Cultural Competence and Weight Loss
My thoughts on cultural sensitivity and cultural competence when it comes to fitness, nutrition and/or weight loss (also relevant to health in general
So you’ve decided to lose weight and your coach asks for demographic data. Fine. But this coach wants to know about your race/ethnicity. What the hell? What does that have to do wi
th weight loss? A lot.
As someone who works with a diverse array of people who are trying to lose weight, and as a coach who subscribes to a biopsychosocial model of weight loss, I would be remiss if I didn’t talk about the role that the social construct of race plays in weight, weight loss and body mass index. Notice that I said the social construct of race and not genetics. Genetics do play a role in weight and I will discuss that later in a post about something called Set Point Theory. Race is not meaningful in a biological or genetic sense. There is no one gene shared by all Black or all White people. Instead, the racial identity of individuals is formed by a combination of how that individual perceives herself and how she is perceived by the world. That doesn’t mean that race isn’t real. Instead it means that we make race real through our daily interactions with our environment and each other.
All sustainable weight loss involves making lifestyle changes. This is why I coach you on how to change your attitude, thoughts and behavior around diet and exercise. However, there are racial disparities in weight. For starters, being overweight or obese is much more common in non‐Hispanic Black adults (74%) compared to non‐Hispanic Whites (67%), with the highest rates in Black women.
Because high weights are common in all populations, weight loss interventions are a priority for public health. Because of social pressures, there is also a huge market for commercial weight loss programs as well. To be sure, there is no shortage of programs by both doctors and businesses designed to help people lose weight. There is, however, a shortage of programs that actually work.
An astonishingly high number of individuals of all races fail to lose weight. But weight loss interventions have generally been less effective in the Black population. This is especially true for Black women. The reasons are complex and may have to do with a whole host of things from dietary compliance to activity levels to cultural factors. The fact that these interventions don’t work simply compounds other social factors that leave minorities more vulnerable to poor health outcomes.
For this reason, public health leaders have been calling for culturally competent weight loss interventions. But what does that even mean?
Cultural competence means the ability to communicate effectively and leverage knowledge of culture and cultural practices to create more relevant and relatable interventions.
It means understanding that common measurements such as the BMI and other traditionally used markers for normal weights are inherently biased. Based on this knowledge, a good coach would provide psycho education to the client, spend additional resources to find and utilize appropriate measures to create realistic and attainable goals.
It means understanding and leveraging cultural values, such as spirituality, to help someone tap into their motivations, and creating a plan that includes these factors to encourage activity and healthy eating.
It also means considering the impact that appearance has on motivation and how beauty standards vary by culture. Although I work hard to ensure that appearance is not the only reason that someone is trying to lose weight, I would be foolish to not consider this. Although there is overlap, there are plenty of differences in what cultures view as ideal. While certainly I understand that not everyone within a certain culture has the same values, it is useful to know that not everyone subscribes to the dominant beauty standards.
Cultural competence is a huge value for those involved in any sort of healthcare capacity, and health coaching is no exception. As a Black woman, I have “insider information” on many of the concerns that Black women have around weight, eating and exercise. Still, he majority of people who seek my services are not Black and some of them are not women. How do I manage? By realizing that everyone has a culture and a relationship to that culture.
Svetkey, Laura P, et al. Predictors of Long-Term Weight Loss in Adults With Modest Initial Weight Loss, by Sex and Race. Obesity., vol. 20, no. 9, 2012, pp. 1820-1828.
Eichen, D.M., Rhee, K.E., Strong, D.R. et al. Impact of Race and Ethnicity on Weight-Loss Outcomes in Pediatric Family-Based Obesity Treatment. J. Racial and Ethnic Health Disparities (2020).