Prime Time Sister Circles: Addressing the paradox of obesity in midlife African-American women

Prime Time Sister Circles: Addressing the paradox of obesity in midlife African-American women


>>Tiffany Townsend: Good afternoon. My name
is Tiffany Townsend. I’m the director of the Office of Ethnic Minority Affairs. I want
to welcome you to our February installment of the Ethnicity and Health in America Series.
I don’t know if any of you follow, but our office has a series where we focus on the people of color in the United States for each of the Heritage Months. So for Black History Month, for this year
2015, we’re focusing on obesity. So we are very, very excited, and I don’t think I can
use very too much, excited, to welcome doctors Marilyn Gaston and Gayle Porter who will be
here to discuss obesity as it relates to middle-aged African-American women. But I think you’ll
see because if you have not seen them present, they are a joy. Even though this is focused
on African-American women, I’m sure you’ll get little kernels, little nuggets of truth
and really good strategies that could be used for all ethnic groups and populations. I wanted to just give you a little information
about our presenters so that you would be as excited as I am that they’re here. Dr.
Marilyn Gaston is the former Assistant Surgeon General, and Dr. Gayle Porter is a clinical
psychologist by training. The co-directors of Gaston and Porter Health Improvement Centers,
doctors Marilyn Gaston and Gayle Porter have both spent their careers trying to improve
the emotional and physical health of children, adults and families, especially those who
are poor, minority, and underserved. They have provided direct clinical services, organized
and developed systems of care, provided educational programs, directed healthcare program, conducted
research and trained students and healthcare providers. Both are recognized nationally and internationally
for their efforts and are frequently sought-after speakers on effective and evidence-based healthcare
and disparities. After receiving rave reviews on this presentation, we saw no better way
to end African-American Heritage Month than to extend an invitation to our esteemed guests
to deliver us their presentation on Prime Time: The African-American Woman’s Complete
Guide to Midlife Health and Wellness. Without further ado, please, join me in giving a warm
welcome to doctors Marilyn Gaston and Gayle Porter.>>Gayle Porter: Good afternoon. We have decided
that we’re taking Dr. Townsend on the road with us because we can’t think of a marketing
person who’s any better. But we also just want to thank everyone at APA, particularly
Dr. Keita and Dr. Beatty for extending this invitation.>>Female Voice: [Inaudible]>>Gayle Porter: Right. I’m Dr. Porter. We
want to start this presentation with a fact that maybe many people don’t know. There are
over 9 million black women between 40 and 75. We are very diverse in terms of our interest,
our levels of education, our incomes, our commitments, our responsibilities and our
professions, but there is something that we share.>>Marilyn Gaston: We share in crisis [inaudible]
in health in our nation starting with obesity. The yellow bar are the white women, the green
are the Hispanic, red are us, African-American. The color coding is the same. Every time you
see a red bar, it’s us. And if you’re like the women we encounter, they say, “Oh, no,
not another red bar.” Anyway, this is looking at an overweight – national
and in Maryland and obese women, okay? You know, now when you look at the evening news
and you hear them say 68 percent of our population is having an obesity epidemic, and 68 of us
are obese or overweight. Now, that means that that 68 percent, most of those people are
overweight, only a smaller percentage are obese. This chart shows it. So if you look
at the white women and the obese women, whether you’re looking at national American, most
of them are overweight, fewer of them are obese compared to the other percentage. But
when you look at us, most of us are obese. So we mainly have a problem with obesity,
and it starts in childhood. So what’s the definition? It’s based on body
mass index, BMI. I hope many of you had gone on the Web and gotten your own personal BMIs
based on the weight and height. So you can see, a normal BMI is between 18.5 and 24.9;
overweight is between 25 and 29.9; obese is 30 and 39.9. And if you’re over 40, you’re
considered extremely obese. And there’s a major risk factor for obesity. Anytime you
want to look at an illness and really understand it better for yourself, you need to know the
general risk factors, but you also then need to look at your own personal risk factors
so that you can live lives in prevention and prevent that particular issue. On the left, the less controllable risk factors
are genetics. There’s always going to be a genetic predisposition. Our age, as we get
older, many of you probably know – I certainly do – how much harder it is to control our
weight as we age. Medical problems, for instance, with arthritis, you can’t exercise the way
you did, so that’s going to put some weight on you. If you have hypothyroidism, that’s
going to be a problem in terms of weight. Also certain medications, anti-depressants,
anti-psychotics, and if you’re being treated with corticosteroids, you will gain weight
on those. Socioeconomic factors, the general data show that most of the women, most of
the African-American women that are poor have a major problem with obesity compared to our
middle class women because it’s harder for them to really find the food that they need
to eat. They have fewer opportunities to exercise, etc. The more controllable risk factors, of course,
are emotional eating. Dr. Porter will talk a great length with that. Unhealthy diets,
physical inactivity, all of you know, and I hope by now you also know that if you don’t
have adequate sleep, your weight isn’t being controlled. Because during sleep, your hormones
will become active, and there’s an issue with you losing weight. Family lifestyle, our habits that we have
as African-Americans, our soul food that we eat that’s full of salt and fat and sugar,
all of that are risk factors for our obesity. But obesity is a major risk factor for all
these chronic illnesses that are killing us, diabetes being number one. You know that we’re
having the twin epidemics of obesity and diabetes in this nation. But hypertension, heart disease,
cancer, gallbladder, renal, stroke, high cholesterol, atherosclerosis, arthritis, and breathing
problems. So these, quickly, are the main ones that
I mentioned. So here is diabetes prevalence. The colors are the same. You can see African-American
women have a problem with diabetes. In fact, it’s our number four cause of death. We’re
the only group where diabetes is number four. You know, heart disease is one, cancer is
two, three is stroke, four is diabetes for us. And here’s hypertension. I hope all of you
know we already have hypertension going on whether we’re obese or not. So when we get
obese, then it’s further aggravated. Look at this disparity here in D.C. in terms of
how much hypertension we have. It’s probably because you’re looking at that news every
night and seeing what’s going on on the Hill that’s making us sicker. The cancer side, many don’t know that obesity
is a main risk factor for cancer, especially breast cancer. That has been well-documented.
One of the reasons is estrogen is stored in fat. So as we age, and we have even postmenopausal,
we have estrogen in our fat. So that then makes the risk for breast cancer even greater.
But then endometrial, colorectal, all the way down to kidney. So all of these – increased prevalence, increased
complications cause us to die more from heart disease, cancer, stroke and diabetes. You
can see those red bars. We’re dying at rates greater than any other group of women from
these four main chronic illnesses. You can see who’s doing the best in every area, Asian-American
women. That gives you a clue, start watching those women. Dr. Porter and I have share an
Asian massage therapist, and we watched her like a hawk, let me tell you. And then as a consequence, our life expectancy
is less than anybody else, 77, and these are women. First of all, I want to point out that
as a country we are 49th in the world in terms of our life expectancy. Does that shock you?
Forty-ninth. We’re number one in how much money we spend on our health. So we spend
more money for some of these poor results, and I think all of you need to know that.
But in the rest of the women, you can see Asian women doing the best, and we’re doing
the worst, even worse than Native American women.>>Gayle Porter: But we know it’s not only
our physical health challenges that we have to worry about but our emotional ones. Did
you ever wonder why so many sisters look so angry? Why we walk like we have bricks in
our bags and we’ll slash and curse you at the drop of a hat? It’s because stress is
hemmed into our dresses, pressed into our hair, mixed into our perfume and painted on
our fingers. Stress from deferred dreams. The dreams not voiced. Stress from the broken
promises, the blatant lies. Stress from always being at the bottom, from never being thought
beautiful, from always being taken for granted, taken advantage of. Stress from being a black
woman in white America. We read this quote by Opal Palmer Adisa in
our chapter called “Stress Can Be Managed” in the book that Dr. Gaston and I co-authored
called Prime Time: The African-American Woman’s Complete Guide Midlife Health and Wellness.
And we read it because we want to remind sisters that stress is every place. I don’t care what
you’re doing, you are going to have some stress. So the issues is not whether there is going
to be stress, it’s what do we do when we get stressed. Just today, when we were driving down here
on K Street, which is a street designed to make you crazy, people were coming across
the yellow line. You know there is not that much room anyway. And we had a choice. We
could roll down the window, start screaming and cursing, sticking up our finger, or we
could do like we did which was to turn to one another and say, “I’m so glad that we’re
in this car on this side.” And when I’m by myself, I usually turn on Richard Smallwood
and play Angels All Around Me. So it’s always about what we choose to do. And we know that
there is a mind-body connection that stress, depression, and anxiety impact on everything
from hypertension to aging to emotional eating. In our community, this is a major issue, and
I’m talking about an African-American community. Because for so many of us, to acknowledge
that we’re stressed, depressed or anxious somehow means that we are not believers. In
fact, about two years ago, I was in the CVS on Georgia Avenue. And I saw a sister, when
I came in I looked around and I noticed most of the people were trying to check out at
the pharmacy in the back. The only person who was at the front was a brother and then
going to be me. I saw this sister. She was snapping at everybody,
hair all over her head, looking wild and crazed. But she had a big button on that said: I’m
too blessed to be stressed. I walked up to her, and I said, “Sister, I give a talk called
I’m Too Stressed to Know How Blessed I Am. And we have an intervention called Prime Time
Sister Circles that we think you should be in.” But this is something we have to contend
with. That for many, many black women, they are not comfortable acknowledging the level
of stress and depression that they’re feeling. CDC did a study a few years ago. They looked
at 11 million people to see if where we live had an impact on what they call negative mood,
which is a blend of anxiety, mild depressive symptoms, anger, sadness, and hopelessness.
They found that no matter where we lived, black women had the highest level of this.
Caucasian males had the lowest level, and African-American women had the highest. And
the tragedy was that it didn’t make any difference, our socioeconomic level. We still had the
highest rate. So money and education were not protective factors for us against this. But another finding that I found particularly
distressing since I am well into midlife was that we think that when we’re young, between
25, 34, 44, we’re starting our families, we’re working out things with our partners, we’re
starting our jobs. So it’s not a surprise that we’re stressed. But as we get older,
the stress gets greater. Because now, we’re not only taking care of our children, we’re
taking care of our grandchildren, and our great-grandchildren. We’re worried about mama
or papa. We’ve got all of these other aging relatives. And for many of us, we are in positions
where we are also managing other people. So age is not helping us to become less distressed,
nor is it helping any of our other sisters to become less distressed. And some of the
major distressors that African-American women in this age group experience are concerns
about their physical and emotional health, personal and professional relationships, family
problems, financial difficulties, and care giving responsibility. One of the ones that I get most concerned
about, because I so often hear from women, they’ll say things like, “My daughter seems
to think I’m an ATM machine. Only the money goes out and never comes back in.” I wondered
about that because what we know, and I’ll never forget I found this out from a 40-year-old
man when I was doing counseling at Howard University. One day, he came in and he said
— we were talking because he was always having difficulty at his work sites. He said, “You
know, if my mother died, I don’t know what I’d do.” He didn’t say, “Because I love her,”
though I knew he did, but he was so used to his mother bailing him out when the rent needed
to be paid, when the car note needed to be paid, that he had lost the capacity to believe
in his own ability to take care of himself. So it’s one of the reasons that we really
need to start looking at what we’re doing to our adult children and grandchildren when
we continue to do it. Because we know what we’re doing to ourselves, that we’re getting
stressed out over it. And when I talk about emotional eating, I
mean the use of food to manage our emotions, especially stress, anxiety, fear, and anger.
The symptoms are we’re unable to stop eating even when full, overeating when emotionally
upset, hiding food or feeling ashamed after eating. And then also, it’s frequently starting
new diets, embarrassed over weight gain, or resentful when others suggest dieting. We show this slide because when sisters come
in – and you’re going to see it – most of the women who join our Prime Time Sister Circles
are overweight to obese because that’s what most of us are as black women. But we tell
them, we are not concerned with where you are now. The focus is on where you’re going
and that we have to let go of this embarrassment and of the shame because that is not going
to help us to get healthy. And that’s one of the things you will see that the circle
is really focused on.>>Marilyn Gaston: So that was the bad news
– most of it. Did we make you stressed and depressed? We hope not because anyway, now,
here comes the good news. We’re here to talk about our Prime Time Sister Circles, which
Gayle and I co-founded and now co-direct. They’re holistic support groups of 25 to 30
black women ages 40 to 75. And you might say, “Why did you choose those folks?” First of
all, that’s where most of our deaths are, in that age group. Even though we’re more
apt to not only die more than any other group of women, we die earlier than any other group
of women. Premature death is before the age of 65, and you just think about that. So most
of us, our deaths are premature and most of those deaths I showed you are preventable. The Prime Time Sister Circle is designed to
help women really stop dying too early and dying needlessly. So 40 to 75, we chose that
group because, first of all, we know that we have the attention of the women because
everything started to go south, right? Your weight is increasing. Your belly is increasing.
Your blood pressure is increasing. Your blood sugar is increasing, on and on. I know you
don’t want to hear anymore, right? But that’s what happens. So we have their attention,
and we know they’re trying to find solutions to what’s happening. So we wanted to be there
with the book, first of all, and now with this intervention. But we also know that these are our matriarchs.
These women are very powerful, and the rest of the family use them as role models. Not
only in their family, the total community: their churches, their workplace, etc. So we
know if we can change the lifestyle of just one midlife woman, we’re going to have a major
ripple effect because she’s going to impact on her children, her entire family really,
her children especially, her grandchildren in particular, but also the rest of her family
and her community. And their impact can be very great. There’s
a story that we really want to share with you. It’s one of our favorite stories. It’s
about a grandmother that entered the circle in D.C. All of our stories are based on actual
stories in the circle. So she entered the circle. She had lost her daughter from AIDS,
and she had adopted her little nine-year-old grandson. When they entered, the facilitators
always tell the women, “Go home, and tell whoever you’re living with what you’re doing,
that you started this, and your lifestyle is going to change. So just get ready. And
also, invite them to join you to get healthier.” So she went home, she sat her little nine-year-old
grandson down. She said, “Baby, your nana has joined this thing called Prime Time Sister
Circles because I want to live long enough to see your grandchildren.” So he said, “Great,
nana.” So they’re going along, and he’s joining her. They’re eating better. Now, one of the things she did surprised me,
she taught a nine-year-old how to read that complex food label that many of us are struggling
with as it is. She taught him. So one day, they’re in their neighborhood store and she’s
shopping, and Doritos are on sale. So she grabbed her bag full of Doritos and her salsa.
She told her sisters the next week, “I knew I didn’t need all that, but they were on sale.
I thought I could just eat one bag a week or something.” You know, that’s the first
mistake. Don’t ever bring it in your house because you’re not going to control it if
it’s certainly something you really are trying to avoid. Anyway, he’s running around the store and
she’s checking out, and he catches up with it. On the belt are all these Doritos. He
picks up one bag, he said, “Nana, what are you doing?” She said, “I’m buying some Doritos.”
He said, “I can see that, but did you see how much fat is in here and how much salt?
And I’m only talking about five Doritos, nana.” He knew that much about the food label. She
said, “What I can say.” She told her sisters, “He was right.” So he gave the cashier all
the Doritos back and said, “My nana is not buying any of these because she’s going to
live long enough to see my grandchildren.” That’s right. So it’s 12 weeks for two hours. First of all,
it’s community-based. We go to the women; they do not come to us. We spent a lot of
effort and time making it culturally competent. It also addresses all levels of education
to deal with health literacy. And 12 weeks, two hours a week is the intensive session.
But we follow our women for as long as possible. In fact, we have, we are in touch with the
women in our first circle, which was 12 years ago. We have a database of every woman that
has gone through the program. We constantly are in touch with them. We have conferences,
and we usually have updates for them, too. It focuses on prevention. It’s evidence-based.
The goal over that three-month period of time is to help these women develop habits of health.
That should be your goal, to have a habit that’s going to help you prevent these chronic
illnesses. We use four major tools. The resource book
that we wrote that you have, this was a bestseller. That’s a bestseller, by the way. We have this
professionally designed curriculum. We have a facilitator and a co-facilitator for every
circle, and that run the circles. Then we also have experts in stress, nutrition, and
fitness. These experts – by the time, the women leave that intensive session after three
months, the experts have provided them their own individual plan for prevention in these
specific areas, because as you can guess, these women are volunteering. So we have somebody
that hasn’t had a high school education sitting next to a physician. So the range is broad
in terms of what they need to do every day to get their habits of health. So they have
their individual one. We focus on helping women prioritize their
health. You know, we, as women, especially as black women, we’re so busy taking care
of la-de-da-de and everybody that we can’t take care of ourselves. That’s a habit we
absolutely have to change if we’re going to really impact on our health. But we also focus
on stress management, physical activity and nutrition.>>Gayle Porter: One of the most important
things about our facilitators and our experts, they are all black women in midlife. And that
came about because in our focus groups, the black women told us, “Don’t send a perky 20-year
old who weighs 90 pounds to teach my 60-year-old body, that hasn’t been exercising since I
was in 8th grade, how to do anything.” We used three major theories. The social cognitive
theory which is Bandura’s and which really is for us very good because it builds on efficacy.
And we really do a lot in terms of helping black women to think about what did you do
well before? What’s an accomplishment that we can build on, and how have we overcome
things like slavery, and also, racism and sexism? The transtheoretical model works very well
because this is a model that talks about focusing on where you are now. Once you get in the
circle, and since we have obesity as such a major issue on our community, this really
works well to help women think about, “I’m here now, where am I going? What do I need
to do to get there?” Finally, the PEN – which is person, extended family, neighborhood community
– was started in Africa, in South Africa, in fact. The whole idea was at first you had
to help women to claim help, to accept the responsibility. And this is the question we’re
going to ask you, “Do you wake up every morning thinking about being healthy?” So that’s what
this did. Then the next piece was to take it to their
families and to take it to their communities. Whenever I see that, I think about that movie
which is an iconic movie in our community, Soul Food, where the matriarch had everybody
come over every Sunday for dinner. This woman wound up dying from complications of diabetes.
In fact, while she was sitting there, cooking this huge meal, she burned her arm because
she didn’t even realize the damage that was done. And the last scene in the movie is everybody
sitting around the dinner table doing the same thing. That’s part of the revolution
and thought that we have to change.>>Marilyn Gaston: So these are some of the
habits that we help the women to establish. The literature shows that it takes about three
months for you to develop or to change a habit, so that’s another reason we have a three-month
program. But we also realize that you need support just like all of us do to maintain
that habit. I mean, just think about your New Year’s resolutions. We’re now in the end
of February. Do you remember what they were? Have you changed anything? Do you do it every
day? You know the questions, right? Anyway, prioritizing their health, I talked
about that. Practicing prevention, women come in, even highly educated women, when you say
prevention; they’re like, “What does that look like? What is it I need to do every day?”
We teach them that. One of the main cruxes of the matter in terms of prevention is knowing
your own personal risk factors and what do you need to do. You should have a plan for
everything you’re trying to change with your healthcare team. If you don’t have one, you
ask them for it because you should be doing it, and you should be monitoring your success
and what needs to change. Our old habit was to not move and to end up
getting fat, okay? The new habit, increase your activity and get fit. Now, let me just
mention, too. All of you know this, but there’s one new thing – and I don’t think you know
– that’s really being researched now. That we used to say well inactivity, we got to
increase that so that that was what we were looking mainly at. We now know though, we
need to look specifically at sedentary behavior. And they’re now starting to monitor how many
hours do you sit all day. Now, here, I’m looking at the wonderful APA staff, and you need to
ask yourself. Because when you sit all day, six to eight hours, even if you get up and
exercise, exercising for an hour, you’ve negated a lot of that benefit that you’ve done. I was one of those morning exercises. I felt
proud of myself. I was doing my treadmill, etc, etc. And when I read all about sedentary
behavior, I panicked because I sat all day, writing proposals on the computer, etc. So
the goal is while I’m talking, I should be doing this. You just increase your activity.
When you’re on that phone, stand up. Even standing is better than sitting. Sitting is
better than lying down. I used to get on the bed and have a conversation on the phone.
No, we don’t do that anymore. When you’re watching TV, sit and do some exercises. You
don’t have to constantly be moving across the room, but you’re constantly moving your
body in some way. Eating to live, our old habit was living to
eat; we need to change that. That’s a hard one. We need a lot of support with it. Our
family needs to support it. It’s hard when your husband wants to continue with that whole
milk, or your wife, and you’re trying to get to skim or less. So anyway, that’s a major
one. Let me just say, too, women in this age group
it’s a challenge for our nutritionists and dietitians. Because all of us – you see how
I get excited about this – all of us have our recipes that not only do we know — I
mean, it’s the best recipe in the county, right? Our family, they want it. Every Thanksgiving
they want it. If it was just every Thanksgiving, that would be fine. But, no, like you heard,
this might be every week. This pound cake that’s got a pound of butter, a pound of sugar,
okay? So women in this age group, they own and they’re emotionally attached to their
recipes, so that our dietitians and nutritionists know how to really help them make these changes
with their recipes, which is very important. And they can still have ownership. But that’s
a challenge. That’s not a challenge in younger age groups. Partnering with your healthcare
team is absolutely important in managing your stress.>>Gayle Porter: Again, the managing of stress
is absolute. I know all of you know stress is a primary risk factor for depression. So
if you are not doing that, and the first way is through every day, starting the day with
prayer and/or meditation. I was in a seminar once with Reverend Renita Weems. And if you
ever get to hear her speak, rush to it. Reverend Weems said that every morning you have to
get your head ready before you go outside. She said, “Because you are bound to run into
some Babylonians, and you are better able to deal with them if your head is ready.” In a talk that I was giving to a group of
women – and men, in fact – I said the same thing. I said, “Remember what Dr. Weems said,
we have to get our minds ready before we leave that house because we are going to encounter
some Babylonians.” This sister raised her hands. She said, “Dr. Porter, I do that in
the bathroom because I live with some Babylonians. If I go downstairs, I have to get ready.” Positive relationships, you know, this is
another one that we talk about all the time. Many of us have been born to people who are
stressful. Many of us have given birth to people who are stressful. And many of us are
married or partnered with people who are stressful. So the question is as Van Sant once said,
“Why do you choose to bring more stressful people into your life? That you have to start
and looking around to see – is this relationship helping me to do better in terms of being
healthy or not?” And when she said, “You know, there are people whom you need to love from
afar. Pray for them because you are already in a little raggedy boat. And you’re trying
to put all these other raggedy people in your boat and you all sink. So it is important
not to do that.” You need as I already stated, to get enough
sleep. In fact, I tell people, “If my house isn’t on fire, don’t call me after 9:30.”
It is that important. The exercising, as has been talked about, the deep breathing. Again,
this is something you can do for free. You can breathe all day long. We teach our women
that, because as Dr. Gaston said, we have sisters. We have our circles in public housing,
as well as in churches, so we have a wide range of folks. This is important, the yoga,
muscle relaxation. Time management is a major issue in terms
of helping us to relax. Schedule personal times, this is very important one where it
becomes critical. If you can go on a vacation or a trip with your significant other or your
best friend, then you come back and you’re relaxed and feeling great, fine. But if when
you go on a trip with that person, you come back, you’re tired, you’re angry. You’re not
talking to one another. Then next time, don’t go with that person. Go with somebody else. Having balanced meal, I hope all of you know
counseling and therapy. I don’t know anything that goes better with counseling and therapy
than prayer. So it’s something that you can do. Certainly, laughter, good healthy laughter,
not laughter at another person’s expense but really positive laughter makes a major difference.
Now we’d like to show you an example. Because we have this wonderful AV person, he’s going
to be able to do it for us of our Prime Time Sister Circle. [pause]>>Gayle Porter: So what we want to end with
is the results of our evaluation. Because no matter how good something is, if it doesn’t
document itself in a way that makes sense, it’s just something nice. It’s not something
that’s really going to be effective or evidence-based. This was the result of an evaluation that
we did. We have both clinical and demographic surveys that we do. They’re all anonymous.
At this point, we have had about 3,000 women to go through our program. One of the things that we found was that – the
red is pre, the yellow is post – women come in and they’re very uncomfortable talking
about taking care of themselves first. By the time they end, they’re wearing t-shirts
that says, “Stand behind me. I’m taking care of me first. Then, I’m going to take care
of you.” Their stress levels have dropped, because they’re learning how to do things
like deep breathing, how to walk when they are feeling stressed, how to be focused on
taking time to look at what is really stressing them. Their nutritional behaviors, we got funding,
a second round of funding from the Wal-Mart Foundation to just look at nutrition. We found
that our women, in terms of weight control, this is a major area for them. Portion control,
because with many of us, we are looking for a $4 buffet where we can eat $80 worth of
food and at our churches. In fact, one of our sisters say it, “You know, I thought I
was going to have to leave my church, because my pastor was saving my soul in the sanctuary,
and my body was killed in the friendship hall.” It’s really having to do that, changing our
diet specifically to get healthier. Look at this reduction in salt, where we were seeing
a major reduction, which is one of our major issues. Exercising more every week, we had women who
had literally not exercised since they had been in grammar school. Now when the circles
ended, we had no women who weren’t exercising at least once or twice per week. In terms of their satisfaction, their satisfaction
with the Prime Time Sister Circle was almost 100 percent. Ninety one percent talked about
the knowledge and skills that they gained, and the curriculum usefulness. Because as
Dr. Gaston said what we do is to work with some specialists who are able to develop a
curriculum that’s not only culturally competent, but takes care of the fact that we have such
a range in terms of literacy in our circles. Because as I said, we have women who are living
in public housing and we have women who are physicians.>>Marilyn Gaston: So we want to show you two
of the main areas that are the most difficult and very common for us. We’re interested in
obesity. Here’s the weight loss data. This is on over 1,300 women. All the data you’re
seeing is on over 1,300 women. All the data are statistically significant. This is not
percentages. This is actual pounds. So you can see the major drop here. The average drop,
well, first of all, 68 percent of the women lost weight. The average weight loss was around
four to eight pounds with a range from one woman who did, well, a few women did not lose
any weight at all to upwards of 30 pounds over that three-month period of time. We’ve also found, because we follow them at
six months, twelve months, some are even longer than that, two-year data. We have two. There’s
some drop off. But for the most part, they either continue with the weight loss. They
maintain their weight or they continue to lose over time. So they’re really implementing
this habit and supporting each other. Let me just say, too, again, to remind you that
most of our women after the three months, they continue their circles. Over 50 percent
of them are still in place. They don’t meet every week. But they meet once a month. They
realize how important that support is they get from each other. Also, as important as the support is, that
they hold each other accountable. So the women will say, like the women that had the Doritos,
she said, “Oh I’m going to have to go tell my sisters I bought these Doritos, because
I know they’re going to fuss. So they’re going to really talk about how did you get so off-track?”
But anyway, weight loss is a major issue. That’s one of the things we’re changing. We’re
looking at really partnering, because the Prime Time Sister Circle is not a weight loss
program. It’s a holistic program. So they lose weight though, because if they put into
place managing their stress, all of the things we do, you will lose weight. But we are going
to set-up a partnership with a weight loss program, especially for our extremely obese
women. Over half of the women that come in our program
have hypertension. In fact, nationally, now 52 percent, half the people in here, have
hypertension. It’s a major problem in our community. So we’re very happy to see these
results. This is a 30 percent drop in that three-month period of time in terms of women
with hypertension. That’s really statistically significant. One of the things that we learned
though, we always had a drop in hypertension. We never saw this kind of drop though until
we started teaching the women how to take their own blood pressure, and making cuffs
available to them. They love it. They’d love it, love it, love it, and say things like,
“I had no idea I could take my own blood pressure.” But more than that, they say, “This program
gave me ownership of my own health. Therefore, when I take my blood pressure, if I had a
high salt meal the night before, I’m just going to expect it to be up. If I don’t exercise
for a while, I can see my blood pressure creeping up.” They said, “I know that it’s all in my
hands, and I have some control and can deal with that.”>>Gayle Porter: This is a publication that
we did with Dr. Veronica Thomas, who is also one of our evaluators at Howard University.
It was entitled the Paradoxes in Obesity with Mid-life African-American Women. We saw this.
We were frankly very surprised as we looked at the information that was coming through.
The first paradox was that we are the only group of women – the only group – for which
education and income are not protective factors. The fact that we have money and education
does not make a difference. If you look at this, you’ll see that our women who had a
high school education or less, and we have many women who did not graduate from high
school, or are college graduate, the group was similar in terms of their levels of obesity,
the same in terms of their levels of extreme obesity. When it came to income, again, I want you
to look at the fact that there was almost minimal difference when it came to their levels
of obesity and their levels of extreme obesity. So this is something we really have to attend
to. The other thing that we saw that was very ironic was, that even though there is a myth
that black women who are obese, they like their weight. That’s not what our data showed
us. That in fact, women who were obese or extremely obese, we looked at all women where
weight was an issue, only 25 percent were comfortable with their weight. For obese and
very obese women, it was only 8 percent who were comfortable. So they didn’t like being
obese. But this was the paradox, when you ask about
their health knowledge, 80 percent said they had good health knowledge. When you ask about
their health attitudes, almost 70 percent said they had good health attitudes. When
you talk about their health behaviors, almost 50 percent thought that their health behaviors
were good. So there’s not the kind of connection between health and obesity that we really
need to start talking about in order to make this change. We have sites that are from Florida
now to D.C. As we said, we’ve got over 3,000 women in all of these having PTSCs in all
of these states. Some of our awards have included Johnson & Johnson
for Women’s Health Leadership, the Civic Ventures, and the International Black Women. We were
invited to meet with President Obama. We were designated both by SAMHSA as a model for training
community organizations, and also from the Edinburgh Medical School as one of 30 outstanding
models on an international basis. Finally, our return on investment, which of
course, people want to see is that of, this was a study that was done by Dr. Darrell J.
Gaskin and Dr. Richard. Dr. Gaskin is at Hopkins. He’s the deputy director of Health Disparities.
What he showed was that programs that have the PTSC, improve hypertension, obesity, and
mental health status. Improvements translate into medical care cost. If health impacts
persist for three years, you see a return on investment from $2 to $9 and that’s even
at the beginning. So what we’d like to do is to end this. But I think we should tell
them.>>Marilyn Gaston: One of the things I know
that you got – I hope you do is a feel. You can see I’m taking this sedentary behavior
seriously. So that we wanted to, again, emphasize this whole connection as APA employees between
the mind and the body. That most women, even highly educated women, when they enter, they
haven’t really put that association as close as they have it when they leave. To emphasize this, this is a story we tell
too. It’s about two women entering heaven. One turns to the other one and says, “How
did you die?” She says, “Well, I froze to death.” She said, “Oh, that must have been
horrible.” She said, “It was until I started to die, then it was pretty peaceful.” The
other one turned to her and say, “Well, how did you die?” She said, “It was a long story.
But I can tell you it happened because my neighbors were telling me that my husband
was bringing some woman in there in the afternoon while I was at work. So one day, I got off
early. I went in there to see if I could catch them. He’s sitting there reading the paper.
I asked about her. In his tone, I knew that she was in that house. So I ran up to the
attic, looked all around. I ran to the second floor, looked under the beds, in the closet.
I ran down in the basement and looked all around – nothing. I ran up and did it again.
Now you know I was all out of shape. I was angry as I could be.” Our anger is killing
us too. “So I had a heart attack and died.” The other woman looked at me and said, “Oh,
that was too bad. I’m so sorry. But you know what? You could have saved both of our lives
if you had just looked in that freezer.”>>Gayle Porter: So you see the necessity of
the mind and body connection and of good laughter.>>Marilyn Gaston: We wanted to give you a
good belly laugh before you left. We want to end the way we end the chapter. The last
chapter in the book is called “Reaching the North Star.” All our chapters, we end with
a saying or a poem or something that sets the stage. This poem is by Becky Birtha called
Poem for Flight. We read this every time we give a presentation. We read it even when
people have heard it 100 times, because we think that this underlines one of the major
points we make with our women and their health. “There will come a day – it is not far off
now – when you wake in the morning and know you were meant to be happy and healthy and
that you want it more than you want things, or memories or any concrete place called home.
You want it more than you want justice or pride or even your old clay image of yourself
on the faint chance that all that has gone wrong may still change.”>>Gayle Porter: “It is you who hold the power
to change. And whatever it is that holds you, whatever it is you think you cannot live without
the time has come to open your hands and let it go. Run, flee, disappear, break loose,
take wing, fly by night, move like a meteor, be gone. If you fear it will never be possible,
think of Harriet Tubman, who traveled alone the first time, who finally freed three hundred
people but first had to free herself.” There’s a Harriet in all of us, and we must
take the opportunity to finally free her. Thank you so much.>>Tiffany Townsend: Did I lie? Didn’t I say
it was going to be a treat? Didn’t I say you would learn? Let’s just take a moment to thank
our presenters once again. I wanted to open the floor for questions from the audience,
and also if we have questions from our Internet viewers, this is the time to ask those questions.
I’ll be Oprah. I have the mic. I guess, Donahue, right, because Oprah doesn’t do that anymore.
Not everybody at one time, one at a time, please. Okay.>>Female Voice: Here.>>Tiffany Townsend: Yes, I’m coming.>>Female Voice: Okay. For women who might
want to become involved in the Prime Time Sister Circles, how do they go about it and
what are the steps?>>Gayle Porter: You can go on our website,
gastonandporter.org or call the 202-403-6266 number. What we do is to list where the circles
are going to be held. They are always in a community setting, so you can find out. We
have two circles that are going to be starting in Capitol Heights, Maryland. I think it’s
about a month-and-a-half. We have circles that have just started in Philadelphia. We
have circles that are going to be starting in Rochester, New York. So they’re really
starting all over. But that’s the best way to do it. For people who would like to start their own
circles, then they need to call us. Because the curriculum and the training, one of the
things that we do is, once you go through the circle, if you would like to be a facilitator,
all of our facilitators are PTSC graduates at this point. You can go through a three-and-a-half
day training. Be apprenticed for 12 weeks, because our mantra is “First, you learn to
take care of yourself. Then you learn how to take care of other people.” Again, you
can get a stipend for both the training, as well as for running the circles.>>Male Voice: Hi. Thank you, guys, again.
Earlier in your presentation, you mentioned that you guys focus on women in the age bracket
of 40 to 75. What can be said for women beneath that age bracket who also wanted to pursue
the help over aid?>>Marilyn Gaston: That’s a very good question.
You can bet, we’ve heard a lot from them. We really have. What we’re doing is we are
planning – in fact, I was looking for funding for money – to redesign the curriculum for
our younger women. Also, let me just say that our different race ethnicities women have
asked for it too. So Asian women say they need it. The Caucasian women say they need
it – Hispanic women. So we now have a curriculum to do that. We are also looking for adequate
funding to pilot that and do it. The brothers, they say they want Brother Circles. One thing we did, we don’t do anything until
we have a focus group or multiple focus groups. We have multiple focus groups before we write,
wrote the book or designed the PTSC because we’re guided by the women – what they need,
etc. As we talked about, they said, “Don’t bring that perky woman in here that don’t
know me or know my joints, etc.” So there’s no question, we have the focus groups first. We had a focus group where we asked, this
was only African-American women. We said, “What would you think if we had women of different
races, ethnicities, join you in the circle?” They said, “You know that might be good that
we could learn from each other. We could cross-fertilize, etc, etc.” Then we said, “What about younger
women? What about having them join?” They said, “Well, maybe they could for the first
couple of weeks. But after that they have to go because first of all, they don’t understand
our issues. We don’t understand or want to understand theirs. Even more important, we
would be ending up taking care of them. We’re trying to take care of ourselves.” We said, “Well, what about the brothers?”
Well, they almost ran us out of the room. “The brothers, they would really take over
the circle, so no. No, we’re not doing it, so no.” We’re trying to really position it
so that we’re going to first touch the other women of different races and ethnicities.>>Tiffany Townsend: I had a question. You
talked about the fact that there was the disconnect between their body image and perception, and
their knowledge about health. I wondered, and I don’t know if you guys have kind of
thought about what that was about. I was wondering if you maybe thought that it was self-protective
of them to not connect, make that connection. Because then it’s out of their control, right?
So now I can say, this is just how I am, or I’m big-boned, and I don’t have to take responsibility
for my behaviors.>>Gayle Porter: I think you’re absolutely
right. That’s at least one of the factors that impact on what we connect with. But I
think that it goes even beyond that. If we take a minute right now to think about what
was the first thing on your mind when you woke up this morning? Was it your health?
Were you thinking, today I have to focus on my health? So I think that for a lot of sisters,
this disconnect is in part protective. But it’s also because if they think about
health, they just don’t make the connection between the fact that if I’m going to change
this body image, if I’m going to take control of my weight, it is major. It takes so much
effort and so much time. If you ask them, “Do you know what you need to do?” Many of
them will say, “Yes, I have to stop eating as much as I’m eating. I have to do all of
that.” For them, it’s the knowledge. They think they
have the knowledge. But where the real disconnect is, is in terms of that behavior. That if
you say you know what to do, you say you think you ought to change, but you have to actually
say in church, “I’m not going to go downstairs. Or I’m going to go downstairs, but I’m not
going to eat that and have to face that person. Or I’m not going to go to my mama’s house
or my grandmother’s house. Or I’m not going to tell my family, I’m not cooking that.”
I think it’s part defensive, but I also think that there’s no support really for making
that kind of change, and that we have to change that.>>Marilyn Gaston: Yeah. I think I agree totally.
If you think about it, our attitudes were really developed way back in babyhood, at
least those women in my age group, because there was a push. The bigger the babies were,
the more healthy that the grandmothers thought they were. Then as I was growing up, and I
was very skinny back then, my older brother and my younger brothers kept saying, “Marilyn,
you know you got to eat more, because men don’t want a bone.” They said, “The only thing
that wants a bone is a dog.” As I was growing up as a woman, there was
a lot of pressure for me to put on weight. And then as you get older, then you have a
Mo’Nique who says, “Wait a minute.” Now this was before she lost weight. You remember she
said, “Show me a skinny woman, I’m going to slap her.” So things like that, they’re ambivalent
to do that hard work. I’m just emphasizing what you’re saying.>>Gayle Porter: There in fact is a recent
study that was in Science Digest. They looked at, I think, it was 70 obese black and white
women. One of the biggest differences was that the white women had family members and
friends who encouraged them to lose weight. Black women did not have that kind of support.
There was not the external push towards losing weight. In fact, if anything, there was almost
a conspiracy of silent support for it because if they were girlfriends, most of their girlfriends
were obese. So they’re not actively encouraging you to lose weight. And health, the white women talk more about
obesity as a health issue than black women did. And they certainly talk more about it
as an issue of attractiveness. That if you’re working with black women, one of the things
we’ve learned is don’t talk about this as an attractive issue. Because so many black
women think they are and they are attractive, no matter what size they are.>>Marilyn Gaston: And don’t forget the boyfriends
and husbands who say, the women come in and say, “Now, am I going to lose my love handles,
because my husband likes those. Am I going to lose my behind?” So there’s a lot of reinforcement
from this. You said from family. I just want to add the men in their family.>>Gayle Porter: Right. [pause]>>Female Voice: Hello. I would like to thank
Dr. Gaston and Dr. Porter. I’m a graduate of the Prime Time Sister Circle 2009. As a
result of that circle, I lost 60 pounds in the beginning; I gained a few of it back.
Well, I still have not gotten back to where I was. I’m very conscious. I’m conscious of
my walking. It was the first time that I ever had a pedometer when we were conscious about
walking 10,000 steps a day. So I just want to thank you. It does work. It has lasted
– with me – I feel a lifetime. I’ve cut back on my salt levels. So there are still things
that I still do, that I still practice as a result of having been a part of your group.
Yes.>>Tiffany Townsend: Anyone else? Back to you.>>Male Voice: What have been some of the challenges
you got to face while starting the program and continuing the growth of the program with,
I guess, on a grand level and as far as the individual members go? Have you guys hit any
rocks?>>Female Voice: Which challenge do you have
to face in developing and implementing the program?>>Marilyn Gaston: I always like to start with
the book whenever this question is asked. We got an agent in New York, a lawyer and
an agent who was marketing it and us to the big publishing companies. Okay. You know them
all. Every time we go in there, now here we are. We’re black women in midlife who’ve written
this book. The people who interview us, they’d always send out white women aged 21-20. Okay.
Thin as a rail, etc, etc. So they would all tell us, the mantra was,
“Black women don’t read books like this. Black women do not.” We said, “Well, wait a minute.
We’re black women. Our families have black women, yadda, yadda, yadda. And we read all
kinds of books.” They said, “No, black women want fiction. They really don’t read books
like this.” That was a major barrier right away. But of course, we didn’t get discouraged
and it was an instant bestseller. We couldn’t wait to let these folks know, here is the
book that you said black women weren’t going to read. So that was the first.>>Gayle Porter: I think that with the circles
themselves, because we started having women call us, because in the book we recommend
that you form a circle. Because we know how hard these challenges are. So we got some
funding from the Ford Foundation to start writing a curriculum. We found Dr. Veronica
Thomas at Howard to help to develop the evaluation piece. So we were able initially to do it.
But even with getting that funding from the Ford Foundation, and then we got funding from
the University of Maryland. We’ve been fairly lucky in terms of getting funding. But it is very, very difficult to convince
funders that a program that has really still a relatively small number of people. We’ve
been doing it now for over 10 years. We’ve had over 3,000 women that go through the program,
and we’ve had thousands more to learn as we’ve been doing our recruitment. But they want
big things. They want to be able to say that you touched 80,000 women. Now the fact that
this is a one-shot effort, and you have no idea as to how these women have done, that
doesn’t matter. But in their annual report, they can say, “We gave funding to somebody
who touched 75,000 people.” So that’s been a challenge and that increases. Another challenge is just that we started
doing this when we were well into midlife. So having support, enough money, because foundations,
they don’t want to give you infrastructure money. They want to give you program money.
When you’re trying to do it all yourselves, and you’re trying to write the grants and
make sure that its being evaluated the way that it needs to be, that’s a major challenge.
So I would say to anybody who is starting, wants to do something like this, you have
to get your evaluation straight. What has gotten us money is our evaluation. We have
Dr. Thomas at Howard. We have Dr. Windham at the American Institutes for Research. So
we take money off the top to pay to get an outside evaluator to look at our data. But I would also say, you need to have a business
model. We didn’t have that. We’ve always worked for the government. Working focused on poor
people and underserved. You need a good business model, so that in the beginning you start
getting a marketer. You get grants people because that’s been a challenge. It has really
been hard to do that.>>Marilyn Gaston: But then again the issue
is getting funded. We can’t underline enough. This is a problem when you meet with other
nonprofits. This is across the board – the issue of funders wanting to fund only programs.
I don’t care what you’d say to them about, “Well, who’s going to run the program? Who’s
going to –?” They don’t want – no. They just want that no infrastructure. They’re not going
to fund the grant writers. They’re not going to fund the marketer. The issue is where does
that money come from? That’s a major — So I think one of the solutions too is that
you partner with other nonprofits and larger organizations so that you can begin to share
resources about everybody put in for one marketer that they can share across organizations.
Dr. Keita, did you have a question?>>Gwendolyn Keita: I just want to say something
that neither one of them will probably say. I’ve known them since they began this process
on how committed they were to it and what hard work they put in. Because when you started,
both of you were working full time. They really put their hearts and souls into this. Also
that they stuck to it. Nothing got in their way. No matter what hardships they came across.
But they also wanted to do it right. The evaluation was critical to them, and it
is critical to know that what you’re doing is working, and what is working because there
are a number of interventions out there. But most of them are not evaluated in the way
this is. It makes a big difference. I think that’s a part of how they have been able to
get some of the funding that they’ve gotten because the evaluation, showing that it really
works. They live what they preach. And they try to make all their friends do the same
thing.>>Tiffany Townsend: This has been a pleasure
to say the least. We want to thank you again. Are there any more questions? I know we’re
running up on the end of our time. But I wanted to thank you again for coming. I have to say,
not only did they come and they did this for us, they did it in the middle of 20-degree
weather when they were in Florida. This was a real sacrifice on their part. So we want
to really extend our heartfelt thank you. Thank you so much. I also wanted to extend a thank you to Dr.
Lula Beatty who’s the Health Disparities Initiative director. She is co-sponsoring this session
with us. Dr. Keita, who I guess kind of maybe said a little something so that the cold weather
wasn’t too much of a — so we want to thank her for extending that invitation as well.
I also wanted to thank the OEMA staff. Deonte’ Williams who is our intern, and he helps to
coordinate our Ethnicity and Health in America series. I wanted just thank him. Stephanie
is our other intern. Sherry always provides the great food for
us, so thank you, Sherry. Alberto who’s our assistant director. We wanted to also thank
Steven Schwark who is the AV. He is the silent mastermind behind this whole deal. Thank you
all for coming out. Remember that this is a series we do every year, every Heritage
Month. We’ll be having another installment in May. Thank you all.

10 thoughts on “Prime Time Sister Circles: Addressing the paradox of obesity in midlife African-American women

  1. that is ridiculous!!!!you can exercise at your home! you can get exercise by cleaning the fucking house! or running around with there bastard kids!!!!

  2. A huge component to black female obesity is black men’s “attraction to obese women” (of all races). Non-black women tend to have more difficulty attracting non-black men if they are obese, while many black men actually “reward” black women for being obese with sexual attention, which is something that most non-black men do not do for obese black women.

  3. "Sistas" kicked black men to the curb in favor of feminism and welfare. They look for love everywhere but with the black man. Go figure if they can't find it outside.

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