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interventions developed for use on Anglo American subjects do not appear to have been
effective for Hispanic/Latino individuals.
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One of the biggest limitations of studies is a lack
of acknowledgment for diversity among Hispanics/Latinos (eg, country of origin) as well as
acculturation and ethnic sensitivity. This heterogeneity among the Hispanic/Latino population
in the United States is an important factor to consider when designing and implementing a
culturally appropriate weight loss intervention because of the potential impact of this cultural
diversity on the intervention effect.
83
A study by Lindberg and Stevens of Mexican American immigrant women
70
found that while
generally rejecting the idea of extreme thinness as physically attractive, participants were
very concerned about weight-related health problems, particularly diabetes, and all expressed
great interest in achieving and maintaining a healthy weight as a way to prevent illness. It is
clear that efforts to promote weight loss among Mexican American women should address
these health concerns, emphasizing that even moderate weight reductions are associated
with specific health benefits, including reducing the risks of diabetes, hypertension, and OA.
Another successful group program for Spanish-speaking Mexican women emphasized the
value of leisure physical activity not only as a means to improve energy balance and promote
good health but also as a way to manage stress and improve mood.
84
African American women have the highest rates of obesity in the U.S., are less likely to
participate in weight loss programs, and are less successful in their weight loss attempts.
85
One Black female personal trainer noted in an online article: “There are many reasons why
Black women are disproportionately obese. Cultural beliefs and cuisine, social traditions and
expectations, genetics and ignorance all play a role in the Black female obesity epidemic… it’s
important to understand how certain popular beliefs are unhealthy and encourage obesity.”
86
An important insight about motivation to lose weight that emerged from the focus group study
by Blixen and colleagues was that “health” as opposed to “appearance” was identified by both
African American and White women as the motivation to lose weight as they became older.
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The U.S. Preventive Services Task Force (USPTF), an independent panel of non-Federal
experts in prevention and evidence-based medicine composed of primary care providers
(such as internists, pediatricians, family physicians, gynecologists/obstetricians, nurses, and
health behavior specialists), conducts scientific evidence reviews of a broad range of clinical
preventive health care services and develops recommendations for primary care clinicians
and health systems. Their
Recommendation Statement for Screening for and Management of
Obesity in Adults
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recommends that patients with a BMI ≥30 should be offered or referred to
intensive, multicomponent behavioral interventions. The USPSTF found that the most effective
interventions were comprehensive and were of high intensity (12 to 26 sessions in a year).
Although the USPSTF could not determine the effectiveness of other specific intervention
components, most of the higher-intensity behavioral interventions included multiple behavioral
management activities, such as group sessions, individual sessions, setting weight-loss goals,
improving diet or nutrition, physical activity sessions, addressing barriers to change, active use
of self-monitoring, and strategizing how to maintain lifestyle changes.