improve exercise motivation and associated variables may be warranted to increase MVPA in underserved African American men.

ClinicalTrials.gov # NCT01025726

An Investigation of Health Management Perceptions and Wellness Behaviors in African American Males in Central Texas

Little is known regarding interventions that incorporate health management perceptions among African American (AA) men, to reduce the risk for developing various medical conditions. Using the Theory of Planned Behavior (TPB), the study objective was to better understand health-care perceptions of AA men by assessing participants' attitudes, subjective norms (SNs), and perceived behavioral control (PBC) regarding health management. AA adult males in Texas were recruited to participate in one of four qualitative focus groups. The TPB was used to assess participants' attitudes (advantages/disadvantages), SNs (approvers/disapprovers), and PBC (enablers/barriers) regarding health management. All four sessions were audiotaped, transcribed, and independently analyzed by researchers to identify major themes. Participants ( n = 23) were 45.2 ± 16.2 years of age (range 24-74). Regarding attitudes toward health management, participants viewed increased longevity and avoiding future health problems as advantages; however, increased cost, lack of confidence in health care, and social pressures were disadvantages. Regarding SNs, parents and children were positive influencers, while spouses and coworkers were both positive and negative influencers. For PBC, a support system and health awareness were identified as enablers, while medical mistrust, fear, and culture were barriers. The results convey that health management behaviors in AA males are multifaceted. Health-care providers should seek to understand these factors, discuss these issues with AA males, and integrate treatment strategies that are culturally informed and patient centered. Findings from this study may be used to develop targeted interventions that improve health outcomes for AA males.

Romain J, Jerrod T, Griffith DM, Myers V. Development of a mobile phone app to maintain physical activity in African American men: MobileMen

BACKGROUND

African American men experience health disparities across a number of chronic diseases. mHealth technology is widely utilized to address lifestyle factors that contribute to these conditions. Participation of African American men in qualitative and quantitative studies of mHealth is low. Therefore, little is known regarding the acceptability of mHealth interventions and few interventions have been specifically developed for this population. The purpose of the current study is to describe the development of a smartphone application, MobileMen, to promote the maintenance of physical activity (PA) in African American men and to report on app feasibility when applied to the target population.

METHODS

We used a mixed methods study design including formative research, user-centered design, and a feasibility study. Focus groups (n=26) were conducted to inform the acceptability of the app and desired features. Lab usability (n=19) was used to develop the app through an iterative process. A feasibility study was conducted to assess utilization of the app over a 1-month timeframe. Measures of usability and user-friendliness were collected during lab usability sessions. Satisfaction and app usage were collected following the feasibility study.

RESULTS

The focus groups revealed that African American men use smartphone apps and that they are willing to utilize an app to maintain PA habits. The MobileMen app was subsequently developed and contained a dashboard, rewards, a learning component, a prompting system, and activity tracking. Scores increased between the first and last lab sessions for usability [5.0 (0.0) vs. 4.3 (1.0)] and user-friendliness [74.2 (17.0) vs. 70.6 (12.4)]. Participants reported acceptable satisfaction (mean values >3.5 on a 1-5 Likert scale) with most app components.

CONCLUSIONS

African American men are willing to utilize mHealth to improve their health behavior, including PA. An initial version of the MobileMen app has been developed that is acceptable and user-friendly. However, there are several components requested by African American men could not be included in the current app but warrant future app development.

It Takes a Village Coach: Cost-Effectiveness of an Intervention to Improve Diet and Physical Activity Among Minority Women

BACKGROUND

This study gauged the cost-effectiveness of a community-based health coaching intervention aimed at improving diet and physical activity among women in culturally diverse communities.

METHODS

The Coalition for a Healthier Community for Utah Women and Girls recruited women from 5 cultural and ethnic groups and randomized them to receive quarterly versus monthly health coaching. Coaching was performed by trained community health workers from the targeted communities. Cost-effectiveness ratios were estimated to gauge the cost-effectiveness of the intervention.

RESULTS

Estimated quality-adjusted life years gained from both increased physical activity and improved diet were positive. Cost-effectiveness ratios varied by intervention arm, but all ratios fell within the favorable range described in the literature.

CONCLUSIONS

This culturally adapted health coaching intervention was deemed to be cost-effective. Our findings suggest that to achieve the highest level of cost-effectiveness, programs should focus on enrolling at-risk women who do not meet recommended physical activity standards and/or dietary guidelines.

Healthy Weight and Cardiovascular Health Promotion Interventions for Adolescent and Young Adult Males of Color: A Systematic Review

Cardiovascular disease is the leading cause of mortality in the United States, accounting for one fourth of deaths. Higher rates of obesity put Hispanic and Black men at increased risk. The American Heart Association cites diet quality, physical activity, and body weight as alterations responsive to health promotion intervention. Prevention strategies need to begin in adolescence and the emerging adulthood years to impact cumulative risk factors. A scoping review identified search terms and this was followed by a systematic review of Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PubMed databases for articles published in English from January 1, 2002, through May 11, 2017. This review explores community-based content, delivery, recruitment, or retention strategies used with young men of color aged 15 to 24 years. Of 17 articles describing 16 individual interventions and 1 describing multiple interventions (with samples ranging from 37 to 4,800), 13 reported significant results in one or more domains. No studies specifically targeted the needs of young men and only three had more than 50% male participants. There was a gap in studies that addressed young men in the ages of interest with most interventions reaching participants aged 11 to 19 years. Cultural tailoring was addressed through recruitment setting, interventionist characteristics, community involvement, and theoretical frameworks such as motivational interviewing that allow individual goal setting. Because young men seek access to preventive health services less than young women, it is suggested that interventions that are community based or use push technology (send information directly to the user) be increased.

"If I Can Afford Steak, Why Worry About Buying Beans": African American Men's Perceptions of Their Food Environment

Due to the high level of food-related chronic diseases for African American men, the purpose of this qualitative study was to induce (n = 83) urban American men’s perspective of their food environment considering different ethnic subgroups, built environment, and the temporal context using a phenomenological method and snowball sampling. Focus group interviews were audio-recorded, transcribed, and entered into ATLAS.ti to aid in establishing themes. African American men perceived that fast-food chains are their food choices and that they do not have any other healthy alternatives near their residential community. Their perspective of their current environment was primarily influenced by their formative years, the availability of current food environments, marketing and advertising of food on television, and the cost of eating healthy as compared to the cost of eating what is convenient to their residence. A central theme of the findings of this study is that the availability and accessibility of restaurants and food options are harmful to health over time. The finding suggests that future interventions should consider and incorporate how people develop and understand their current food practices and environment through the lens of time, not just their adult context.

The combination of obesity and hypertension: a highly unfavorable phenotype requiring attention

PURPOSE OF REVIEW

Body habitus is a key lifestyle characteristic whose current status and future projections are disconcerting. The percentage of the global population who are either overweight or obese has substantially increased, with no indication that any country has a solution to this issue. Hypertension is a key unfavorable health metric that, like obesity, has disastrous health implications if left uncontrolled. Poor lifestyle characteristics and health metrics often cluster together to create complex and difficult to treat phenotypes. Excess body mass is such an example, creating an obesity-hypertension phenotype, which is the focus of this review.

RECENT FINDINGS

An increased risk for hypertension is clearly linked to obesity, indicating that the two conditions are intimately linked. The cascade of obesity-induced pathophysiologic adaptations creates a clear path to hypertension. Adopting a healthy lifestyle is a primary intervention for the prevention as well as treatment of the obesity-hypertension phenotype.

SUMMARY

The obesity-hypertension phenotype is highly prevalent and has disastrous health implications. A primordial prevention strategy, focused on lifelong healthy lifestyle patterns, is the optimal approach for this condition. For those individuals already afflicted by the obesity-hypertension phenotype, interventions must aggressively focus on weight loss and blood pressure control.

Physical Activity Interventions With African American or Latino Men: A Systematic Review

Relatively little is known about what helps increase physical activity in African American men, and even less is known about promoting physical activity among Latino men. This systematic review aimed to address the key questions: (a) what is the state of the evidence on health-related behavior change interventions targeting physical activity among African American or Latino men? and (b) What factors facilitate physical activity for these men? For this review, nine electronic databases were searched to identify peer-reviewed articles published between 2011–2017 that reported interventions to promote physical activity among African American or Latino men. Following PRISMA guidelines, nine articles representing seven studies that met our criteria were identified: six published studies that provided data for African American men, and one published study provided data for Latino men. Consistent with previous reviews, more research is needed to better understand how gender can be incorporated in physical activity interventions for African American and Latino men. Future interventions should explore how being an adult male and a man of color shapes motivations, attitudes, and preferences to be physically active. Studies should consider how race and ethnicity intersect with notions of masculinity, manhood and Machismo to enhance the effectiveness of physical activity interventions for these populations. Despite the health benefits of physical activity, rates of these behaviors remain low among African American and Latino men. It is essential to determine how best to increase the motivation and salience for these men to overcome the obesogenic environments and contexts in which they often live.

Racial/ethnic representation in lifestyle weight loss intervention studies in the United States: A systematic review

Obesity remains a persistent public health and health disparity concern in the United States. Eliminating health disparities, particularly among racial/ethnic minority groups, is a major health priority in the US. The primary aim of this review was to evaluate representation of racial/ethnic sub-group members in behavioral weight loss interventions conducted among adults in the United States. The secondary aims were to assess recruitment and study design approaches to include racial/ethnic groups and the extent of racial/ethnic sub-group analyses conducted in these studies. PubMed, PsycInfo, Medline, and CINAHL were searched for behavioral weight loss intervention trials conducted in 2009–2015 using keywords: weight, loss, overweight, obese, intervention and trial. Most of the 94 studies included a majority of White participants compared to any other racial/ethnic group. Across the included studies, 58.9% of participants were White, 18.2% were African American, 8.7% were Hispanic/Latino, 5.0% were Asian and 1.0% were Native Americans. An additional 8.2% were categorized as “Other”. Nine of the 94 studies exclusively included minority samples. Lack of adequate representation of racial and ethnic minority populations in behavioral trials limits the generalizability and potential public health impact of these interventions to groups that might most benefit from weight loss. Given racial/ethnic disparities in obesity rates and the burden of obesity and obesity-related diseases among minority groups in the United States, greater inclusion in weight loss intervention studies is warranted.

•

Describes racial/ethnic minority inclusion in behavioral weight loss studies

•

Majority of studies continue to include a majority white sample.

•

Modest increases in the representation of some racial/ethnic minority groups.

•

Lack of adequate representation of minority groups limits generalizability.

•

Greater racial/ethnic inclusion in weight loss intervention studies is warranted.

Together Eating & Activity Matters (TEAM): results of a pilot randomized-clinical trial of a spousal support weight loss intervention for Black men

Objectives

The objective of this study is to evaluate the feasibility, participation, preliminary efficacy and retention in a couples-based weight loss intervention among Black men.

Design setting participants

Two-arm pilot randomized clinical trial in an academic clinical setting. Forty self-identified Black men and their female cohabitating partners (n = 80) aged 18 to 65 years with body mass index from 25 to 45 kg/m2 were randomized using computer generated tables to allocate treatments.

Intervention

Participants were randomized to a standard behavioural weight loss (Standard) programme or the Standard programme plus partner involvement (Enhanced). Both interventions focused on calorie reduction, physical activity and self-monitoring to facilitate weight loss. Enhanced included couples skills training and couple's communication components.

Main outcome and measures

Changes in weight from baseline to 3 months among men. Partner weight loss (secondary).

Results

Forty Black couples (men mean [SD] age, 47.4[11] years; body mass index, 35.0[6.1]), were recruited. Retention was 100% of the men and 98% of female partners. Attendance at group sessions was 63-73%. Between groups, mean (SD) weight changes among men were -3.4[.04] and -4.7[5.9] kg (p = 0.57) and among women -0.23[4.46] and -2.47[3.62] kg (p = 0.09), in the standard and enhanced groups.

Conclusions

Weight losses from an intervention enhanced by partner involvement and an intervention with no partner involvement were not different. Treatment choice can be based on preference rather than outcome as both treatments are effective in producing clinically significant percent weight loss.Trial registration Clinical Trials NCT02458053.

Efficacy and Mediation of a Theory-Based Physical Activity Intervention for African American Men Who Have Sex with Men: A Randomized Controlled Trial

BACKGROUND

Few trials have tested physical-activity interventions among sexual minorities, including African American men who have sex with men (MSM).

PURPOSE

We examined the efficacy and mediation of the Being Responsible for Ourselves (BRO) physical-activity intervention among African American MSM.

METHOD

African American MSM were randomized to the physical-activity intervention consisting of three 90-min one-on-one sessions or an attention-matched control intervention and completed pre-intervention, immediately post-intervention, and 6- and 12-month post-intervention audio computer-based surveys.

RESULTS

Of the 595 participants, 503 completed the 12-month follow-up. Generalized estimating equation models revealed that the intervention increased self-reported physical activity compared with the control intervention, adjusted for pre-intervention physical activity. Mediation analyses suggested that the intervention increased reasoned action approach variables, subjective norm and self-efficacy, increasing intention immediately post-intervention, which increased physical activity during the follow-up period.

CONCLUSIONS

Interventions targeting reasoned action approach variables may contribute to efforts to increase African American MSM's physical activity.

CLINICAL TRIAL REGISTRATION

The trial was registered with the ClinicalTrials.gov Identifier NCT02561286 .

Sex, Obesity, and Blood Pressure Among African American Adolescents: The Jackson Heart KIDS Pilot Study

BACKGROUND

This study examined the degree to which sex, weight status, and the presence of hypertension and obesity in parents/grandparents were associated with systolic (SBP) and diastolic (DBP) blood pressure (BP) among African American youth in a pilot offspring study examining obesity-related cardiovascular disease (CVD) risks among adolescents.

RESULTS

Fully adjusted linear regression models of the total sample produced results indicating that obesity was associated with BP (SBP: β = 7.08, P < 0.01; DBP: β = 8.14, P < 0.001). Sex-stratified analyses indicated that overweight and obesity were associated with SBP (overweight: β = 6.77, P < 0.01; obese: β = 11.65, P < 0.001) and obesity was correlated with DBP (β = 9.86, P < 0.001) among males. For females, overweight was correlated with SBP (β = 4.11, P < 0.05) while obesity was associated with DBP (β = 6.98, P < 0.01). Attempting to lose weight was inversely related to SBP (β = -4.01, P < 0.05) in the full sample and among males (β = -11.94, P < 0.001). Familial presence of hypertension and/or obesity was significantly associated with SBP among adolescent females but not males.

CONCLUSIONS

The relationship between weight status, familial hypertension and obesity status, and BP among adolescents vary by sex. This study underscores the need for additional research investigating the relationship between individual sex, weight status, BP and familial BP, and obesity status on risk among African American adolescents.

Black Women's Recommendations for Developing Effective Type 2 Diabetes Programming

The purpose of this study was to learn from 29 Black women how to develop effective Type 2 diabetes programming. Three focus groups were held in Des Moines, Iowa, during fall 2012. Results highlighted themes related to diabetes knowledge, diabetes management and prevention, physical activity, diet, and diabetes management programming. Opinions were shared as to whether family members should be included in programs for supporting those diagnosed with diabetes. These results provided guidance and ideas to scholars and health care professionals aiming to improve effectiveness of diabetes programs for Black women and families.

Refining a Church-Based Lifestyle Intervention Targeting African-American Adults at Risk for Cardiometabolic Diseases: A Pilot Study

Objective

The pilot study was intended to test the feasibility of a multiple-component lifestyle intervention targeting African American adults in a weight control and cardiometabolic risk reduction program on diet, activity, and stress, using community-engagement principles.

Methods

Applying mixed qualitative and quantitative measures, the intervention had a two-part sequential study design consisting of 12 weekly small group sessions that provided individual and group counseling in nutrition, exercise, and mindfulness, while incorporating focus group and interactive techniques to learn about barriers and acceptable practices for this population. The program was implemented at an African-American church in Nashville, Tennessee.

Results

Thirty-four participants (aged 56.1 ± 11 years, body mass index (BMI) 36.7 ± 6.6 kg/m²) completed the intervention. Lifestyle changes after the 12 weekly sessions showed some positive trends including reduced sodium intake (from 2725.3 ± 326.5 to 2132 ± 330, mg/day, P = 0.008), increased walking steps (from 4392.1 ± 497.2 to 4895.3 ± 497.9, steps/day, not significant), and slightly decreased Perceived Stress Scale (PSS) scores (from 13.7 ± 1.4 to 12.4 ± 1.5, not significant). Body fat % among male participants decreased significantly (from 33.8 ± 2.6 to 28 ± 2.6, %, P = 0.043). Among cardiometabolic risk biomarkers, hemoglobin A1c (HbA1c) decreased significantly (from 6.6 ± 0.2 to 6.1 ± 0.2, %, P < 0.001). The baseline PSS score was positively associated with baseline adiposity levels (e.g., weight, β = 2.4, P = 0.006). Twenty-one participants took part in focus groups during the program to identify barriers to healthy lifestyle changes. Primary barriers reported were price, time for preparing healthy meals, unfamiliarity with mindfulness activities, their health condition, and daily schedule available for physical activities.

Conclusions

This church-based pilot intervention was proven feasible by showing modest progress in reducing adiposity and decreasing HbA1c levels. The focus group and interactive methods facilitated program direction. Future full-scale studies are warranted to identify key strategies that provide more personalized approaches and supportive environments to sustain a healthy lifestyle among these at risk minorities with limited resources.

Community-Based Participatory Research to Promote Healthy Diet and Nutrition and Prevent and Control Obesity Among African-Americans: a Literature Review

INTRODUCTION

The literature on community-based participatory research (CBPR) approaches for promoting healthy diet and nutrition and preventing and controlling obesity in African-American communities was systematically reviewed as part of the planning process for new research.

METHODS

CBPR studies of diet, nutrition, and weight management among African-Americans were identified from 1989 through October 31, 2015, using PubMed and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases and MeSH term and keyword searches.

RESULTS

A total of 16 CBPR studies on healthy diet, nutrition, and weight management among African-Americans were identified; outcome evaluation results were available for all but two. Of the remaining 14 studies, 11 focused on adults, 1 on children, and 2 on both children and adults. Eight studies employed CBPR methods to address diet, nutrition, and weight management in church settings. Four had a cluster-randomized controlled design. Others had a pre-post test, quasi-experimental, or uncontrolled design. Only one study addressed four levels of the socioecological model; none addressed all five levels of the model. The studies identified in this review indicate that CBPR approaches can be effective for promoting healthy diet, nutrition, and weight management among African-American adults, but there is a need for additional studies with rigorous study designs that overcome methodologic limitations of many existing studies. There is only limited evidence for the effectiveness of CBPR approaches for promoting healthy eating and weight control among African-American children and adolescents.

CONCLUSION

To address health disparities, additional CBPR studies are needed to promote healthy diet, nutrition, and weight management in African-American communities. Of particular interest are multilevel CBPR studies that include interventions aimed at multiple levels of the socioecological model.

Organizational-Level Recruitment of Barbershops as Health Promotion Intervention Study Sites: Addressing Health Disparities Among Black Men

This article describes the process and results associated with the organizational-level recruitment of Black barbershops into Fitness in the Shop (FITShop), a 6-month barbershop-based intervention study designed to promote physical activity among Black men. Organizational-level recruitment activities included (1) a telephone call to prospective barbershop owners to assess their interest and eligibility for participation, (2) an organizational eligibility letter sent to all interested and eligible barbershops, (3) a visit to interested and eligible barbershops, where a culturally sensitive informational video was shown to barbershop owners to describe the study activities and share testimonies from trusted community stakeholders, and (4) a signed agreement with barbershop owners and barbers, which formalized the organizational partnership. Structured interviews were conducted with owners of a total of 14 enrolled barbershops, representing 30% of those determined to be eligible and interested. Most enrolled shops were located in urban settings and strip malls. Barbershop owners were motivated to enroll in the study based on commitment to their community, perceived client benefits, personal interest in physical activity, and a perception that the study had potential to make a positive impact on the barbershop and on reducing health disparities. Results offer important insights about recruiting barbershops into intervention trials.

Geography, Race/Ethnicity, and Physical Activity Among Men in the United States

Engaging in regular physical activity reduces one’s risk of chronic disease, stroke, cardiovascular disease, and some forms of cancer. These preventive benefits associated with physical activity are of particular importance for men, who have shorter life expectancy and experience higher rates of chronic diseases as compared to women. Studies at the community and national levels have found that social and environmental factors are important determinants of men’s physical activity, but little is known about how regional influences affect physical activity behaviors among men. The objective of this study is to examine the association between geographic region and physical activity among men in the United States, and to determine if there are racial/ethnic differences in physical activity within these geographic regions. Cross-sectional data from men who participated the 2000 to 2010 National Health Interview Survey (N = 327,556) was used. The primary outcome in this study was whether or not men had engaged in sufficient physical activity to receive health benefits, defined as meeting the 2008 Physical Activity Guidelines for Americans. Race/ethnicity and geographic region were the primary independent variables. Within every region, Hispanic and Asian men had lower odds of engaging in sufficient physical activity compared to white men. Within the Northeast, South, and West, black men had lower odds of engaging in sufficient physical activity compared to white men. The key findings indicate that the odds of engaging in sufficient physical activity among men differ significantly between geographic regions and within regions by race/ethnicity.

Visible and Invisible Trends in Black Men's Health: Pitfalls and Promises for Addressing Racial, Ethnic, and Gender Inequities in Health

Over the past two decades, there has been growing interest in improving black men's health and the health disparities affecting them. Yet, the health of black men consistently ranks lowest across nearly all groups in the United States. Evidence on the health and social causes of morbidity and mortality among black men has been narrowly concentrated on public health problems (e.g., violence, prostate cancer, and HIV/AIDS) and determinants of health (e.g., education and male gender socialization). This limited focus omits age-specific leading causes of death and other social determinants of health, such as discrimination, segregation, access to health care, employment, and income. This review discusses the leading causes of death for black men and the associated risk factors, as well as identifies gaps in the literature and presents a racialized and gendered framework to guide efforts to address the persistent inequities in health affecting black men.

Lessons Learned About Motivation From a Pilot Physical Activity Intervention for African American Men

African American men are less likely than White men to meet physical activity recommendations, and few physical activity interventions have focused on the unique needs of African American men. Because health is not more important to men than fulfilling the role of a provider or other socially important roles, one of the biggest challenges in creating interventions for African American men is helping them identify reasons that they should prioritize both health and life goals. In a recent pilot physical activity intervention for 30- to 70-year-old African American men, we used self-determination theory and motivational interviewing principles to create worksheets that helped men identify their core values and life goals and asked them to describe how their values and goals were related to health and physical activity. We used basic statistics and thematic analysis to identify and examine key sources of motivation for men to be healthier and more physically active. We found that being healthy, a good Christian, a good spouse/partner, disciplined, and successful were among men's most important life goals. This article highlights a strategy for identifying key sources of motivation in African American men's lives and key themes that can be used in to enhance future interventions.

Physician role in physical activity for African-American males undergoing radical prostatectomy for prostate cancer

Purpose

Physical activity is recognized as a complementary therapy to improve physical and physiological functions among prostate cancer survivors. Little is known about communication between health providers and African-American prostate cancer patients, a high risk population, regarding the health benefits of regular physical activity on their prognosis and recovery. This study explores African-American prostate cancer survivors’ experiences with physical activity prescription from their physicians.

Methods

Three focus group interviews were conducted with 12 African-American prostate cancer survivors in May 2014 in St. Louis, MO. Participants’ ages ranged from 49 to 79 years, had completed radical prostatectomy, and their time out of surgery varied from 7 to 31 months.

Results

Emerged themes included physician role on prescribing physical activity, patients’ perceived barriers to engaging in physical activity, perception of normalcy following surgery, and specific resources survivors’ sought during treatment. Of the 12 men who participated, 8 men (67%) expressed that their physicians did not recommend physical activity for them. Although some participants revealed they were aware of the importance of sustained physical activity on their prognosis and recovery, some expressed concerns that urinary dysfunction, incontinence, and family commitments prevented them from engaging in active lifestyles.

Conclusions

Transitioning from post radical prostatectomy treatment to normal life was an important concern to survivors. These findings highlight the importance of physical activity communication and prescription for prostate cancer patients.

Electronic supplementary material

The online version of this article (doi:10.1007/s00520-016-3505-7) contains supplementary material, which is available to authorized users.

Relationships between Lifestyle, Living Environments, and Incidence of Hypertension in Japan (in Men): Based on Participant's Data from the Nationwide Medical Check-Up

This study aims to investigate factors that contribute to the differences in incidence of hypertension between different regions in Japan, by accounting for not only individual lifestyles, but also their living environments. The target participants of this survey were individuals who received medical treatment for hypertension, as well as hypertension patients who have not received any treatment. The objective variable for analysis was the incidence of hypertension as data aggregated per prefecture. We used data (in men) including obesity, salt intake, vegetable intake, habitual alcohol consumption, habitual smoking, and number of steps walked per day. The variables within living environment included number of rail stations, standard/light vehicle usage, and slope of habitable land. In addition, we analyzed data for the variables related to medical environment including, participation rate in medical check-ups and number of hospitals. We performed multiple stepwise regression analyses to elucidate the correlation of these variables by using hypertension incidence as the objective variable. Hypertension incidence showed a significant negative correlation with walking and medical check-ups, and a significant positive correlation with light-vehicle usage and slope. Between the number of steps and variables related to the living environment, number of rail stations showed a significant positive correlation, while, standard- and light-vehicle usage showed significant negative correlation. Moreover, with stepwise multiple regression analysis, walking showed the strongest effect. The differences in daily walking based on living environment were associated with the disparities in the hypertension incidence in Japan.

Conducting Precision Medicine Research with African Americans

Importance

Precision medicine is an approach to detecting, treating, and managing disease that is based on individual variation in genetic, environmental, and lifestyle factors. Precision medicine is expected to reduce health disparities, but this will be possible only if studies have adequate representation of racial minorities.

Objective

It is critical to anticipate the rates at which individuals from diverse populations are likely to participate in precision medicine studies as research initiatives are being developed. We evaluated the likelihood of participating in a clinical study for precision medicine.

Design, Setting, Participants

Observational study conducted between October 2010 and February 2011 in a national sample of African Americans.

Main Outcome Measure

Intentions to participate in a government sponsored study that involves providing a biospecimen and generates data that could be shared with other researchers to conduct future studies.

Results

One third of respondents would participate in a clinical study for precision medicine. Only gender had a significant independent association with participation intentions. Men had a 1.86 (95% CI = 1.11, 3.12, p = 0.02) increased likelihood of participating in a precision medicine study compared to women in the model that included overall barriers and facilitators. In the model with specific participation barriers, distrust was associated with a reduced likelihood of participating in the research described in the vignette (OR = 0.57, 95% CI = 0.34, 0.96, p = 0.04).

Conclusion and Relevance

African Americans may have low enrollment in PMI research. As PMI research is implemented, extensive efforts will be needed to ensure adequate representation. Additional research is needed to identify optimal ways of ethically describing precision medicine studies to ensure sufficient recruitment of racial minorities.

Reduced Prevalence of Obesity in 14 Disadvantaged Black Communities in the United States: A Successful 4-Year Place-Based Participatory Intervention

OBJECTIVES

To assess the impact of a large-scale place-based intervention on obesity prevalence in Black communities.

METHODS

The Racial and Ethnic Approaches to Community Health across the United States (REACH US) project was conducted in 14 predominantly Black communities in California, Illinois, Massachusetts, New York, Ohio, Pennsylvania, South Carolina, Virginia, Washington, and West Virginia. We measured trends from 2009 to 2012 in the prevalence of obesity. We used Behavioral Risk Factor Surveillance System data to compare these trends with trends among non-Hispanic Whites and non-Hispanic Blacks in the United States and in the 10 states where REACH communities were located, and with a propensity score-matched national sample of non-Hispanic Blacks.

RESULTS

The age-standardized prevalence of obesity decreased in REACH US communities (P = .045), but not in the comparison populations (P = .435 to P = .996). The relative change was -5.3% in REACH US communities versus +2.4% in propensity score-matched controls (P value for the difference = .031). The net effect on the reduction of obesity prevalence was about 1 percentage point per year for REACH.

CONCLUSIONS

Obesity prevalence was reduced in 14 disadvantaged Black communities that participated in the REACH project.

Disparities in Treatment Uptake and Outcomes of Patients with Obesity in the USA

There are clear and persistent disparities in obesity prevalence within the USA. Some of these disparities fall along racial/ethnic lines; however, there are a number of other social and demographic constructs where obesity disparities are present. In addition to differing rates of obesity across groups, there is growing evidence that subgroups of patients both seek out and respond to obesity treatment differently. This review article explores the epidemiology of obesity disparities, as well as the existing evidence around how different groups may respond to behavioral, medical, and surgical therapies, and potential reasons for differential uptake and response, from culture, to access, to physiology. We find that the vast majority of evidence in this area has focused on the observation that African Americans tend to lose less weight in clinical trials compared to non-Hispanic whites and mainly pertains to behavioral interventions. Moving forward, there will be a need for studies that broaden the notion of health disparity beyond just comparing African Americans and non-Hispanic whites. Additionally, a more thorough examination of the potential for disparate outcomes after medical and surgical treatments of obesity is needed, coupled with the careful study of possible physiologic drivers of differential treatment response.

Men on the Move-Nashville: Feasibility and Acceptability of a Technology-Enhanced Physical Activity Pilot Intervention for Overweight and Obese Middle and Older Age African American Men

Men on the Move-Nashville was a quasi-experimental, 10-week pilot physical activity intervention. A total of 40 overweight or obese African American men ages 30 to 70 (mean age = 47) enrolled in the intervention. Participants attended 8 weekly, 90-minute small group sessions with a certified personal trainer. Each session consisted of discussions aimed to educate and motivate men to be more physically active, and an exercise component aimed to increase endurance, strength, and flexibility. Throughout each week, men used wearable activity trackers to promote self-monitoring and received informational and motivational SMS text messages. Of the 40 enrolled men, 85% completed the intervention, and 80% attended four or more small group sessions. Additionally, 70% of participants successfully used the activity tracker, but only 30% of men utilized their gym memberships. Participants benefited from both the small group discussions and activities through increasing social connection and guidance from their trainer and group members. These African American men reported being motivated to engage in physical activity through each of these technologies. Men reported that the activity trackers provided an important extension to their social network of physically active people. The intervention resulted in significant increases in men's self-reported levels of light, moderate, vigorous, and sports-related physical activities, and high-density lipoprotein cholesterol levels, and significant decreases in weight and body fat percentage with small, moderate and large effects shown. Including technology and didactic components in small group-based interventions holds promise in motivating African American men to increase their physical activity.

Explaining Racial Disparities in Obesity Among Men: Does Place Matter?

National data indicate that Black men have higher rates of obesity than White men. Black men also experience earlier onset of many chronic conditions and premature mortality linked to obesity. Explanations for these disparities have been underexplored, and existing national-level studies may be limited in their ability to explicate these long-standing patterns. National data generally do not account for race differences in risk exposures resulting from racial segregation or the confounding between race and socioeconomic status. Therefore, these differences in obesity may be a function of social environment rather than race. This study examined disparities in obesity among Black and White men living in the same social and environmental conditions, who have similar education levels and incomes using data from the Exploring Health Disparities in Integrated Communities-SWB (EHDIC-SWB) study. The findings were compared with the 2003 National Health Interview Survey (NHIS). Logistic regression was used to examine the association between race and obesity adjusting for demographics, socioeconomic status, and health conditions. In the NHIS, Black men had a higher odds of obesity (odds ratio=1.29, 95% confidence interval=1.12-1.49) than White men. However in the EHDIC-SWB, which accounts for social and environmental conditions of where these men live, Black men had similar odds of obesity (odds ratio=1.06, 95% confidence interval=0.70-1.62) compared with White men. These data highlight the importance of the role that setting plays in understanding race disparities in obesity among men. Social environment may be a key determinant of health when seeking to understand race disparities in obesity among Black and White men.

Developing Effective Diabetes Programming for Black Men

The purpose of this study is to obtain feedback from 20 men on developing effective programming to reduce the impact of diabetes (t2dm) among Black men. Three focus groups were convened in Des Moines, Iowa. Men were recruited, all either diagnosed with t2dm (n = 10), pre-diabetic (n = 1), or experienced t2dm through family and friends (n = 9). The results highlighted themes related to t2dm knowledge, masculinity, and behavioral health; gender-centered diabetes management education; and family support and functioning. Men provided recommendations for program format and content, desirable facilitator characteristics, and whether to include spouses/partners, relatives, and friends. These results provide guidance and ideas to nurses wishing to enhance t2dm education and patient outcomes for Black men.

Race, Social and Environmental Conditions, and Health Behaviors in Men

Although understanding race differences in health behaviors among men is an important step in reducing disparities in leading causes of death in the United States, progress has been stifled when using national data because of the confounding of race, socioeconomic status, and residential segregation. The purpose of this study is to examine the nature of disparities in health behaviors among African American and white men in the Exploring Health Disparities in Integrated Communities Study-Southwest Baltimore, which was conducted in a racially integrated neighborhood of Baltimore to data from the 2003 National Health Interview Survey. After adjusting for age, marital status, insurance, income, educational attainment, poor or fair health, and obesity status, African American men in National Health Interview Survey had greater odds of being physically inactive (odds ratio [OR] = 1.48; 95% confidence interval [CI], 129-1.69), reduced odds of being a current smoker (OR = 0.77; 95% CI, 0.65-0.90), and reduced odds of being a current drinker (OR = 0.58; 95% CI, 0.50-0.67). In the Exploring Health Disparities in Integrated Communities Study-Southwest Baltimore sample, African American and white men had similar odds of being physically inactive (OR = 0.79; 95% CI, 0.50-1.24), being a current smoker (OR = 0.86; 95% CI, 0.60-1.23), or being a current drinker (OR = 1.34; 95% CI, 0.81-2.21). Because race disparities in these health behaviors were ameliorated in the sample where African American and white men were living under similar social, environmental, and socioeconomic status conditions, these findings suggest that social environment may be an important determinant of health behaviors among African American and white men. Public health interventions and health promotion strategies should consider the social environment when seeking to better understand men's health disparities.

Racial Disparities in Sugar-Sweetened Beverage Consumption Change Efficacy Among Male First-Year College Students

Racial disparities in weight-related outcomes among males may be linked to differences in behavioral change efficacy; however, few studies have pursued this line of inquiry. The purpose of this study was to determine the degree to which self-efficacy associated with changing sugar-sweetened beverage (SSB) consumption intake varies by race among male first-year college students. A self-administered, cross-sectional survey was completed by a subsample of freshmen males (N = 203) at a medium-sized southern university. Key variables of interest were SSB intake and self-efficacy in reducing consumption of sugared beverages. African American and Whites had similar patterns of SSB intake (10.2 ± 2.8 vs. 10.1 ± 2.6); however, African Americans had lower proportions of individuals who were sure they could substitute sugared beverages with water (42.2% vs. 57.5%, p < .03). The results from logistic regression models suggest that self-efficacy to reduce SSB intake among males vary by race. African American males were less likely to assert confidence in their ability to change behaviors associated with SSB (odds ratio = 0.51; confidence interval [0.27, 0.95]) in the full model adjusting for weight-related variables including SSB consumption. The findings suggest that weight loss and weight prevention interventions targeting young African American males require components that can elevate self-efficacy of this group to facilitate behavioral modifications that reduce SSB consumption and their risk for obesity-related diseases.

Weight Status and Blood Pressure among Adolescent African American Males: The Jackson Heart KIDS Pilot Study

BACKGROUND

Obesity had not been considered a significant factor contributing to high levels of hypertension among African American males until recently. Epidemiologic research on heart disease among males has primarily focused on adults; however, the significant rise in obesity and hypertension prevalence among African American boys indicates that studies examining the relationship between excess body weight and elevated blood pressure among this high-risk population are critically needed. The purpose of our study was to examine the degree to which weight status has implications for elevated blood pressure among young African American males.

METHODS

The data for this cross-sectional study were drawn from adolescent males (N=105), aged 12-19 years and who participated in the Jackson Heart KIDS Pilot Study - an offspring cohort study examining cardiovascular disease risks among adolescent descendants of Jackson Heart Study participants. Blood pressure was the primary outcome of interest and weight status was a key independent variable. Other covariates were fruit and vegetable consumption, physical activity, sleep, and stress.

RESULTS

Approximately 49% of adolescent males in the study were overweight or obese. Bivariate and multiple variable analyses suggest that obesity may be correlated with elevated diastolic blood pressure (DBP) levels among African American boys. Results from ordinary least squared regression analysis indicate that the DBP for boys carrying excess weight was 4.2 mm Hg (P<.01) higher than the corresponding DBP for their normal weight counterparts, after controlling for age, fruit and vegetable consumption, physical activity, and sleep.

CONCLUSIONS

Additional studies are needed to specify the manner through which excess weight and weight gain can accelerate the development and progression of CVD-related diseases among African American males over the life course, thereby providing evidenced-based information for tailored interventions that can reduce risks for premature morbidity, disability, and mortality among this group.

Clinical Effectiveness of Weight Loss and Weight Maintenance Interventions for Men: A Systematic Review of Men-Only Randomized Controlled Trials (The ROMEO Project)

Men are underrepresented in obesity services, suggesting current weight loss service provision is suboptimal. This systematic review evaluated evidence-based strategies for treating obesity in men. Eight bibliographic databases and four clinical trials' registers were searched to identify randomized controlled trials (RCTs) of weight loss interventions in men only, with mean/median body mass index of ≥30 kg/m² (or ≥28 kg/m² with cardiac risk factors), with a minimum mean/median duration of ≥52 weeks. Interventions included diet, physical activity, behavior change techniques, orlistat, or combinations of these; compared against each other, placebo, or a no intervention control group; in any setting. Twenty-one reports from 14 RCTs were identified. Reducing diets produced more favorable weight loss than physical activity alone (mean weight change after 1 year from a reducing diet compared with an exercise program -3.2 kg, 95% confidence interval -4.8 to -1.6 kg, reported p < .01). The most effective interventions combined reducing diets, exercise, and behavior change techniques (mean difference in weight at 1 year compared with no intervention was -4.9 kg, 95% confidence interval -5.9 to -4.0, reported p < .0001). Group interventions produced favorable weight loss results. The average reported participant retention rate was 78.2%, ranging from 44% to 100% retention, indicating that, once engaged, men remained committed to a weight loss intervention. Weight loss for men is best achieved and maintained with the combination of a reducing diet, increased physical activity, and behavior change techniques. Strategies to increase engagement of men with weight loss services to improve the reach of interventions are needed.

Examining the evidence for policy and environmental strategies to prevent childhood obesity in black communities: new directions and next steps

Exposure to physical and policy environments that limit availability, affordability and appeal of healthy eating and active living options is higher for U.S. blacks than whites. This may contribute to high risk of obesity in black communities and limit effectiveness of preventive interventions. Here, we assess applicability to black Americans of findings from a prior evidence review system designed to accelerate the discovery and application of policy and environmental strategies for childhood obesity prevention and assess external validity. The database included 600 peer-reviewed articles reporting data from 396 sets of studies (study groupings) published from January 2000 through May 2009 and pertained to 24 types of policy and environmental strategies. Only 33 study groupings (~8%) included ≥ 50% black Americans or reported subgroup analyses. Of 10 evaluation studies for interventions rated as effective for all populations in the primary review, 8 suggested effectiveness of child-focused interventions in school or child care settings for obesity- or physical activity-related outcomes in black Americans. Overall findings highlight the need for rigorous evaluations of interventions that reach black children in community or institutional settings, and conceptual frameworks and research designs geared to identifying ethnic or ethnicity-income group differences in intervention effects.

Introduction to the special issue on achieving healthy weight in black American communities

The prevalence of obesity is high in the United States, and highest among racial and ethnic minority groups. This special issue of Obesity Reviews is based upon evidence reviews prepared for and presented at a national invited workshop convened by the African American Collaborative Obesity Research Network (AACORN) in August of 2012. A set of potential topics was developed, a priori, and AACORN network members and colleagues with relevant expertise were invited to lead evidence reviews. The result is 10 articles focused on providing a comprehensive picture of what is known and unknown about interventions to prevent and treat obesity or improve weight-related behaviours in African American adults and children. Evidence reviews included in this special issue focus on children and adolescents (n=2); adults from various perspectives (n=5); eHealth interventions (n=1); interventions within faith organizations (n=1); and environmental and policy change interventions (n=1). Overall, the reviews show a small evidence base for research on African Americans and call for additional prioritization of funding to include studies that can inform action and bring progress in obesity prevention and treatment in African Americans on par with the scope and seriousness of the problem.

What works for obesity prevention and treatment in black Americans? Research directions

Obesity prevalence in black/African American children and adults of both sexes is high overall and compared with US whites. What we know, and do not know, about how to enhance the effectiveness of obesity prevention and treatment interventions in African Americans is the focus of the 10 articles in this special issue of Obesity Reviews. The evidence base is limited in quantity and quality and insufficient to provide clear guidance. With respect to children, there is relatively consistent, but not definitive support for prioritizing the systematic implementation and evaluation of child-focused interventions in pre-school and school settings and outside of school time. For adults or all ages, developing and refining e-health approaches and faith-based or other culturally and contextually relevant approaches, including translation of the Diabetes Prevention Program intervention to community settings is indicated. Major evidence gaps were identified with respect to interventions with black men and boys, ways to increase participation and retention of black adults in lifestyle behaviour change programmes, and studies of the impact of environmental and policy changes on eating and physical activity in black communities. Bold steps related to research funding priorities, research infrastructure and methodological guidelines are recommended to improve the quantity and quality of research in this domain.