Examining Preferences for Weight Loss Interventions Among Black Men and Women Experiencing Overweight or Obesity: A Qualitative Approach

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Idiong, Rachel Anderson, Kate Killion, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4644353/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Background Behavioral interventions aiming to modify dietary habits and physical activity have been less effective in achieving clinically significant weight loss in Black adults. Weight loss needs vary by race and gender, so different strategies are needed to engage individuals in healthy behaviors. While there have been some research efforts focused on weight loss in Black women, participation rates of Black men in weight loss interventions are lower. This may perpetuate the development of obesity-related conditions such as diabetes, heart disease, and other cardiovascular problems. This qualitative study investigated the barriers and facilitators to healthy eating and physical activity and the weight loss desires among Black adults with overweight or obesity. Methods Black adults mainly residing in Hartford, Connecticut were recruited for the study. Semi-structured interviews were conducted with Black males and females who self-reported being overweight or obese. Preferences for weight loss specific to each gender, barriers, and facilitators for weight-related behaviors such as diet and physical activity, were examined through thematic analysis to inform the development of a culturally relevant behavioral weight loss intervention. Results The sample consisted of Black adults from diverse racial and ethnic backgrounds. Black females (n = 16) and Black males (n = 8) were mostly non-Hispanic Black Americans. The key themes that emerged were: 1. the creation of a weight loss program for Black adults, 2. healthy eating barriers, 3. physical activity barriers, 4. healthy living facilitators, and social support. Both Black females and Black males identified unique weight loss preferences. Community and personalization were preferred by Black females while Black males preferred personalized diet and exercise regimes for diverse health conditions, not limited to weight loss. While both genders referred to digital devices and apps for recording weight, diet and physical activity as a major facilitator to adopting healthy habits, social support in the form of culturally relevant information from healthcare providers was highly desired to be incorporated into the intervention. Conclusion The findings of this study hold relevance for designing and developing of weight loss programs that promote behavior change for Black adults and help reduce obesity-related health inequities within this population. Obesity Weight loss Black Adults Health Disparity Figures Figure 1 INTRODUCTION Obesity remains a persistent public health challenge, impacting 42.0% of adults in the United States[ 1 ]. Black adults are disproportionately affected with nearly 50.0% living with obesity, a prevalence that is greater than other racial and ethnic groups[ 2 ]. The disproportionate burden of obesity increases Black adults’ risk of developing preventable diseases such as type 2 diabetes, cardiovascular diseases and some types of cancers[ 3 ]. Efficacious obesity treatment is found through behavioral weight loss interventions[ 4 , 5 ]. Seminal trials combine cognitive behavioral therapy, dietary modification, and physical activity behavior change to produce clinically meaningful weight loss of 5–10% [ 6 , 7 ]. While behavioral weight loss interventions are regarded as efficacious, consistent challenges exist concerning treatment among Black adults[ 8 ]. In seminal weight control trials, Black men remain underrepresented precluding them from experiencing the benefits of obesity treatment[ 9 – 11 ]. When Black men are engaged in behavioral weight loss interventions, positive and clinically meaningful outcomes have resulted[ 8 ]. However, a disparity between Black and White men’s weight loss exists, with approximately 2% lower weight changes observed[ 10 , 11 ]. A similar disparity in weight loss has been observed among Black women[ 12 ]. Notably, among Black women, weight losses produced through standard behavioral weight loss treatment interventions are typically modest (2–3%) and below the clinically meaningful target of 5–10%[ 13 , 14 ]. While behavioral weight loss interventions for obesity treatment have been established as the standard of care, disparities in representation and outcomes for Black adults reflect a need to reconsider what may and may not work for this population subgroup[ 8 , 15 ]. Thus, there is a need to determine the best approach to engage Black adults and to develop weight loss interventions that can consistently produce clinically meaningful outcomes to improve their health. Current evidence indicates a need to understand weight-related behaviors such as diet, physical activity and what supports or creates barriers to the adoption of these behaviors[ 13 , 16 , 17 ]. While quantitative outcomes have illustrated the need for continued development of weight loss interventions, investigators have called for the use of qualitative methods to understand disparities in treatment and engagement among Black adults[ 8 , 17 , 18 ]. Qualitative research is useful for exploring phenomena, provide richer insights to contextualize quantitative outcomes, and design interventions to better address obesity treatment in Black adults[ 12 , 19 ]. Using qualitative methods, this study examined the barriers and facilitators of behavioral targets of weight loss interventions (healthy diet, physical activity), and identified desires for weight loss treatment among Black adults with overweight or obesity. METHODS Research Team To maintain credibility in research, a diverse group of researchers from interdisciplinary backgrounds was involved in the study. This qualitative study was developed by four researchers (KCS, LBC, MP, and JK) with a focus on health equity research. A five-team member (henceforth referred to as the working team)led the entire research process. The working team, comprising 4 females and 1 male was guided through the process of data collection and data analysis by two professors KCS and LBC with expertise in research aimed at reducing obesity-related health disparities. LBC and a doctoral-level researcher (SR) with a background in nutritional sciences and qualitative coding conducted the interviews. Two doctoral-level coders (CI,KK and CA) with a background in allied health contributed to qualitative coding and theme generation. An undergraduate researcher who self-identified as a female performed data management and analysis (RA). Recruitment Active recruitment occurred in collaboration with community partners from a mid-sized New England city before COVID-19. They initiated and monitored communication with individuals interested in the study, as well as organizations from which interested individuals may be potentially recruited. Individuals interested in the study were then contacted by the study team. Due to the emergence of COVID-19, in-person research activities were halted and recruitment strategies were expanded to include individuals beyond the initially targeted local region. Passive strategies were also implemented during recruitment. Passive recruitment strategies included the use of ResearchMatch, a nationwide online recruitment resource for health research, supported by the National Institute of Health[ 20 ].In the local community, additional strategies for recruitment included the distribution of quarter cards, flyers, and listserv email announcements. All study procedures were approved by the University of Connecticut’s Institutional Review Board. Eligibility criteria Individuals were considered eligible for the study if they self-identified as either Black, African American, or Afro-Caribbean, had a body mass index (BMI) ≥ 25 kg/m 2 , based on self-reported height and weight, and expressed a willingness to participate in audio-recorded individual interviews. Individuals who expressed interest in the study were contacted via telephone by a study staff member. If no response was received, then the participants were contacted through email requesting a call back to describe the study in detail to determine their interest and eligibility. After an individual expressed interest and confirmed a date and time, the virtual interview was scheduled. Data collection Individual interviews were conducted during the COVID-19 pandemic between August 2020 to August 2021 using a semi-structured interview guide. The interview guide was developed based on the scholarly literature indicating the gaps in knowledge and challenges regarding weight loss and behavioral obesity treatment with Black adults[ 12 , 19 , 21 ]. Table 1 provides a list of questions that were asked during the interview. Current evidence indicated a need to understand weight-related behaviors such as diet, physical activity and what supports or creates barriers to adoption of these behaviors, therefore the interview guide was broken into sections with probes pertinent to each question. The WebEx software was used to conduct and audio record the interviews. Prior to the administration of the interview questions, informed consent was gained from participants. A doctoral-level trained moderator conducted the individual interviews via WebEx. A note taker was present to record any verbal and non-verbal communications in the event that there was a recording malfunction or internet disconnection. Each interview lasted about 35–45 minutes. At the end of the interview, participants were asked to complete a short survey to collect demographic information and social support for diet and physical activity. Participants were provided a $ 50 gift card for their participation in the study. Table 1 Sample semi-structured interview questions Interview Questions Probes Section: Feedback on intervention components 1. What are your first thoughts about what’s included in a typical weight loss program? 2. What do you think a weight loss program for Black adults should look like? 3. What is missing in the typical weight loss program for Black men/women? (asked according to self-identified gender) Section: Barriers 4. What gets in the way, or makes it hard, for you to eat healthy? 5. Which healthy eating barriers are the hardest for you to overcome? 6. Which healthy eating barriers are the easiest to work around? 7. What barriers, or things get in the way, of you getting regular exercise? Section: Assets 8. What makes it possible, or easier, to eat healthy? 9. What makes it possible, or easier, to be active? Section: Social Support 10. What are the ways others support you to eat healthy foods? 11. How do people support you to be physically active (Eg. exercise) in your spare time? • What should be added, or removed, for Black men/women (ask according to self-identified gender) • If you were in a weight loss program for Black adults, what do you want to have included? • Cooking skills • Flavor/seasoning food • Taste preferences • Time • Recipes • Food Storage information • Transportation • Cost • Time • Opportunities to sit • Safety • Family commitments • Hair care • Home resources • Community resources • Educational • Religious structures/faith-based (ex. Church, Mosque) • Community programs • Work (people, places, structures) • Technology (ex. Phone apps, websites, etc.) • Who gives you support? (family, friends, coworkers) • How is the support different between people? Demographic Information Participants completed a demographic survey including information such as age, gender, BMI, racial heritage, Hispanic or Latino ethnicity, ancestry, education, marital status, household income, and employment status. Categorical variables were represented through frequencies and percentages while continuous variables were summarized using means and standard deviations. The SPSS software version 29.0 was used for handling all quantitative data. Data Analysis Qualitative data were audio recorded and transcribed verbatim. A team-based approach was used to code individual transcripts and Dedoose software version 4.12 was employed. The thematic analysis, consisting of a 6-step process developed by Braun and Clarke (Fig. 1 ), was followed to analyze data and generate themes[ 22 ]. To increase familiarity with the transcripts 3 members of the coding team (KCS,KK and RA) listened to audio recordings and read the transcripts several times to develop and revise the coding guide after applying the coding scheme to a subsample of transcripts. Then the larger research working team, consisting of the Co-primary investigator (KCS) and 3 pairs of trained graduate students met to compare codes and provide code definitions. Through an iterative process, the team and principal investigator convened to refine and finalize the coding guide (comprising codes and definitions). With the finalized codebook, 3 pairs of coders coded all transcripts (individually and then met to reconcile differences) and convened to discuss the analysis and to generate the final themes. The coders achieved an average inter-reliability score of 0.83. RESULTS Twenty-four Black adults participated in this study with an average age of 46.0 ± 13.3 years and were predominantly female (n = 16; 66.0%). The mean BMI of the total sample was 33.0 ± 8.0 kg/m2, with half of the participants classified as overweight and half having obesity. Most participants identified as Black American (n=18; 75.0%) with 60.0% of Jamaican origin (n=14). Most of the participants identified as non-Hispanic (n=22, 91.0%), were born in the US (n=18; 75.0%), and living in Hartford, Connecticut (n=11; 46.0%). Most of the sample reported a household income of more than $60,000 ( n=14, 59.0%) and had some college education (n=7; 29.0%). The description of the sample is provided in Table 2. Table 2: Baseline Demographic Variable of Study Participants Variable N (%) Sex Female Male 16 8 66.7 33.3 Age (Average [SD]) 46.1 13.3 Weight Status Overweight Obesity 12 12 50.0 50.0 Location Hartford Other 11 13 45.8 54.2 Racial Heritage African American Afro-Caribbean American Indian/Alaska Native 18 5 1 75.0 20.8 4.2 Hispanic/Latino Ethnicity Non-Hispanic Hispanic/Latino 22 2 91.7 8.3 Household Income >$60,000 $40,000-$60,000 $10,000-$30,000 <$10,000 10 5 4 3 41.7 20.8 16.7 12.5 Immigration Status Born in the US Not born in the US 18 6 75.0 25.0 Marital Status Single Married Divorced Widowed 13 5 4 2 54.2 20.8 16.7 8.3 Highest Education Graduate School or Professional Education College/University Degree Some College Education (<4 years) Technical School or Vocational Training Graduated from High School Did not complete high school 5 7 7 1 3 1 20.8 29.1 29.1 4.16 12.5 4.1 The following themes emerged from the interviews with Black adults who were either overweight or obese. A summary of the key themes, subthemes, and representative statements of the Black female and male participants are presented in Table 3 (females) and Table 4 (males). Theme 1: Black male vs female preferences creating a weight loss program for Black adults. Participants expressed their preferences regarding how a weight loss intervention could be made more desirable to Black adults. Black female participants indicated incorporation of the local community, and group activities and to model community programs that are successful. They stressed the importance of community, as participants identified that the community was where they could source support, motivation and engagement. Black female participants desired personalization in weight loss interventions through the incorporation of flavorful and culturally relevant recipes tailored to the preferences of Black adults and personalized exercise routines and avoiding general prescriptions for diet consumption and exercise engagement. Black male participants, on the other hand, expressed a strong interest in a program that was specifically customized for Black adult males, emphasizing healthy eating and exercise. They highlighted the desire for awareness and education concerning certain health conditions (e.g. hypertension, diabetes, and arthritis) as well as promoting tailored recipes designed to manage health conditions such as low sodium and diabetes-friendly recipes. Both genders highlighted the importance of a personalized program that includes flavorful and culturally relevant recipes tailored to the preferences of Black adults. While Black female participants predominantly emphasized community as a necessity in weight loss programs, Black male participants emphasized the need for a program that will concentrate not just concentrating on weight loss, but also connects to other health concerns such as type 2 diabetes and hypertension. Theme 2: Healthy Eating Barriers The primary barrier included a lack of knowledge and skills in preparing nutritious meals, scarcity of healthy recipes, and general dislike for cooking. Specifically, female participants indicated limited or no time as the primary barrier to cooking healthy meals. They also emphasized family responsibilities as a significant challenge to cooking and consuming healthy foods. Male participants identified time constraints for cooking healthy meals, grocery shopping, and family commitments as significant barriers to consuming healthy meals. Both male and female participants frequently cited time constraints and family responsibilities as primary barriers to consuming healthy meals. Theme 3: Physical Activity Barriers Black female participants frequently discussed a lack of motivation to exercise and challenges in finding the time to maintain an exercise routine as the primary barriers to engaging in physical activity. Black female participants uniquely mentioned that time constraints were mainly due to career and job commitments and family responsibilities. Black male participants identified time as the primary barrier to physical activity. Additionally, they mentioned lacking motivation to create and maintain an exercise regime. Both genders indicated a lack of time and motivation as the primary barriers to engaging in physical activity. There was no noted gender difference in terms of barriers encountered for engaging in physical activity. Theme 4: Healthy Living Facilitators Technology, mindset and routine were emphasized to have a high influence for engaging in healthy eating and physical activity. Female participants indicated an openness to engaging with technology-delivered resources and guidance for nutrition and exercise. This included smartphone apps such as MyFitnessPal and social networking sites, such as Facebook. Responses stated by female participants highlighted mindset and routine, defined as engaging in health behaviors out of routine and keeping motivated towards those healthy behaviors as major factors to facilitating healthy lifestyle choices. These two factors were cited as driving forces to maintain motivation to engage in healthy behaviors such as healthy eating and physical activity. Male participants highlighted having access to online resources to find information and guidance on healthy recipes, exercise and social media applications that create an online community. Male participants noted routine as a necessity for engaging in healthy behaviors. Specifically, initiating and maintaining an exercise routine was highlighted as the primary motivation for engaging in physical activity. Mindset and routine were emphasized equally among male participants compared to female participants. The notable gender contrast was highlighted among facilitators, with female participants predominantly expressing a desire for technology to engage in healthy behaviors whereas male participants sought online resources and information for managing weight and other health conditions. Theme 5: Social Support Differences existed between sex when comparing how participants felt best supported to engage in healthy behaviors. Female participants mentioned feeling most supported by healthcare professionals and the advice for selecting health behaviors regarding nutrition and physical activity. Coworkers were also mentioned by female participants as sources of support for engaging in healthy behaviors. Female participants specifically noted feeling most supported when engaging in healthy behaviors with family members and receiving verbal encouragement from a person in their social network. Male participants noted support from healthcare professionals and coworkers to be a trusted source when looking to engage in eating healthy and exercise but ranked their friends higher when considering who influenced engaging in healthy behaviors most. Examples specifically noted included sharing meals or walking together as large facilitators for eating healthy and engaging in exercise, respectively. Both female and male participants found the least support from romantic partners. Table 3: Summary of Emergent Themes and Representative Statements by Female Participants. Key Themes Subtheme Representative Statements Creating Weight Loss Program for Black Adults Community “Like, um, you know, um, and that's not always like directly related, but to be honest, any type of support, or just like an, an internal, like community building that you can do with Black people will, will help any program, even if it's not directly related to weight loss”, Age 26 Personalization “Yeah, definitely, because I feel like each person gets excited about a different thing, like not everyone- You know, a goal about how they... Why fitness is important. So, um, yeah, personalization is definitely important, in my opinion.” Age 40 Healthy Eating Barriers Time “Because you have to it's... When you don't know, or you trying to learn something, it takes time. When it's something effortlessly that comes together. Like if you were to ask me to make, um, fried plantains, I could do that within seconds. But if you were to ask me a big potato or something in the oven, I had to sit down and I have to Google it, look for recipes and it takes a lot more time.” Age 29 Cooking Skills “Um, so, and then with cooking too, sometimes, like, the- the details to, like, paying attention to this, how long you have to leave this, or you're trying to cook multiple things at once, something might get cold.” Age 45 Physical Activity Barriers Motivation “Uh, what makes it hard? Um, sometimes I just don't have the energy, sometimes, um, sometimes I'm just, just tired, uh, so you know, that does it.” Age 26 Time “Just not getting up and building the extra time into your schedule. Well, it [time] can be affected by work if I am traveling and my day may start at 8:00 AM, and I might not get home till 10:00 PM. So I know if I'm having a long day, I might not get up that extra hour that morning and go workout because I know I have a eight hour work day, then I have six more hours of travel.” Age 44 Healthy Living Facilitators Mindset and Routine “It's just a mindset. You make a mind, where you tell yourself, "I gotta do this. I gotta walk." For example, exercising, I gotta go down the street now, and you walk till you feel tired or about to get tired, and you come right back. So, it's just a whole mindset, 'cause I have to wake up before six, or by six in the morning. And, it's a whole mindset, if I have to do something, I have it do it. Nothing stops.” Age 53 Technology “I mean really what motivates me is just really just social media. I go on YouTube. YouTube is like is life. I go on YouTube every day and I'm pretty proud to say that because YouTube for me is like, I don't go in there just to watch other people's life. I go on there and I learn so much, like I have, you know, I could list like five people right now who are like influencers who take really good pride, like in, in their content. And they talk about like their diet and what they eat. And they also upload like exercising videos, you know, some of them are really... So I get a lot of inspiration from just like looking at their bodies and I'm like, oh wow. Like I know I can get to that.” Age 26 Social Support Family and Friends “And the receive, the support I received from my mom It's more, it's more, um, knowledge in anything else. So I guess everybody plays a different part in it and it's in a way a compliment and it builds the whole pyramid.” Age 29 Other Support “Yes, absolutely. I have some coworkers that are very health conscious. So we are often just talking about like, who's the health person in the office. They’ll recommend that we try or eat and that's type of thing.” Age 37 Table 4: Summary of Emergent Themes and Representative Statements by Male Participants. Key Themes Subtheme Representative Statements Creating Weight Loss Program for Black Adults Community “Um, I mean, I think that all sounds good. I do, I think the group component again is a big part of success when you're able to communicate with other people going through the same program. Um, and then again, the healthy choice, healthy options for food” Age 19 Personalization “Um, I would, like, I feel like the like I don't know, about like the exercise in particular. I feel like, I feel like, it depends on the person, you know? I feel like it depends on the person.” Age 32 Healthy Eating Barriers Time “So obviously the time commitment, uh, if I'm not meal prepping, finding, it's easy to go to a fast food restaurant and get, you know, the popular meals that you like, or, um, you know, just getting something quick. the amount of time it takes to prepare meal versus going across the street and buying something, I think, um, you know, obviously it's less amount of time to purchase something that's already prepared.” Age 32 Cooking Skills “I don't cook, so. And I wanna learn but I haven't uh, I haven't taken the steps to learn yet.” Age 65 Physical Activity Barriers Motivation “I think that- that is the biggest one, outside of, um, I guess, um- um, motivation. Sometimes you- you won't always be motivated to do it.” Age 39 Time “Well, 30 minutes a day is way too much time. (laughing) No one has time for that. Um, I'm sure that if I went jogging every morning, or went to the gym every day, I would probably be healthier but, you know, big time factor. I mean, no one has time for that, you know.” Age54 Healthy Living Facilitators Mindset and Routine “I would say the main thing for me [that makes it easier to be active] is maintaining a routine. It's so much easier when you're accustomed to doing things, you know.” Age 54 Technology “I have an Apple watch and several of my friends do too. I guess this isn't, us talking, but we are communicating through like ... I guess this is more of an encouragement ... If you see someone close their activity rings, or they, had a workout, that is sometimes encouraging to get those messages in.” Age 36 Social Support Family and Friends “They [friends] know that I'm, I'm trying to uh, s- be active. So they, they uh, I have a few friends who'll come by and try to get me to go out and do things... if you wanna call it exercise, yeah, some of 'em do. Some of 'em will take a walk every now and then but usually it's just me by myself.” Age 65 Other Support “Well, my doctor always tries to encourage me to lose a few pounds, but it's nothing serious. He doesn't really press me too much. He just says, in general, it's better to lose a few. I try to listen to him because I'm at the point to lose 10 or 15. But now, maybe he's saying maybe lose five. So, I have lost.” Age 54 DISCUSSION Currently, limited research exists that qualitatively examines the desires of Black adults for the creation of weight loss interventions by learning about what supports or creates a barrier to diet and physical activity behaviors. This qualitative study investigated the barriers and facilitators to weight loss behaviors such as healthy diet and physical activity and the individual weight loss program preferences of Black adults. Major themes that emerged from the interviews included preferences for weight loss programs among both Black males and Black females, barriers to adopting healthy eating and physical activity, healthy living facilitators, and desire for social support. Centering on the weight loss program creation for Black adults, the responses revealed differences in the preferences of Black males and females. For Black females, the sub-themes generated were community and personalization while for Black males, programs focusing on personalized exercise and healthy eating for managing various health conditions emerged as major sub-themes for weight loss program creation. Black males and females in the sample identified unique, sex-specific needs for weight loss with small areas of similar desires for weight loss program creation. Inclusion of community was highlighted by Black females. Specifically, desires for community, a source of support, as part of weight loss intervention design was raised. Black females in the sample discussed the importance of including pre-existing community programs in obesity treatment. This finding aligns with recommendations for obesity control and equity where provision of and support for existing community programs that seek to improve physical activity and nutrition is a key strategy[ 23 , 24 ]. This may look like obesity treatment alongside nutrition assistance programs that improve access to social and economic resources or treatment through community programs like Black Girls Run! that already focus on a weight-related behavior (physical activity) and provide social support to an engaged audience[ 14 , 25 ]. Community-engaged efforts like the Racial and Ethnic Approaches to Community Health across the United States (REACH US) project that utilized participatory methods to generate multi-level, culturally and contextually relevant health interventions, reduced obesity prevalence across fourteen Black communities[ 26 ]. Males in this study wanted weight loss interventions designed specifically for them. Incorporating both eating and exercise was of equal importance to Black males as a means to reduce weight and address comorbidities like diabetes and hypertension. This finding is supported by the literature among older Black males, where diagnosis with a disease is noted as a motivator to participate in health research for better disease management and understanding[ 27 ]. Gender-specific weight control programs may be relevant as weight loss strategies differ between Black males and females[ 28 , 29 ]. For example, Black male respondents to a community survey reported more regular exercise engagement than Black females’ and had less engagement with weight loss strategies and attempts[ 30 ]. Across genders, personalization through culturally relevant dietary prescriptions and exercise was seen as necessary by Black adults in this qualitative study, which resonates with current weight control literature to address inequities. Still, gender-specific needs exist in weight-related behaviors like physical activity that indicate the relevance of race- and gender-specific weight control treatment as a future direction[ 30 , 31 ]. Participants recognized several barriers to consuming healthy meals. Black females emphasized that their primary barriers to cooking and consumption of healthy foods were lack of time to procure and prepare nutritious meals and family obligations. Unlike the findings of this study, several qualitative studies examining barriers to healthy eating mentioned a lack of knowledge to be the major challenge to healthy eating and expressed uncertainty about what and how to cook healthy, in contrast to the current study where lack of time was identified as the primary barrier[ 32 , 33 ]. Additionally, qualitative study findings in Black women indicated that women felt pressured to consume more, lacking support when attempting to eat healthy and reported that this created a hindrance to adopting healthy eating habits[ 33 , 34 ]. On the other hand, lack of knowledge, skills, and a shortage of healthy recipes was identified as major barrier by males. To address this issue, future weight loss interventions should focus on integrating cooking methods, stressing the importance of portion control, and helping understand the nutritional value of foods[ 29 ]. Programs should also aim to incorporate a range of resources, including cooking classes, online tutorials of culturally relevant recipes, and community programs dedicated to healthy cooking[ 35 , 36 ]. As Black males expressed a desire for recipes that could assist in managing health conditions such as hypertension, the use of the DASH (Dietary Approaches to Stop Hypertension) diet, which has been proven effective in controlling hypertension and supporting weight loss, may be beneficial and attractive[ 37 , 38 ]. Black females and Black males identified distinct barriers to engaging in physical activity. Black females specifically identified challenges related to busy work schedules and caretaking responsibilities, leading to fatigue and tiredness, leaving little energy for exercise[ 14 , 39 ]. In the context of physical activity, utilizing home-based programs through weight loss interventions, personalized to the level of resources available, may provide significant improvement and adherence to physical activity[ 40 ]. Black males noted a lack of motivation to maintain a physical routine. This finding is consistent with qualitative research findings that suggested Black males experience decreased motivation to participate in physical activity due to challenges and stress associated with fulfilling key gendered social roles as a worker, provider, father, and spouse/partner[ 25 , 41 ]. Black male participants desired personalized exercise regimens for different age groups to enhance motivation and distributed the exercise schedule in small intervals throughout the week. When designing interventions for Black males, it is essential to incorporate exercises preferred by men and create a consistent routine to perform these exercises [ 12 , 41 , 42 ]. Black adult participants noted what supports or would be beneficial in their healthy eating and physical activity pursuits. The distinctive aspect of the current study findings is that participants of both genders emphasized the use of technological resources as a facilitator for promoting healthy eating and physical activity. Special reference was made to personal devices or smartphone apps for tracking weight, and diet, recording daily physical activity, and connecting to a health coach remotely for guidance and problem-solving. Despite the high usage of smartphones and smartphone-related tools and apps in Black adults (83%), few studies have used smartphone apps for tracking diet and physical activity and targeted this population[ 43 – 45 ]. This indicates that future interventions could use digital modalities for delivering weight loss programs. Considering the personalized weight loss program preference among both genders, future research in this area should aim to provide tailored messages and individualized intervention components[ 45 – 47 ]. These can comprise languages and terminologies that connect effectively with both Black males and Black females. It is likely essential to investigate the most effective ways to deliver personalized interventions through digital technology. Female participants expressed a preference for seeking social support from social contacts primarily from friends and family. They also indicated a desire for guidance on healthy eating, particularly from healthcare professionals such as dieticians, valuing their expertise in this area. Findings from a research study by Tucker et.al (2022), show similar trends where Black women emphasized that the weight loss journey depends on an effective communication from the healthcare providers and feeling comfortable trusting the advice provided by them[ 46 ]. In line with a study by Bowie et. al. (2018), Black female participants stressed the significance of learning culturally relevant diet and exercise information from healthcare providers and connecting with them remotely for problem-solving. Female participants expressed feeling most supported when engaging in healthy behaviors with family members[ 47 ]. Similarly, Jenkins et. al.(2017), found Black women highlighted the positive impact of having a family member as an exercise or walking partner, contributing to their physical activity goals and facilitating weight loss[ 40 ]. While social support for weight loss behaviors in Black males has been less studied, some research findings indicated that having a friend or peer with similar health goals provides encouragement and accountability for physical activity goals[ 48 , 49 ]. This study identified that Black male participants expressed a need for friends and coworkers to participate in both dietary and physical activity behaviors. In both Black female and male participants, social support has been recognized as a major factor for improving diet and physical activity and requires support from family members, friends, and coworkers. Weight loss interventions should aim to incorporate social support subscales for both genders, enabling a deeper understanding of how the involvement of family and friends influences each aspect of diet and physical activity behaviors with Black adults[ 50 , 51 ]. This study has both strengths and limitations. A notable strength lies in the inclusion of diverse Black male and female participants from various geographical locations. Another notable strength is the diversity encompassing the ancestry, socioeconomic statuses and educational backgrounds of the participants. Participants self-identified as African American, Afro-Caribbean, and Jamaican origin and therefore reflected a variety of cultural heritage. The participants included Black adults from various socioeconomic and educational backgrounds. However, the sample was predominantly females (67%) potentially limiting their generalizability to a broader national sample. Another limitation is that the data collection occurred during the COVID-19 pandemic, potentially impacting participant’s responses due to the unique circumstances during that time which may have shifted their typical behavioral engagement to modify diet and physical activity. The participants, with an average age of 46.1 years, were mostly single (54%) and therefore the findings about weight loss program creation may not be generalizable to individuals who are older (65 years or more), or living with a partner. The current study captured the desires of both the sexes for a weight loss program, facilitators and barriers to modifying diet and physical activity. Though we acknowledge limitations in generalizability are present, the utilization of the qualitative approach allowed for a focused and commendable effort towards understanding the unique needs of Black adults for engagement in weight loss interventions for traditionally in-person and digital modalities. Future qualitative studies should aim toward addressing this identified gender imbalance to strengthen the transferability of findings. IMPLICATIONS FOR FUTURE RESEARCH The study findings indicate the unique weight loss preferences of Black adults with overweight or obesity. The results signify the importance of support from friends and family and the use of technological resources most beneficial to adopting weight loss behaviors. Female participants prioritized the need for a community and personalization for weight loss programs and expressed a desire to learn cooking skills and recipes to support culturally relevant meal preparation. While weight loss was the primary focus, male participants expressed a desire to learn about other health conditions, such as type 2 diabetes and hypertension and diets that could help manage these conditions. The findings hold relevance when designing weight loss interventions for including Black adults. Future research in this area should take into account the weight loss preferences of Black adults across diverse ethnicities, considering individuals living with various chronic health conditions and utilizing a greater nationally representative sample. Abbreviations BMI Body Mass Index Declarations Supplementary Information No supplementary information is available Acknowledgment The authors want to thank the University of Connecticut, College of Agriculture Health and Natural Resources for their support, the community partners in Connecticut who helped with the recruitment, and the participants for sharing their valuable experience for the study. Authors contribution LBC, KCS, MP, and JK were involved in conceptualization and funding acquisition. LBC and SR were involved in data collection. CI, CA, KK, and RA were involved in data coding and analysis. The writing team comprised of SR, CI, and LBC. All the authors reviewed and edited different versions of the manuscript. Funding This project has been made possible by the funds from the University of Connecticut’s College of Agriculture, Health and Natural Resources(CAHNR). Data availability In order to safeguard participant privacy and comply with the University of Connecticut's Institutional Review Board regulation, the data analyzed in this study are not accessible to the public. Please reach out to Dr. Loneke Blackman Carr for any data-related inquiries at [email protected] . Ethical approval and consent to participate All study procedure was approved by the University of Connecticut's Institutional Review Board (L20-0031). Each participant provided informed consent before joining the study. Prior to the interview, received a clear explanation of the study’s specifics, including the risks and benefits of participating. They were welcome to ask any questions they had about the study. A study staff was available to provide answers until they were fully convinced about their decision to participate in the study. All study procedures were performed as per the norms and standards of the University of Connecticut’s research guidelines. Consent for publication N/a. All participants provided consent for publication and all the participant information was de-identified after data collection. Competing Interests There are no competing interests to declare by the authors. References Stierman B, Afful J, Carroll MD, Chen TC, Davy O, Fink S, et al. National health and nutrition examination survey 2017–march 2020 prepandemic data files-development of files and prevalence estimates for selected health outcomes. National Health Statistics Reports. 2021. Obesity and African Americans - The Office of Minority Health. https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=25. Accessed 11 Aug 2021. Lofton H, Ard JD, Hunt RR, Knight MG. Obesity among African American people in the United States: A review. Obesity. 2023;31:306–15. Diabetes Prevention Program Research Group. REDUCTION IN THE INCIDENCE OF TYPE 2 DIABETES WITH LIFESTYLE INTERVENTION OR METFORMIN. N Engl J Med. 2002;346:393–403. 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NIH Clinical Center and ResearchMatch | Clinical Center Home Page. https://www.cc.nih.gov/recruit/ResearchMatch.html. Accessed 18 Jun 2024. Ginsburg ZA, Bryan A, Rubinstein EB, Frankel HJ, Maroko AR, Schechter CB, et al. Unreliable and Difficult-to-Access Food for Those in Need: A Qualitative and Quantitative Study of Urban Food Pantries. J Community Health. 2019;44:16–31. Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology. 2006;3:77–101. Kumanyika SK. A Framework for Increasing Equity Impact in Obesity Prevention. Am J Public Health. 2019;109:1350–7. Fitzgibbon ML, Tussing-Humphreys LM, Porter JS, Martin IK, Odoms-Young A, Sharp LK. Weight Loss and Black Women: A Systematic Review of the Behavioral Weight Loss Intervention Literature. Obes Rev. 2012;13:193–213. Kalinowski J, Idiong C, Blackman-Carr L, Stowers KC, Davis S, Pan C, et al. Leveraging the Black Girls Run Web-Based Community as a Supportive Community for Physical Activity Engagement: Mixed Methods Study. JMIR Formative Research. 2023;7:e43825. Liao Y, Siegel PZ, Garraza LG, Xu Y, Yin S, Scardaville M, et al. Reduced Prevalence of Obesity in 14 Disadvantaged Black Communities in the United States: A Successful 4-Year Place-Based Participatory Intervention. Am J Public Health. 2016;106:1442–8. James DCS, Harville C. Barriers and Motivators to Participating in mHealth Research Among African American Men. Am J Mens Health. 2017;11:1605–13. James DCS. Gender differences in body mass index and weight loss strategies among African Americans. Journal of the American Dietetic Association. 2003;103:1360–2. James D. Factors influencing food choices, dietary intake, and nutrition-related attitudes among African Americans: Application of a culturally sensitive model. Ethnicity and Health. 2004. https://doi.org/10.1080/1355785042000285375. Joseph R, Ainsworth B, Keller C, Dodgson J. Barriers to Physical Activity Among African American Women: An Integrative Review of the Literature. Women & health. 2015;55. Ray R. Black people don’t exercise in my neighborhood: Perceived racial composition and leisure-time physical activity among middle class blacks and whites. Social Science Research. 2017;66:42–57. Pawlak R, Colby S. Benefits, barriers, self-efficacy and knowledge regarding healthy foods; perception of African Americans living in eastern North Carolina. Nutr Res Pract. 2009;3:56–63. Soliah LAL, Walter JM, Jones SA. Benefits and Barriers to Healthful Eating: What Are the Consequences of Decreased Food Preparation Ability? American Journal of Lifestyle Medicine. 2012;6:152–8. Bell CN, Holder MB. The Interrelationship between Race, Social Norms and Dietary Behaviors among College-Attending Women. Am J Health Behav. 2019;43:23–36. Kris‐Etherton PM, Petersen KS, Velarde G, Barnard ND, Miller M, Ros E, et al. Barriers, Opportunities, and Challenges in Addressing Disparities in Diet‐Related Cardiovascular Disease in the United States. Journal of the American Heart Association. 2020;9:e014433. Webb FJ, Khubchandani J, Doldren M, Balls-Berry J, Blanchard S, Hannah L, et al. African-American Womens’ Eating Habits and Intention to Change: a Pilot Study. J Racial and Ethnic Health Disparities. 2014;1:199–206. Tyson CC, Davenport CA, Lin P-H, Scialla JJ, Hall R, Diamantidis CJ, et al. DASH Diet and Blood Pressure Among Black Americans With and Without CKD: The Jackson Heart Study. Am J Hypertens. 2019;32:975–82. Whitt-Glover MC. Translating the Dietary Approaches to Stop Hypertension (DASH) Diet for Use in Underresourced, Urban African American Communities, 2010. Prev Chronic Dis. 2013;10. Liao KY-H, Wei M, Yin M. The Misunderstood Schema of the Strong Black Woman: Exploring Its Mental Health Consequences and Coping Responses Among African American Women. Psychology of Women Quarterly. 2020;44:84–104. Jenkins F, Jenkins C, Gregoski MJ, Magwood GS. Interventions Promoting Physical Activity in African American Women: An Integrative Review. J Cardiovasc Nurs. 2017;32:22–9. Griffith DM, Gunter K, Allen JO. Male gender role strain as a barrier to African American men’s physical activity. Health Educ Behav. 2011;38:482–91. Davis KK, Tate DF, Lang W, Neiberg RH, Polzien K, Rickman AD, et al. Racial Differences in Weight Loss among Adults in a Behavioral Weight Loss Intervention: Role of Diet and Physical Activity. J Phys Act Health. 2015;12:1558–66. Atske S, Perrin A. Home broadband adoption, computer ownership vary by race, ethnicity in the U.S. Pew Research Center. https://www.pewresearch.org/fact-tank/2021/07/16/home-broadband-adoption-computer-ownership-vary-by-race-ethnicity-in-the-u-s/. Accessed 21 Feb 2023. Kozak AT, Buscemi J, Hawkins MAW, Wang ML, Breland JY, Ross KM, et al. Technology-based interventions for weight management: current randomized controlled trial evidence and future directions. J Behav Med. 2017;40:99–111. James DCS, Harville C. Smartphone Usage, Social Media Engagement, and Willingness to Participate in mHealth Weight Management Research Among African American Women. Health Educ Behav. 2018;45:315–22. Tucker CM, Anton SD, Wippold GM, Marsiske M, Bilello LA, Henry MA, et al. Promoting weight-loss maintenance among Black women primary care patients: A cluster RCT of a culturally sensitive versus standard behavioural approach. Clinical Obesity. 2022;12:e12553. Bowie O, Kusch J, Morris GL, Flood T, Gill J, Walker RE, et al. Patient Barriers for Weight Management Among African American Women. J Patient Cent Res Rev. 2018;5:287–97. Gothe NP. Correlates of Physical Activity in Urban African American Adults and Older Adults: Testing the Social Cognitive Theory. Annals of Behavioral Medicine. 2018;52:743–51. Cyriac J, Jenkins S, Patten CA, Hayes SN, Jones C, Cooper LA, et al. Improvements in Diet and Physical Activity–Related Psychosocial Factors Among African Americans Using a Mobile Health Lifestyle Intervention to Promote Cardiovascular Health: The FAITH! (Fostering African American Improvement in Total Health) App Pilot Study. JMIR Mhealth Uhealth. 2021;9:e28024. Kumanyika SK, Wadden TA, Shults J, Fassbender JE, Brown SD, Bowman MA, et al. Trial of Family and Friend Support for Weight Loss in African American Adults. Archives of Internal Medicine. 2009;169:1795–804. Turner-McGrievy GM, Beets MW, Moore JB, Kaczynski AT, Barr-Anderson DJ, Tate DF. Comparison of traditional versus mobile app self-monitoring of physical activity and dietary intake among overweight adults participating in an mHealth weight loss program. J Am Med Inform Assoc. 2013;20:513–8. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4644353","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":322089126,"identity":"18c0cdf9-2712-41a8-8156-4028ccb88086","order_by":0,"name":"Snehaa Ray","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3ElEQVRIiWNgGAWjYHACNijNfAAmYkCsFrYEkrXwwFXi1yI/u/nYgx81DPn8M3K+SfyouJPHwN68TQKfFoM7x9INe44xWM64kbtNsufMs2IGnmNl+LVI5JhJ8LAB3QLUIs3YdjixASSC12Ez8r9J/vnHYCB/I+cZRIv8G/xaGG7ksEnztjEYGIAYEFt48GsxuJFmJi3bJ2FgeOaZsWXPmcOJbTxpxRb4HZb8TPLNNxsDuePJD2/8qDic2M9+eOMNvA6DAKBLBBIgTDa8ClEA/wHi1Y6CUTAKRsHIAgBa0EYG+nx6YgAAAABJRU5ErkJggg==","orcid":"","institution":"University of Connecticut","correspondingAuthor":true,"prefix":"","firstName":"Snehaa","middleName":"","lastName":"Ray","suffix":""},{"id":322089127,"identity":"45c2cbae-f68d-45f4-b821-b3c7a51fca2b","order_by":1,"name":"Christie I. Idiong","email":"","orcid":"","institution":"University of Connecticut","correspondingAuthor":false,"prefix":"","firstName":"Christie","middleName":"I.","lastName":"Idiong","suffix":""},{"id":322089128,"identity":"05ba839c-a4cf-41a4-a830-a36cd0c6bd89","order_by":2,"name":"Rachel Anderson","email":"","orcid":"","institution":"University of Connecticut","correspondingAuthor":false,"prefix":"","firstName":"Rachel","middleName":"","lastName":"Anderson","suffix":""},{"id":322089129,"identity":"c660f738-4d78-4d7a-b74e-81aaf14fffa3","order_by":3,"name":"Kate Killion","email":"","orcid":"","institution":"University of Connecticut","correspondingAuthor":false,"prefix":"","firstName":"Kate","middleName":"","lastName":"Killion","suffix":""},{"id":322089130,"identity":"f920a8cb-607a-4441-8afe-b1037027fc17","order_by":4,"name":"Curtis Antrum","email":"","orcid":"","institution":"University of Connecticut","correspondingAuthor":false,"prefix":"","firstName":"Curtis","middleName":"","lastName":"Antrum","suffix":""},{"id":322089131,"identity":"d7175db4-35ac-4100-8a02-6465a28798e2","order_by":5,"name":"Michael Puglisi","email":"","orcid":"","institution":"University of Connecticut","correspondingAuthor":false,"prefix":"","firstName":"Michael","middleName":"","lastName":"Puglisi","suffix":""},{"id":322089132,"identity":"e682c94c-d4f9-4a12-9a9b-c6c88f7b6a48","order_by":6,"name":"Jolaade Kalinowski","email":"","orcid":"","institution":"University of Connecticut","correspondingAuthor":false,"prefix":"","firstName":"Jolaade","middleName":"","lastName":"Kalinowski","suffix":""},{"id":322089133,"identity":"43f26d0e-2951-4dc9-9073-be166ece2f08","order_by":7,"name":"Kristen Cooksey Stowers","email":"","orcid":"","institution":"University of Connecticut","correspondingAuthor":false,"prefix":"","firstName":"Kristen","middleName":"Cooksey","lastName":"Stowers","suffix":""},{"id":322089134,"identity":"41cfc65c-aff1-4768-982b-eb0b29ccc752","order_by":8,"name":"Loneke T. Blackman Carr","email":"","orcid":"","institution":"University of Connecticut","correspondingAuthor":false,"prefix":"","firstName":"Loneke","middleName":"T. Blackman","lastName":"Carr","suffix":""}],"badges":[],"createdAt":"2024-06-26 17:47:01","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4644353/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4644353/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":60929967,"identity":"654b56f8-8e98-473d-857f-3610cf2d09eb","added_by":"auto","created_at":"2024-07-23 16:56:37","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":11006,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSix-Step Thematic Analysis Process\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4644353/v1/b0bbac65d9c0aec6e83c4078.png"},{"id":60930955,"identity":"da250951-796b-4c89-b1a1-169f7c84a160","added_by":"auto","created_at":"2024-07-23 17:04:37","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":721521,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4644353/v1/abea3be8-0fd2-498d-9cef-f17b6a2523bb.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Examining Preferences for Weight Loss Interventions Among Black Men and Women Experiencing Overweight or Obesity: A Qualitative Approach","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eObesity remains a persistent public health challenge, impacting 42.0% of adults in the United States[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Black adults are disproportionately affected with nearly 50.0% living with obesity, a prevalence that is greater than other racial and ethnic groups[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The disproportionate burden of obesity increases Black adults\u0026rsquo; risk of developing preventable diseases such as type 2 diabetes, cardiovascular diseases and some types of cancers[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEfficacious obesity treatment is found through behavioral weight loss interventions[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Seminal trials combine cognitive behavioral therapy, dietary modification, and physical activity behavior change to produce clinically meaningful weight loss of 5\u0026ndash;10% [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. While behavioral weight loss interventions are regarded as efficacious, consistent challenges exist concerning treatment among Black adults[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In seminal weight control trials, Black men remain underrepresented precluding them from experiencing the benefits of obesity treatment[\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. When Black men are engaged in behavioral weight loss interventions, positive and clinically meaningful outcomes have resulted[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. However, a disparity between Black and White men\u0026rsquo;s weight loss exists, with approximately 2% lower weight changes observed[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. A similar disparity in weight loss has been observed among Black women[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Notably, among Black women, weight losses produced through standard behavioral weight loss treatment interventions are typically modest (2\u0026ndash;3%) and below the clinically meaningful target of 5\u0026ndash;10%[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. While behavioral weight loss interventions for obesity treatment have been established as the standard of care, disparities in representation and outcomes for Black adults reflect a need to reconsider what may and may not work for this population subgroup[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Thus, there is a need to determine the best approach to engage Black adults and to develop weight loss interventions that can consistently produce clinically meaningful outcomes to improve their health.\u003c/p\u003e \u003cp\u003eCurrent evidence indicates a need to understand weight-related behaviors such as diet, physical activity and what supports or creates barriers to the adoption of these behaviors[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. While quantitative outcomes have illustrated the need for continued development of weight loss interventions, investigators have called for the use of qualitative methods to understand disparities in treatment and engagement among Black adults[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Qualitative research is useful for exploring phenomena, provide richer insights to contextualize quantitative outcomes, and design interventions to better address obesity treatment in Black adults[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Using qualitative methods, this study examined the barriers and facilitators of behavioral targets of weight loss interventions (healthy diet, physical activity), and identified desires for weight loss treatment among Black adults with overweight or obesity.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eResearch Team\u003c/h2\u003e \u003cp\u003eTo maintain credibility in research, a diverse group of researchers from interdisciplinary backgrounds was involved in the study. This qualitative study was developed by four researchers (KCS, LBC, MP, and JK) with a focus on health equity research. A five-team member (henceforth referred to as the working team)led the entire research process. The working team, comprising 4 females and 1 male was guided through the process of data collection and data analysis by two professors KCS and LBC with expertise in research aimed at reducing obesity-related health disparities. LBC and a doctoral-level researcher (SR) with a background in nutritional sciences and qualitative coding conducted the interviews. Two doctoral-level coders (CI,KK and CA) with a background in allied health contributed to qualitative coding and theme generation. An undergraduate researcher who self-identified as a female performed data management and analysis (RA).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eRecruitment\u003c/h2\u003e \u003cp\u003eActive recruitment occurred in collaboration with community partners from a mid-sized New England city before COVID-19. They initiated and monitored communication with individuals interested in the study, as well as organizations from which interested individuals may be potentially recruited. Individuals interested in the study were then contacted by the study team. Due to the emergence of COVID-19, in-person research activities were halted and recruitment strategies were expanded to include individuals beyond the initially targeted local region. Passive strategies were also implemented during recruitment. Passive recruitment strategies included the use of ResearchMatch, a nationwide online recruitment resource for health research, supported by the National Institute of Health[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].In the local community, additional strategies for recruitment included the distribution of quarter cards, flyers, and listserv email announcements. All study procedures were approved by the University of Connecticut\u0026rsquo;s Institutional Review Board.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eEligibility criteria\u003c/h2\u003e \u003cp\u003eIndividuals were considered eligible for the study if they self-identified as either Black, African American, or Afro-Caribbean, had a body mass index (BMI)\u0026thinsp;\u0026ge;\u0026thinsp;25 kg/m\u003csup\u003e2\u003c/sup\u003e, based on self-reported height and weight, and expressed a willingness to participate in audio-recorded individual interviews. Individuals who expressed interest in the study were contacted via telephone by a study staff member. If no response was received, then the participants were contacted through email requesting a call back to describe the study in detail to determine their interest and eligibility. After an individual expressed interest and confirmed a date and time, the virtual interview was scheduled.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eData collection\u003c/h2\u003e \u003cp\u003eIndividual interviews were conducted during the COVID-19 pandemic between August 2020 to August 2021 using a semi-structured interview guide. The interview guide was developed based on the scholarly literature indicating the gaps in knowledge and challenges regarding weight loss and behavioral obesity treatment with Black adults[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e provides a list of questions that were asked during the interview. Current evidence indicated a need to understand weight-related behaviors such as diet, physical activity and what supports or creates barriers to adoption of these behaviors, therefore the interview guide was broken into sections with probes pertinent to each question. The WebEx software was used to conduct and audio record the interviews. Prior to the administration of the interview questions, informed consent was gained from participants. A doctoral-level trained moderator conducted the individual interviews via WebEx. A note taker was present to record any verbal and non-verbal communications in the event that there was a recording malfunction or internet disconnection. Each interview lasted about 35\u0026ndash;45 minutes. At the end of the interview, participants were asked to complete a short survey to collect demographic information and social support for diet and physical activity. Participants were provided a \u003cspan\u003e$\u003c/span\u003e50 gift card for their participation in the study.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSample semi-structured interview questions\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInterview Questions\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProbes\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSection: Feedback on intervention components\u003c/b\u003e\u003c/p\u003e \u003cp\u003e1. What are your first thoughts about what\u0026rsquo;s included in a typical weight loss program?\u003c/p\u003e \u003cp\u003e2. What do you think a weight loss program for Black adults should look like?\u003c/p\u003e \u003cp\u003e3. What is missing in the typical weight loss program for Black men/women? (asked according to self-identified gender)\u003c/p\u003e \u003cp\u003e\u003cb\u003eSection: Barriers\u003c/b\u003e\u003c/p\u003e \u003cp\u003e4. What gets in the way, or makes it hard, for you to eat healthy?\u003c/p\u003e \u003cp\u003e5. Which healthy eating barriers are the hardest for you to overcome?\u003c/p\u003e \u003cp\u003e6. Which healthy eating barriers are the easiest to work around?\u003c/p\u003e \u003cp\u003e7. What barriers, or things get in the way, of you getting regular exercise?\u003c/p\u003e \u003cp\u003e\u003cb\u003eSection: Assets\u003c/b\u003e\u003c/p\u003e \u003cp\u003e8. What makes it possible, or easier, to eat healthy?\u003c/p\u003e \u003cp\u003e9. What makes it possible, or easier, to be active?\u003c/p\u003e \u003cp\u003e\u003cb\u003eSection: Social Support\u003c/b\u003e\u003c/p\u003e \u003cp\u003e10. What are the ways others support you to eat healthy foods?\u003c/p\u003e \u003cp\u003e11. How do people support you to be physically active (Eg. exercise) in your spare time?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; What should be added, or removed, for Black men/women (ask according to self-identified gender)\u003c/p\u003e \u003cp\u003e\u0026bull; If you were in a weight loss program for Black adults, what do you want to have included?\u003c/p\u003e \u003cp\u003e\u0026bull; Cooking skills\u003c/p\u003e \u003cp\u003e\u0026bull; Flavor/seasoning food\u003c/p\u003e \u003cp\u003e\u0026bull; Taste preferences\u003c/p\u003e \u003cp\u003e\u0026bull; Time\u003c/p\u003e \u003cp\u003e\u0026bull; Recipes\u003c/p\u003e \u003cp\u003e\u0026bull; Food Storage information\u003c/p\u003e \u003cp\u003e\u0026bull; Transportation\u003c/p\u003e \u003cp\u003e\u0026bull; Cost\u003c/p\u003e \u003cp\u003e\u0026bull; Time\u003c/p\u003e \u003cp\u003e\u0026bull; Opportunities to sit\u003c/p\u003e \u003cp\u003e\u0026bull; Safety\u003c/p\u003e \u003cp\u003e\u0026bull; Family commitments\u003c/p\u003e \u003cp\u003e\u0026bull; Hair care\u003c/p\u003e \u003cp\u003e\u0026bull; Home resources\u003c/p\u003e \u003cp\u003e\u0026bull; Community resources\u003c/p\u003e \u003cp\u003e\u0026bull; Educational\u003c/p\u003e \u003cp\u003e\u0026bull; Religious structures/faith-based (ex. Church, Mosque)\u003c/p\u003e \u003cp\u003e\u0026bull; Community programs\u003c/p\u003e \u003cp\u003e\u0026bull; Work (people, places, structures)\u003c/p\u003e \u003cp\u003e\u0026bull; Technology (ex. Phone apps, websites, etc.)\u003c/p\u003e \u003cp\u003e\u0026bull; Who gives you support? (family, friends, coworkers)\u003c/p\u003e \u003cp\u003e\u0026bull; How is the support different between people?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eDemographic Information\u003c/h2\u003e \u003cp\u003eParticipants completed a demographic survey including information such as age, gender, BMI, racial heritage, Hispanic or Latino ethnicity, ancestry, education, marital status, household income, and employment status. Categorical variables were represented through frequencies and percentages while continuous variables were summarized using means and standard deviations. The SPSS software version 29.0 was used for handling all quantitative data.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eQualitative data were audio recorded and transcribed verbatim. A team-based approach was used to code individual transcripts and Dedoose software version 4.12 was employed. The thematic analysis, consisting of a 6-step process developed by Braun and Clarke (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), was followed to analyze data and generate themes[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. To increase familiarity with the transcripts 3 members of the coding team (KCS,KK and RA) listened to audio recordings and read the transcripts several times to develop and revise the coding guide after applying the coding scheme to a subsample of transcripts. Then the larger research working team, consisting of the Co-primary investigator (KCS) and 3 pairs of trained graduate students met to compare codes and provide code definitions. Through an iterative process, the team and principal investigator convened to refine and finalize the coding guide (comprising codes and definitions). With the finalized codebook, 3 pairs of coders coded all transcripts (individually and then met to reconcile differences) and convened to discuss the analysis and to generate the final themes. The coders achieved an average inter-reliability score of 0.83.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eTwenty-four Black adults participated in this study with an average age of 46.0 \u0026plusmn; 13.3 \u0026nbsp;years and were predominantly female (n = 16; 66.0%). The mean BMI of the total sample was 33.0 \u0026plusmn; 8.0 \u0026nbsp;kg/m2, with half of the participants classified as overweight and half having obesity. Most participants identified as Black American (n=18; 75.0%) with 60.0% of Jamaican origin (n=14). \u0026nbsp;Most of the participants identified as non-Hispanic (n=22, 91.0%), were born in the US (n=18; 75.0%), and living in Hartford, Connecticut (n=11; 46.0%). Most of the sample reported a household income of more than $60,000 ( n=14, 59.0%) and had some college education (n=7; 29.0%). The description of the sample is provided in Table 2.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2: Baseline Demographic Variable of Study Participants\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"58.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.833333333333332%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.833333333333332%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"58.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Female\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Male\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.833333333333332%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.833333333333332%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e66.7\u003c/p\u003e\n \u003cp\u003e33.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"58.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e (Average [SD]) \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.833333333333332%\" valign=\"top\"\u003e\n \u003cp\u003e46.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.833333333333332%\" valign=\"top\"\u003e\n \u003cp\u003e13.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"58.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eWeight Status\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Overweight\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Obesity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.833333333333332%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.833333333333332%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e50.0\u003c/p\u003e\n \u003cp\u003e50.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"58.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLocation\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Hartford\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Other\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.833333333333332%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.833333333333332%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e45.8\u003c/p\u003e\n \u003cp\u003e54.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"58.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eRacial Heritage\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; African American\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Afro-Caribbean\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; American Indian/Alaska Native\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.833333333333332%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003cp\u003e1\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.833333333333332%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e75.0\u003c/p\u003e\n \u003cp\u003e20.8\u003c/p\u003e\n \u003cp\u003e4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"58.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHispanic/Latino Ethnicity\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Non-Hispanic \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Hispanic/Latino\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.833333333333332%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.833333333333332%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e91.7\u003c/p\u003e\n \u003cp\u003e8.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"58.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHousehold Income\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.833333333333332%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.833333333333332%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"58.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026gt;$60,000\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; $40,000-$60,000\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; $10,000-$30,000\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026lt;$10,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.833333333333332%\" valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.833333333333332%\" valign=\"top\"\u003e\n \u003cp\u003e41.7\u003c/p\u003e\n \u003cp\u003e20.8\u003c/p\u003e\n \u003cp\u003e16.7\u003c/p\u003e\n \u003cp\u003e12.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"58.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eImmigration Status\u003c/strong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Born in the US\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Not born in the US\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.833333333333332%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e18\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.833333333333332%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e75.0\u003c/p\u003e\n \u003cp\u003e25.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"58.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital Status\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Single\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Married\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Divorced\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Widowed\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.833333333333332%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e13\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.833333333333332%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e54.2\u003c/p\u003e\n \u003cp\u003e20.8\u003c/p\u003e\n \u003cp\u003e16.7\u003c/p\u003e\n \u003cp\u003e8.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"58.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHighest Education\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Graduate School or Professional Education\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; College/University Degree\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Some College Education (\u0026lt;4 years)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Technical School or Vocational Training\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Graduated from High School\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Did not complete high school\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.833333333333332%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.833333333333332%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e20.8\u003c/p\u003e\n \u003cp\u003e29.1\u003c/p\u003e\n \u003cp\u003e29.1\u003c/p\u003e\n \u003cp\u003e4.16\u003c/p\u003e\n \u003cp\u003e12.5\u003c/p\u003e\n \u003cp\u003e4.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe following themes emerged from the interviews with Black adults who were either overweight or obese. A summary of the key themes, subthemes, and representative statements of the Black female and male participants are presented in Table 3 (females) and Table 4 (males).\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 1:\u003c/strong\u003e \u003cem\u003eBlack male vs female preferences creating a weight loss program for Black adults.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eParticipants expressed their preferences regarding how a weight loss intervention could be made more desirable to Black adults. Black female participants indicated incorporation of the local community, and group activities and to model community programs that are successful. They stressed the importance of community, as participants identified that the community was where they could source support, motivation and engagement. Black female participants desired personalization in weight loss interventions through the incorporation of flavorful and culturally relevant recipes tailored to the preferences of Black adults and personalized exercise routines and avoiding general prescriptions for diet consumption and exercise engagement.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBlack male participants, on the other hand, expressed a strong interest in a program that was specifically customized for Black adult males, emphasizing healthy eating and exercise. They highlighted the desire for awareness and education concerning certain health conditions (e.g. hypertension, diabetes, and arthritis) as well as promoting tailored recipes designed to manage health conditions such as low sodium and diabetes-friendly recipes. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBoth genders highlighted the importance of a personalized program that includes flavorful and culturally relevant recipes tailored to the preferences of Black adults. While Black female participants predominantly emphasized community as a necessity in weight loss programs, Black male participants emphasized the need for a program that will concentrate not just concentrating on weight loss, but also connects to other health concerns such as type 2 diabetes and hypertension.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 2:\u003c/strong\u003e \u003cem\u003eHealthy Eating Barriers\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe primary barrier included a lack of knowledge and skills in preparing nutritious meals, scarcity of healthy recipes, and general dislike for cooking. Specifically, female participants indicated limited or no time as the primary barrier to cooking healthy meals. They also emphasized family responsibilities as a significant challenge to cooking and consuming healthy foods. Male participants identified time constraints for cooking healthy meals, grocery shopping, and family commitments as significant barriers to consuming healthy meals. Both male and female participants frequently cited time constraints and family responsibilities as primary barriers to consuming healthy meals.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 3:\u003c/strong\u003e \u003cem\u003ePhysical Activity Barriers\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eBlack female participants frequently discussed a lack of motivation to exercise and challenges in finding the time to maintain an exercise routine as the primary barriers to engaging in physical activity. Black female participants uniquely mentioned that time constraints were mainly due to career and job commitments and family responsibilities. Black male participants identified time as the primary barrier to physical activity. Additionally, they mentioned lacking motivation to create and maintain an exercise regime. Both genders indicated a lack of time and motivation as the primary barriers to engaging in physical activity. There was no noted gender difference in terms of barriers encountered for engaging in physical activity. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 4:\u003c/strong\u003e \u003cem\u003eHealthy Living Facilitators\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTechnology, mindset and routine were emphasized to have a high influence for engaging in healthy eating and physical activity. Female participants indicated an openness to engaging with technology-delivered resources and guidance for nutrition and exercise. This included smartphone apps such as MyFitnessPal and social networking sites, such as Facebook. Responses stated by female participants highlighted mindset and routine, defined as engaging in health behaviors out of routine and keeping motivated towards those healthy behaviors as major factors to facilitating healthy lifestyle choices. These two factors were cited as driving forces to maintain motivation to engage in healthy behaviors such as healthy eating and physical activity. Male participants highlighted having access to online resources to find information and guidance on healthy recipes, exercise and social media applications that create an online community. Male participants noted routine as a necessity for engaging in healthy behaviors. Specifically, initiating and maintaining an exercise routine was highlighted as the primary motivation for engaging in physical activity.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMindset and routine were emphasized equally among male participants compared to female participants. The notable gender contrast was highlighted among facilitators, with female participants predominantly expressing a desire for technology to engage in healthy behaviors whereas male participants sought online resources and information for managing weight and other health conditions.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 5:\u003c/strong\u003e \u003cem\u003eSocial Support\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eDifferences existed between sex when comparing how participants felt best supported to engage in healthy behaviors. Female participants mentioned feeling most supported by healthcare professionals and the advice for selecting health behaviors regarding nutrition and physical activity. Coworkers were also mentioned by female participants as sources of support for engaging in healthy behaviors. Female participants specifically noted feeling most supported when engaging in healthy behaviors with family members and receiving verbal encouragement from a person in their social network. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Male participants noted support from healthcare professionals and coworkers to be a trusted source when looking to engage in eating healthy and exercise but ranked their friends higher when considering who influenced engaging in healthy behaviors most. Examples specifically noted included sharing meals or walking together as large facilitators for eating healthy and engaging in exercise, respectively. Both female and male participants found the least support from romantic partners.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3: Summary of Emergent Themes and Representative Statements by Female Participants.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"631\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.27416798732171%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eKey Themes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.832012678288432%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubtheme\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"56.89381933438986%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eRepresentative Statements\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.27416798732171%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eCreating Weight Loss Program for Black Adults\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.832012678288432%\" valign=\"top\"\u003e\n \u003cp\u003eCommunity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"56.89381933438986%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026ldquo;Like, um, you know, um, and that\u0026apos;s not always like directly related, but to be honest, any type of support, or just like an, an internal, like community building that you can do with Black people will, will help any program, even if it\u0026apos;s not directly related to weight loss\u0026rdquo;, \u003cem\u003e\u0026nbsp;Age 26\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.226053639846743%\" valign=\"top\"\u003e\n \u003cp\u003ePersonalization\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"68.77394636015326%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026ldquo;Yeah, definitely, because I feel like each person gets excited about a different thing, like not everyone- You know, a goal about how they... Why fitness is important. So, um, yeah, personalization is definitely important, in my opinion.\u0026rdquo; \u003cem\u003eAge 40\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.27416798732171%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eHealthy Eating Barriers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.832012678288432%\" valign=\"top\"\u003e\n \u003cp\u003eTime\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"56.89381933438986%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026ldquo;Because you have to it\u0026apos;s... When you don\u0026apos;t know, or you trying to learn something, it takes time. When it\u0026apos;s something effortlessly that comes together. Like if you were to ask me to make, um, fried plantains, I could do that within seconds. But if you were to ask me a big potato or something in the oven, I had to sit down and I have to Google it, look for recipes and it takes a lot more time.\u0026rdquo;\u003cem\u003e\u0026nbsp;Age 29\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.226053639846743%\" valign=\"top\"\u003e\n \u003cp\u003eCooking Skills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"68.77394636015326%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026ldquo;Um, so, and then with cooking too, sometimes, like, the- the details to, like, paying attention to this, how long you have to leave this, or you\u0026apos;re trying to cook multiple things at once, something might get cold.\u0026rdquo;\u003cem\u003e\u0026nbsp;Age 45\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.27416798732171%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003ePhysical Activity Barriers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.832012678288432%\" valign=\"top\"\u003e\n \u003cp\u003eMotivation\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"56.89381933438986%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026ldquo;Uh, what makes it hard? Um, sometimes I just don\u0026apos;t have the energy, sometimes, um, sometimes I\u0026apos;m just, just tired, uh, so you know, that does it.\u0026rdquo;\u003cem\u003e\u0026nbsp;Age 26\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.226053639846743%\" valign=\"top\"\u003e\n \u003cp\u003eTime\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"68.77394636015326%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026ldquo;Just not getting up and building the extra time into your schedule. Well, it [time] can be affected by work if I am traveling and my day may start at 8:00 AM, and I might not get home till 10:00 PM. So I know if I\u0026apos;m having a long day, I might not get up that extra hour that morning and go workout because I know I have a eight hour work day, then I have six more hours of travel.\u0026rdquo; \u003cem\u003eAge 44\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.27416798732171%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eHealthy Living Facilitators\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.832012678288432%\" valign=\"top\"\u003e\n \u003cp\u003eMindset and Routine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"56.89381933438986%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026ldquo;It\u0026apos;s just a mindset. You make a mind, where you tell yourself, \u0026quot;I gotta do this. I gotta walk.\u0026quot; For example, exercising, I gotta go down the street now, and you walk till you feel tired or about to get tired, and you come right back. So, it\u0026apos;s just a whole mindset, \u0026apos;cause I have to wake up before six, or by six in the morning. And, it\u0026apos;s a whole mindset, if I have to do something, I have it do it. Nothing stops.\u0026rdquo; \u003cem\u003eAge 53\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.226053639846743%\" valign=\"top\"\u003e\n \u003cp\u003eTechnology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"68.77394636015326%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026ldquo;I mean really what motivates me is just really just social media. I go on YouTube. YouTube is like is life. I go on YouTube every day and I\u0026apos;m pretty proud to say that because YouTube for me is like, I don\u0026apos;t go in there just to watch other people\u0026apos;s life. I go on there and I learn so much, like I have, you know, I could list like five people right now who are like influencers who take really good pride, like in, in their content. And they talk about like their diet and what they eat. And they also upload like exercising videos, you know, some of them are really... So I get a lot of inspiration from just like looking at their bodies and I\u0026apos;m like, oh wow. Like I know I can get to that.\u0026rdquo;\u003cem\u003e\u0026nbsp;Age 26\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.27416798732171%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eSocial Support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.832012678288432%\" valign=\"top\"\u003e\n \u003cp\u003eFamily and Friends\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"56.89381933438986%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026ldquo;And the receive, the support I received from my mom It\u0026apos;s more, it\u0026apos;s more, um, knowledge in anything else. So I guess everybody plays a different part in it and it\u0026apos;s in a way a compliment and it builds the whole pyramid.\u0026rdquo;\u003cem\u003e\u0026nbsp;Age 29\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.226053639846743%\" valign=\"top\"\u003e\n \u003cp\u003eOther Support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"68.77394636015326%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026ldquo;Yes, absolutely. I have some coworkers that are very health conscious. So we are often just talking about like, who\u0026apos;s the health person in the office. They\u0026rsquo;ll recommend that we try or eat and that\u0026apos;s type of thing.\u0026rdquo;\u003cem\u003e\u0026nbsp;Age 37\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4: Summary of Emergent Themes and Representative Statements by Male Participants.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"631\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.27416798732171%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eKey Themes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.832012678288432%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubtheme\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"56.89381933438986%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eRepresentative Statements\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.27416798732171%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eCreating Weight Loss Program for Black Adults\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.832012678288432%\" valign=\"top\"\u003e\n \u003cp\u003eCommunity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"56.89381933438986%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026ldquo;Um, I mean, I think that all sounds good. I do, I think the group component again is a big part of success when you\u0026apos;re able to communicate with other people going through the same program. Um, and then again, the healthy choice, healthy options for food\u0026rdquo; \u003cem\u003eAge 19\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.226053639846743%\" valign=\"top\"\u003e\n \u003cp\u003ePersonalization\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"68.77394636015326%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026ldquo;Um, I would, like, I feel like the like I don\u0026apos;t know, about like the exercise in particular. I feel like, I feel like, it depends on the person, you know? I feel like it depends on the person.\u0026rdquo; \u003cem\u003eAge 32\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.27416798732171%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eHealthy Eating Barriers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.832012678288432%\" valign=\"top\"\u003e\n \u003cp\u003eTime\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"56.89381933438986%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026ldquo;So obviously the time commitment, uh, if I\u0026apos;m not meal prepping, finding, it\u0026apos;s easy to go to a fast food restaurant and get, you know, the popular meals that you like, or, um, you know, just getting something quick. the amount of time it takes to prepare meal versus going across the street and buying something, I think, um, you know, obviously it\u0026apos;s less amount of time to purchase something that\u0026apos;s already prepared.\u0026rdquo;\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eAge 32\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.226053639846743%\" valign=\"top\"\u003e\n \u003cp\u003eCooking Skills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"68.77394636015326%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026ldquo;I don\u0026apos;t cook, so. And I wanna learn but I haven\u0026apos;t uh, I haven\u0026apos;t taken the steps to learn yet.\u0026rdquo;\u003cem\u003e\u0026nbsp;Age 65\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.27416798732171%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003ePhysical Activity Barriers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.832012678288432%\" valign=\"top\"\u003e\n \u003cp\u003eMotivation\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"56.89381933438986%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026ldquo;I think that- that is the biggest one, outside of, um, I guess, um- um, motivation. Sometimes you- you won\u0026apos;t always be motivated to do it.\u0026rdquo; \u003cem\u003e\u0026nbsp;Age 39\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.226053639846743%\" valign=\"top\"\u003e\n \u003cp\u003eTime\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"68.77394636015326%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026ldquo;Well, 30 minutes a day is way too much time. (laughing) No one has time for that. Um, I\u0026apos;m sure that if I went jogging every morning, or went to the gym every day, I would probably be healthier but, you know, big time factor. I mean, no one has time for that, you know.\u0026rdquo;\u003cem\u003e\u0026nbsp;Age54\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.27416798732171%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eHealthy Living Facilitators\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.832012678288432%\" valign=\"top\"\u003e\n \u003cp\u003eMindset and Routine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"56.89381933438986%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026ldquo;I would say the main thing for me [that makes it easier to be active] is maintaining a routine. It\u0026apos;s so much easier when you\u0026apos;re accustomed to doing things, you know.\u0026rdquo;\u003cem\u003e\u0026nbsp;Age 54\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.226053639846743%\" valign=\"top\"\u003e\n \u003cp\u003eTechnology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"68.77394636015326%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026ldquo;I have an Apple watch and several of my friends do too. I guess this isn\u0026apos;t, \u0026nbsp;us talking, but we are communicating through like ... I guess this is more of an encouragement ... If you see someone close their activity rings, or they, had a workout, that is sometimes encouraging to get those messages in.\u0026rdquo;\u003cem\u003e\u0026nbsp;Age 36\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.27416798732171%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eSocial Support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.832012678288432%\" valign=\"top\"\u003e\n \u003cp\u003eFamily and Friends\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"56.89381933438986%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026ldquo;They [friends] know that I\u0026apos;m, I\u0026apos;m trying to uh, s- be active. So they, they uh, I have a few friends who\u0026apos;ll come by and try to get me to go out and do things... if you wanna call it exercise, yeah, some of \u0026apos;em do. Some of \u0026apos;em will take a walk every now and then but usually it\u0026apos;s just me by myself.\u0026rdquo;\u003cem\u003e\u0026nbsp;Age 65\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.226053639846743%\" valign=\"top\"\u003e\n \u003cp\u003eOther Support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"68.77394636015326%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026ldquo;Well, my doctor always tries to encourage me to lose a few pounds, but it\u0026apos;s nothing serious. He doesn\u0026apos;t really press me too much. He just says, in general, it\u0026apos;s better to lose a few. I try to listen to him because I\u0026apos;m at the point to lose 10 or 15. But now, maybe he\u0026apos;s saying maybe lose five. So, I have lost.\u0026rdquo;\u003cem\u003e\u0026nbsp;Age 54\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eCurrently, limited research exists that qualitatively examines the desires of Black adults for the creation of weight loss interventions by learning about what supports or creates a barrier to diet and physical activity behaviors. This qualitative study investigated the barriers and facilitators to weight loss behaviors such as healthy diet and physical activity and the individual weight loss program preferences of Black adults. Major themes that emerged from the interviews included preferences for weight loss programs among both Black males and Black females, barriers to adopting healthy eating and physical activity, healthy living facilitators, and desire for social support. Centering on the weight loss program creation for Black adults, the responses revealed differences in the preferences of Black males and females. For Black females, the sub-themes generated were community and personalization while for Black males, programs focusing on personalized exercise and healthy eating for managing various health conditions emerged as major sub-themes for weight loss program creation.\u003c/p\u003e \u003cp\u003eBlack males and females in the sample identified unique, sex-specific needs for weight loss with small areas of similar desires for weight loss program creation. Inclusion of community was highlighted by Black females. Specifically, desires for community, a source of support, as part of weight loss intervention design was raised. Black females in the sample discussed the importance of including pre-existing community programs in obesity treatment. This finding aligns with recommendations for obesity control and equity where provision of and support for existing community programs that seek to improve physical activity and nutrition is a key strategy[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. This may look like obesity treatment alongside nutrition assistance programs that improve access to social and economic resources or treatment through community programs like Black Girls Run! that already focus on a weight-related behavior (physical activity) and provide social support to an engaged audience[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Community-engaged efforts like the Racial and Ethnic Approaches to Community Health across the United States (REACH US) project that utilized participatory methods to generate multi-level, culturally and contextually relevant health interventions, reduced obesity prevalence across fourteen Black communities[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMales in this study wanted weight loss interventions designed specifically for them. Incorporating both eating and exercise was of equal importance to Black males as a means to reduce weight and address comorbidities like diabetes and hypertension. This finding is supported by the literature among older Black males, where diagnosis with a disease is noted as a motivator to participate in health research for better disease management and understanding[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Gender-specific weight control programs may be relevant as weight loss strategies differ between Black males and females[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. For example, Black male respondents to a community survey reported more regular exercise engagement than Black females\u0026rsquo; and had less engagement with weight loss strategies and attempts[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Across genders, personalization through culturally relevant dietary prescriptions and exercise was seen as necessary by Black adults in this qualitative study, which resonates with current weight control literature to address inequities. Still, gender-specific needs exist in weight-related behaviors like physical activity that indicate the relevance of race- and gender-specific weight control treatment as a future direction[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eParticipants recognized several barriers to consuming healthy meals. Black females emphasized that their primary barriers to cooking and consumption of healthy foods were lack of time to procure and prepare nutritious meals and family obligations. Unlike the findings of this study, several qualitative studies examining barriers to healthy eating mentioned a lack of knowledge to be the major challenge to healthy eating and expressed uncertainty about what and how to cook healthy, in contrast to the current study where lack of time was identified as the primary barrier[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Additionally, qualitative study findings in Black women indicated that women felt pressured to consume more, lacking support when attempting to eat healthy and reported that this created a hindrance to adopting healthy eating habits[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. On the other hand, lack of knowledge, skills, and a shortage of healthy recipes was identified as major barrier by males. To address this issue, future weight loss interventions should focus on integrating cooking methods, stressing the importance of portion control, and helping understand the nutritional value of foods[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Programs should also aim to incorporate a range of resources, including cooking classes, online tutorials of culturally relevant recipes, and community programs dedicated to healthy cooking[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. As Black males expressed a desire for recipes that could assist in managing health conditions such as hypertension, the use of the DASH (Dietary Approaches to Stop Hypertension) diet, which has been proven effective in controlling hypertension and supporting weight loss, may be beneficial and attractive[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eBlack females and Black males identified distinct barriers to engaging in physical activity. Black females specifically identified challenges related to busy work schedules and caretaking responsibilities, leading to fatigue and tiredness, leaving little energy for exercise[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. In the context of physical activity, utilizing home-based programs through weight loss interventions, personalized to the level of resources available, may provide significant improvement and adherence to physical activity[\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. Black males noted a lack of motivation to maintain a physical routine. This finding is consistent with qualitative research findings that suggested Black males experience decreased motivation to participate in physical activity due to challenges and stress associated with fulfilling key gendered social roles as a worker, provider, father, and spouse/partner[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Black male participants desired personalized exercise regimens for different age groups to enhance motivation and distributed the exercise schedule in small intervals throughout the week. When designing interventions for Black males, it is essential to incorporate exercises preferred by men and create a consistent routine to perform these exercises [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e Black adult participants noted what supports or would be beneficial in their healthy eating and physical activity pursuits. The distinctive aspect of the current study findings is that participants of both genders emphasized the use of technological resources as a facilitator for promoting healthy eating and physical activity. Special reference was made to personal devices or smartphone apps for tracking weight, and diet, recording daily physical activity, and connecting to a health coach remotely for guidance and problem-solving. Despite the high usage of smartphones and smartphone-related tools and apps in Black adults (83%), few studies have used smartphone apps for tracking diet and physical activity and targeted this population[\u003cspan additionalcitationids=\"CR44\" citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. This indicates that future interventions could use digital modalities for delivering weight loss programs. Considering the personalized weight loss program preference among both genders, future research in this area should aim to provide tailored messages and individualized intervention components[\u003cspan additionalcitationids=\"CR46\" citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. These can comprise languages and terminologies that connect effectively with both Black males and Black females. It is likely essential to investigate the most effective ways to deliver personalized interventions through digital technology.\u003c/p\u003e \u003cp\u003e Female participants expressed a preference for seeking social support from social contacts primarily from friends and family. They also indicated a desire for guidance on healthy eating, particularly from healthcare professionals such as dieticians, valuing their expertise in this area. Findings from a research study by Tucker et.al (2022), show similar trends where Black women emphasized that the weight loss journey depends on an effective communication from the healthcare providers and feeling comfortable trusting the advice provided by them[\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. In line with a study by Bowie et. al. (2018), Black female participants stressed the significance of learning culturally relevant diet and exercise information from healthcare providers and connecting with them remotely for problem-solving. Female participants expressed feeling most supported when engaging in healthy behaviors with family members[\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. Similarly, Jenkins et. al.(2017), found Black women highlighted the positive impact of having a family member as an exercise or walking partner, contributing to their physical activity goals and facilitating weight loss[\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWhile social support for weight loss behaviors in Black males has been less studied, some research findings indicated that having a friend or peer with similar health goals provides encouragement and accountability for physical activity goals[\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. This study identified that Black male participants expressed a need for friends and coworkers to participate in both dietary and physical activity behaviors. In both Black female and male participants, social support has been recognized as a major factor for improving diet and physical activity and requires support from family members, friends, and coworkers. Weight loss interventions should aim to incorporate social support subscales for both genders, enabling a deeper understanding of how the involvement of family and friends influences each aspect of diet and physical activity behaviors with Black adults[\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study has both strengths and limitations. A notable strength lies in the inclusion of diverse Black male and female participants from various geographical locations. Another notable strength is the diversity encompassing the ancestry, socioeconomic statuses and educational backgrounds of the participants. Participants self-identified as African American, Afro-Caribbean, and Jamaican origin and therefore reflected a variety of cultural heritage. The participants included Black adults from various socioeconomic and educational backgrounds. However, the sample was predominantly females (67%) potentially limiting their generalizability to a broader national sample. Another limitation is that the data collection occurred during the COVID-19 pandemic, potentially impacting participant\u0026rsquo;s responses due to the unique circumstances during that time which may have shifted their typical behavioral engagement to modify diet and physical activity. The participants, with an average age of 46.1 years, were mostly single (54%) and therefore the findings about weight loss program creation may not be generalizable to individuals who are older (65 years or more), or living with a partner. The current study captured the desires of both the sexes for a weight loss program, facilitators and barriers to modifying diet and physical activity. Though we acknowledge limitations in generalizability are present, the utilization of the qualitative approach allowed for a focused and commendable effort towards understanding the unique needs of Black adults for engagement in weight loss interventions for traditionally in-person and digital modalities. Future qualitative studies should aim toward addressing this identified gender imbalance to strengthen the transferability of findings.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eIMPLICATIONS FOR FUTURE RESEARCH\u003c/h2\u003e \u003cp\u003eThe study findings indicate the unique weight loss preferences of Black adults with overweight or obesity. The results signify the importance of support from friends and family and the use of technological resources most beneficial to adopting weight loss behaviors. Female participants prioritized the need for a community and personalization for weight loss programs and expressed a desire to learn cooking skills and recipes to support culturally relevant meal preparation. While weight loss was the primary focus, male participants expressed a desire to learn about other health conditions, such as type 2 diabetes and hypertension and diets that could help manage these conditions. The findings hold relevance when designing weight loss interventions for including Black adults. Future research in this area should take into account the weight loss preferences of Black adults across diverse ethnicities, considering individuals living with various chronic health conditions and utilizing a greater nationally representative sample.\u003c/p\u003e \u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eBMI Body Mass Index\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eSupplementary Information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo supplementary information is available\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors want to thank the University of Connecticut, College of Agriculture Health and Natural Resources for their support, the community partners in Connecticut who helped with the recruitment, and the participants for sharing their valuable experience for the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLBC, KCS, MP, and JK were involved in conceptualization and funding acquisition. LBC and SR were involved in data collection. CI, CA, KK, and RA were involved in data coding and analysis. The writing team comprised of SR, CI, and LBC. All the authors reviewed and edited different versions of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis project has been made possible by the funds from the University of Connecticut\u0026rsquo;s College of Agriculture, Health and Natural Resources(CAHNR).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn order to safeguard participant privacy and comply with the University of Connecticut\u0026apos;s Institutional Review Board regulation, the data analyzed in this study are not accessible to the public. Please reach out to Dr. Loneke Blackman Carr for any data-related inquiries at [email protected].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll study procedure was approved by the University of Connecticut\u0026apos;s Institutional Review Board (L20-0031). Each participant provided informed consent before joining the study. Prior to the interview, received a clear explanation of the study\u0026rsquo;s specifics, including the risks and benefits of participating. They were welcome to ask any questions they had about the study. A study staff was available to provide answers until they were fully convinced about their decision to participate in the study. All study procedures were performed as per the norms and standards of the University of Connecticut\u0026rsquo;s research guidelines.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eN/a. All participants provided consent for publication and all the participant information was de-identified after data collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere are no competing interests to declare by the authors.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eStierman B, Afful J, Carroll MD, Chen TC, Davy O, Fink S, et al. National health and nutrition examination survey 2017\u0026ndash;march 2020 prepandemic data files-development of files and prevalence estimates for selected health outcomes. 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Am J Health Promot. 2022;36:1162\u0026ndash;9.\u003c/li\u003e\n \u003cli\u003eHaughton CF, Silfee VJ, Wang ML, Lopez-Cepero AC, Estabrook DP, Frisard C, et al. Racial/ethnic representation in lifestyle weight loss intervention studies in the United States: A systematic review. Prev Med Rep. 2018;9:131\u0026ndash;7.\u003c/li\u003e\n \u003cli\u003eKumanyika S, Whitt-Glover MC, Gary TL, Prewitt TE, Odoms-Young AM, Banks-Wallace J, et al. Expanding the Obesity Research Paradigm to Reach African American Communities. Prev Chronic Dis. 2007;4:A112.\u003c/li\u003e\n \u003cli\u003eKumanyika SK, Whitt-Glover MC, Haire-Joshu D. What works for obesity prevention and treatment in black Americans? Research directions. Obesity Reviews. 2014;15:204\u0026ndash;12.\u003c/li\u003e\n \u003cli\u003eWatkins DC. Qualitative Research: The Importance of Conducting Research That Doesn\u0026rsquo;t \u0026ldquo;Count.\u0026rdquo; Health Promotion Practice. 2012;13:153\u0026ndash;8.\u003c/li\u003e\n \u003cli\u003eCampbell RD, Dennis MK, Lopez K, Matthew R, Choi YJ. Qualitative Research in Communities of Color: Challenges, Strategies, and Lessons. Journal of the Society for Social Work and Research. 2021;12:177\u0026ndash;200.\u003c/li\u003e\n \u003cli\u003eNational Institute of Health. NIH Clinical Center and ResearchMatch | Clinical Center Home Page. https://www.cc.nih.gov/recruit/ResearchMatch.html. Accessed 18 Jun 2024.\u003c/li\u003e\n \u003cli\u003eGinsburg ZA, Bryan A, Rubinstein EB, Frankel HJ, Maroko AR, Schechter CB, et al. Unreliable and Difficult-to-Access Food for Those in Need: A Qualitative and Quantitative Study of Urban Food Pantries. J Community Health. 2019;44:16\u0026ndash;31.\u003c/li\u003e\n \u003cli\u003eBraun V, Clarke V. Using thematic analysis in psychology. 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Reduced Prevalence of Obesity in 14 Disadvantaged Black Communities in the United States: A Successful 4-Year Place-Based Participatory Intervention. Am J Public Health. 2016;106:1442\u0026ndash;8.\u003c/li\u003e\n \u003cli\u003eJames DCS, Harville C. Barriers and Motivators to Participating in mHealth Research Among African American Men. Am J Mens Health. 2017;11:1605\u0026ndash;13.\u003c/li\u003e\n \u003cli\u003eJames DCS. Gender differences in body mass index and weight loss strategies among African Americans. Journal of the American Dietetic Association. 2003;103:1360\u0026ndash;2.\u003c/li\u003e\n \u003cli\u003eJames D. Factors influencing food choices, dietary intake, and nutrition-related attitudes among African Americans: Application of a culturally sensitive model. Ethnicity and Health. 2004. https://doi.org/10.1080/1355785042000285375.\u003c/li\u003e\n \u003cli\u003eJoseph R, Ainsworth B, Keller C, Dodgson J. Barriers to Physical Activity Among African American Women: An Integrative Review of the Literature. Women \u0026amp; health. 2015;55.\u003c/li\u003e\n \u003cli\u003eRay R. Black people don\u0026rsquo;t exercise in my neighborhood: Perceived racial composition and leisure-time physical activity among middle class blacks and whites. Social Science Research. 2017;66:42\u0026ndash;57.\u003c/li\u003e\n \u003cli\u003ePawlak R, Colby S. Benefits, barriers, self-efficacy and knowledge regarding healthy foods; perception of African Americans living in eastern North Carolina. Nutr Res Pract. 2009;3:56\u0026ndash;63.\u003c/li\u003e\n \u003cli\u003eSoliah LAL, Walter JM, Jones SA. Benefits and Barriers to Healthful Eating: What Are the Consequences of Decreased Food Preparation Ability? American Journal of Lifestyle Medicine. 2012;6:152\u0026ndash;8.\u003c/li\u003e\n \u003cli\u003eBell CN, Holder MB. The Interrelationship between Race, Social Norms and Dietary Behaviors among College-Attending Women. Am J Health Behav. 2019;43:23\u0026ndash;36.\u003c/li\u003e\n \u003cli\u003eKris‐Etherton PM, Petersen KS, Velarde G, Barnard ND, Miller M, Ros E, et al. Barriers, Opportunities, and Challenges in Addressing Disparities in Diet‐Related Cardiovascular Disease in the United States. Journal of the American Heart Association. 2020;9:e014433.\u003c/li\u003e\n \u003cli\u003eWebb FJ, Khubchandani J, Doldren M, Balls-Berry J, Blanchard S, Hannah L, et al. African-American Womens\u0026rsquo; Eating Habits and Intention to Change: a Pilot Study. J Racial and Ethnic Health Disparities. 2014;1:199\u0026ndash;206.\u003c/li\u003e\n \u003cli\u003eTyson CC, Davenport CA, Lin P-H, Scialla JJ, Hall R, Diamantidis CJ, et al. DASH Diet and Blood Pressure Among Black Americans With and Without CKD: The Jackson Heart Study. Am J Hypertens. 2019;32:975\u0026ndash;82.\u003c/li\u003e\n \u003cli\u003eWhitt-Glover MC. Translating the Dietary Approaches to Stop Hypertension (DASH) Diet for Use in Underresourced, Urban African American Communities, 2010. Prev Chronic Dis. 2013;10.\u003c/li\u003e\n \u003cli\u003eLiao KY-H, Wei M, Yin M. The Misunderstood Schema of the Strong Black Woman: Exploring Its Mental Health Consequences and Coping Responses Among African American Women. Psychology of Women Quarterly. 2020;44:84\u0026ndash;104.\u003c/li\u003e\n \u003cli\u003eJenkins F, Jenkins C, Gregoski MJ, Magwood GS. Interventions Promoting Physical Activity in African American Women: An Integrative Review. J Cardiovasc Nurs. 2017;32:22\u0026ndash;9.\u003c/li\u003e\n \u003cli\u003eGriffith DM, Gunter K, Allen JO. Male gender role strain as a barrier to African American men\u0026rsquo;s physical activity. Health Educ Behav. 2011;38:482\u0026ndash;91.\u003c/li\u003e\n \u003cli\u003eDavis KK, Tate DF, Lang W, Neiberg RH, Polzien K, Rickman AD, et al. Racial Differences in Weight Loss among Adults in a Behavioral Weight Loss Intervention: Role of Diet and Physical Activity. J Phys Act Health. 2015;12:1558\u0026ndash;66.\u003c/li\u003e\n \u003cli\u003eAtske S, Perrin A. Home broadband adoption, computer ownership vary by race, ethnicity in the U.S. Pew Research Center. https://www.pewresearch.org/fact-tank/2021/07/16/home-broadband-adoption-computer-ownership-vary-by-race-ethnicity-in-the-u-s/. Accessed 21 Feb 2023.\u003c/li\u003e\n \u003cli\u003eKozak AT, Buscemi J, Hawkins MAW, Wang ML, Breland JY, Ross KM, et al. Technology-based interventions for weight management: current randomized controlled trial evidence and future directions. J Behav Med. 2017;40:99\u0026ndash;111.\u003c/li\u003e\n \u003cli\u003eJames DCS, Harville C. Smartphone Usage, Social Media Engagement, and Willingness to Participate in mHealth Weight Management Research Among African American Women. Health Educ Behav. 2018;45:315\u0026ndash;22.\u003c/li\u003e\n \u003cli\u003eTucker CM, Anton SD, Wippold GM, Marsiske M, Bilello LA, Henry MA, et al. Promoting weight-loss maintenance among Black women primary care patients: A cluster RCT of a culturally sensitive versus standard behavioural approach. Clinical Obesity. 2022;12:e12553.\u003c/li\u003e\n \u003cli\u003eBowie O, Kusch J, Morris GL, Flood T, Gill J, Walker RE, et al. Patient Barriers for Weight Management Among African American Women. J Patient Cent Res Rev. 2018;5:287\u0026ndash;97.\u003c/li\u003e\n \u003cli\u003eGothe NP. Correlates of Physical Activity in Urban African American Adults and Older Adults: Testing the Social Cognitive Theory. Annals of Behavioral Medicine. 2018;52:743\u0026ndash;51.\u003c/li\u003e\n \u003cli\u003eCyriac J, Jenkins S, Patten CA, Hayes SN, Jones C, Cooper LA, et al. Improvements in Diet and Physical Activity\u0026ndash;Related Psychosocial Factors Among African Americans Using a Mobile Health Lifestyle Intervention to Promote Cardiovascular Health: The FAITH! (Fostering African American Improvement in Total Health) App Pilot Study. JMIR Mhealth Uhealth. 2021;9:e28024.\u003c/li\u003e\n \u003cli\u003eKumanyika SK, Wadden TA, Shults J, Fassbender JE, Brown SD, Bowman MA, et al. Trial of Family and Friend Support for Weight Loss in African American Adults. Archives of Internal Medicine. 2009;169:1795\u0026ndash;804.\u003c/li\u003e\n \u003cli\u003eTurner-McGrievy GM, Beets MW, Moore JB, Kaczynski AT, Barr-Anderson DJ, Tate DF. Comparison of traditional versus mobile app self-monitoring of physical activity and dietary intake among overweight adults participating in an mHealth weight loss program. J Am Med Inform Assoc. 2013;20:513\u0026ndash;8.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Obesity, Weight loss, Black Adults, Health Disparity ","lastPublishedDoi":"10.21203/rs.3.rs-4644353/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4644353/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e \u003cp\u003eBehavioral interventions aiming to modify dietary habits and physical activity have been less effective in achieving clinically significant weight loss in Black adults. Weight loss needs vary by race and gender, so different strategies are needed to engage individuals in healthy behaviors. While there have been some research efforts focused on weight loss in Black women, participation rates of Black men in weight loss interventions are lower. This may perpetuate the development of obesity-related conditions such as diabetes, heart disease, and other cardiovascular problems. This qualitative study investigated the barriers and facilitators to healthy eating and physical activity and the weight loss desires among Black adults with overweight or obesity.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eBlack adults mainly residing in Hartford, Connecticut were recruited for the study. Semi-structured interviews were conducted with Black males and females who self-reported being overweight or obese. Preferences for weight loss specific to each gender, barriers, and facilitators for weight-related behaviors such as diet and physical activity, were examined through thematic analysis to inform the development of a culturally relevant behavioral weight loss intervention.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe sample consisted of Black adults from diverse racial and ethnic backgrounds. Black females (n\u0026thinsp;=\u0026thinsp;16) and Black males (n\u0026thinsp;=\u0026thinsp;8) were mostly non-Hispanic Black Americans. The key themes that emerged were: 1. the creation of a weight loss program for Black adults, 2. healthy eating barriers, 3. physical activity barriers, 4. healthy living facilitators, and social support. Both Black females and Black males identified unique weight loss preferences. Community and personalization were preferred by Black females while Black males preferred personalized diet and exercise regimes for diverse health conditions, not limited to weight loss. While both genders referred to digital devices and apps for recording weight, diet and physical activity as a major facilitator to adopting healthy habits, social support in the form of culturally relevant information from healthcare providers was highly desired to be incorporated into the intervention.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe findings of this study hold relevance for designing and developing of weight loss programs that promote behavior change for Black adults and help reduce obesity-related health inequities within this population.\u003c/p\u003e","manuscriptTitle":"Examining Preferences for Weight Loss Interventions Among Black Men and Women Experiencing Overweight or Obesity: A Qualitative Approach","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-23 16:56:32","doi":"10.21203/rs.3.rs-4644353/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-08-20T04:42:53+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-08-20T00:37:47+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-08-14T21:51:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"112732393684233307876541595605531143854","date":"2024-07-29T13:46:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"98857366090552816087287367240876526765","date":"2024-07-24T15:36:30+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-07-24T07:17:33+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-07-01T05:38:21+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-06-29T14:46:51+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-06-29T14:46:04+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2024-06-26T17:45:46+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"40b7a6cd-b5e0-4ed1-8da7-5c1f93cf7043","owner":[],"postedDate":"July 23rd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-07-24T06:53:55+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-23 16:56:32","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4644353","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4644353","identity":"rs-4644353","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}