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There is little qualitative research on the type of weight loss counseling patients prefer from their physicians and whether preferences differ by race. White and AA women appeared to internalize weight stigma differently. AA participants spoke about their pride and positive body image, while white women more frequently expressed self-deprecation and feelings of depression.
Despite these differences, both groups of women desired similar physician interactions and weight management counseling, including: 1 giving specific weight loss advice and individualized plans for weight management; 2 addressing weight in an empathetic, compassionate, nonjudgmental, and respectful manner; and 3 providing encouragement to foster self-motivation for weight loss. While both AA and white women desired specific strategies from physicians in weight management, some white women may first need assistance in overcoming their stigma, depression and low self-esteem before attempting weight loss.
The U. Preventive Services Task Force recommends that physicians screen all patients for obesity and offer or refer obese patients to intensive multicomponent behavioral interventions. Cultural differences in attitudes toward obesity among white and AA women may affect their desires and expectations regarding physician interactions and counseling strategies in the management of weight loss.
Compared to obese white women, obese AA women tend to under perceive their weight 10 — 13 and have more satisfaction with and acceptance for a larger body size. Data came from semi-structured in-depth interviews of 33 white and AA women, conducted between March and August in New Jersey, all of whom were enrolled in a parent qualitative study focusing on barriers to breast and cervical cancer screening among obese women.
To simplify recruitment procedures, a cutoff weight of pounds was also used to establish eligibility. This weight corresponded to the lower limit of moderate obesity BMI at least 35 for height of 67 inches 90 th percentile height in women in a similar sample. The Institutional Review Board of the University of Medicine and Dentistry of New Jersey approved the study protocol, and all women provided informed consent. Two trained qualitative interviewers conducted interviews by telephone or in-person. Interviews lasted 60—90 minutes, and were digitally recorded, transcribed verbatim, and de-identified.
Recruitment and interviews continued until data saturation was achieved, i. Initially, we read transcripts together to understand the subject matter and to develop a set of preliminary codes. t analysis continued until we agreed on coding schemes. The remaining data were then analyzed individually, with research team members meeting regularly to resolve coding differences and refine coding schemes as needed. All transcripts were independently coded by at least two research team members, and any coding differences were resolved through group consensus. The quotations chosen below best depict and exemplify our key findings.
Table 1 describes our study population of 18 white and 15 AA women.
The presentation of our is organized around four themes that emerged from our analysis. Cultural differences regarding body image and self-esteem were confirmed in our. AA women we interviewed spoke more about pride and a positive body-image:. I dress nice. I smell good. You know when I step out, I want to look good when I step out. Because I am a full-figured woman, so you want to take a little bit of extra care than maybe a skinny person.
Because people is going to notice you; they going to look at you and something. But when you love you, you know you going to do what you have to do. Age 45, AA, lbs.
Journal of obesity
These participants sometimes attributed their personal self-respect to their family values and upbringing:. Age 64, AA, lbs. You know I come from a family of full-figured women… my aunties and stuff, they were well-dressed, church-going ladies. And no matter where they go, they could go to the corner store, they always be dressed. Conversely, white participants often described low self-esteem and poor body image concerning their weight:. How do I feel? Depressed, angry, sad, very ashamed. Age 71, white, lbs. Both AA and white participants expressed a desire for specific advice and personalized weight management plans.
When women received generalized and nonspecific weight loss advice from their physician, they equated this with lack of concern, attention, and support. For example:. Age 57, white, lbs. Subjects mentioned frequent weight monitoring, graphic charting, specific dietary inquiry and recommendations, and providing reference materials and resources, as forms of individualized plans that they wanted from their physician.
Age 59, AA, lbs. And that, I think would be something that would be helpful for a doctor to have.
It would be less threatening And it would be nice if, ideally there was a way to have that handout. Age 56, white, lbs. Both AA and white participants indicated that they were more likely to have favorable weight related interactions with physicians who possessed certain qualities such as being: empathetic, sensitive, respectful, trustworthy, compassionate, non-judgmental, encouraging, honest, and comforting.
So if they were to show some compassion and caring towards people that are overweight, I think that might be a good thing. That would be helpful. Age 55, AA, lbs.
In addition to tactful communication, participants described the importance of having a positive bedside manner:. Just the tone of their voice. People have all kinds of illnesses. Obesity is one of them.
So, you're on the receiving end of factual comments that are — the intonation is disapproving It's, in most of the cases, it's not what you say, it's how you say it. For instance:. Specifically, you really need training on how to be polite to their patients.
You really need to be educated.
Age 58, white, lbs. Educating the doctors… Education, educate the doctors how we feel. Do a video letting them — look, this is the way that we feel. I care.
I want you to care. AA and white participants agreed that the desire and willingness to lose weight largely depended on self-motivation:. You need to tell yourself. A person who wants to lose weight has to be the one to lose the weight. Age 66, AA, lbs.
I have to do it. I have to want to do it. Nobody can help me. The same thing with smoking. Nobody can stop me until I want to stop. Age 67, white, lbs. However, they noted the need for added encouragement from their physician to help foster their own self-motivation:.
At least bring it up once in a while. You could comment about it, and even if you had lost a few pounds, say something about it. Try to be encouraging.
But at least ask if you need help or if you want help. That in itself would be a big opening. Age 49, white, lbs. This is the first qualitative study to examine whether cultural differences in perceptions of weight between obese white and AA women affect their desires and expectations regarding specific physician interactions and counseling strategies in the management of weight loss.
While we found cultural differences regarding body image and self-esteem, both white and AA women desired similar physician interactions and weight loss counseling techniques.