DESTREZAS/HABILIDADES

“Severe” or “Class III” obesity is defined as having a BMI greater than or equal to 40 kg/m2. This excess weight puts severely obese populations at significantly higher risk of a chronic disease.128 _{Based on 2010 data, the number of individuals who are severely obese in the}

US is growing at twice the rate of the obese population (those with a BMI between 30 kg/m2 and 39.9 kg/m2, Classes I and II).1 Prevalence rates of severe obesity (18.0%) in African American women are substantially higher than their Caucasian female counterparts (7.3%) and African American male counterparts (7.6%).1,186

One of the most robust, salient and well-studied themes in the African American weight- disparity literature is “stress”,6,55,185,187-190 but less is known about the specific role of stress in severe obesity. The impact of stress on physical health (among many other determinants)

operates through multiple factors including how the individual perceives stress. Perception can then impact how they will (behaviorally) cope with the stress. The effectiveness of the coping response often determines how the body will (physiologically) respond. When coping responses are ineffective, the hormonal feedback loops that regulate the stress-response pathways are disrupted, which can lead to excess fat accumulation, particularly in the abdomen.48-51 Previous studies with African American women have shown that race and gender can play a role in: characterizing the types of stressors they will be exposed to, shape the way they perceive these stressors and finally, determine how they will respond to those stressors – whether out of choice or necessity.

Several recent publications attest to both the high amount and unique sources of stress in the lives of African Americans, especially African American women.6,34,191 _{Although African}

American women face many significant and unique stressors, the concept of RO is especially prominent. In their 1985 publication Barnett et al. coined the term RO, which they define as having so many role demands or obligations that the individual feels unable to perform them all adequately.53 Many historical, social and cultural factors that are unique to African American women contribute to the high risk of experiencing RO-related stress. Included among them are (1) the embodiment of the MCR, (2) low levels of social support and (3) low socioeconomic status.54

In a qualitative study with southern, mostly rural African American women with diabetes, Samuel-Hodge et al. (2000) coined the term “multiple caregiver role” (MCR) to “describe the feeling of responsibility for providing emotional and/or tangible aid to extended family members and friends”.54 The seventy women in 10 focus groups included in the Samuel-Hodge study went on to describe how this role was a significant source of stress in their lives and often left them

physically and mentally tired, which, in turn, impacted their ability to successfully manage their diabetes. There are many reasons why African American women are subject to embodying the MCR. Some women report that assuming the MCR meant having the ability to wear many hats (e.g. wife, mother, second mother, cook, household manager, worker outside the home,

chauffeur, church member, caregiver and confidante), which gave them a sense of purpose, independence and control and most importantly, confirmed their identification as strong Black women.56,58 However, sometimes, African American women embody this role out of a feeling of obligation or as a result of having difficulties in saying “no” or due to fears fear that if they focused too much on themselves (as opposed to serving the needs of others) they will be viewed as “weak” by other African American women.59

Cultural expectations and norms play a significant role in how African American women cope with the chronic stressor, RO. The Superwoman Role (SR) developed out of a necessity to survive and has been shaped by a long history of racism, disenfranchisement and oppression, which forced these women to take on multiple roles including wife, mother, provider, etc.56 Being a “superwoman” is a role that is reinforced by community perceptions/ideas/values that Black women do not get depressed and they do not need assistance to manage their life

struggles.59 Woods-Giscombe et al. (2010) conducted focus groups with a diverse sample of 48 African American women living in the southeastern United States in order to explore the benefits and liabilities of this role and how this cultural concept influences overall well-being.56 From her work, five inter-related characteristics emerged that are relevant to how African American women cope with RO including the following: (1) an obligation to manifest strength, (2) an obligation to suppress emotions, (3) resistance to being vulnerable or dependent, (4)

publication Giscombe et al. suggest that one of the implications for their future research may be to investigate how the SR may contribute to the weight disparities in African American women, especially African American women who are severely obese. The purpose of our formative research is to both confirm and expand the scope of the previous research done by Samuel- Hodge, Woods-Giscombe and others by exploring views the contextually defined chronic stressors—RO and SR—and their relationship to health behaviors in a specific population of African American women. We addressed these questions through a mixed-methods approach using questionnaires and focus groups.