Appetite Awareness Training to Prevent Obesity in African-American Women

Background and Purpose: African-American women have the highest rates of obesity within the United States.  Obesity is of public health significance, and is associated with numerous co-morbid conditions, including hypertension, diabetes, and various cancers.  Behavioral weight loss interventions have not been as effective in African-American women who are obese compared to their white counterparts.  A significant number of AA women have certain eating behaviors (e.g., binge eating, overeating, emotional eating) that may contribute to obesity and poorer behavioral weight loss treatment outcomes. Currently, there is scant intervention research to address the eating behaviors of African-American women.  We tested the feasibility of an eight-week Appetite Awareness Training (AAT) program, a cognitive-behavioral intervention for binge eating, in a community-based sample of African-American women with reported binge and/or overeating behaviors. The purpose of this study is to evaluate participant satisfaction with AAT, and generate information to improve its effectiveness among African-American women.

 Methods: African-American women, aged 18-70, with reported binge, overeating, or loss of control of eating behaviors, were invited to attend a focus group discussion, following participation in an eight-week community-based AAT intervention. Session content was recorded using a digital audio recorder and transcribed verbatim. Data were analyzed by use of open coding and constant comparison. Themes were generated to describe the experience of participating in the intervention.

 Results: Seventeen women participated in three focus group discussions to evaluate their experience in AAT. On average, participants were 49.41 ± 12.12 years of age, and had completed 15.12 ± 2.60 years of education.  Approximately 41% of participants had an income ≤ $29,000, 11% reported an income $30-59,000, and 47% reported an income that was ≥$60,000.  Pertinent themes include the following: satisfaction, cultural relevance, lessons learned, and aspects of the intervention they would like to change. AAT was satisfactory, and participants found it valuable to learn more about listening to biological signals of hunger and satiety, and to receive group support from other African-American women. Participants expressed that having the intervention be led by an African-American PI, and having all group members be of the same cultural background created an atmosphere of comfort, and made the program feel culturally relevant. Suggested changes include improving the paper self-monitoring form, increasing the length of the intervention, and providing food in the sessions as part of the intervention instruction. 

 Conclusions and Implications: In conclusion, AAT is acceptable, and provides eating behavior instruction that was culturally relevant to participating African-American women.  Social workers, while not traditionally involved in obesity treatment teams, have an incredible opportunity to administer  eating behaviors interventions among African-American women who are overweight and/or obese. It will be critical for the next generation of weight loss and eating behavior research to seek to understand some of the cultural and environmental challenges that impact the health behaviors of African-American women. Future research should examine the potential of AAT to improve disordered eating behaviors, and prevent further weight gain in this population.