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Weighing the Options: Criteria for Evaluating Weight-Management Programs
demographic factors on weight management is not known. The subjective elements of perceived stress (i.e., the threshold above which stress is perceived or the importance assigned to a given stress) are influenced by culture (Dohrenwend et al., 1978). This complicates cross-cultural comparisons of the prevalence of stress or of its effects.
Studies that provide a randomized, controlled comparison suggest that black women or black participants in the United States lose less weight than whites under the same conditions of behavioral treatment (Kumanyika et al., 1991; Wylie-Rosett et al., 1993). Observational follow-up data from a national survey also indicate that black women are less likely than white women to lose weight during adulthood (Kahn et al., 1991). Behavioral factors that could predispose black women and men to have a relatively greater difficulty with weight loss are easier to identify than metabolic variables that may be operating, although the latter are not precluded. Attitudes indicating a more multidimensional and less uniformly negative view of obesity among blacks than among whites have been documented as indirect evidence that the motivation for weight reduction is lower in black women (Allan et al., 1993; Kumanyika et al., 1992). Black women responding to a survey were more likely than white women to agree with the statement that there is little people can do to change their body weight (IBNMRR, 1993).
Survey data on self-reported weight-loss practices suggest that differences in weight management between black and white women are influenced primarily by factors relating to differences in the duration of adherence to weight-control regimens rather than to the level of adherence while on the regimen. Williamson et al. (1992) reported that black women were less likely than white women to be involved in long-duration weight-loss attempts (>1 year), but that race was not related to the rate of weight loss and to weight losses achieved among the subset of women who remained on diets. A report of a work-site lifestyle change program also provides evidence consistent with this finding (Brill et al., 1991). Blacks were significantly less likely to enroll in the program, and those who enrolled were significantly less likely to remain in the program. However, among those who did not drop out, weight losses among blacks were similar to those of whites.
The national survey data analyzed by Williamson et al. (1992) showed a higher starting weight for the current weight-loss attempts in blacks compared to whites. This may reflect the common finding that, compared to white women, fewer black women who are not overweight are dieting. A survey of weight-control practices of blacks and whites shows differences in dieting strategies, with black dieters reporting more practices defined as questionable (Levy and Heaton, 1993). One study has found that blacks lose less weight than whites from gastric surgery