Motivational interviewing fails to improve outcomes of a behavioral weight loss program for obese African American women: a pilot randomized trial

  • Christie A. Befort
  • Nicole Nollen
  • Edward F. Ellerbeck
  • Debra K. Sullivan
  • Janet L. Thomas
  • Jasjit S. Ahluwalia
Article

Abstract

Compared to other racial/ethnic groups, African American (AA) women are more likely to be obese but less likely to participate in weight loss interventions or to successfully lose weight. Sustained motivation for weight loss may be especially difficult for AA women due to socioeconomic and cultural factors. The purpose of this study was to examine whether the addition of motivational interviewing (MI) to a culturally-targeted behavioral weight loss program for AA women improved adherence to the program, diet and physical activity behaviors, and weight loss outcomes. Forty-four obese (mean BMI = 39.4, SD = 7.1) AA women were randomized to receive a 16-week behavioral weight loss program plus four MI sessions, or the same behavioral weight loss program plus four health education (HE; attention control) sessions. Results showed that participants in both MI and HE conditions lost a significant amount of weight, reduced their energy intake and percent calories from fat, and increased their fruit and vegetable consumption (ps < .05). However, adherence to the behavioral weight loss program and changes in diet, physical activity, and weight did not differ across MI and HE conditions. Future research is warranted to determine the subpopulations with which MI is most effective.

Keywords

African American Obesity Weight loss Motivational interviewing Behavioral treatment 

References

  1. Agurs-Collins, T. D., Kumanyika, S. K., Ten Have, T. R., & Adams-Campbell, L. L. (1997). A randomized controlled trial of weight reduction and exercise for diabetes management in older African-American subjects. Diabetes Care, 20(10), 1503–1511. doi:10.2337/diacare.20.10.1503.PubMedCrossRefGoogle Scholar
  2. Ahluwalia, J. S., Nollen, N., Kaur, H., James, A. S., Mayo, M. S., & Resnicow, K. (2007). Pathway to health: Cluster-randomized trial to increase fruit and vegetable consumption among smokers in public housing. Health Psychology, 26(2), 214–221. doi:10.1037/0278-6133.26.2.214.PubMedCrossRefGoogle Scholar
  3. Ahluwalia, J. S., Okuyemi, K., Nollen, N., Choi, W. S., Kaur, H., Pulvers, K., et al. (2006). The effects of nicotine gum and counseling among African American light smokers: A 2 × 2 factorial design. Addiction (Abingdon, England), 101(6), 883–891. doi:10.1111/j.1360-0443.2006.01461.x.Google Scholar
  4. Ainsworth, B. E., Haskell, W. L., Leon, A. S., Jacobs, D. R., Jr., Montoye, H. J., Sallis, J. F., et al. (1993). Compendium of physical activities: Classification of energy costs of human physical activities. Medicine and Science in Sports and Exercise, 25(1), 71–80. doi:10.1249/00005768-199301000-00011.PubMedCrossRefGoogle Scholar
  5. Bandura, A. (2005). Guide for constructing self-efficacy scales. In T. Urdan & F. Pajares (Eds.), Self-efficacy beliefs of adolescence (pp. 307–338). Information Age Publishing, Ch 14.Google Scholar
  6. Befort, C. A., Thomas, J. L., Daley, C. M., Rhode, P. C., & Ahluwalia, J. S. (2006). Perceptions and beliefs about body size, weight, and weight loss among obese African American women: A qualitative inquiry. Health Education & Behavior, Online First, published Nov. 29, 2006. Google Scholar
  7. Buzzard, I. M., Faucett, C. L., Jeffery, R. W., McBane, L., McGovern, P., Baxter, J. S., et al. (1996). Monitoring dietary change in a low-fat diet intervention study: Advantages of using 24-h dietary recalls vs food records. Journal of the American Dietetic Association, 96(6), 574–579. doi:10.1016/S0002-8223(96)00158-7.PubMedCrossRefGoogle Scholar
  8. Campbell, M. K., Resnicow, K., Carr, C., Wang, T., & Williams, A. (2007). Process evaluation of an effective church-based diet intervention: Body & soul. Health Education & Behavior, 34(6), 864–880.Google Scholar
  9. Carels, R. A., Darby, L., Cacciapaglia, H. M., Konrad, K., Coit, C., Harper, J., et al. (2007). Using motivational interviewing as a supplement to obesity treatment: A stepped-care approach. Health Psychology, 26(3), 369–374. doi:10.1037/0278-6133.26.3.369.PubMedCrossRefGoogle Scholar
  10. Centers for Disease Control and Prevention. (2005). Trends in leisure-time physical inactivity by age, sex, and race/ethnicity—United States, 1994–2004. Morbidity and Mortality Weekly Report, 54(39), 991–994.Google Scholar
  11. Clark, J. M., Bone, L. R., Stallings, R., Gelber, A. C., Barker, A., Zeger, S., et al. (2001). Obesity and approaches to weight in an urban African-American community. Ethnicity & Disease, 11(4), 676–686.Google Scholar
  12. Conway, J. M., Ingwersen, L. A., Vinyard, B. T., & Moshfegh, A. J. (2003). Effectiveness of the US Department of Agriculture 5-step multiple-pass method in assessing food intake in obese and nonobese women. The American Journal of Clinical Nutrition, 77(5), 1171–1178.PubMedGoogle Scholar
  13. DeNavas-Walt, C., Proctor, B. D., & Lee, C. H. (2005). Income, Poverty, and Health Insurance Coverage in the United States, 2004. U.S. Census Bureau. Current Population Reports. Series P-28, Special Censuses, pp. 60–229.Google Scholar
  14. Diabetes Prevention Program (DPP). (2002). Description of lifestyle intervention. Diabetes Care, 25(12), 2165–2171. doi:10.2337/diacare.25.12.2165.CrossRefGoogle Scholar
  15. Elfhag, K., & Rossner, S. (2005). Who succeeds in maintaining weight loss? A conceptual review of factors associated with weight loss maintenance and weight regain. Obesity Reviews, 6(1), 67–85. doi:10.1111/j.1467-789X.2005.00170.x.PubMedCrossRefGoogle Scholar
  16. Fitzgibbon, M. L., Stolley, M. R., Schiffer, L., Sanchez-Johnsen, L. A., Wells, A. M., & Dyer, A. (2005). A combined breast health/weight loss intervention for Black women. Preventive Medicine, 40(4), 373–383. doi:10.1016/j.ypmed.2004.06.018.PubMedCrossRefGoogle Scholar
  17. Flynn, K. J., & Fitzgibbon, M. (1998). Body images and obesity risk among black females: A review of the literature. Annals of Behavioral Medicine, 20(1), 13–24. doi:10.1007/BF02893804.PubMedCrossRefGoogle Scholar
  18. Foster, G. D., Wadden, T. A., Swain, R. M., Anderson, D. A., & Vogt, R. A. (1999). Changes in resting energy expenditure after weight loss in obese African American and white women. The American Journal of Clinical Nutrition, 69(1), 13–17.PubMedGoogle Scholar
  19. Frankenfield, D. C., Rowe, W. A., Smith, J. S., & Cooney, R. N. (2003). Validation of several established equations for resting metabolic rate in obese and nonobese people. Journal of the American Dietetic Association, 103(9), 1152–1159. doi:10.1016/S0002-8223(03)00982-9.PubMedCrossRefGoogle Scholar
  20. Hargreaves, M. K., Schlundt, D. G., & Buchowski, M. S. (2002). Contextual factors influencing the eating behaviours of African American women: A focus group investigation. Ethnicity & Health, 7(3), 133–147. doi:10.1080/1355785022000041980.CrossRefGoogle Scholar
  21. Kanders, B. S., Ullmann-Joy, P., Foreyt, J. P., Heymsfield, S. B., Heber, D., Elashoff, R. M., et al. (1994). The black American lifestyle intervention (BALI): The design of a weight loss program for working-class African-American women. Journal of the American Dietetic Association, 94(3), 310–312. doi:10.1016/0002-8223(94)90374-3.PubMedCrossRefGoogle Scholar
  22. Karanja, N., Stevens, V. J., Hollis, J. F., & Kumanyika, S. K. (2002). Steps to soulful living (steps): A weight loss program for African-American women. Ethnicity & Disease, 12(3), 363–371.Google Scholar
  23. Kennedy, B. M., Paeratakul, S., Champagne, C. M., Ryan, D. H., Harsha, D. W., McGee, B., et al. (2005). A pilot church-based weight loss program for African-American adults using church members as health educators: A comparison of individual and group intervention. Ethnicity & Disease, 15(3), 373–378.Google Scholar
  24. Kreuter, M. W., Lukwago, S. N., Buchholtz, D. C., Clark, E. M., & Sanders-Thompson, V. (2002). Achieving cultural appropriateness in health promotion programs: Targeted and tailored approaches. Health Education & Behavior, 30(2), 133–146. doi:10.1177/1090198102251021.CrossRefGoogle Scholar
  25. Kumanyika, S. K., & Charleston, J. B. (1992). Lose weight and win: A church-based weight loss program for blood pressure control among black women. Patient Education and Counseling, 19(1), 19–32. doi:10.1016/0738-3991(92)90099-5.PubMedCrossRefGoogle Scholar
  26. Kumanyika, S. K., Espeland, M. A., Bahnson, J. L., Bottom, J. B., Charleston, J. B., Folmar, S., et al. (2002). Ethnic comparison of weight loss in the trial of nonpharmacologic interventions in the elderly. Obesity Research, 10(2), 96–106. doi:10.1038/oby.2002.16.PubMedCrossRefGoogle Scholar
  27. Kumanyika, S. K., Morssink, C., & Agurs, T. (1992). Models for dietary and weight change in African-American women: Identifying cultural components. Ethnicity & Disease, 2(2), 166–175.Google Scholar
  28. Kumanyika, S. K., Obarzanek, E., Stevens, V. J., Hebert, P. R., Whelton, P. K., & Kumanyaka, S. K. (1991). Weight-loss experience of black and white participants in NHLBI-sponsored clinical trials. The American Journal of Clinical Nutrition, 53(6, Suppl), 1631S–1638S.PubMedGoogle Scholar
  29. Kumanyika, S. K., Shults, J., Fassbender, J., Whitt, M. C., Brake, V., Kallan, M. J., et al. (2005). Outpatient weight management in African-Americans: The Healthy Eating and Lifestyle Program (HELP) study. Preventive Medicine, 41(2), 488–502. doi:10.1016/j.ypmed.2004.09.049.PubMedCrossRefGoogle Scholar
  30. Martin, P. D., Dutton, G. R., & Brantley, P. J. (2004). Self-efficacy as a predictor of weight change in African-American women. Obesity Research, 12(4), 646–651. doi:10.1038/oby.2004.74.PubMedCrossRefGoogle Scholar
  31. Mattfeldt-Beman, M. K., Corrigan, S. A., Stevens, V. J., Sugars, C. P., Dalcin, A. T., Givi, M. J., et al. (1999). Participants’ evaluation of a weight-loss program. Journal of the American Dietetic Association, 99(1), 66–71. doi:10.1016/S0002-8223(99)00018-8.PubMedCrossRefGoogle Scholar
  32. McNabb, W., Quinn, M., Kerver, J., Cook, S., & Karrison, T. (1997). The PATHWAYS church-based weight loss program for urban African-American women at risk for diabetes. Diabetes Care, 20(10), 1518–1523. doi:10.2337/diacare.20.10.1518.PubMedCrossRefGoogle Scholar
  33. McTigue, K. M., Harris, R., Hemphill, B., Lux, L., Sutton, S., Bunton, A. J., et al. (2003). Screening and interventions for obesity in adults: Summary of the evidence for the U.S. Preventive Services Task Force. Annals of Internal Medicine, 139(11), 933–949.PubMedGoogle Scholar
  34. Miller, W. R., & Rollnick, S. (2002). Motivational Interviewing: Preparing People for Change (2nd ed.). New York: Guilford Press.Google Scholar
  35. Must, A., Spadano, J., Coakley, E. H., Field, A. E., Colditz, G., & Dietz, W. H. (1999). The disease burden associated with overweight and obesity. Journal of the American Medical Association, 282(16), 1523–1529. doi:10.1001/jama.282.16.1523.PubMedCrossRefGoogle Scholar
  36. Nollen, N., Befort, C. A., Pulvers, K., James, A., Kaur, H., & Mayo, M., et al. Psychosocial factors associated with increased fruit and vegetable consumption among smokers in public housing enrolled in a randomized trial. Health Psychology (in press).Google Scholar
  37. Ogden, C. L., Carroll, M. D., Curtin, L. R., McDowell, M. A., Tabak, C. J., & Flegal, K. M. (2006). Prevalence of overweight and obesity in the United States, 1999–2004. Journal of the American Medical Association, 295(13), 1549–1555. doi:10.1001/jama.295.13.1549.PubMedCrossRefGoogle Scholar
  38. Okuyemi, K. S., James, A. S., Mayo, M. S., Nollen, N., Catley, D., Choi, W. S., et al. (2007). Pathways to health: A cluster randomized trial of nicotine gum and motivational interviewing for smoking cessation in low-income housing. Health Education & Behavior, 34(1), 43–54. doi:10.1177/1090198106288046.CrossRefGoogle Scholar
  39. Perri, M. G., Nezu, A. M., McKelvey, W. F., Shermer, R. L., Renjilian, D. A., & Viegener, B. J. (2001). Relapse prevention training and problem-solving therapy in the long-term management of obesity. Journal of Consulting and Clinical Psychology, 69(4), 722–726. doi:10.1037/0022-006X.69.4.722.PubMedCrossRefGoogle Scholar
  40. Resnicow, K., Baranowski, T., Ahluwalia, J. S., & Braithwaite, R. L. (1999). Cultural sensitivity in public health: Defined and demystified. Ethnicity & Disease, 9(1), 10–21.Google Scholar
  41. Resnicow, K., Jackson, A., Wang, T., De, A. K., McCarty, F., Dudley, W. N., et al. (2001). A motivational interviewing intervention to increase fruit and vegetable intake through Black churches: Results of the Eat for Life trial. American Journal of Public Health, 91(10), 1686–1693.PubMedCrossRefGoogle Scholar
  42. Resnicow, K., Campbell, M. K., Carr, C., McCarty, F., Wang, T., Periasamy, S., et al. (2004). Body and soul; a dietary intervention conducted through African-American churches. American Journal of Preventive Medicine, 27(2), 97–105. doi:10.1016/j.amepre.2004.04.009.PubMedCrossRefGoogle Scholar
  43. Resnicow, K., McCarty, F., Blissett, D., Wang, T., Heitzler, C., & Lee, R. E. (2003). Validity of a modified CHAMPS physical activity questionnaire among African-Americans. Medicine and Science in Sports and Exercise, 35(9), 1537–1545. doi:10.1249/01.MSS.0000084419.64044.2B.PubMedCrossRefGoogle Scholar
  44. Samuel-Hodge, C. D., Fernandez, L. M., Henriquez-Roldan, C. F., Johnston, L. F., & Keyserling, T. C. (2004). A comparison of self-reported energy intake with total energy expenditure estimated by accelerometer and basal metabolic rate in African-American women with type 2 diabetes. Diabetes Care, 27(3), 663–669. doi:10.2337/diacare.27.3.663.PubMedCrossRefGoogle Scholar
  45. Smith, D. E., Heckemeyer, C. M., Kratt, P. P., & Mason, D. A. (1997). Motivational interviewing to improve adherence to a behavioral weight-control program for older obese women with NIDDM. A pilot study. Diabetes Care, 20(1), 52–54. doi:10.2337/diacare.20.1.52.PubMedCrossRefGoogle Scholar
  46. Stewart, A. L., Mills, K. M., King, A. C., Haskell, W. L., Gillis, D., & Ritter, P. L. (2001). CHAMPS physical activity questionnaire for older adults: Outcomes for interventions. Medicine and Science in Sports and Exercise, 33(7), 1126–1141. doi:10.1097/00005768-200107000-00010.PubMedCrossRefGoogle Scholar
  47. Walcott-McQuigg, J. A., Chen, S. P., Davis, K., Stevenson, E., Choi, A., & Wangsrikhun, S. (2002). Weight loss and weight loss maintenance in African-American women. Journal of the National Medical Association, 94(8), 686–694.PubMedGoogle Scholar
  48. Walsh, M. C., Hunter, G. R., Sirikul, B., & Gower, B. A. (2004). Comparison of self-reported with objectively assessed energy expenditure in black and white women before and after weight loss. The American Journal of Clinical Nutrition, 79(6), 1013–1019.PubMedGoogle Scholar
  49. West, D. S., DiLillo, V., Bursac, Z., Gore, S. A., & Greene, P. G. (2007). Motivational interviewing improves weight loss in women with type 2 diabetes. Diabetes Care, 30(5), 1081–1087. doi:10.2337/dc06-1966.PubMedCrossRefGoogle Scholar
  50. Wilbur, J., Michaels Miller, A., Chandler, P., & McDevitt, J. (2003). Determinants of physical activity and adherence to a 24-week home-based walking program in African American and Caucasian women. Research in Nursing & Health, 26(3), 213–224. doi:10.1002/nur.10083.CrossRefGoogle Scholar
  51. Wilcox, S., Richter, D. L., Henderson, K. A., Greaney, M. L., & Ainsworth, B. E. (2002). Perceptions of physical activity and personal barriers and enablers in African-American women. Ethnicity & Disease, 12(3), 353–362.Google Scholar
  52. Williams, G. C., Grow, V. M., Freedman, Z. R., Ryan, R. M., & Deci, E. L. (1996). Motivational predictors of weight loss and weight-loss maintenance. Journal of Personality and Social Psychology, 70(1), 115–126. doi:10.1037/0022-3514.70.1.115.PubMedCrossRefGoogle Scholar
  53. Wing, R. R., & Anglin, K. (1996). Effectiveness of a behavioral weight control program for blacks and whites with NIDDM. Diabetes Care, 19(5), 409–413. doi:10.2337/diacare.19.5.409.PubMedCrossRefGoogle Scholar
  54. Wing, R. R., Hamman, R. F., Bray, G. A., Delahanty, L., Edelstein, S. L., Hill, J. O., et al. (2004). Achieving weight and activity goals among diabetes prevention program lifestyle participants. Obesity Research, 12(9), 1426–1434.PubMedCrossRefGoogle Scholar
  55. Wolfe, W. A. (2004). A review: Maximizing social support: A neglected strategy for improving weight management with African-American women. Ethnicity & Disease, 14(2), 212–218.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Christie A. Befort
    • 1
  • Nicole Nollen
    • 1
  • Edward F. Ellerbeck
    • 1
  • Debra K. Sullivan
    • 1
  • Janet L. Thomas
    • 2
  • Jasjit S. Ahluwalia
    • 2
  1. 1.University of Kansas Medical CenterKansas CityUSA
  2. 2.University of MinnesotaMinneapolisUSA

Personalised recommendations