Journal of General Internal Medicine

, Volume 22, Issue 7, pp 908–914 | Cite as

Obese African-American Women’s Perspectives on Weight Loss and Bariatric Surgery

  • Cheryl Sterling Lynch
  • Judy C. Chang
  • Angela F. Ford
  • Said A. IbrahimEmail author
Original Article



African-American (AA) women have higher rates of obesity and obesity-related diseases but are less likely than other women to undergo bariatric surgery or have success with conventional weight loss methods.


To explore obese AA women’s perceptions regarding barriers to weight loss and bariatric surgery.


Focus groups to stimulate interactive dialogue about beliefs and attitudes concerning weight management.

Participants and Approach

We partnered with a community organization to recruit women who were AA, were ≥18 years old, and had a body mass index (BMI) of ≥30 kg/m2. We audiotaped the 90-minute focus groups and used content analysis for generating and coding recurring themes.


In our sample of 41 participants, the mean age was 48.8 years and mean BMI was 36.3. Most participants were unmarried, had some postsecondary education, and reported good or fair health. About 85% knew someone who had undergone bariatric surgery. Qualitative analysis of 6 focus group sessions revealed that the most common barriers to weight loss were lack of time and access to resources; issues regarding self-control and extrinsic control; and identification with a larger body size. Common barriers to bariatric surgery were fears and concerns about treatment effects and perceptions that surgery was too extreme or was a method of last resort.


Only through the elimination of barriers can AA women receive the care needed to eliminate excess weight and prevent obesity-related morbidity and mortality.


African American obesity body mass index weight loss bariatric surgery 



This research was supported by the EXPORT Health Project at the Center for Minority Health (CMH), Graduate School of Public Health, University of Pittsburgh, NIH/NCMHD Grant No. P60 MD-000-207-03 and the Division of General Internal Medicine, School of Medicine, University of Pittsburgh. Sincerest thanks to our collaborating partners for their efforts with recruitment and data management and analysis—CMH and Black Women’s Health and Outreach for Longer Life and Empowerment (BWHOLE) and University Center for Survey and Urban Research, University of Pittsburgh—R. Schulz, S. Shulman. Finally, we express our gratitude to Laurel Person, Natalie Solomon, and Andrea Arrington who assisted in data collection and analysis.

Conflict of Interest

None disclosed.


  1. 1.
    Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the United States, 2000. JAMA. 2004;291(10):1238–45.PubMedGoogle Scholar
  2. 2.
    Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of overweight and obesity in the United States, 1999–2004. JAMA. 2006;295(13):1549–55.PubMedGoogle Scholar
  3. 3.
    Flegal KM, Carroll MD, Ogden CL, Johnson CL. Prevalence and trends in obesity among US adults, 1999–2000. JAMA. 2002;288(14):1723–27.PubMedGoogle Scholar
  4. 4.
    Wechsler JG, Leopold K. Medical management of obesity. Langenbecks Arch Surg. Dec 2003;388(6):369–74.PubMedGoogle Scholar
  5. 5.
    McTigue KM, Harris R, Hemphill B, et al. Screening and interventions for obesity in adults: summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2003;139(11):933–49.PubMedGoogle Scholar
  6. 6.
    Residori L, Garcia-Lorda P, Flancbaum L, Pi-Sunyer FX, Laferrere B. Prevalence of co-morbidities in obese patients before bariatric surgery: effect of race. Obes Surg. 2003;13(3):333–40.PubMedGoogle Scholar
  7. 7.
    Choban PS, Jackson B, Poplawski S, Bistolarides P. Bariatric surgery for morbid obesity: why, who, when, how, where, and then what? Cleve Clin J Med. 2002;69(11):897–903.PubMedGoogle Scholar
  8. 8.
    Presutti RJ, Gorman RS, Swain JM. Primary care perspective on bariatric surgery. Mayo Clin Proc. 2004;79(9):1158–66; quiz 1166.PubMedCrossRefGoogle Scholar
  9. 9.
    McGuire MT, Wing RR, Klem ML, Hill JO. Behavioral strategies of individuals who have maintained long-term weight losses. Obes Res. 1999;7(4):334–41.PubMedGoogle Scholar
  10. 10.
    Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–37.PubMedGoogle Scholar
  11. 11.
    Sjostrom CD, Lissner L, Wedel H, Sjostrom L. Reduction in incidence of diabetes, hypertension and lipid disturbances after intentional weight loss induced by bariatric surgery: the SOS Intervention Study. Obes Res. 1999;7(5):477–84.PubMedGoogle Scholar
  12. 12.
    Avenell A, Brown TJ, McGee MA, et al. What interventions should we add to weight reducing diets in adults with obesity? A systematic review of randomized controlled trials of adding drug therapy, exercise, behaviour therapy or combinations of these interventions. J Hum Nutr Diet. 2004;17(4):293–316.PubMedGoogle Scholar
  13. 13.
    Anderson JW, Konz EC, Frederich RC, Wood CL. Long-term weight-loss maintenance: a meta-analysis of US studies. Am J Clin Nutr. 2001;74(5):579–84.PubMedGoogle Scholar
  14. 14.
    Wing RR, Hill JO. Successful weight loss maintenance. Annu Rev Nutr. 2001;21:323–341.PubMedGoogle Scholar
  15. 15.
    Tyler DO, Allan JD, Alcozer FR. Weight loss methods used by African American and Euro-American women-QUALIT. Res Nurs Health. 1997;20(5):413–23.PubMedGoogle Scholar
  16. 16.
    Cachelin FM, Rebeck RM, Chung GH, Pelayo E. Does ethnicity influence body-size preference? A comparison of body image and body size. Obesity Res. 2002;10(3):158–66.Google Scholar
  17. 17.
    Kumanyika S, Wilson JF, Guilford-Davenport M. Weight-related attitudes and behaviors of black women. J Am Diet Assoc. 1993;93(4):416–22.PubMedGoogle Scholar
  18. 18.
    Serdula MK, Mokdad AH, Williamson DF, Galuska DA, Mendlein JM, Heath GW. Prevalence of attempting weight loss and strategies for controlling weight. JAMA. 1999;282(14):1353–58.PubMedGoogle Scholar
  19. 19.
    Wing RR, Anglin K. Effectiveness of a behavioral weight control program for blacks and whites with NIDDM. Diabetes Care. 1996;19(5):409–13.PubMedGoogle Scholar
  20. 20.
    Buffington CK, Marema RT. Ethnic differences in obesity and surgical weight loss between African-American and Caucasian females. Obes Surg. 2006;16(2):159–65.PubMedGoogle Scholar
  21. 21.
    Daly A, Konz EC, Soler N, Anderson JW, Yergler C, Carpenter P. Successful long-term maintenance of substantial weight loss: one program’s experience. J Am Diet Assoc. 2000;100(12):1456.PubMedGoogle Scholar
  22. 22.
    Wadden TA, Berkowitz RI, Womble LG, et al. Randomized trial of lifestyle modification and pharmacotherapy for obesity. N Engl J Med. 2005;353(20):2111–20.PubMedGoogle Scholar
  23. 23.
    Sjostrom L, Rissanen A, Andersen T, et al. Randomised placebo-controlled trial of orlistat for weight loss and prevention of weight regain in obese patients. European Multicentre Orlistat Study Group. Lancet. 1998;352(9123):167–72.PubMedGoogle Scholar
  24. 24.
    Encinosa WE, Bernard DM, Steiner CA, Chen CC. Use and costs of bariatric surgery and prescription weight-loss medications. Health Aff (Millwood, Va.). 2005;24(4):1039–46.Google Scholar
  25. 25.
    Steinbrook R. Surgery for severe obesity. N Engl J Med. 2004;350(11):1075–79.PubMedGoogle Scholar
  26. 26.
    Buchwald H, Williams SE. Bariatric surgery worldwide 2003. Obes Surg. 2004;14(9):1157–64.PubMedGoogle Scholar
  27. 27.
    Freedman DS, Khan LK, Serdula MK, Galuska DA, Dietz WH. Trends and correlates of class 3 obesity in the United States from 1990 through 2000. JAMA. 2002;288(14):1758–61.PubMedGoogle Scholar
  28. 28.
    Schauer PR, Ikramuddin S, Gourash W, Ramanathan R, Luketich J. Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Ann Surg. 2000;232(4):515–29.PubMedGoogle Scholar
  29. 29.
    Christou NV, Sampalis JS, Liberman M, et al. Surgery decreases long-term mortality, morbidity, and health care use in morbidly obese patients. Ann Surg. 2004;240(3):416–23; Discussion 423–14.PubMedGoogle Scholar
  30. 30.
    Pope GD, Birkmeyer JD, Finlayson SR. National trends in utilization and in-hospital outcomes of bariatric surgery. J Gastrointest Surg. 2002;6(6):855–60; Discussion 861.PubMedGoogle Scholar
  31. 31.
    [computer program]. Version 3rd Edition. Berlin, Germany; 2005.Google Scholar
  32. 32.
    Pope C, Ziebland S, Mays N. Qualitative research in health care. Analysing qualitative data. BMJ. 2000;320(7227):114–6.PubMedGoogle Scholar
  33. 33.
    Krueger RA, Casey MA. Focus groups: a practical guide for applied research. 3rd ed. Thousand Oaks: Sage Publications; 2000.Google Scholar
  34. 34.
    Hayward LM, Nixon C, Jasper MP, et al. The process of restructuring and the treatment of obesity in women-QUALIT. Health Care Women Int. 2000;21(7):615–30.PubMedGoogle Scholar
  35. 35.
    Dietz W. Focus group data pertinent to the prevention of obesity in African Americans. Am J Med Sci. 2001;322(5):275–8.PubMedGoogle Scholar
  36. 36.
    Belza B, Walwick J, Shiu-Thornton S, Schwartz S, Taylor M, LoGerfo J. Older adult perspectives on physical activity and exercise: voices from multiple cultures. Prev Chronic Dis. 2004;1(4):A09.PubMedGoogle Scholar
  37. 37.
    Walcott-McQuigg JA, Sullivan J, Dan A, Logan B. Psychosocial factors influencing weight control behavior of African American women. West J Nursing Res. 1995;17(5):502–20.Google Scholar
  38. 38.
    Walcott-McQuigg JA, Chen SP, Davis K, Stevenson E, Choi A, Wangsrikhun S. Weight loss and weight loss maintenance in African-American women. J Natl Med Assoc. 2002;94(8):686–94.PubMedGoogle Scholar
  39. 39.
    Walcott-McQuigg JA. Stress, women and weight control behavior. J Cult Divers. 1995;2(2):64–71.PubMedGoogle Scholar
  40. 40.
    Striegel-Moore R, Wilfley D, Caldwell M, Needham M, Brownell K. Weight-related attitudes and behaviors of women who diet to lose weight: a comparison of black dieters and white dieters. Obes Res. 1996;4(2):109–16.PubMedGoogle Scholar
  41. 41.
    Blixen CE, Singh A, Thacker H. Values and beliefs about obesity and weight reduction among African American and Caucasian women. J Transcult Nurs. 2006;17(3):290–7.PubMedGoogle Scholar
  42. 42.
    Calle EE, Thun MJ, Petrelli JM, Rodriguez C, Heath CW, Jr. Body-mass index and mortality in a prospective cohort of U.S. adults. N Engl J Med. 1999;341(15):1097–105.PubMedGoogle Scholar
  43. 43.
    Foster GD, Wadden TA, Makris AP, et al. Primary care physicians’ attitudes about obesity and its treatment. Obes Res. 2003;11(10): 1168–77.PubMedCrossRefGoogle Scholar
  44. 44.
    Arfken CL, Houston CA. Obesity in inner-city African Americans. Ethn Health. 1996;1(4):317–26.PubMedCrossRefGoogle Scholar
  45. 45.
    Libeton M, Dixon JB, Laurie C, O’Brien PE. Patient motivation for bariatric surgery: characteristics and impact on outcomes. Obes Surg. 2004;14(3):392–8.PubMedGoogle Scholar
  46. 46.
    Wee CC, Jones DB, Davis RB, Bourland AC, Hamel MB. Understanding patients’ value of weight loss and expectations for bariatric surgery. Obes Surg. 2006;16(4):496–500.PubMedGoogle Scholar
  47. 47.
    von Soest T, Kvalem IL, Skolleborg KC, Roald HE. Psychosocial factors predicting the motivation to undergo cosmetic surgery. Plast Reconstr Surg. 2006;117(1):51–62; Discussion 63–54.Google Scholar

Copyright information

© Society of General Internal Medicine 2007

Authors and Affiliations

  • Cheryl Sterling Lynch
    • 1
  • Judy C. Chang
    • 1
    • 2
  • Angela F. Ford
    • 3
  • Said A. Ibrahim
    • 1
    • 4
    Email author
  1. 1.Department of MedicineUniversity of Pittsburgh School of MedicinePittsburghUSA
  2. 2.Departments of Obstetrics, Gynecology and Reproductive Sciences and MedicineUniversity of Pittsburgh School of MedicinePittsburghUSA
  3. 3.Center for Minority Health, Graduate School of Public HealthUniversity of PittsburghPittsburghUSA
  4. 4.Center for Health Equity Research and Promotion (151-C)VA Pittsburgh Healthcare SystemPittsburghUSA

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