A weight-management strategy that emphasised prevention of weight gain, rather than weight loss, helped black women maintain their weight for 18 months in a new study.

In the study published in JAMA Internal Medicine, a group of 194 black women, ages 25 to 44 were placed in an intervention programme in which they received counselling on weight maintenance techniques while the other half received weight loss counselling.

Research suggests black women are typically more satisfied with their bodies and seem to care less about shedding excess weight, says Gary Bennett, head of the Duke Obesity Prevention Program in Durham, North Carolina, and associates.

Prevention of weight gain may be a worthwhile goal in black women because they might be more receptive to intervention messages about weight maintenance versus loss. Maintenance also offers the advantage of requiring less-intensive changes compared to weight loss interventions.

"If black women continue to gain weight year and after year, and they almost invariably do … they go from that lower level of obesity, where health risks are relatively low, to that higher level of obesity,” says Bennett.

A weight loss focus could prove to be especially challenging as premenopausal black women gain more weight per year than any other racial/ethnic group. By age 40 to 59, twice as many black women have class 2 obesity.

To prevent weight gain, the participants received customized health goals to follow for 18 months. The goals were simple and involved regulating habits such as limiting the number of sugar-sweetened drinks and eating more fruits and vegetables. Researchers also monitored the amount of time spent sleeping and brisk walking.

"These goals make a slight calorie deficit, enough to prevent weight gain,” Bennett said. "You only need to reduce 100 to 200 calories a day to prevent weight gain, whereas if you want to lose, you have to reduce by 500 calories a day.”

After a year, 45 per cent of the women in the weight loss group were at or below their weight at the start of the program, compared to 62 per cent of the maintenance group. After 18 months, the weight loss group continued to gain weight while the maintenance group remained the same.

Researchers did not find any differences in blood pressure or cholesterol despite preventing weight gain. But, they wrote, "It may be that greater weight losses than those reported … are required to achieve improvements in cardiovascular disease risk factors, and weight maintenance may need to be sustained longer to achieve such health benefits.”

The results of the study demonstrates that "a moderate-intensity intervention can prevent weight gain among a high-risk population,” said Dr Regina Benjamin and co-authors Dr Susan Z. Yanovski, of the National Institute of Diabetes and Digestive and Kidney Diseases, and Dr Denise G. Simons-Morton, of the National Heart, Lung and Blood Institute.

"Although clinical interventions are important to prevent weight gain in adults and reduce weight in obese adults, we also need effective strategies throughout the lifespan to prevent obesity and its comorbid conditions, as seen at baseline by Bennett et al.,” they added.

Bennett said that because the study program was coordinated through primary care offices and largely computerized, it was less expensive than a weight loss intervention and should be feasible in a range of communities.

For overweight women who can’t or don’t want to lose weight, "maintaining and not gaining weight should be the absolute clinical priority,” concludes Bennett.

Dr Cory Couillard is an international health columnist working in collaboration with the World Health Organisation’s goals of disease prevention and global health care education.

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