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

Addressing Structural Racism Is Critical for Ameliorating the Childhood Obesity Epidemic in Black Youth

Racism and childhood obesity are both pervasive factors adversely affecting the health and wellbeing of children and adolescents in the United States. The association between racism and obesity has been touched upon in the literature; yet most work has focused on a few dimensions of intersectionality of these two domains at one time. The renewed focus on structural racism as the primary contributor to distress of Black individuals in the United States has highlighted the urgency of identifying the contributions of racism to the childhood obesity epidemic. The current article is not a complete review of the literature, rather, it is meant to take a broad narrative review of the myriad ways in which racism contributes to the obesity epidemic in Black youth to serve as a call to action for more research, prevention, and intervention. The current article illustrates how a number of mechanisms for the etiology and maintenance of obesity are heavily influenced by racism and how addressing racism is critical for ameliorating the childhood obesity epidemic.

Using Black Feminist Theory and Methods to Uncover Best Practices in Health Promotion Programming

This study was created to uncover the social determinants of Black American women's success in health promotion programs. We used the Superwoman Schema to understand the complexities of Black womanhood and uncover best practices in the promotion of their health. The sample consisted of women ages 18-25 who attend a large southern HBCU. We collected data using qualitative focus groups. Participants reported the greatest health-related concerns Black American women facing are mental health, obesity, and relationships with Black men. When it comes to health promotion programs, respondents reported a desire for classes that are fun, interactive, informative, educational, and include group interaction, accessible, and incentivize participation. Uncovering the social determinants of Black American women's health and program success is central in decreasing extant health disparities. Future health scholars are urged to incorporate Black feminist theory and methods into their work to create health promotion interventions tailored for Black women.

Mediating roles of psychological factors and physical and social environments between socioeconomic status and dietary behaviors among African Americans with overweight or obesity

The study aim was to examine the relationship between socioeconomic status (SES) and dietary behaviors through psychological and environmental mediators among African Americans with overweight or obesity. We conducted a cross-sectional study in 225 African American men and women. Data were analyzed using structural equation modeling with bootstrapping procedures. In the multiple mediation model, SES had a significant indirect effect on dietary behaviors through psychological and environmental factors (β = -.27; p = .01; 95% confidence interval [CI] = -0.59--0.10), but it had no significant direct effect on dietary behaviors (β = .06; p = .70; 95% CI = -0.21-0.39). SES had significant direct effects on psychological (β = .52; p = .01; 95% CI = 0.31-0.77) and environmental factors (β = -.40; p = .03; 95% CI = -0.53--0.25). Psychological (β = -.31; p = .02; 95% CI = -0.68--0.04) and environmental factors (β = .26; p = .01; 95% CI = 0.04-0.47) also showed significant direct effects on dietary behaviors. Thus, psychological and environmental factors mediated the relationship between SES and dietary behaviors in African Americans with overweight or obesity. Interventions that enhance psychological and environmental factors such as self-efficacy, perceived barriers to healthy eating, health perceptions, and physical and social environments may improve dietary behaviors among socioeconomically disadvantaged African Americans.

Combined intervention approaches for initiating and maintaining physical activity in depressed individuals: design and rationale of the Project MOVE randomized clinical trial

INTRODUCTION

Regular engagement in physical activity decreases risks for many chronic conditions, and may also improve depression symptoms. However, rates of physical activity and adherence to exercise interventions remain low among depressed individuals relative to non-depressed individuals.

METHODS

This is a study protocol for Project MOVE. This study is a theoretically-driven, 3-arm randomized controlled trial for increasing physical activity with depressed adults. Each successive arm includes an added component that may serve to increase and maintain physical activity. The arms are: 1) Brief advice (BA) to exercise alone (minimal treatment control condition); 2) BA + supervised and home-based exercise (SHE) + health education (HE; serves as contact control for CBEX); and 3) BA + SHE +cognitive-behavioral sessions focused on increasing and maintaining exercise (CBEX). The target sample size is 240. Assessments are conducted at baseline, Month 1.5, end of intervention (month 3), and at 6 and 9 months. The primary outcome is minutes of moderate-to-vigorous physical activity, assessed via an accelerometer. Secondary outcomes include cardiorespiratory fitness, body composition, and depression, and maintenance of moderate-vigorous physical activity through 6 and 9 month follow-ups. Mediators and moderators derived from behavior change theories, including the Health Behavior Model, Self-Determination Theory, and Social Ecological Theory, will be examined.

CONCLUSION

Project MOVE is designed to test primarily whether both a structured exercise program (SHE) and a cognitive-behavioral group (CBEX) increase physical activity in depressed adults during both a 3-month intervention period, and during the 6-months that follow.

The Accumulating Data to Optimally Predict Obesity Treatment (ADOPT) Core Measures Project: Rationale and Approach

BACKGROUND

Individual variability in response to multiple modalities of obesity treatment is well documented, yet our understanding of why some individuals respond while others do not is limited. The etiology of this variability is multifactorial; however, at present, we lack a comprehensive evidence base to identify which factors or combination of factors influence treatment response.

OBJECTIVES

This paper provides an overview and rationale of the Accumulating Data to Optimally Predict obesity Treatment (ADOPT) Core Measures Project, which aims to advance the understanding of individual variability in response to adult obesity treatment. This project provides an integrated model for how factors in the behavioral, biological, environmental, and psychosocial domains may influence obesity treatment responses and identify a core set of measures to be used consistently across adult weight-loss trials. This paper provides the foundation for four companion papers that describe the core measures in detail.

SIGNIFICANCE

The accumulation of data on factors across the four ADOPT domains can inform the design and delivery of effective, tailored obesity treatments. ADOPT provides a framework for how obesity researchers can collectively generate this evidence base and is a first step in an ongoing process that can be refined as the science advances.

Systemic F2-Isoprostane Levels in Predisposition to Obesity and Type 2 Diabetes: Emphasis on Racial Differences

This review focuses on racial differences in systemic levels of lipid peroxidation markers F₂-isoprostanes as metabolic characteristics predisposing to obesity and type 2 diabetes. Elevated levels F₂-isoprostanes were found in obesity, type 2 diabetes and their comorbidities. It was hypothesized that increased F₂-isoprostane levels reflect the obesity-induced oxidative stress that promotes the development of type 2 diabetes. However, African Americans have lower levels of systemic F₂-isoprostane levels despite their predisposition to obesity and type 2 diabetes. The review summarizes new findings from epidemiological studies and a novel interpretation of metabolic determinants of systemic F₂-isoprostane levels as a favorable phenotype. Multiple observations indicate that systemic F₂-isoprostane levels reflect intensity of oxidative metabolism, a major endogenous source of reactive oxygen species, and specifically, the intensity of fat utilization. Evidence from multiple human studies proposes that targeting fat metabolism can be a productive race-specific strategy to address the existing racial health disparities. Urinary F₂-isoprostanes may provide the basis for targeted interventions to prevent obesity and type 2 diabetes among populations of African descent.

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.