February 2007

Grant Results

SUMMARY

In 2005, Erica G. Phillips-Caesar, M.D., M.S., and a team of researchers at the Weill Medical College of Cornell University conducted focus groups with African-American and Hispanic women in the East and Central Harlem neighborhoods of New York City. The purpose was to find out what got in the way of their eating healthy foods and increasing their physical activity.

Key Findings

  • The focus groups identified four principal causes of obesity: genetic predisposition; aging; eating habits developed during childhood that are difficult to break; food insecurity.
  • The focus groups were split on their understanding of "physical activity" versus "exercise.
  • The focus groups identified four main components of a healthy diet: Portion size; food preparation; types of food; timing of eating.
  • The focus groups identified four barriers to healthy nutrition and physical activity: Costs; lack of accessibility to healthy food options; lack of willpower; time constraints.
  • The researchers found that data collected on the weight of focus group participants came close to what participants thought their weight was.

Key Results
Using the women's input, the researchers created Eating Well and Exercising for a Healthier Harlem, a workbook to help overweight and obese women make lifestyle changes to improve their health.

The study and workbook are the first phase of a larger-scale program to reduce the serious health consequences of overweight and obesity among minority women living in these New York neighborhoods.

Funding
The Robert Wood Johnson Foundation (RWJF) supported this unsolicited project with a grant of $25,000.

 See Grant Detail & Contact Information
 Back to the Table of Contents


THE PROBLEM

Obesity is currently an epidemic in the United States. While rates of obesity have increased in all age, racial and ethnic groups, minority women have been disproportionately affected.

Data from the 2002 New York City Health and Mental Hygiene survey reveal that African-American (30 percent) and Hispanic (26 percent) women are more likely to be obese than white (13 percent) and Asian (7 percent) women. Consequently, African-American and Hispanic women suffer a disproportionate burden of obesity-related diseases.

This disparity is apparent in East and Central Harlem, where rates of mortality remain two times higher than in 41 other neighborhoods in New York City. In Harlem, the death rate from diabetes is almost double that for New York City as a whole.

Although many conditions contribute to racial disparities in mortality, a study in the New England Journal of Medicine (November 14, 2002) noted that more than 40 percent of the differences result from increased levels of:

  • Hypertension.
  • Diabetes.
  • Cardiovascular diseases (especially ischemic heart disease, a condition that reduces blood supply to the heart).

Research suggests that modest amounts of regular physical activity and healthy eating habits can prevent weight gain and promote weight loss. Yet rates of adopting these behaviors remain poor, particularly among ethnic minorities.

 Back to the Table of Contents


RWJF STRATEGY

RWJF has supported a number of projects addressing nutrition and exercise issues for African-American and other minority women:

  • Researchers at the University of Alabama conducted a study of the factors that promote physical activity among rural African-American women in Wilcox County, Ala. See Grant Results on ID# 038325.
  • Researchers at seven universities conducted a study of groups of racially and ethnically diverse women about the factors that affect their level of physical activity. RWJF provided a grant of $387,929 to fund expansion of the survey sample in the study. The results of the complete study will be used to develop and test a model of the determinants of physical activity. See Grant Results on ID# 044181.
  • A researcher explored the practices, knowledge and attitudes regarding physical activity of four groups: mothers on welfare; chronically ill adults; senior citizens and low-income, minority women. These and other underserved groups often experience unique challenges-both environmental and individual-to becoming physically active. See Grant Results on ID# 038140.

 Back to the Table of Contents


THE PROJECT

During 2005, researchers conducted four focus groups made up of overweight and obese African-American and Hispanic women in East and Central Harlem in New York City. The purpose was to identify the reasons for unhealthy nutrition and reduced physical activity. See Findings.

The researchers also collected basic data from the focus-group participants, including demographics, general health, physical activity and their intake of dietary fat, fruits and vegetables.

To conduct the study, researchers worked with the Harlem Community Academic Partnership (the partnership), a group committed to community-based research and interventions to improve the health of urban residents. The partnership is made up of community-based organizations, the New York City Health Department and the Center for Urban Epidemiology Studies at the New York Academy of Medicine.

The researchers met regularly with a subcommittee of the partnership focused on obesity to develop the recruitment process and an interview guide for the focus groups. Three local Harlem organizations, which are part of the partnership, provided members for the focus groups and hosted groups at their organization offices.

The study was the first phase of a large-scale intervention to promote healthier eating and increased physical activity in ethnic minority communities leading to reductions in obesity and its related health consequences. See After the Grant.

 Back to the Table of Contents


RESULTS

Project staff reported these results:

  • The researchers created a 30-page workbook, Eating Well and Exercising for a Healthier Harlem, that helps users:
    • Calculate their body mass and establish weight-loss goals.
    • Understand the importance of physical activity, establish a schedule of exercises and keep a daily pedometer record.
    • Understand healthful nutrition and keep a log of foods eaten.
    • Gain confidence in making lifestyle changes.
    • Work with the support system in the community.
    • Contact and work with a "buddy."
    • Sign a nutrition and exercise "contract" and make progress reports.
    • Stay positive.

Findings

Project staff reported these findings from the focus groups:

  • The focus groups identified four principal causes of obesity:
    • Genetic predisposition. ("Everyone in my family is big.")
    • Aging. ("I used to be very thin, but after age 40 I started gaining weight.")
    • Eating habits developed during childhood that are difficult to break. ("I grew up in the household of a minister, so food was a part of our culture.")
    • Food insecurity. ("I grew up hungry, my family was on welfare. When I go to the grocery, I buy in abundance. The more I get for my money, the better. I push food on my kids; no one in my house will ever be hungry.")
  • The focus groups were split on their understanding of "physical activity" versus "exercise":
    • Some participants felt that daily physical activity had little to no benefit in weight loss and that only "exercise" (i.e., aerobics, weight training) would lead to weight loss. ("During exercise you exert more energy than you would say doing housework, where you can stop and sit down. With exercise you put all that energy out at that one particular moment.")
    • Other participants felt that physical activity is similar to exercise with the same benefits. ("When I clean the house I am reaching, mopping, climbing on things; that's the same as exercising.")
  • The focus groups identified four main components of a healthy diet:
    • Portion size. ("I think also that we need to cut down on the portions we eat.")
    • Food preparation. ("Boil or broil your chicken, not fried; don't eat fried foods.")
    • Types of food. ("Eat vegetables, fruit and fish; those things are not fattening.")
    • Timing of eating. ("Eating and then going to sleep is a bad thing; that's why so many of us are blowing up.")
  • The focus groups identified four barriers to healthy nutrition and physical activity:
    • Costs. ("Healthy food costs more. Just like when I take the kids out, we are not buying a salad, which is four dollars, while the 99 cent menu is full of fattening stuff. Being poor, you can't spend a lot of money on all this healthy stuff.")
    • Lack of accessibility to healthy food options. ("In my country [Mexico] we are used to harvesting fruit and vegetables. You come to this country and the only thing to eat here is pizza, fried food and McDonald's.")
    • Lack of willpower. ("I do not have the willpower to follow a diet. Willpower is what a person needs to put all the effort to avoid eating food that is bad for you.")
    • Time constraints. ("The main problem for many of us who work and come home tired, you do not feel like exercising. We have to work more hours to earn more money to be able to afford rent, for everything.")
  • The researchers found that data collected on the weight of focus group participants came close to what participants thought their weight was.

 Back to the Table of Contents


LESSONS LEARNED

  1. Focus groups are an excellent source of information for developing a community-based program. While this process increases the time needed to move a project forward, it also enhances its chances of success. (Project Director)

 Back to the Table of Contents


AFTER THE GRANT

Phillips-Caesar, the project director, presented study findings at "The Ecology of Obesity" conference hosted by the College of Human Ecology at Cornell University, June 6–7, 2006. She also has prepared a manuscript about the project to be submitted to a peer-reviewed journal.

To help develop the large-scale intervention, Phillips-Caesar used the workbook to train 15 women age 50 and over in East Harlem to be teachers of others regarding nutrition and physical activity.

The 12 training sessions were held in a recreation center in Harlem between March and September 2006. The Cornell Institute for Translational Research in the Aging (CITRA), for research regarding people age 50 and older, funded the training sessions.

In the large-scale intervention, the teachers trained in the pilot will partner with overweight mothers who are enrolled in Women, Infants and Children, a federally funded supplemental nutrition program for low-income women and children, to teach them to improve their nutrition and physical activity.

 Back to the Table of Contents


GRANT DETAILS & CONTACT INFORMATION

Project

Identifying Determinants of Nutrition and Physical Activity Among Overweight Minority Women

Grantee

Weill Medical College of Cornell University (New York,  NY)

  • Amount: $ 25,000
    Dates: February 2005 to February 2006
    ID#:  052726

Contact

Erica G. Phillips-Caesar, M.D., M.S.
(212) 746-1607
erp2001@med.cornell.edu

 Back to the Table of Contents


BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

Reports

Phillips EG, "Eating Well and Exercising for a Healthier Harlem," New York: Center for Complimentary and Integrative Medicine, Joan and Sanford I. Weill Medical College of Cornell University, 2005.

 Back to the Table of Contents


Report prepared by: Carl A. Taylor
Reviewed by: Kelsey Menehan
Reviewed by: Molly McKaughan
Program Officer: Jeane Ann Grisso