DISCUSSION
Despite the abundance and variety of weight-loss programs
that are available to the public, 80% of African-American
women are still overweight or obese (22). The women’s narrative
from this study revealed a struggle between accepting
themselves and their bodies “as is” and being motivated to
make substantial lifestyle changes to manage their weight
and decrease their health risks.
The decision to lose weight is heavily based on the perception
of one’s weight (23). Participants made distinctions between
“healthy weight,” “overweight,” and “obese.” Weight
perception differs by culture, with African-American women
half as likely to consider themselves overweight or obese
compared to their white counterparts (24). African-American
women need help in assessing their weight in the context of
their health risks. In addition to using BMI, health risks should
also be assessed with waist circumference, waist-to-hip ratio,
and biochemical indicators (25).
Practitioners should also remember that obesity is a medical
diagnosis and not a personal characteristic. Describing
someone as obese is often perceived as an insult (26). It is
more accurate and sensitive to tell a client that they have been
diagnosed with obesity rather than saying “you are obese.”
Most women believed culture and genetics made them susceptible
to obesity. African-American culture appears to have
a cocoon effect that prevents many women from buying into
the popular notion that “thin is beautiful” (27). Dietetics practitioners
walk a fine line when addressing weight within a
cultural context. It might be helpful to emphasize that obesity
is a health threat for all Americans, regardless of ethnicity,
income, and sex.