Obesity-related comorbidities in obese African Americans in an outpatient weight loss program.

OBJECTIVE: To identify, among obese African-American enrollees in an outpatient weight loss program, differences between those with and without obesity-related comorbidities (ORCMs). RESEARCH METHODS AND PROCEDURES: Data were from 237 obese African Americans (BMI, 30 to 50 kg/m2; 90% women) who enrolled in a 10-week lifestyle weight loss program. Analyses compared subgroups defined by ORCM status (from medical history) on baseline characteristics, program attendance, and postprogram weight change. RESULTS: Most participants (76%) had one or more ORCMs. Those with versus without ORCMs, respectively, were older (mean age, 45.6 vs. 37.1 years; p < 0.001), were less educated (59.2% vs. 76.6% with > 12 years; p = 0.031), were more likely to perceive a physical limitation affecting activity (22.2% vs. 1.8%; p < 0.001), and had higher waist circumference (mean, 113.7 vs. 106.9 cm; p < 0.001) but not BMI (38.3 vs. 37.0 kg/m2; p = 0.095). Logistic regression analyses confirmed the independence of these associations. Having ORCMs was not associated with class attendance or return for data collection after the 10-week program. Postprogram weight change (n = 134) was unrelated to ORCMs, but better weight loss was seen among those without perceived physical limitations (1.9 vs. 0.4 kg in those without versus with limitations; p = 0.069). CONCLUSION: Data from this clinical sample of obese African Americans suggest that waist circumference is relevant to ORCM status at BMI levels up to 50 kg/m2. Clear indications for tailoring of treatment based on ORCM status were not identified, although the possible influence of ORCM-related activity limitations warrants further study.

Outpatient weight management in African-Americans: the Healthy Eating and Lifestyle Program (HELP) study.

BACKGROUND: Effective clinical weight management approaches are needed to reach African-Americans. METHODS: African-Americans recruited through outpatient practices for a culturally-adapted Healthy Eating and Lifestyle Program were offered 10 weekly weight loss classes (Phase 1) with the option of continuing for another 8-18 months (Phase 2) in a randomized comparison of further group counseling or staff-facilitated self-help vs. follow-up clinic visits only. RESULTS: Of 237 enrollees (91% women; mean age 43.5 years; mean body mass index 38.0 kg/m(2)), 70 [corrected] attended no classes or only the first Phase 1 class, 134 provided Phase 1 follow-up data, 128 were randomized in Phase 2, and 87 provided final follow-up data ("completers"). Mean weight changes for completers were: -1.5 (P < 0.001), +0.3 (P = 0.47), and -1.2 (P = 0.04) kg, respectively, for Phase 1, Phase 2, and overall (baseline to final visit; average 18 months total duration), with no Phase 2 treatment effect (P = 0.55). Final study weight was > or =5% below baseline for 25% of completers and was strongly predicted by Phase 1 weight loss. CONCLUSIONS: Weight loss achieved in Phase 1 was maintained even with relatively minimal follow-up contact. Increasing the percent who achieve clinically significant weight loss initially would improve long-term results.

Racial and ethnic disparities in cardiac catheterization for acute myocardial infarction in the United States, 1995--2001.

OBJECTIVE: To examine recent trends in racial and ethnic disparities in cardiac catheterization for acute myocardial infarction (AMI) to determine whether disparities documented from the 1980s through mid-1990s persist, and evaluate whether patient and hospital characteristics are associated with any observed disparities METHODS: Cross-sectional analyses of 585,710 white, 51,369 black and 31,923 Hispanic discharges from hospitals in the Nationwide Inpatient Sample (which includes data on all discharges from 951 representative hospitals in 23 states) that had performed cardiac catheterization from 1995--2001 with a primary diagnosis of AMI. Adjusted procedure rates and prevalence ratios (PR) were computed to compare catheterization rates by race and ethnicity. MEASUREMENTS AND MAIN RESULTS: Catheterization rates were higher for whites than blacks for all years examined; rates among Hispanics increased during this period and approached the rate among whites. After adjustment for age, demographics, comorbidity, year and hospital characteristics, rates (per 100 discharges) were 58.4 for whites, 50.1 for blacks (PR 0.87; 95% CI 0.84-0.91) and 55.2 for Hispanics (PR 0.95; 95% CI 0.90-0.99). CONCLUSIONS: These nationwide data suggest blacks remain less likely than whites and Hispanics to undergo catheterization during a hospitalization for AMI. Whether this disparity stems from patient or provider factors remains to be determined.

Analysis of data with multiple sources of correlation in the framework of generalized estimating equations.

This paper is motivated by a study of physical activity participation habits in African American women with three potential sources of correlation among study outcomes, according to method of assessment, timing of measurement, and intensity of physical activity. To adjust for the multiple sources of correlation in this study, we implement an approach based on generalized estimating equations that models association via a patterned correlation matrix. We present a general algorithm that is relatively straightforward to program, an analysis of our physical activity study, and some asymptotic relative efficiency comparisons between correctly specifying the correlation structure vs ignoring two sources of correlation in the analysis of data from this study. The efficiency comparisons demonstrate that correctly modeling the correlation structure can prevent substantial losses in efficiency in estimation of the regression parameter.

Walking patterns in a sample of African American, Native American, and Caucasian women: the cross-cultural activity participation study.

This analysis describes walking patterns among African American, Native American, and Caucasian women from South Carolina and New Mexico. Walking was assessed using pedometer and physical activity (PA) record data based on 4 consecutive days on either three (Study Phase 1) or two (Study Phase 2) occasions. Participants walked 5,429 +/- 2,959 steps per day and recorded 159 +/- 59 minutes per day of total walking in the PA record. Most daily walking was accumulated during household (46%), transportation (26%), occupation (16%), and exercise-related (10%) walking. There was a modest correlation between steps per day and minutes per day. Steps per day were higher with education and household size, and lower with increasing age and body mass index. These findings have implications for developing PA surveys and for planning interventions related to walking patterns among women.

Evaluation of a two-part survey item to assess moderate physical activity: the Cross-Cultural Activity Participation Study.

PURPOSE: This study evaluated a two-part survey item that assessed adherence to the national moderate physical activity (MPA) recommendation (>/=30 min/day on >/=5 days/week). METHODS: Participants were African American (n = 137), Native American (n = 129), and Caucasian (n = 50) women >/= 40 years from South Carolina and New Mexico, who were participating in a study validating physical activity surveys. The survey item was compared with data obtained from MPA recorded in PA records (min/day), Caltrac accelerometers (Muscle Dynamics, Torrance, CA) (kcal/day), and pedometers (steps/day). RESULTS: Approximately 64% of the participants reported meeting the MPA recommendation on the survey item. Adjusted analyses showed that those who reported meeting the recommendation were more active than those who reported not meeting the recommendation (109.2 vs. 83.9 min/day, 2171.2 vs. 2088.4 kcal/day, and 5795.7 vs. 4797.2 steps/day, respectively; all p < 0.0001). The types of activities recorded in the PA record did not differ by self-reported adherence to the MPA recommendation except for walking (25.2 vs. 14.0 min/day for those who reported meeting vs. not meeting the recommendation, respectively; p < 0.05). A higher proportion of those who reported meeting the recommendation also reported participating in conditioning activities compared with those who reported not meeting the recommendation (31% vs. 19%, respectively; p < 0.05). CONCLUSIONS: The two-part survey item can reliably differentiate between higher and lower levels of activity. Those who perceive themselves as meeting the MPA recommendation are, on average, likely to have higher activity levels than those who perceive that they do not meet the recommendation.

Ambulatory activity and simple cardiorespiratory parameters at rest and submaximal exercise.

The purpose of this study was to explore the relationship between objectively determined ambulatory activity and simple cardiorespiratory parameters (heart rate and blood pressure at rest and during submaximal exercise) in individuals who were stratified for self-reported participation (yes/any vs. no/none) in vigorous physical activity (PA). Ninety-eight subjects (African Americans: 7 M, 16 F; Caucasians: 33 M, 42 F; mean age 46.4 +/- 15.4 yrs; mean BMI 26.7 +/- 4.8) wore a pedometer for 21 consecutive days and completed a 10-min submaximal treadmill graded exercise test with HR (beats/min) and BP (mmHg) measured while walking at 4.8 km/hr and a 10% grade. Subjects averaged 7,618 +/- 3.045 steps/day. There were no differences in steps/day by self-reported vigorous PA strata. There was an inverse relationship (r = -0.35, p = 0.03) between steps/day and resting HR in subjects who reported no vigorous PA. There was an inverse relationship (r = -0.22, p = 0.04) between steps/day and submaximal HR in all subjects. When stratified for self-reported vigorous PA, the inverse relationship between steps/day and submaximal HR was stronger for those reporting no vigorous PA (r = -0.39, p = 0.01) vs. those reporting any vigorous PA (r = -0.28, p = 0.05). There was no relationship between steps/day and BP at rest or during exercise in this normotensive sample.

Tailoring counseling on physical activity and inactivity for African-American women.

Physician counseling is one potential avenue to decrease levels of inactivity among African-American (AA) women and, possibly, to decrease the prevalence of adverse health outcomes, which can be reduced through regular participation in physical activity. Physical inactivity has been associated with increased morbidity and mortality, as well as risk for various health outcomes, including cardiovascular disease, stroke, diabetes, and some forms of cancer. The problem of inactivity applies to all US adults, but national data consistently show that levels are highest among AA women. The first section of this brief review provides background information related to the prevalence of physical activity, current physical activity recommendations for various outcomes, and the healthcare provider's role in increasing physical activity. The second section suggests practical approaches for physicians who wish to counsel AA women about increasing physical activity. Many of the approaches are also applicable to AA men and to the general population.