Dietary approaches for weight management in African Americans.

Obesity is a serious health condition that has reached epidemic proportions. About 60% of adults in the United States are overweight, with the prevalence of obesity increasing in the last decade for all age, race, and gender groups.1,2 Although obesity is becoming more prevalent in the US population overall, African-American and low-income women are disproportionately affected.3 Based on data from the most recent National Health and Nutrition Examinations Survey (NHANES III), the prevalence of overweight for nonHispanic Black women was 48.6% compared to 32.2% for non-Hispanic White women and 30.9% for non-Hispanic Black men.2 Especially alarming is the high prevalence of Class III obesity (BMI 40), which affects more than 10% of Black women, ages 40–59. Overweight and obesity are linked with a host of chronic health conditions, including cardiovascular disease, diabetes mellitus, osteoarthritis, hyperlipidemia and hypertension.4–5 Approximately 300,000 deaths a year are attributable to overweight and obesity.6 In 1995, it was estimated that the direct and indirect economic consequences associated with obesity and its related health problems was an alarming $99 billion, which included healthcare costs incurred for treatment of weight-related conditions, as well as loss of wages resulting from illness or disability.7 To alleviate the social and economic burden related to obesity, the development of successful weight loss strategies is essential. Diet therapy is a key component in effective weight management. Identifying appropriate dietary approaches for weight loss is crucial because studies show that even modest reductions in weight can have significant implications for chronic disease prevention and management.8 Weight loss programs are particularly important for African-American women who bear the excess burden of obesity and overweight, as well as the associated chronic conditions. Blacks show lower levels of dietary adherence to guidelines, compared to Whites.9 Furthermore, while weight loss interventions have not been an overwhelming success in promoting long-term weight management for the White population, efforts to address weight-related issues in Blacks have been even less effective.10 In a study examining raceand sex-specific weight reduction results from 2 randomized multicenters trials, Kumanyika and colleagues reported that Black participants had smaller net weight loss, compared to White participants in the same program.11 Wing and colleagues described similar results for Blacks and Whites in a behavioral weight control program for adults with type 2 diabetes.12