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Growing up on a farm in Texas, Otelio Randall understood the basic principles involved in preparing livestock for butchering. You put an animal in a small pen to keep it from moving about and stuff it with food to fatten it up. For Randall, now a cardiologist in Washington, D.C., these memories are all too analogous to the behavior he sees in many of his patients. “What these people are doing is sitting themselves in a pen, watching TV and eating,” he says. “It's no mystery why people are getting fatter.”
Randall has set up a supervised diet and exercise program at Howard University Hospital, targeted mainly at African-American women who, he says, are “the most obese population in the United States.” The numbers bear him out. One recent study even showed that a staggering 78 percent of black women are overweight, 50 percent are obese and 15 percent weigh 100 pounds or more in excess of a healthy weight. Other minority groups, including African-American men, Latinos and Pacific Islanders, suffer from greater weight problems than society as a whole.
Dianna Wright checks Jacqueline Starr at a weigh station during the “Fun, Fit and Free Festival” in Philadelphia on July 3, 2001. A recent study showed that 78 percent of black women are overweight. (Getty Images/William Thomas Cain)
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For that reason, many researchers initially assumed there were genetic differences to blame for the high obesity rates within these groups, says Shiriki Kumanyika, associate dean for health promotion and disease prevention at the University of Pennsylvania medical school. But with the rest of the population catching up in weight gain, it appears that those groups were just hit by the obesity epidemic harder and earlier. “If you make a list of the kind of environmental factors that are obesity promoting,” Kumanyika says, “many of them are more prevalent in areas where minorities live, especially African-Americans.” Among the factors in inner-city neighborhoods that contribute to obesity are fewer opportunities for exercise, due to lack of open space and safety concerns, plus a dearth of full-service groceries or other food stores that might offer fruits and vegetables.
“Safety in the neighborhood is a concern,” says Marie Primas-Bradshaw, a retired schoolteacher who lives in a black-dominated southeastern section of Washington. Primas-Bradshaw has long had poor eating habits. She loves Pepsi and potato chips and says, “I baked cakes and ate half of them.” As a result, even though she had been petite as a young woman, she eventually carried 190 pounds on her 4'11” frame.
Having reached her late 50s — the same age her father was when he suffered the first in a series of strokes — Primas-Bradshaw grew sufficiently concerned about the effect her weight was having on her health to enter Randall's expensive program at Howard. Participants in the program spend at least 45 minutes three times a week exercising on treadmills and eat meals that Randall, with the help of his wife Donna, provides. The meals are low in salt and fat — particularly saturated fat — with enough choices so that no dish is repeated within a two-week timeframe. “We figured these meals had to look good, taste good and have some variety,” he says. They offer instruction on both shopping and cooking, so that participants can re-create the meals that helped them shed the weight.
For Primas-Bradshaw, the program worked. She lost 40 pounds, and, although she admits she recently regained seven of them over the holidays, she says she's eating right and keeping up her time on her home treadmill. Other success stories from the program have been written up in People, Ebony and The New York Times. Many patients have not only lost weight, but have been able to cut back on their diabetes and cholesterol medications. The Randalls have written Menu For Life, a book describing their diet and exercise program that will be published in March.
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For Dr. Randall, the challenge is not helping his relatively limited universe of patients to lose weight. That, he says, is not a problem. His larger hope is that African-Americans and the greater population at large will make the lifestyle changes needed to beat obesity. He's encouraged by some anecdotal signs of change. Black churches, which traditionally have fed their parishioners perhaps too well at functions, have become major partners in blood-pressure screening, and many of them now offer gym classes and full fitness regimens.
“People are going to be there anyway, it's convenient,” says Jeanne Charleston, director of a University of Maryland program that sends trainers and dieticians to about 20 black churches a year. In addition, fitness chains, such as Bally Total Fitness and 24 Hour Fitness, which is partnering with former basketball great Magic Johnson, have discovered the urban core as a ready market.
“People say you can't change behavior, but I believe you can,” Dr. Randall says. “I don't think there's anyone who doubts the benefits of this — they just don't do it.”
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