Original Article
Motivators, Barriers, and Facilitators to Weight Loss and Behavior Change Among African American Adults in Baltimore City: A Qualitative Analysis

https://doi.org/10.1016/j.jnma.2017.01.006Get rights and content

Abstract

Background

African American adults achieve smaller amounts of weight loss than their white counterparts when exposed to the same intervention and are more likely to regain weight during long-term follow-up.

Objective

To identify perceived motivators, barriers, and facilitators to weight loss and behavior change among African American adults.

Methods

Two focus groups were conducted between April and May 2015 at an urban community health center in Baltimore City, Maryland. A total of 13 participants took part in the discussions. Eligible participants were obese (BMI 30+) African American adults aged 21–70 who had at least one obesity-related comorbidity. Discussion questions were designed to identify the personal, social, and environmental factors that influence weight loss and behavior change among urban minority populations.

Results

Statements were first classified as a motivator, barrier, or facilitator, then divided further as a personal, social, or environmental factor influencing weight loss and behavior change. Among the findings, several novel motivators (reducing or eliminating medication, improving physical intimacy) and barriers (personal transportation, lack of access to scales) emerged that were not previously characterized in the existing literature.

Conclusions

This study was intended to provide preliminary evidence that may be used to guide the development of innovative and culturally relevant weight-loss interventions in the future. Results are applicable to similar urban minority populations.

Introduction

The rate of obesity among black/African American adults in Baltimore City, Maryland is more than twice that of white adults (38.49% versus 18.82%, respectively).1 This far exceeds the racial disparity in obesity rates nationally (47.8% versus 33.4%, respectively),2 and is accompanied by disproportionately higher rates of various obesity-related comorbidities, including hypertension, stroke, and diabetes.1

Wellness-promoting activities, such as healthy eating and regular physical activity, have been shown to promote weight loss3 and lower the risk of obesity-related comorbidities.4 Despite this, evidence from existing behavioral weight loss interventions suggest that African American adults achieve smaller amounts of weight loss than their white counterparts when exposed to the same intervention5, 6, 7, 8, 9, 10, 11 and are more likely to regain weight during long-term follow-up.7, 10

A number of lifestyle intervention trials have been designed specifically to encourage physical activity and weight loss among African American adults.10, 12, 13 Unfortunately, long-term maintenance of behavior change specific to African American adults has not been reported.10, 14 These findings indicate that there continues to be a need for further development of culturally appropriate interventions that promote weight loss and behavior change among African American adults.

Qualitative research, including the use of focus groups, has been shown to be useful in intervention development15, 16 and understanding the factors that influence behavior change.17 The purpose of this study is to conduct focus groups among African American men and women in Baltimore City to identify perceived motivators, barriers, and facilitators to weight loss and behavior change. Findings may be used to guide the development of innovative and culturally relevant weight-loss interventions for similar urban minority populations.

Section snippets

Participants

Eligible participants were obese (BMI 30+) African American adults between the ages of 21–70 who were actively receiving care at Total Health Care (THC) – one of Maryland's largest minority-run, nonprofit, tax-exempt community health centers. Participants also had at least one obesity-related comorbidity (e.g., hypertension, dyslipidemia, or type II diabetes mellitus) and spoke English as a primary language. Those who met the inclusion criteria were identified and informed of the study by

Motivators

Across the male and female focus groups, key motivators included the desire to achieve good health, inner drive and self-determination, a concern for longevity and quality of life, and family. Male participants also stated that seeing results from weight loss efforts and the potential for improved physical intimacy were motivators to weight loss and behavior change.

Discussion

The purpose of this study was to identify perceived motivators, barriers, and facilitators to weight loss and behavior change among African American adults in Baltimore City. The most significant motivators among both male and female participants were the desire to achieve good health and family, which support the findings from previous research.14

In contrast, while Young and colleagues14 concluded that sedentary women were motivated by external factors, a majority of participants in this study

Conclusion

Using focus groups, this study characterized the motivators, barriers, and facilitators to weight loss and behavior change among African American adults in Baltimore City. Results were intended to serve as preliminary evidence that may be used to guide the development of innovative and culturally appropriate weight-loss interventions for similar urban minority populations. To expand and solidify understanding in this field, further research is needed on the motivators to weight loss and

Acknowledgements

The authors would like to acknowledge the contributions of Shiellina Russ, Nedra Beulah, and others at Total Health Care who helped to recruit participants and coordinate the focus group discussions; and Robin Frutchey, Shavise Glascoe, Byron Mui, and others at the Johns Hopkins Weight Management Center who assisted in the study design and focus group training. The authors would also like to thank the participants for their time and willingness to engage in discussion and share their thoughts.

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  • Cited by (8)

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    Funding: This work was supported by the Johns Hopkins School of Medicine and Warnock Foundation.

    Disclosure: The authors have no conflicts of interest to disclose.

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