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"Maintain, Don't Gain": A New Approach to Fight Obesity

Teresa Tanoos's picture
Study says focusing on preventing weight gain instead of weight loss may be best

New research from Duke University has found a successful alternative to fighting obesity by focusing on weight control instead of weight loss.

In obese black women, this “maintain, don’t gain” approach worked better at preventing weight gain, the researchers report in a new study published in JAMA Internal Medicine on August 26, 2013.

African-American women have higher rates of obesity than any other group in the United States, with 4 out of 5 of them being overweight or obese, according to the U.S. Department of Health and Human Services.

Unfortunately, programs designed to help black women lose weight have not been as successful as they have been for black or white men and women.

In background information, the study authors wrote that "black women have higher rates of body weight satisfaction, fewer social pressures to lose weight, and sociocultural norms that tolerate heavier body weights."

Lead author, Gary G. Bennett, Ph.D., said that new weight management strategies are necessary, but losing weight and keeping it off is the real challenge.

"Many people go to great lengths to lose weight when their doctor recommends it. They may try a series of diets or join a gym or undergo really complex medical regimens. The complexity of these treatments can make it difficult for many to lose a sufficient amount of weight," said Bennett, an associate professor of psychology and neuroscience and global health at Duke who studies obesity prevention.

"Our approach was different. We simply asked our patients to maintain their weight," he explained. "By maintaining their current weight, these patients can reduce their likelihood of experiencing health problems later on in life."

The study cited other research showing that overweight and slightly obese premenopausal black women actually have a lower risk for many chronic diseases than obese white people and other racial groups.

But by age 40 to 59, black women are more than twice as likely to be moderately obese, and three times more likely to be extremely obese than white women. This combination of rapid premenopausal weight gain and extreme obesity contributes to a disproportionate risk of chronic disease among black women, and that risk increases as the pounds pile on over time.

"It’s true that there are some health risks for these overweight and slightly obese women," Bennett said. "However, these health risks increase dramatically as women continue to gain weight, usually 2 to 4 pounds, year after year," he added.

Thankfully, there may be something that can be done about it.

"We could reduce these health risks if women simply maintained their current weight," explained Bennett. "Fortunately, it's much easier to maintain weight than it is to lose it. We think this 'maintain, don’t gain' approach can help some women reduce their risk of obesity-related chronic disease."

Accordingly, Bennett and his team launched a clinical trial called Shape to find out if preventing additional weight gain had any effect on reducing an obese black woman’s risk of developing other health problems, such as high blood pressure, high cholesterol, diabetes, cardiovascular disease, stroke and certain cancers.

The trial involved 194 premenopausal black women, aged 25 to 44, and compared changes in weight and risk for diabetes, heart disease or stroke. The female participants were recruited from one of Piedmont Health's six nonprofit community health centers in North Carolina, which serves predominantly poor patients.

Half of the participants (97) were randomly placed in a primary care-based intervention program called Shape, while the other 97 women received general weight-loss counseling from their physicians.

For the intervention program group, each woman received personalized software that came with an individualized set of behavior-change goals for diet and physical activity. These women were also provided with a personal health coach and a gym membership. The researchers then tracked each woman’s weekly progress in the intervention program via automated phone calls.

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After 12 months, the women participating in the intervention program had stabilized their weight, while the women under general care from a physician continued to gain weight. Of the 97 intervention participants, 62 percent had maintained or lost weight since starting the program. For the participants under general weight loss care from a physician, only 45 percent maintained their weight.

After 18 months, intervention participants had still maintained their weight, while the women in the usual care group continued to gain weight.

"We explicitly informed participants that Shape was not a weight loss trial. We did not expect participants to be motivated to lose weight,” the study authors wrote. “Instead, we informed participants that Shape was an approach designed to improve their overall well-being and to maintain their current body shape."

So why was this "maintain, don't gain" approach so effective for obese African-American women?

The study authors gave two primary reasons:

1. Compared to white women, black women are typically more satisfied with their weight and face fewer social pressures to lose weight, so they may be particularly receptive to intervention messages about maintaining their weight, according to Bennett.

2. Preventing weight gain is less intense than trying to lose it, so this approach could be achieved more easily.

Although the researchers did not observe any difference between the treatment groups in regard to lipid levels, blood glucose, blood pressure, blood pressure control or waist circumference, Bennett again emphasized the need for new weight management strategies for black women, especially those from low-income households.

"It is clear that new treatment approaches, such as weight gain prevention, are necessary to contend with the considerable challenge of obesity in this population," Bennett and his team concluded in the study.

What about the role of exercise in a "maintain, don't gain" approach?

According to Dr. Amy J. McMichael, from Wake Forest University, a lot of black women simply don't do it. And the reason may surprise you.

As she wrote in JAMA, the main reason many African-American women don't do exercise is because of hair care and maintenance.

"I treat a lot of African American women in our clinic and had noticed how many of them are overweight, and I wanted to know why,” McMichael said. “I'm treating them for dermatology related issues, but as a doctor this was even more concerning because excess weight puts these women at risk for hypertension, diabetes and other serious problems."

As a result, Dr. McMichael decided to launch a study of her own and found that many African-American women use chemical products or heat straighteners to straighten their hair, which causes it to become very fragile. When over-washed, the fragile hair breaks off.

For that reason, many black women cannot easily wash their hair after exercise. So instead of exercising, they avoid it altogether, she explained.


1. JAMA Internal Medicine, "Behavioral Treatment for Weight Gain Prevention Among Black Women in Primary Care Practice: A Randomized Clinical Trial" (published online August 26, 2013); doi:10.1001/jamainternmed.2013.7776.

2. U.S. Department of Health and Human Services, "Minority Women's Health" (last updated May 18, 2010).