This article was featured in the January issue of ESSENCE.
Maybe you were a little girl who couldn't get enough of Grandma's peach cobbler or the former high school athlete who grew plump on a steady diet of fast food in college. Chances are, if you're a Black woman, you're carrying excess weight that may be putting your health at risk. A recent study from Columbia University found that more than one in four African-American women will likely die of obesity-related diseases. And it's not for lack of trying that we haven't kept the weight off. "I've tried Atkins, South Beach and Weight Watchers," says Angela Rogers, 48, who has struggled with her weight since she was a child. "No matter how much people talk about Black women liking their curves, no one wants to be obese. I never feel comfortable in my body; I can't move around the way I want. It's not something a lot of Black women talk about, but I hate being fat."
According to the Centers for Disease Control and Prevention, obesity is characterized by having a body mass index (BMI) of 30 or more. A 5-foot 5-inch, 180-pound woman has a BMI of 30; normal BMI is between 18.5 and 24.9. (To find your BMI, plug your height and weight into the BMI calculator available online at cdc.gov.) For years prevailing wisdom held that African-American women's higher obesity rate was linked to socioeconomics. A large percentage of us live in economically depressed neighborhoods in which there are few safe places to exercise, a paucity of healthy food choices and an abundance of pizza spots and fried chicken joints. But research shows "African-Americans are disproportionately overweight and obese across all socioeconomic statuses," notes Michelle Bailey, M.D., director of medical education at Duke Integrative Medicine in Durham, North Carolina. "There's something more going on than just lack of education and financial resources." Undoubtedly, there are a host of factors contributing to our rising rates of obesity, but experts agree, unlocking the mystery of why we are prone to putting on extra weight is the first step to taking it off.
LEAVING THE FOLD
If you really want to understand weight gain and loss among African-American women, a good place to start is the Black Women's Health Study (BWHS). For the past 20 years, Boston University's Slone Epidemiology Center has collected detailed health questionnaires from 59,000 Black women across all socioeconomic groups and all regions of the country. One of the most surprising pieces of information to emerge from the research is the age at which we are most inclined to put on weight, says epidemiologist Julie R. Palmer, BWHS's coprincipal investigator.
Most overweight women experience the majority of their weight gain in the decade leading up to, and right after, menopause. According to J. Shah, M.D., a bariatric physician and director of Amari Medical in Scarsdale, New York, "The average woman puts on between 20 and 25 pounds between the ages of 35 and 55."
The BWHS found that overweight Black women gain the majority of their weight a decade earlier. "When we look at the prevalence of obesity, the steepest increase is before age 35," notes Palmer. She says researchers haven't identified the reasons for the earlier gain, but one possibility is that between 60 and 70 percent of Black women have their first child before age 25. "We see Black women putting on a substantial amount of weight in those first couple of years after the first baby," says Palmer.
Atlanta health researcher Fleda Mask Jackson, Ph.D., suggests another factor may be at play. She says before their mid-twenties many African-American women are "cocooned in their communities," where they received support and validation. "Then they transition into the workforce only to face discrimination and the stressors of both racism and sexism. This stress can contribute to whether a woman eats healthily or not, whether she sleeps or not, and whether she gets proper exercise. The social isolation and stressors may be a greater risk for poor health outcomes than we realize."
Participants in the BWHS were asked to rate their experience of racism with questions such as "How often do you feel people are afraid of you?" and "How often do you feel people think you are less intelligent than you are?" The data was then compared with respondents' weight gain over an eight-year period. "We found a higher weight gain in women who had perceived the most racism," says Palmer. "What we're seeing is that the body's response to the chronic stress of racism can lead to weight gain and obesity."
WEIGHT LOSS RX:
"Black women need to be very deliberate about creating supportive communities for themselves," says Jackson. Try getting involved with a group outside of work, through your church, sorority, gym or volunteer organization. "In those circles make a commitment to support each other around your health and well-being," she adds. Connecting with friends allows Black women to speak openly about their experiences of racism and to hold one another accountable for their health goals. Research shows African-American women who enjoy support from pals are more likely to engage in regular physical activity. In fact, encouragement from girlfriends was linked to more positive health behaviors than support from a spouse.
Gayle Porter, Ph.D., and Marilyn Gaston, M.D., founders of the Gaston & Porter Health Improvement Center in Potomac, Maryland, have based their practice on the benefits of social support. In their Prime Time Sister Circles, Black women in communities around the country meet two hours a week to focus on improving their fitness, nutrition and stress management. One of the complaints Gaston and Porter say they hear most often is that women are too fatigued to exercise. That's no surprise, given all we have on our plates. "We are focusing on taking care of everybody else," says Gaston, a former assistant surgeon general and coauthor, with Porter, of Prime Time: The African American Woman's Complete Guide to Midlife Health and Wellness (One World/Ballantine). Black women are often the primary breadwinners in their families as well as caretakers of children, grandchildren and elderly relatives. All this responsibility can lead to unhealthy patterns, says Bailey. "Black women feel obligated to take care of the family, and we often put ourselves at the bottom of the list. We sometimes cope through emotional eating—often dining after everyone else, so we're eating in isolation or late at night because we're trying to get everything done. Sometimes we don't eat at all, and we know that skipping meals leads to accelerated rates of weight gain."
WEIGHT LOSS RX:
Can't imagine putting yourself ahead of the needs of your family? Porter and Gaston pose the following question to women: If you knew that walking 30 minutes a day would cut your child's, your mama's or your spouse's risk of having a heart attack in half, would you do it? "If you would do it for them, do it for yourself," adds Gaston. "Half an hour of walking will also cut your weight by 5 to 7 percent, which will decrease your risk for diabetes by 60 percent. So when women say they want to give a gift to their loved ones, we say focus on your health."
Show us a superwoman, and we'll show you a sister who's not getting enough sleep. Sure, a double cappuccino will help you get through the morning, but that lack of rest is leaving you more than bleary-eyed. Several recent studies have shown that getting fewer than six hours of sleep a night puts you at greater risk for obesity. Among Black professionals, only 58 percent of us logged the optimal amount of zzz's. A 2013 study from UC Berkeley found that lack of sleep causes an increase in appetite and cravings for sugary and high-fat food. "If I had to pick one thing to help with weight loss, it would be to get more sleep," says fitness and nutrition expert JJ Virgin, author of The Virgin Diet: Drop 7 Foods, Lose 7 Pounds, Just 7 Days (Harlequin). "Just one night of poor sleep creates total hormonal chaos in your body. Your cortisol is higher, which makes you more insulin-resistant, meaning you're better at storing fat, worse at burning it off. On top of that you're craving junk." Have you ever heard of a 2 A.M. salad run?
WEIGHT LOSS RX:
The only way to get a good night's sleep is to make it a priority. Give yourself a strict bedtime, one that's seven and a half hours before you need to wake up, and then stick to a routine. One hour before bedtime, turn off all electronics; half an hour before, engage in some relaxing activity, such as reading or taking a bath. Ten minutes before bed, practice deep breathing.
THRIFTY GENE HYPOTHESIS
While some women gain weight in response to the stress of a doing-it-all life, others note all the females in their family who appear to be battling the same slow metabolism and chalk it up to genetic predisposition. They may be right. "There seem to be factors driving obesity that are purely genetic," agrees Alan Christianson, a naturopathic doctor specializing in endocrinology in Scottsdale, Arizona. Christianson explains that one theory, the thrifty gene hypothesis, holds that certain genes, which may be more prevalent in African-Americans, "respond to an abundance of calorie-rich food by storing weight." The thrifty gene may have been beneficial when we lived in a time of feast or famine, but in a country with 24-hour access to supersize meals, not so much.
Holly Lofton, M.D., director of the Medical Weight Management Program at NYU's Langone Medical Center, says genetics can also determine whether you store fat around your middle or on your hips and thighs (think apple-shaped versus pear-shaped). "This is significant," says Lofton, "because there is a high correlation between having abdominal fat and having fat around the heart and within the coronary vessels. That's what leads to heart disease." Lofton stresses that, "Research shows exercise can overcome genetic predisposition. While that won't always necessarily make us achieve a normal BMI according to the scale, it can help us decrease our risks for weight-related health problems and increase life span."
WEIGHT LOSS RX:
If you're convinced that you're genetically wired to store fat more easily, your best defense is to make a few simple changes to your diet and up your physical activity. "Stay away from food that is most easily stored as fat, such as sugars and refined carbohydrates, like the ones found in breads, pastas, cakes and cookies," advises Christianson. "Build your diet around produce and protein." He also recommends beginning your meal with high-volume, low-calorie foods, such as a large salad, to give you a feeling of fullness. Lofton suggests starting the healthy habit of identifying 250 "negotiable calories" that you can eliminate from your diet. For instance, replace one soda a day with water. Then get moving. "Exercise gets a bad rap because people think, I'm in the gym, on a machine, like a hamster in a wheel," says Lofton. "But it doesn't have to be that way. I encourage people to find something that is already part of their lives and just do it more vigorously. For instance, if you're at your kid's soccer game, walk briskly around the track." Try marching in place during the commercial breaks of Scandal or twerking to RiRi while you wait for the laundry to dry. "It doesn't have to be something that will take hours out of your life, but it should be something you'll enjoy so it's more likely you'll stick with it."
TOO MANY CARBS
One of the most enduring tenets of weight loss is that to lose weight you have to cut calories. But according to Gary Taubes, founder of the Nutrition Science Initiative, a not-for-profit think tank dedicated to obesity research, if you really want to lighten your load, focus less on counting calories and more on reducing the real culprit: sugar and refined carbohydrates.
In his book, Good Calories, Bad Calories (Anchor), Taubes states that a diet high in sugar and carbs is inherently more fattening than a diet of the same number of calories without the carbs. "I would argue that if I fed identical twins 2,500 calories a day and one of them ate sugars and refined grains and the other one did not, only the twin eating the sugar and carbs would become obese." Obesity is "not a problem of eating too much, it's a biological disorder," says Taubes, explaining that carbohydrates, which are broken down into sugar in the body, stimulate the production of insulin, which, in turn, leads to the accumulation of fat and the development of type 2 diabetes. Taubes maintains that African-Americans are especially sensitive to the effects of sugar and carbohydrates because these foods have been in our diets for less time than for people of European descent. "There is a theory that says the newer something is in your environment the greater the effect it's going to have on you," he explains. "So European populations that have been eating refined grains for 10,000 years will have adapted to them. African-Americans, who were forcibly imported to the U.S. 300 to 400 years ago, for the most part hadn't had sugar in their diets before."
WEIGHT LOSS RX:
"For years the medical community has told us to eat carbs, not fat," says Taubes. "It turns out when you eat fat and not carbs, not only do you tend to lose weight but your heart disease risk factors also improve." Skeptical? Try eliminating sugar, refined carbs and processed foods, and eat as much as you want of everything else. Taubes maintains you won't feel hungry and you'll lose weight.
AN IMPERFECT PAST
A growing body of research suggests that sometimes the biggest obstacle to a healthy future is a troubled past. Nadine Burke Harris, M.D., CEO of the Center for Youth Wellness in San Francisco and an expert on the effects of childhood trauma, says, "Significant data demonstrates that being exposed to trauma increases your risk for a number of poor health outcomes, including obesity."
The Adverse Childhood Experiences study looks at the health outcomes of adults who, as children, experienced physical, emotional or sexual abuse, physical or emotional neglect; had a parent who was mentally ill, substance dependent or incarcerated; or were exposed to domestic violence, parental separation or divorce. "If you've had four or more of these childhood experiences, your risk of being overweight or obese more than doubles," says Harris. The weight gain is caused by multiple factors connected to the release of cortisol in response to chronic stress. Trauma also impacts the pleasure center of the brain, adds Harris. "This is the area activated by drug addiction but also stimulated by high-sugar, high-fat foods. Changes in the brain cause folks with a history of trauma to feel pleasurable experiences less intensely, so they need more stimuli to get the same amount of enjoyment as someone else. That's partly why people who've undergone trauma have higher rates of smoking, alcohol and substance abuse and food addiction."
WEIGHT LOSS RX:
"I recommend that women who have a history of trauma get counseling," says Harris. "I know as Black people we don't always like to go there. But research shows therapy is crucial. I also recommend daily exercise." Physical activity helps metabolize the hormone cortisol so there is less of it in your body, explains Harris. "It also stimulates the release of endorphins, the feel-good hormone, which can support the pleasure center of the brain."
SMART GIRLS WORKOUT
Adding 30 minutes of physical activity to your daily routine will help you reduce stress, sleep better and cut down on your risk of heart disease, diabetes and depression. But if you want to use exercise as a means of dropping weight, you've got to be strategic about it. That means engaging in high-intensity interval training, which fitness experts say impacts your metabolism most efficiently.
WEIGHT LOSS RX:
Pick a challenging activity that suits your current fitness level—say walking up stairs if you're sedentary or running up stairs two at a time if you are more active—and then do it for 30 to 60 seconds at your maximum capacity, suggests fitness expert JJ Virgin. Take a break for twice as long as you engaged in the activity (60 to 120 seconds) and then repeat the cycle. Do this eight times, for a total workout of about 20 minutes. "For people who weigh 300 and 400 pounds, the activity might be getting in and out of a chair," says Virgin. "Whatever your level, high-intensity intervals will get your body to burn fat better than walking on a treadmill."
Let's be honest: Exercise is fun if you're good at it. But for a lot of us the idea of being told to sprint up and down stairs to lose the weight can trigger a response that makes us dig in our heels. You know, You're not the boss of me and you can't tell me what to do. I don't have to conform to your idea of beauty. Sound familiar? You're not alone, says Hanne Blank, author of The Unapologetic Fat Girl's Guide to Exercise and Other Incendiary Acts (Ten Speed Press). "I love to exercise, but if somebody told me to go to the gym so I can lose 40 pounds I'd tell them to get lost." In fact, a recent study from Baylor College of Medicine in Houston suggests that for Black women, many of whom don't subscribe to Hollywood's stick-thin notion of beauty, exercising for the sole purpose of losing weight is perhaps the least effective motivation available. "Black women do quite well with our body image," says NYU's obesity expert Holly Lofton. "And we don't always want to achieve what's considered 'normal' on the BMI table." Lofton says if a woman is leading a healthy lifestyle, getting regular exercise, seeing her doctor and maintaining her weight, "even if she doesn't fit the 'normal' range on the BMI table, she doesn't necessarily need to push herself to get there." According to the Baylor study, we are most successful at maintaining long-term weight loss when improved health is the goal.
WEIGHT LOSS RX:
About to embark on an exercise plan? Instead of posting a picture of a bikini on the fridge, focus on how regular activity improves your mood, gives you more energy and makes you healthier. "Think about things you want to do and how you want to feel," says Blank. "Like I want to ride a bicycle or I want to play with my kids and not worry if they want to get down on the floor and wrestle. Being able to move freely in the world and take joy in your body is invaluable." And that is perhaps the greatest motivator of all.