Obesity is a public health concern that affects over 30% of Americans. Approximately 78% of African-American women are overweight/obese, as compared to 46% of Caucasian women. Obese African-American women are at higher risk for associated morbidities (e.g., hypertension, type II diabetes, select cancers, and early mortality) as compared to non-Hispanic whites. Weight gain after young adulthood (ages 20-35) is associated with an increased risk of cardiovascular disease and other health problems later in life. Research that seeks to explain, predict, or control obesity among African-American women has focused on individual behavior change. Few studies have addressed the social contexts within which these behaviors occur. The purpose of this exploratory study was to examine the weight-related beliefs, behaviors, and social network characteristics of obese, young adult African-American women. A conceptual framework based on social support and social network theory guided the design of the study. Ten African-American women between the ages of 20 and 35, self-described as “plus-size” or “full-figured,” completed initial informal conversations about weight-related issues and concerns and semi-structured, in-depth face-to-face interviews. Five participants were randomly selected to complete social network profiles to identify potential social influences on weight-related beliefs and behaviors. Results of the initial conversations revealed approximately half of the participants were class III obesity (BMI > 40), reported overall good health, and 70% participated in physical activity at least one day a week. Semi-structured interviews results disclosed two primary reasons for unsuccessful long-term weight loss: (a) inconsistent weight loss behaviors and (b) lack of accountability. Weight-related beliefs and behaviors of study participants were similar to those reported for older adult African-American women. Similarities included (a) mixed levels of body satisfaction; (b) the belief that health is not determined by weight; (c) sedentary lifestyles and; (d) social support from family and friends impacts long-term weight loss success. The five social network profiles indicated participants’ networks are small, comprised of at least two overweight/obese females, and exhibited positive social support behaviors. Social networks included positive, negative, and non-positive relationships. Social support for weight loss is shared among network members through face-to-face interactions, phone conversations, and use of social media tools such as Facebook, Twitter, and text messaging. Future healthy weight studies would benefit from comprehensive analyses of the social networks of obese, young adult African-American women, inclusive of interviews with social network members. Culture-based healthier weight interventions that organize social support networks through social media tools are promising strategies for promoting healthy weight management among obese, young adult African-American women.

Background: Overweight and obesity affects almost 30% of Canadian children and adolescents aged 2-17 years old which can lead to chronic disease later on in life. Research shows that healthy weight programs are effective at reducing BMI but have issues regarding recruitment and retention. One way to address these problems is by using a Social Marketing framework to determine what adolescents need in a community-based healthy weight program. Methods: Open-ended and closed-ended question surveys were conducted with multiple perspectives including youth aged 13-17 years, parents, and youth workers in Fall 2018. Open-ended question answers were a priori categorized by the ‘4Ps’ of the SM framework (Product, Price, Place, and Promotion) while frequency count data was generated for closed-ended question answers. Open-ended answer data were managed using NVivo 12 and were analyzed using Braun and Clarke’s six-step approach to thematic analysis (Braun & Clarke, 2006). Results: A ‘marketing mix’ was thematically generated to identify elements of a healthy weight program that adolescents need in order to participate from all three perspectives. Based on the findings, programs should include physical activity, nutrition, and emotional/social health components that are relevant and fun (Product). They should also emphasize benefits to participating such as improvement to physical and mental health, having fun, receiving incentives, and building relationships (Product) while minimizing barriers including emotional health concerns, lack of time, financial cost, transportation, boring programs (Price). Differences were found amongst perspectives in terms of types of incentives, transportation, and cost of program. Programs should take place in convenient, appealing, and safe locations that may already exist including schools or recreation centres (Place) and should also be promoted using social media and peer word-of-mouth or create partnerships with youth-relevant organizations and use body positive language (Promotion). Conclusion: Using this foundational work of a ‘marketing mix’ can help program developers design programs that will help recruit and retain youth in community-based healthy weight programs. Elements of social marketing were not considered in this study including competition, segmentation, and branding which further highlights the need for exploring competing behaviours in youths’ lives, different priority audience segments of BC, and brands that can be used to recruit and retain youth. / Graduate

Since the federal budget for EFNEP is over $66 million, it is crucial to know the effectiveness of program attributes that may bolster its effectiveness. The aim of this study was to determine how effectiveness of Youth EFNEP programs in Virginia is affected by participant, instructional and curriculum attributes for youth enrolled in Healthy Weight for Healthy Kids (HWHK). An ordered probit model was employed to study how these attributes affect dependent variables: Whole Grain, Fruits, Colored Vegetables, MyPlate, and Breathe Hard behavioral scores. The model assessed the probability of a participant having an improved score or improved behavior. Participant Attributes Results: In general, the chosen variables for participant characteristics consistently reduced the probability of participants having an improved behavior score. Instructional Attributes Results: African Americans Program Assistants were consistently associated with negative marginal effects on positive behavioral scores with the exception of the positive Breathe Hard behavioral score. Other PA attributes were not consistently associated with any behavioral models but were heterogeneous in terms of their marginal effects on the positive behavioral scores. Curriculum Attributes results: The curriculum attributes had more positive marginal effects than negative marginal effects across all the five behavioral scores. Attributes that were consistently associated with having a positive marginal effect on behavioral scores were program duration, smart foods lesson, and lesson duration. Other HWHK lessons were not consistent in increasing or reducing the probability of an improved behavior. / Master of Science

Medical and economic costs for obesity are estimated at $147 billion per year, yet less than 1/3 of overweight individuals successfully maintain weight loss. The literature is replete with descriptions of the problem and research on treatments, yet demonstrations of effective loss and maintenance are lacking. Missing is an understanding of the experiences of individuals who successfully maintained healthy weight loss, which could provide insights regarding effective psycho-social interventions. The purpose of this qualitative narrative study was to explore key events and experiences in the lives of former weight cyclers. The primary phenomena of interest included weight cycling and sustained weight loss. Self-determination theory (SDT) and social cognitive theory (SCT) provided the theoretical frameworks to explore concepts like autonomy, mastery, and vicarious learning, which are known to be associated with recovery from other addictions (e.g., smoking cessation, weight loss). Using the tradition of narrative analysis, the stories of 6 formerly obese weight cyclers revealed 5 major themes: structure, strategies, relationship/support, autonomy, and identity as a fat person. Findings support SDT and SCT as meaningful frameworks for understanding how severely obese individuals can attain successful weight maintenance. Findings from this study revealed elements not fully addressed by these theories, such as resilience, the diverse orientations to the problem, and overarching themes common to all participants. Findings can be used to place greater emphasis on psychological components such as autonomy, mastery, and relatedness, which are necessary for successful remission. Findings may contribute to reducing direct and related costs of obesity and improving quality of life for individuals and their families.