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  • March 20, 2019
  • Alick, Candice
    • Affiliation: Gillings School of Global Public Health, Department of Nutrition
  • Black men (BM) suffer disproportionately from obesity and obesity related conditions when compared to White men and women. Behavioral lifestyle weight loss(WL) interventions have been identified as the gold standard for obesity treatment. In current research, BM experience low participation rates and reduced efficacy in response to these interventions. Partner involvement, a culturally appropriate source of social support (SS), and the use of the Theory of Interdependence of Communal Coping, a dyadic theoretical framework, provide the opportunity to increase enrollment and produce greater WL among this population. The overall goal of this research project was to assess whether a spousal support-enhanced WL intervention is effective in producing significant WL among BM. Aim 1 examined factors that influence WL among Black heterosexual couples (n=20) using in-depth interviews from their experiences. Couples reported reasons for maintaining a healthy weight/WL, trigger events for WL, barriers and facilitators to eating habits, physical activity and WL, specific supportive behaviors, the use of social control, and preferences for working to together to improve weight related behaviors. Aim 2 evaluated the feasibility and preliminary efficacy of a 12-week, spousal support-enhanced intervention aimed at increasing WL compared to a standard treatment. All (n=40) male participants and 98% of female partners were retained. Between 63-73% of group sessions were attended. Self-monitoring were low using an online tracking diary in both groups. From baseline to 12 weeks, participants (n=40) in both groups loss weight (standard: 3%, p=0.05 vs. enhanced:4%, p=0.001), with no significant differences between groups. Waist circumferences decreased in both groups, (standard: 2.9 cm, p=<.0001vs. enhanced: 4.7 cm, p=<.0001), with no significant differences between groups overtime. Participants in the enhanced group(n=21), reduced diastolic blood pressure (mean change: -9.4 mmHg, p=0.004), moderately decreased daily caloric intake (mean change: 593.8 kcal/day, p=0.06), and increased weekly energy expenditure (mean change: 826.1 kcal/week, p=0.001) over time. Female partners of the enhanced group lost 2.24% of initial weight compared to female partners of standard group participants (0.15%). Aim 3 examined the effects of the intervention on family functioning (e.g., communication, cohesion, emotional involvement, perceived criticism), SS, self-regulation and self-efficacy. Examining medium effect sizes between groups, the enhanced group reported improved communication (mean change: 0.23; d=0.64, p=0.06 between groups), increased incendiary communication (mean change: 0.52, d=0.44, p=0.19 between groups), decreased cohesion (mean change: -2.33, d=0.76, p=0.03 between groups), and decreased emotional involvement (mean change: -1.70, d=0.77, p=0.4 between groups) relative to the standard group over time. Among all participants, SS, self-regulation and self-efficacy did not change over time. The shifts in family functioning in the opposite direction did not influence WL in the enhanced group. Results of this dissertation project suggest that a spousal support-enhanced WL intervention may be a promising approach to WL among BM and their partners, however, additional research is needed to examine these effects in a larger sample and with a longer study duration.
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  • In Copyright
  • Tate, Deborah
  • Ward, Dianne
  • Rini, Christine
  • Samuel-Hodge, Carmen
  • Ammerman, Alice
  • Doctor of Philosophy
Degree granting institution
  • University of North Carolina at Chapel Hill Graduate School
Graduation year
  • 2017

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