Attitudes and behaviors related to weight control in two diverse populations
Introduction
The obesity epidemic in the US is well documented. Close to two thirds of the population is now overweight (BMI 25–29.9), and nearly a third is obese (BMI > 30) [1]. Epidemiological studies have also identified subgroups at particular risk for this health problem and all of its serious consequences. Obesity is more common among middle age and older adults, persons with little formal education, women, rural residents, and certain minority populations such as African-Americans and Hispanics [2]. In recognition of the behavioral factors that contribute to obesity, studies have described differences in dietary intake and physical activity among population subgroups. Researchers have found positive correlations between these behaviors and the prevalence of overweight and obesity [2], [3], [4]. Identifying specific attitudes and behaviors that contribute to obesity is important, as these often drive interventions in individual, community, or policy level programs.
In addition to examining diet and exercise-related attitudes and behaviors of the population as a whole, some studies have examined the strategies that people use when they are actively trying to lose weight [2], [5], [6]. The measures employed tend to describe general strategies, such as “changing diet”, “increasing exercise,” or enrollment in a weight loss program [5], [7], [8]. A few have measured behavioral strategies on a more specific level, such as attempts to decrease fat or caloric intake or time spent engaging in specific types of physical activity [8], [9].
Weight management activities among African-American women have been the target of several studies and public health programs [1], [10], [11], [12]. Researchers have found that African-American women have concerns about their weight but are less successful in their weight loss efforts compared to Caucasian women [13]. A variety of factors may contribute to the difficulty African-American women have in losing weight including the absence of strong negative social pressure in the community and a relatively positive body image [14]. A qualitative study using in-depth interviews compared weight loss methods used by African-American and Caucasian women over the course of their lives [15]. This study showed that African-American women were more likely to use commercial diet products and to engage in weight loss methods for a shorter period of time than the Caucasian women. The study also showed that both groups were most likely to use positive, general strategies such as exercising on their own and reducing high calorie and/or increasing low calorie foods.
This report involves a comparison of attitudes and behaviors related to diet and exercise in two groups of women: low-income, urban African-American women in Indianapolis, Indiana and Caucasian women in rural Iowa. The report is not designed to isolate the specific effects of either race or rurality on weight management behaviors. Instead, it describes in a much more specific way than previous research has shown, differences in attitudes and use of weight management strategies between these very divergent groups of women who have stated they are currently trying to lose weight. Data are from two surveys that shared many common measures, but were otherwise not related to one another.
Weight management is an ongoing, complicated process that is increasingly likened to the behavioral management of a chronic disease [16], [17]. The choice of measures in the surveys described below was guided by a conceptual framework of chronic disease self-management proposed by Clark, in addition to preliminary work conducted before each survey administration [18], [19]. This framework has been employed to describe management of heart disease [20], asthma [18], [19], [21], and weight management [22]. In this model, predisposing factors such as knowledge, attitudes, feelings, and beliefs about one's condition along with external resources, including role models, technical advice and service, social support, money, etc., are believed to influence the self-regulation activities of the individual. The self-regulatory processes of self-observation (or self-monitoring), self-judgment (e.g., a value judgment about the behavior), and self-reaction (including self-efficacy and outcome expectations) leads the individual to learn which management strategies are most effective. Management strategies are categorized as preventive behaviors, behaviors to manage acute or immediate problems, and use of social skills. Use of these strategies can lead to such endpoints as personal behavioral or health goals.
Applying this conceptual model to weight management, the processes are expected to be as follows. Someone who is successfully managing his or her weight would pay attention to their eating and exercise habits, and keep a mental or written record of their food intake or minutes of exercise (self-monitoring). They would experiment with some behavioral strategies and observe which ones seem to work to keep them on track toward their goals, and which do not. They would also develop a level of self-efficacy (confidence in their ability to perform the behavior) and outcome expectations (expectations about the results of engaging in a particular behavior) depending on the results (“endpoints”) of their efforts.
Although the two surveys described here were guided by this conceptual framework, this report is limited to items and scales that were identical in the two surveys and thus, the full model is not represented here. Comparing results on these available measures, however, contributes to a greater understanding of subgroup differences and similarities in the complex behavioral issues surrounding successful weight management.
Section snippets
Recruitment and survey administration
The first of the two studies to be compared in this report was a telephone survey of urban African-American women who were identified using the Regenstrief Medical Record System (RMRS). The RMRS is one of the oldest, largest, and most comprehensive electronic medical record systems in the world [23]. The Regenstrief Health Center is the outpatient arm of Wishard Memorial Hospital, a county facility serving primarily low-income residents in Indianapolis, Indiana. This study was approved by the
Results and discussion
Table 1 shows demographic characteristics of participants of both studies who stated that they were currently trying to lose weight. In each case, these participants represent 50% of the women surveyed. Compared to women in the urban study, women in the rural study were, on average, about 3 years older, somewhat less likely to be employed, and more highly educated.
Table 2 shows adjusted group means and standard errors for attitudes and behaviors related to diet and exercise, controlling for age
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