COMMENTARY

What's Stopping African American Women From Exercising?

Nefertiti Durant, MD, MPH; Mark Harmel, MPH

Disclosures

May 02, 2016

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The focus of my work is African American women and young adults who are overweight and obese. I'm from Birmingham, Alabama, where rates of obesity and overweight in African American women, young adults, and adolescents are high. I decided to do something about it. Four out of five African American women are overweight or obese, but we can change that if we start early.

I recruited young women from the University of Alabama at Birmingham into a technology-based intervention to promote physical activity. We used an approach where we started by asking the young women what they wanted. The young women were recruited into focus groups where we asked them, "What are the barriers to physical activity?"

We came up with some very interesting results. One of the barriers that they identified was social stigma and shame. In particular, they identified that they were ashamed when they were in the gym. They felt that they couldn't operate the equipment, and this was a very shameful experience for them.

They also felt that some of the young women in the gym were so thin that it was stigmatizing to them. They identified hair concerns—having to deal with their hair and putting their hair together after they worked out—as a barrier for them. They also identified lack of social support from their friends. They felt like they didn't have friends to work out with. And they identified economic concerns about having enough money to pay for a gym membership.

We put that information together with what they identified as their preferred medium for the program, which was the Internet. They wanted an Internet-based portal to promote their physical activity, and this is the program that we built for them. We called it Commit to Fit. We had the young women come to the gym four times a week and work out together, walking as a group. The physical activity technology-based program that we used included a blog, a recipe program, a diet tracker, and a physical activity tracker.

The young women loved it. For the first 3 months, their physical activity and social support went up. It was successful. However, the retention rate was a modest 50%, so we went back to the drawing board.

Our second program was called Fit Heart. We asked the young women, "How can we improve your retention? How can we improve your physical activity?" They said they need better images; they need images of real black women. So we went around Birmingham and took pictures of real black women.

The second study had better retention rates, going up to 81%. Also, sedentary behavior decreased. However, the physical activity results were not as encouraging, so we still have some work to do.

In our next phase of studies, we're looking at text messaging and narrative storytelling—having the women tell their stories by video. We have already taped those videos and are hoping to incorporate them into our Internet-based program.

There's still work to do, but we feel that we can do it. While 80% of black women are overweight or obese, we feel strongly that we can change that by starting with our adolescents and young adults, hearing them, and incorporating their voices into our programs.

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