By Maria Fleet
For Reneé Rawls, learning that obesity is a disease was an epiphany. It meant that the struggle she’d had all her life wasn’t her fault. It wasn’t anyone’s fault. She called her mother right away to tell her. “I wanted to let her know that it was actually not her fault as well, because I’ve dealt with it all my life,” Ms. Rawls explains. “I had to let her know … ‘Mom, it was not your fault. Nothing that you did wrong, not overfeeding me, under feeding me.’” The oldest of 6 siblings – Ms. Rawls was the only one in her family who struggled with excess weight. Discovering that she was dealing with a chronic condition was a relief and gave her permission to find the right doctor to help treat it.
As an African American woman, Ms. Rawls is part of a group that’s particularly affected by obesity. The CDC has found that, among major racial/ethnic categories, non-Hispanic black women had the highest prevalence of obesity in the US at 56.9%. That’s compared to 39.8% of non-Hispanic white women and 42.4% for all adults. Although all the causes of these disparities aren’t clear, many studies cited by the CDC have concluded that social and economic disadvantages are factors.
Dr. Tiffany Powell-Wiley has seen the disparities up close in her practice in the Washington D.C. area. Dr. Powell-Wiley is a physician/researcher with a focus on obesity and cardiovascular health. She became interested in the connection between obesity and heart health during her cardiology training when she came in contact with patients who were developing heart disease at very young ages. “They were coming in in their thirties …with heart attacks or with heart failure, and many of them had health issues that had been untreated for quite some time,” she explains. “So they may have had diabetes or hypertension that hadn’t been dealt with, but obesity was an underlying issue for many of them.”
She was aware that cardiovascular disease is the number one cause of death in America, and she was concerned for her patients. “It really stuck with me… how much of a public health issue it was and how so many people are affected by obesity, but also how complex it was to address.”
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Dr. Powell-Wiley has chosen to focus her research on the racial and ethnic health disparities she observed. “People of color in particular have been disproportionately affected by obesity and the cardiovascular effects of obesity,” she says. “Particularly populations who have been most affected by structural discrimination, structural racism, who have limited access to healthy foods and have limited access to safe neighborhoods where you can do physical activity.” She and her colleagues are working on community-based programs around Washington D.C. that can improve health outcomes for these at-risk populations.
Dr. Powell-Wiley is clear-eyed about how difficult it can be for people struggling with obesity to reach a heart-healthy weight. She knows it can be a long journey. She focuses on the fact that small changes in behavior start that journey and are the essential foundation for lifelong good health. “That’s why it’s so important to really think about how we build in those healthy habits, because even maintaining a certain weight over time is better than gaining weight over time. Getting physical activity, even if you’re overweight or have obesity, is extremely important,” she advises.
She stresses that being active, even a little bit, makes a difference.
“Even if you’re not losing weight, you’re still improving your blood pressure, you’re still improving your cholesterol,” she explains. “You can still have improvements in your heart health despite not losing weight on the scale.”
Striving for a healthier weight is about preventing the potentially deadly outcomes of cardiovascular disease – heart attack and stroke. The way to begin, Dr. Powell-Wiley says, is by talking to your doctor about your risk factors and starting to build healthy habits into your daily routine. The American Heart Association has a checklist called “Life’s Essential Eight” that is a guide to how to keep the risk of heart disease low. The recommendations include paying attention to weight, blood pressure, and blood sugar – and working with your doctor to keep those measurements in a healthy range.
Starting on a new health path can be overwhelming – so Dr. Powell-Wiley suggests breaking it into small manageable goals. “So even if it’s setting the goal of just getting your numbers and knowing those numbers for yourself, that is a huge step,” she says.
Being active is important, but here again, you can start small.
“Even if your goal is to start getting that 10 minutes a day of physical activity, that’s a huge step,” she says.
She also suggests finding a community group that can help you get started and stay on track. Churches and YMCA’s often have wellness programs, for example. Doing something regularly in a group setting can be a way to make yourself accountable and find encouragement.
A crucial support for these lifestyle modifications is finding a doctor that specializes in treating obesity. While menu planning and increased activity are integral for bringing cholesterol and blood pressure into a healthier range, most people grappling with excess weight need medical support as well. The treatment of obesity is a quickly expanding area of medicine, and specialists like Dr. Powell-Wiley can offer the latest treatments, along with ongoing monitoring to guide you to a healthier weight and healthier heart.
Dr. Eldad Einav, an obesity specialist in New York state who is also a cardiologist, is a firm believer in pairing good nutrition and exercise with medical treatments that have been shown to be effective in the long run. The truth is, he says, it’s almost impossible to achieve sustainable weight loss without anti-obesity medications or bariatric surgery. He calls the latest anti-obesity medications “game-changers” because of their effectiveness in helping people lose weight and keep it off. He says he usually starts his patients on medications at the same time as they begin new exercise programs and meal plans. The medications generally make patients feel less hungry, Dr. Einav explains, “so all of a sudden they can do the lifestyle program with less effort.” He sees his patients’ motivation toward success shoot up when they see their health goals are achievable.
In Dr. Powell-Wiley’s work with African American women around Washington D.C., she’s found that social support is also key in building motivation.
Once she and her colleagues find a physical activity that works for a particular community, it can take off on its own through social networks. “There’s definitely a snowball effect that once we are able to engage one woman, she may bring in other women that she knows,” she says.
Part of the challenge is encouraging Black women to put themselves and their health first. “I think we take a lot of time to take care of so many other people, but we have to take care of ourselves,” Dr. Powell-Wiley points out. She even has to stop and remind herself to do it sometimes. “For African American women,” she says, “I think it’s important for us to realize that we are important, that we need to take care of ourselves, and that nobody else’s health and wellness is more important than ours.”
The first step is talking to your family doctor about how they can help you reach a healthier weight and reduce your risk of cardiovascular disease. To find a physician near you who specializes in weight management, click here.
Click here for a helpful guide to having a conversation with your doctor.
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This article was sponsored by Novo Nordisk. All content is created independently by My Weight – What To Know with no influence from Novo Nordisk.