Murphy Pamala J, Williams Roger L
Kaiser Permanente Ohio Center of Research and an Internist at the Bedford Medical Center in Ohio, USA.
Perm J. 2013 Spring;17(2):55-9. doi: 10.7812/TPP/12-094.
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.
非裔美国女性比白人女性超重情况更严重，且在维持体重减轻方面困难更大。有证据表明，非裔美国女性在接受文化适应型减肥项目时更易成功。
始于2005年的一项为期18个月的随机临床试验“关注健康饮食与运动决策项目（Project Take HEED）”，对基于证据的饮食方法和运动项目进行文化适应，以契合非裔美国女性群体，试图提高项目参与率。该研究对223名年龄在35至65岁、体重指数为30千克/平方米或更高的非裔美国女性进行。实验组的120名女性在24次小组会议中接受教育和指导，并被要求记录每日食物摄入量和身体活动情况。文化适应包括社会和精神层面。对照组接受常规护理（转介给营养师）。
18个月后，“关注健康饮食与运动决策项目”呈现以下结果：参与率：在第18个月末，治疗组仅剩下12名非裔美国女性（参与率为87%）。（在第15个月末时为70%。）导致参与率下降的因素包括：照顾者责任、交通困难、工作安排等。然而，那些留下来的参与者为我们的下一项研究提供了动力。总体而言，其余参与者在开始研究时，对减肥和维持体重的自我效能较低。
初步发现：一些女性在干预开始时具有较高的自我效能，但这并未转化为预期的行为改变。本研究中看到的这种反向关系表明，提高参与者自我效能的治疗方法可能会带来更大程度的体重减轻。新方向：一项始于2013年的新研究将使用基于网络的家庭式和虚拟现实技术（虚拟化身），试图增强客户坚持长期体重管理项目的动力。班杜拉关于自我效能的开创性工作将成为该试点研究的理论基础，该研究也将招募非裔美国女性。
