Currently, limited research exists that qualitatively examines the desires of Black adults for the creation of weight loss interventions by learning about what supports or creates a barrier to diet and physical activity behaviors. This qualitative study investigated the barriers and facilitators to weight loss behaviors such as healthy diet and physical activity and the individual weight loss program preferences of Black adults. Major themes that emerged from the interviews included preferences for weight loss programs among both Black males and Black females, barriers to adopting healthy eating and physical activity, healthy living facilitators, and desire for social support. Centering on the weight loss program creation for Black adults, the responses revealed differences in the preferences of Black males and females. For Black females, the sub-themes generated were community and personalization while for Black males, programs focusing on personalized exercise and healthy eating for managing various health conditions emerged as major sub-themes for weight loss program creation.
Black males and females in the sample identified unique, sex-specific needs for weight loss with small areas of similar desires for weight loss program creation. Inclusion of community was highlighted by Black females. Specifically, desires for community, a source of support, as part of weight loss intervention design was raised. Black females in the sample discussed the importance of including pre-existing community programs in obesity treatment. This finding aligns with recommendations for obesity control and equity where provision of and support for existing community programs that seek to improve physical activity and nutrition is a key strategy[23, 24]. This may look like obesity treatment alongside nutrition assistance programs that improve access to social and economic resources or treatment through community programs like Black Girls Run! that already focus on a weight-related behavior (physical activity) and provide social support to an engaged audience[14, 25]. Community-engaged efforts like the Racial and Ethnic Approaches to Community Health across the United States (REACH US) project that utilized participatory methods to generate multi-level, culturally and contextually relevant health interventions, reduced obesity prevalence across fourteen Black communities[26].
Males in this study wanted weight loss interventions designed specifically for them. Incorporating both eating and exercise was of equal importance to Black males as a means to reduce weight and address comorbidities like diabetes and hypertension. This finding is supported by the literature among older Black males, where diagnosis with a disease is noted as a motivator to participate in health research for better disease management and understanding[27]. Gender-specific weight control programs may be relevant as weight loss strategies differ between Black males and females[28, 29]. For example, Black male respondents to a community survey reported more regular exercise engagement than Black females’ and had less engagement with weight loss strategies and attempts[30]. Across genders, personalization through culturally relevant dietary prescriptions and exercise was seen as necessary by Black adults in this qualitative study, which resonates with current weight control literature to address inequities. Still, gender-specific needs exist in weight-related behaviors like physical activity that indicate the relevance of race- and gender-specific weight control treatment as a future direction[30, 31].
Participants recognized several barriers to consuming healthy meals. Black females emphasized that their primary barriers to cooking and consumption of healthy foods were lack of time to procure and prepare nutritious meals and family obligations. Unlike the findings of this study, several qualitative studies examining barriers to healthy eating mentioned a lack of knowledge to be the major challenge to healthy eating and expressed uncertainty about what and how to cook healthy, in contrast to the current study where lack of time was identified as the primary barrier[32, 33]. Additionally, qualitative study findings in Black women indicated that women felt pressured to consume more, lacking support when attempting to eat healthy and reported that this created a hindrance to adopting healthy eating habits[33, 34]. On the other hand, lack of knowledge, skills, and a shortage of healthy recipes was identified as major barrier by males. To address this issue, future weight loss interventions should focus on integrating cooking methods, stressing the importance of portion control, and helping understand the nutritional value of foods[29]. Programs should also aim to incorporate a range of resources, including cooking classes, online tutorials of culturally relevant recipes, and community programs dedicated to healthy cooking[35, 36]. As Black males expressed a desire for recipes that could assist in managing health conditions such as hypertension, the use of the DASH (Dietary Approaches to Stop Hypertension) diet, which has been proven effective in controlling hypertension and supporting weight loss, may be beneficial and attractive[37, 38].
Black females and Black males identified distinct barriers to engaging in physical activity. Black females specifically identified challenges related to busy work schedules and caretaking responsibilities, leading to fatigue and tiredness, leaving little energy for exercise[14, 39]. In the context of physical activity, utilizing home-based programs through weight loss interventions, personalized to the level of resources available, may provide significant improvement and adherence to physical activity[40]. Black males noted a lack of motivation to maintain a physical routine. This finding is consistent with qualitative research findings that suggested Black males experience decreased motivation to participate in physical activity due to challenges and stress associated with fulfilling key gendered social roles as a worker, provider, father, and spouse/partner[25, 41]. Black male participants desired personalized exercise regimens for different age groups to enhance motivation and distributed the exercise schedule in small intervals throughout the week. When designing interventions for Black males, it is essential to incorporate exercises preferred by men and create a consistent routine to perform these exercises [12, 41, 42].
Black adult participants noted what supports or would be beneficial in their healthy eating and physical activity pursuits. The distinctive aspect of the current study findings is that participants of both genders emphasized the use of technological resources as a facilitator for promoting healthy eating and physical activity. Special reference was made to personal devices or smartphone apps for tracking weight, and diet, recording daily physical activity, and connecting to a health coach remotely for guidance and problem-solving. Despite the high usage of smartphones and smartphone-related tools and apps in Black adults (83%), few studies have used smartphone apps for tracking diet and physical activity and targeted this population[43–45]. This indicates that future interventions could use digital modalities for delivering weight loss programs. Considering the personalized weight loss program preference among both genders, future research in this area should aim to provide tailored messages and individualized intervention components[45–47]. These can comprise languages and terminologies that connect effectively with both Black males and Black females. It is likely essential to investigate the most effective ways to deliver personalized interventions through digital technology.
Female participants expressed a preference for seeking social support from social contacts primarily from friends and family. They also indicated a desire for guidance on healthy eating, particularly from healthcare professionals such as dieticians, valuing their expertise in this area. Findings from a research study by Tucker et.al (2022), show similar trends where Black women emphasized that the weight loss journey depends on an effective communication from the healthcare providers and feeling comfortable trusting the advice provided by them[46]. In line with a study by Bowie et. al. (2018), Black female participants stressed the significance of learning culturally relevant diet and exercise information from healthcare providers and connecting with them remotely for problem-solving. Female participants expressed feeling most supported when engaging in healthy behaviors with family members[47]. Similarly, Jenkins et. al.(2017), found Black women highlighted the positive impact of having a family member as an exercise or walking partner, contributing to their physical activity goals and facilitating weight loss[40].
While social support for weight loss behaviors in Black males has been less studied, some research findings indicated that having a friend or peer with similar health goals provides encouragement and accountability for physical activity goals[48, 49]. This study identified that Black male participants expressed a need for friends and coworkers to participate in both dietary and physical activity behaviors. In both Black female and male participants, social support has been recognized as a major factor for improving diet and physical activity and requires support from family members, friends, and coworkers. Weight loss interventions should aim to incorporate social support subscales for both genders, enabling a deeper understanding of how the involvement of family and friends influences each aspect of diet and physical activity behaviors with Black adults[50, 51].
This study has both strengths and limitations. A notable strength lies in the inclusion of diverse Black male and female participants from various geographical locations. Another notable strength is the diversity encompassing the ancestry, socioeconomic statuses and educational backgrounds of the participants. Participants self-identified as African American, Afro-Caribbean, and Jamaican origin and therefore reflected a variety of cultural heritage. The participants included Black adults from various socioeconomic and educational backgrounds. However, the sample was predominantly females (67%) potentially limiting their generalizability to a broader national sample. Another limitation is that the data collection occurred during the COVID-19 pandemic, potentially impacting participant’s responses due to the unique circumstances during that time which may have shifted their typical behavioral engagement to modify diet and physical activity. The participants, with an average age of 46.1 years, were mostly single (54%) and therefore the findings about weight loss program creation may not be generalizable to individuals who are older (65 years or more), or living with a partner. The current study captured the desires of both the sexes for a weight loss program, facilitators and barriers to modifying diet and physical activity. Though we acknowledge limitations in generalizability are present, the utilization of the qualitative approach allowed for a focused and commendable effort towards understanding the unique needs of Black adults for engagement in weight loss interventions for traditionally in-person and digital modalities. Future qualitative studies should aim toward addressing this identified gender imbalance to strengthen the transferability of findings.
IMPLICATIONS FOR FUTURE RESEARCH
The study findings indicate the unique weight loss preferences of Black adults with overweight or obesity. The results signify the importance of support from friends and family and the use of technological resources most beneficial to adopting weight loss behaviors. Female participants prioritized the need for a community and personalization for weight loss programs and expressed a desire to learn cooking skills and recipes to support culturally relevant meal preparation. While weight loss was the primary focus, male participants expressed a desire to learn about other health conditions, such as type 2 diabetes and hypertension and diets that could help manage these conditions. The findings hold relevance when designing weight loss interventions for including Black adults. Future research in this area should take into account the weight loss preferences of Black adults across diverse ethnicities, considering individuals living with various chronic health conditions and utilizing a greater nationally representative sample.