Determinants of Successful Weight Loss in Low-Income African American Women: A Positive Deviance Analysis

Objective: We set out to investigate the behaviors of low-income African American women who successfully lost weight. Methods: From an urban, academic, family medicine practice, we used a mixed methods positive deviance approach to evaluate 35 low-income African American women who were obese and lost at least 10% of their maximum weight, and maintained this loss for 6 months, comparing them with 36 demographically similar control participants who had not lost weight. Survey outcomes included demographics and behaviors that were hypothesized to be related to successful weight loss. Interviews focused on motivations, barriers, and what made weight loss successful. Survey data were analyzed using t tests and linear regression for continuous outcomes and chi-square tests and logistic regression for categorical outcomes. Interviews were analyzed using a modified approach to grounded theory. Results: In adjusted analyses, women in the positive deviant group were more likely to be making diet changes compared with those women who did not lose at least 10% of their initial body weight. Major themes from qualitative analyses included (a) motivations (of health, appearance, quality of life, family, and epiphanies), (b) opportunity (including time and support), (c) adaptability. Conclusions: The findings of this study may be useful in developing motivational interviewing strategies for primary care providers working with similar high-risk populations.