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Publication Date

6-25-2015

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Advisor:

M Lanoue Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, PA.

Abstract

Obesity most disproportionately affects African-American women, and nutritional literacy and food security remain understudied determinants of obesity among this group. The purpose of this study was to elucidate the factors that enable weight loss among Medicaid-insured, African-American women using the positive deviance approach. A secondary analysis was conducted of data from a Jefferson Department of Family and Community Medicine mixed-methods study. In this study, 35 Medicaid-insured, African-American women who lost 10% of their body weight and kept it off for six months were surveyed on demographics, health behaviors, nutritional literacy, and food security. Additionally, 35 controls matched upon age and weight were identically surveyed, and 20 case participants partook in semi-structured interviews about their experiences with weight loss. An independent-groups t-test failed to demonstrate any statistically significant differences in nutritional literacy scores between cases and controls. Similarly, chi-square tests of association did not establish statistically significant relationships between group membership and food security, poverty status, physical activity levels, or dietary changes. A statistically significant association was found between education and group membership, with the case group possessing higher educational achievement. Qualitative analyses revealed that case participants experienced difficulties in affording healthy food, decoding nutritional labels, and understanding the healthfulness of foods, thus underscoring the importance of nutritional literacy and food security. Furthermore, many participants divulged that they began to experience successful weight loss upon receiving professional dietary counseling, additionally emphasizing the impact of nutritional literacy. As such, the quantitative and qualitative results did not match. Between group differences may stem from an unstudied variable or differential efficacy in applying nutritional literacy concepts and/or surmounting food insecurity. Given these findings, more study is needed into nutritional literacy and food security among African-American women in order to determine factors that enable weight loss among this group.

Presentation: 21 minutes

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