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Health, Science, Environment

Thin isn't in for some women

This article first appeared in the St. Louis Beacon: Writer Alice Randall triggered a lot of discussion last summer when she argued in a New York Times column that “many black women are fat because we want to be.”

Some black women prefer bulk over thinness, according to Gary G. Bennett, a psychologist who heads the Duke University Obesity Prevention Program. In a speech today at noon at Washington University, he argues that it might make more sense to make obesity the new normal for some black women rather than preaching weight loss to them.

For one thing, he says, existing obesity treatments tend to be less effective among black women, partly perhaps because they tend to be underrepresented in clinical trials of weight-loss interventions. Rather than preach weight loss to this population, he argues that researchers would have better success by focusing on weight maintenance.

In other words, tell black women who are generally healthy but overweight that their weight shouldn’t pose problems to their health as long as they don’t gain excessive pounds to the point that they are at risk of chronic diseases associated with being fat.

One overlooked point of treatment of obesity, Bennett says, is that “blacks are generally happier with heavier body weight than we might imagine. There are patients who are not at health risk with low levels of obesity and many of them don’t mind aesthetically being at that level of weight. The question becomes how do we get them to maintain that weight as opposed to gaining weight over time?”

His research shows promising results.

“It’s a lot easier to maintain your weight than to lose weight,” he says. “You need to only take in about 100 to 200 fewer calories per day to maintain your weight.” That can be done, he says by “staying away from cookies, candies and sugar-sweetened beverages.”

African-American women have the nation’s highest rates of obesity, according to the federal Office of Minority Health.  It said African American women were 70 percent more likely to be obese than non-Hispanic white women. Obesity trends among blacks and whites in Missouri are similar to those nationwide.  A 2010 study showed that the overall rate of obesity in Missouri had risen to more than 29 percent but that the rate among blacks across the state was 38.4 percent. In 2011, the overall rate for St. Louis was 31 percent or nearly 10 percent lower than the rate in predominantly black areas four years earlier, suggesting that the rate in black communities always has been higher.

The St. Louis Beacon has begun a year-long initiative, called Fit City, to report on obesity on the north side, a part of St. Louis where rates of obesity, diabetes and cardiovascular diseases are disproportionately high. Because obesity is a preventable condition, heading it off would save the nation the billions of dollars spent now and in the future to treat chronic diseases that can be triggered by obesity and inactive lifestyles.

Bennett does not suggest the epidemic shouldn’t be tackled or that more fitness programs aren’t needed. Rather, he is arguing that the chronic illnesses associated with the epidemic need not affect everyone who happens to be slightly obese.

Obesity is a condition under which body weight is sharply higher than the recommended body mass index. For black women struggling with weight problems, Bennett suggests a body mass index of between 30 to 35.

“They are obese, but that’s a small level of obesity,” he says. “But the problem is that everyone gains weight over time. Black women tend to gain about a pound and a half to two pounds a year. If you continue with that minimum weight gain over a 10-to-20 year period, it creates a level of obesity that becomes very problematic for your health.”

That is why his focus is on helping women maintain their current weight rather than worry about losing pounds.

“All we say is that it’s OK to be a little obese, but once you are there, try to not gain additional weight. We find that it’s possible to not gain additional weight when women like the way they look and feel about their level of obesity. It’s much easier to accomplish than to get them to lose weight.”

Bennett mentions a weight of between 180 and 190 for a woman who is about 5’6”.

“That’s obese,” he concedes. “But many people who haven’t developed additional health problems like hypertension and diabetes can afford to stay at that weight.”

Asked how black women were responding to his arguments: “Our experience has been that people are very pleased,” he says. “Many black women don’t value thinness so the idea of losing weight in order to achieve a thin body shape is something that my patients have never been interested in.”

His patients, he says, “are happy with the idea that they can be a little bit heavier and maintain their shape in the way they would like.”

Still, he doesn’t dismiss the real danger of being overweight.

“Obesity among black adults is a major problem,” he says. “It’s an economic problem, a social challenge and a health issue. But the idea of maintaining your body weight at low levels of obesity is a real advantage that blacks have, and we should try to capitalize on that.”

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