Weight-Loss Study in African-American Women: Lessons Learned from Project Take HEED and Future, Technologically Enhanced Directions

Abstract

African-American women are more overweight and have greater difficulty maintaining weight loss than do Caucasian women. Evidence suggests that African-American women are more successful with culturally tailored weight-loss programs. Begun in 2005, an 18-month randomized clinical trial, Project Take HEED (Healthy Eating and Exercise Decisions), culturally adapted an evidence-based dietary approach and exercise program to fit the female African-American population in an attempt to improve program attrition rates. The study was conducted with 223 African-American women (120 women in the experimental group; 103 controls), age 35 to 65 years, with a body mass index of 30 kg/m(2) or higher. The experimental group received education and instruction at 24 group sessions and were asked to record their daily food intake and physical activity. Cultural adaptation included social and spiritual components. Controls received usual care (referral to a dietitian). After 18 months, Project Take HEED demonstrated the following outcomes: ATTRITION: the treatment group consisted of 12 African-American women at the end of month 18-(an attrition rate of 87%). (It had been 70% at the end of month 15.)FACTORS CONTRIBUTING TO ATTRITION INCLUDED: caregiver responsibilities, transportation difficulties, work schedules, and others. Those clients that did remain, however, provided the impetus for our next study. The remaining participants had, by and large, begun the study as being low in self-efficacy regarding weight loss and weight loss maintenance. Initial Findings: The high self-efficacy that some women had at the beginning of the intervention did not translate into the desired behavior change. The inverse relationship seen in this study suggests that treatments that improve participants' self-efficacy may result in greater weight loss. New Directions: A new study, commencing in 2013, will use at-home Web-based and virtual reality technology (avatars) in an attempt to enhance client motivation to persist in long-term weight management programs. Bandura's pioneering work on self-efficacy will be the theoretical foundation of the pilot study, also enrolling African-American women.