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Consuming Chronic Illnesses 1

Consuming Chronic Illnesses

By

Deborah Jones

Capstone Project


Introduction

Nutrition, Health Promotion, and Health Administration are disciplines taught

throughout the country and the world. Now, more than ever, our government is looking

to these disciplines to help our nation combat the obesity epidemic, as well as the

epidemic of chronic illness that has plague Americans. With the passage of the

Affordable Care Act, the federal government has now begun to focus its efforts on

prevention and wellness rather than curative care or health maintenance. Each of the

disciplines named above are instrumental in helping Americans live happier healthier

lives. Whether it be through practicing good nutrition, or participating in classes

teaching stress or change management techniques, or gaining access to healthcare

that was previously unavailable, individuals, undoubtedly, benefit from each of these

disciplines at some point in their lifetime.

Nutrition is defined by Turley and Thompson (2012), “The science of foods and

the nutrients and other substances they contain, and of their actions within the body, as

well as the social, economic, cultural, and psychological implications of food and eating”

(p. 506). Nutrition deals with more than just the foods that are consumed. There are

social, cultural, economic, and psychological implications of nutrition that many don’t

consider. According to Cottrell, Girvan and McKenzie (2012), “Health promotion is any

planned combination of educational, political, environmental, regulatory, or

organizational mechanisms that support actions and conditions of living conducive to

the health of individuals, groups, and communities” (p. 370). Finally, Health

Administration can be defined as the field relating to leadership, administration, and


management, of hospitals, their networks, health care systems, and public health

systems. Health care administrators are considered to be health care professionals.

Healthcare Administration is also concerned with helping individuals to modify behaviors

to improve health status. This is known as Change Management. Because African

Americans have some of the highest rates of chronic illnesses, integrating these

disciplines were very beneficial and produced a two (2) hour wellness class in which

topics such as nutrition, stress management techniques, and the importance of utilizing

skills gained during the class were emphasized. Material informing participants about

access to healthcare were distributed. Participants were asked to complete a pre and

post survey indicating the knowledge about each of these disciplines prior to the

wellness class and immediate following the class. Participation during the class was

high, and the post-test results indicated an increased knowledge about nutrition, health

status, and how to achieve better health outcomes. The information was well received.

A PowerPoint presentation discussing the African-American diet, and the benefits

of using the MyPlate, which is an online tool were thoroughly discussed. Participants

were asked to volunteer their time to learn more about MyPlate and the numerous

health benefits of eating the recommended portions of fruits, vegetables, whole grains,

dairy, and meat. Participants were given actual MyPlates that were donated by Salt

Lake County for the wellness class. Literature regarding stress management, and

gaining access to healthcare was also provided for participants. Change management

tips were shared, and at least two (2) of the attendees have asked for assistance in

losing weight or maintaining their current weight. Both have used the change

management techniques to change their eating habits, and have reported using the


MyPlate, the web-based tool to track calories, and the actual MyPlate distributed at the

wellness class to ensure they are eating a healthy diet. The wellness class was a

holistic approach to wellness. A large percentage of the attendees were African-

American living with chronic illnesses, or African Americans who know someone with a

current illness. Healthy refreshment along were provided, and low-fat southern-style

recipes were also provided. The PowerPoint presentation addressed the common

myths and misconceptions among African-Americans; provided statistics supporting

claims that African Americans have higher rates of chronic illness that other ethnicities;

introduced the MyPlate online tool; discussed health benefits of eating the

recommended amounts from each food group; discussed good calories versus empty

calories, and finally, encouraged participants to learn more about stress management,

and access to healthcare through the Affordable Care Act. The wellness class was a

holistic approach to health, discussing serious issues that affect the African-American

community such as stress, access to healthcare, change management, and nutrition.

To understand the African-American diet, one must first understand the importance of

food in this community, and the social, and cultural aspect of food among this ethnic

group.

Social and cultural aspect of food

Food sharing among African Americans is a social activity that is often

accompanied by conversation and gaiety. Food is lovingly prepared for friends and

family, and is a significant factor in the cohesiveness of the African American

community (Kittler, Sucher & Nelms, 2012). In the South, food is usually the catalyst for

social interaction, and “Southern Hospitality” is renowned (Kittler et al., 2012). Some


Blacks view eating with others from their ethnic community as an intimate or a spiritual

experience (Kittler et al., 2012). This research paper will discuss the contemporary food

habits for African Americans which include holidays, typical meals and meal patterns,

staple foods, and overall, eating practices among this ethnic group. A sample diet of a

middle-age African American female will be reviewed using diet analysis software.

Recommendations to increase fitness levels and to improve dietary behaviors will be

discussed. Interventions must begin early, and should be focused in order to be

successful among this target population. This paper will discuss why early intervention

is necessary if health education specialist and other health professionals are going to be

successful in modifying behaviors regarding diet and fitness among this ethnic group.

Food habits for this population today typically reflect their socioeconomic status, work

schedule, geographic location, more than their Southern or African heritage (Kittler et

al., 2012).

History of African American food and culture

Many of the foods consumed by African Americans today have their influence

from West Africa. When Black indentured servants were taken from West Africa

forcefully by Dutch traders, they brought with them their traditions as well as their foods.

After leaving their homeland, many Africans tried to maintain their cultural values

despite their exposure to slaves of other tribes, white owners, or other ethnic groups.

Today’s African American diet often includes elements from West Africa, and foods that

were eaten by slaves. However, food habits changed among Africans as they were

introduced to “New World” foods. What little is known about this cuisine and what was


recorded resembles much of what we see in today’s African American diet and what

was also seen during the time of slavery (Kittler et al., 2012).

The slave diet

Slavery is the primary historical circumstance that altered indigenous African

food practices (Di Noia et al., 2013). Slaves began to incorporate “New World” foods

such as chilies, peanuts, pumpkins, and tomatoes, into their diet, but brought with them

food such as black-eye peas also called “cow peas”, okra, watermelon, sesame and

taro. Substitutions and adaptations were made based on foods that were available.

West African preparations were added to French, British, Native American, and Spanish

techniques by black cooks in order to create an American Southern Cuisine. Southern

cuisine emphasized methods of cooking such as roasting, frying, and boiling dishes.

These cuisines included pork fat, sweet potatoes, corn, and local green leafy

vegetables. Other African regions, unfortunately, have had very little impact on the

typical American diet although immigrants who have recently arrived in the United

States continue to consume traditional meals (Kittler et al., 2012).

The traditional African diet was low in meats and fat and was high in complex

carbohydrates and parallel with current dietary recommendations. During slavery,

changes in diet were likely influenced by forces such as limited time for food

preparation; selection; procurement (lack of food preparation equipment and utensils);

lack of adequate storage facilities; lack of written recipes for food preparation; the use of

spices to flavor spoilage; the need for extended boiling in order to tenderize tough cuts

of meat and wild vegetation; and finally, the practice of seasoning food with fat in order

to make the food taste more desirable. Passed down through several generations,


many of the food practices founded during slavery are common today (Di Noia et al.,

2013). The pressures of a fast-pace society, however, have directly affected the meal

patterns and traditional foods of many African Americans (Kittler et al., 2012).

Contemporary food habits for African Americans

Dietary choices today for African Americans are influenced by numerous factors,

including taste, cost, convenience, nutrition, and cultural preferences for food.

Research indicates that taste and cost may be the two most important factors in food

choice for this ethnic group (Fulp, Rachael, McManus, & Johnson, 2009). Some

positive aspects of a contemporary diet for blacks include a high intake of foods such as

legumes, poultry and fish, and the family tradition of eating together. Many of the

negative aspects; however, include, but are not limited to, food-preparation methods

such as flavoring foods with fat, salt and sugar. Other negative aspects of food

preparation include the use of boiling food for long periods, which lowers the potency of

water-soluble vitamins, and the use of frying and deep-fat frying methods which adds

calories from saturated fats (Di Noia et al., 2013). Consumption of fast foods in place of

home prepared meals is another negative aspect of the African American contemporary

diet. Unfortunately, this is also the case of the typical American diet.

Today’s African American diet is generally low in calcium due to low dairy food

consumption. Approximately 60 to 95 percent of African Americans are lactose

intolerant. As a result, milk or milk-based products are generally avoided by this ethnic

group substantiating reports that African Americans consume less dairy products; and

thus, diets are generally lower in minerals such as calcium (Kittler et al., 2012).

Although lactose intolerance plays a role in contemporary diets being lower in calcium,


culturally determined food preferences and dietary practices also play a significant role

(Di Noia et al., 2013).

Soul food is a modern term used to describe traditional Southern black cuisine

such as vegetables or meat that is freshly made, or thoroughly cooked. African

Americans usually prefer their food “well-seasoned” or “well spiced”, and view soul food

as a cuisine that symbolizes solidarity regardless of where they reside, or their

socioeconomic status. Many African Americans consider Soul food to be an emblem of

identity and recognition of black history (Kittler et al., 2012).

Many of the staple foods that African Americans enjoy include pork products

such as bacon, sausage, barbecued pork ribs, ham hocks, pig feet, pig ears, and

crackling- fried pork pieces with the fat still attached (Kittler et al., 2012). Pork

chitterlings are a favorite among African Americans and are generally cooked on

holidays such as Thanksgiving and Christmas. Pork cuts are eaten roasted, pickled,

boiled and fried. It is not uncommon for African American families to have their own

special barbecue sauce (Kittler et al., 2012). Sauces are usually spicy, or extremely

sweet as often times they are prepared using brown sugar, maple syrup or molasses to

sweeten them to perfection. Poultry, fish, small game are other meats are frequently

consumed by African Americans (Kittler et al., 2012).

Legumes such as black-eye peas, pinto, kidney, and red beans are also common

staples found in the African-American home. Popular vegetables eaten most frequently

in the African American home are kale, mustard, collard and turnip greens. Okra, fried,

or boiled, beets, broccoli, onions, cabbage, corn, green peas, spinach, green peppers,

sweet potatoes, squash, tomatoes and yams are also favorites among this ethnic group.


Popular fruits include, but are not limited to watermelon, apples, berries and peaches

(Kittler et al., 2012). Hot sauce, usually made from hot peppers, is a staple that can be

found in most African American homes. Biscuits and cornbread are a favorite among

this group, and are served frequently with meals. Butter, meat drippings, lard and

vegetable shortening are still preferred fats used for cooking. Consumption of sugary

drinks such as soft drinks and sweetened tea are high. Coffee, fruit drinks and wine are

also consumed frequently (Kittler et al., 2012).

African Americans celebrate Thanksgiving, Christmas, Easter and New Years

with food being an integral part of these holidays. Holidays are a time for socializing

and spending time with friends and family. For some holidays such as New Years,

certain foods may be symbolic. For example, black eye peas may be eaten for good

luck; fish may be eaten for motivation; greens such as collared or kale greens may be

eaten for money, and rice for prosperity in the upcoming year.

During slavery, Sunday dinner was a large family meal. This meal became the

main meal following emancipation. Today, Sunday dinner is still considered an

important meal that is accompanied with food sharing with family and friends. It is also

a time to extend hospitality to neighbors (Kittler et al., 2012).

Kwanza, an African American holiday, which recognizes the African dispersion of

Africans from their homeland, is celebrated from December 26th to January 1st of each

year. The unity of all Africans is celebrated during Kwanza. Juneteenth celebrations

are celebrated around the country in African American communities to commemorate

the emancipation of slaves. Traditional southern fares, as well as African and Caribbean

cuisines are served during these celebrations (Kittler et al., 2012).


Sample diet

Research has shown that eating a diet rich in fruits, vegetables, low fat dairy

products, and whole grain while reducing sodium intake and increasing potassium

intake can help lower blood pressure among African-Americans with high blood

pressure. This diet is known as the DASH diet (Dietary Approach to Stop Hypertension).

Studies have shown that the DASH diet has been successful in lowering blood pressure

among African-Americans with hypertension an average of 13 points. This is a

decrease comparable to that typically achieved with medications (Geriatrics, 1999).

This DASH diet, an eating plan, encourages a diet low in fat and sodium, and rich in

fruits, vegetables, whole grains and potassium (Treatment of Hypertension, 2015).

There are no unusual recipes or foods. The DASH diet is consistent with other

nutritional recommendations such as MyPlate and the TLC diet which are aimed at

reducing obesity, heart diseases and other diet related chronic illnesses. MyPlate is

stylized plate graphic that has been divided into four wedges. The four wedges

represents fruits and vegetables (which take up half of the "plate"), grains and "protein"

(which includes sources such as poultry, eggs, meat, peas, beans and seeds). MyPlate

is definitely a dramatic shift from how most Americans plan their meals. For example,

the "protein" wedge represents a little less than a quarter of the plate which is not

usually the amount that Americans consume. Generally speaking, most Americans

consume significantly more meat than is nutritionally recommended. A circle adjoining

the plate icon suggests a place for dairy, such as a glass of skim or reduced-fat milk or

reduced fat yogurt. In short, my plate encourages Americans to fill half their plates with

fruits and vegetables, and to control their portion sizes of meats. It also recommends


that at least half of the grains consumed daily by Americans should be whole grains.

Americans can enjoy their food while eat less of it.

This simplified plate imagery omits any depiction of solid fats (saturated and

trans fats) and sodium, as well as added sugars unlike the Food Guide Pyramid should.

It is assumed that these items should be consumed in moderation (“How to Make

‘MyPlate’ Your Plate”, 2011).

The Therapeutic Lifestyle Changes which is known as the TLC diet was designed

primarily for people with high levels of LDL which is the bad cholesterol. This diet

monitors and helps to cap the percentage of calories consumed from fat. It also places

limits on dietary cholesterol, sodium, and total calories consumed daily. It also

encourages the consumption of soluble fiber and plant stanols. As with the other

eating plans such as the DASH diet, and MyPlate, the TLC diet also encourages

physical activity, and weight management in addition to consuming a healthy diet to

prevent or delay the onset of chronic illnesses (“16 Tips to Lower Your Cholesterol”,

2016).

Lifestyle measures can help lower blood pressure and keep it at a healthy level.

These changes include losing weight if you are overweight; following an eating plan

such as the Dietary Approaches to Stop Hypertension (DASH) diet, the TLC diet or

MyPlate. These eating plans not only encourage eating healthier, but they also

encourage regular physical activity; and moderating alcohol consumption.

Incorporating these changes into one’s lifestyle and continuing them over a long period

of time can have a significant effect on preventing and treating chronic illnesses such as

hypertension (“Treatment of Hypertension”, 2015)


A one day sample diet of a middle-aged African American women between the

ages of 40-45 was analyzed using a data analysis software. The results indicate that

the African American women consume excessive amounts of sodium, saturated fat,

cholesterol, and sugar. This report also indicates that consumption of vegetables, fruits,

and whole grains are below the recommended levels. According to the nutrient report

found on page 17, macronutrients such as carbohydrates, protein, and fiber were met

when analyzing this one day diet; however, this report indicates that the intake of fats,

saturated fats and cholesterol exceed recommended levels. The nutrients report shows

a deficiency in micronutrients such as calcium, but also indicates that there is an over

consumption of sodium for this ethnic group in their one day diet. Deficiencies in vitamin

D were also noted in this report. According to Food Groups and Calories report listed

on page 16, this one day diet for a middle-aged African Americans reflects low intake of

whole grains, and excessive consumption of refined grains. The Food Group and

Calories Report indicate that middle-aged black women are consuming large amounts

of empty calories which can be problematic for any ethnic group. In addition to

consumption of excessive calories, both the Food Group and Calories Report and the

Nutrients report indicate and overconsumption of calories. The average African

American women according this report consume 2,000 more calories than what is

recommended.


Meals from 11/12/15 - 11/12/15The Subject’s Meals

Your personal Calorie goal is 2200. Your plan amounts are based on meeting your nutrient needs.

Date Breakfast Lunch Dinner Snacks11/12/15

2 regular slice Bread, 100% whole wheat

1 cup Collards, fresh, cooked (with salt and vegetable shortening)

1 cup Cabbage, mustard, salted

EMPTY

3 large egg(s) Eggs, fried, with butter

1 medium breast Fried chicken, breast, fried in oil, skin/breading eaten

1 fillet (5" x 2-1/2" x 3/8") Catfish, floured or breaded, fried in shortening

1 cup Grits, corn or hominy, quick, cooked (with salt and margarine)

1 cup Macaroni and cheese, made from mix with prepared cheese (Velveeta Shells and Cheese, Kraft Deluxe)

1 piece (1/8 of 9" pie) Pie, sweet potato

1½ cup Hash browns, frozen potatoes

1 cup Mashed potatoes, with milk and margarine or butter

1 cup Potato salad, with egg, no dressing

1 cup Orange juice, frozen (reconstitute

1 piece (1/8 of 9" pie) Pie, lemon meringue

1 cup Red beans and rice,


d with water) cooked with vegetable oil

2 patty Sausage, pork, cooked

1 mug (8 fl oz) Tea, brewed, sweetened with sugar

1 can (12 fl oz) Soft drink, cola (Pepsi, Coke)

The Subject’s Food Groups and Calories Report 11/12/15 - 11/12/15

Your personal Calorie goal is 2200. Your plan amounts are based on meeting your nutrient needs.Food Groups Target Average Eaten StatusGrains 7 ounce(s) 11½ ounce(s) OverWhole Grains ≥ 3½ ounce(s) 2 ounce(s) UnderRefined Grains ≤ 3½ ounce(s) 9½ ounce(s) OverVegetables 3 cup(s) 6½ cup(s) OverDark Green 2 cup(s)/week 1 cup(s) UnderRed & Orange 6 cup(s)/week ¼ cup(s) UnderBeans & Peas 2 cup(s)/week ½ cup(s) UnderStarchy 6 cup(s)/week 3½ cup(s) UnderOther 5 cup(s)/week 1½ cup(s) UnderFruits 2 cup(s) 1 cup(s) UnderWhole Fruit No Specific

Target0 cup(s) No Specific

TargetFruit Juice No Specific

Target1 cup(s) No Specific

TargetDairy 3 cup(s) ¾ cup(s) UnderMilk & Yogurt No Specific

Target¼ cup(s) No Specific

TargetCheese No Specific

Target¼ cup(s) No Specific

TargetProtein Foods 6 ounce(s) 10½ ounce(s) OverSeafood 9

ounce(s)/week2 ounce(s) Under

Meat, Poultry & Eggs

No Specific Target

8½ ounce(s) No Specific Target

Nuts, Seeds & Soy No Specific Target

0 ounce(s) No Specific Target

Oils 6 teaspoon 4 teaspoon Under


Limits Allowance Average Eaten StatusTotal Calories 2200 Calories 4178 Calories OverEmpty Calories* ≤ 266 Calories 1231 Calories OverSolid Fats * 896 Calories *Added Sugars * 335 Calories **Calories from food components such as added sugars and solid fats that provide little nutritional value. Empty Calories are part of Total Calories.

Note: If you ate Beans & Peas and chose "Count as Protein Foods instead," they will be included in the Nuts, Seeds & Soy subgroup.

The Subject’s Nutrients Report 11/12/15 - 11/12/15Your personal Calorie goal is 2200. Your plan amounts are based on meeting your nutrient needs.Nutrients Target Average Eaten StatusTotal Calories 2200 Calories 4178 Calories OverProtein (g)*** 46 g 139 g OKProtein (% Calories)***

10 - 35% Calories

13% Calories OK

Carbohydrate (g)***

130 g 491 g OK

Carbohydrate (% Calories)***

45 - 65% Calories

47% Calories OK

Dietary Fiber 25 g 40 g OKTotal Sugars No Daily Target

or Limit138 g No Daily Target

or LimitAdded Sugars No Daily Target

or Limit84 g No Daily Target

or LimitTotal Fat 20 - 35%

Calories41% Calories Over

Saturated Fat < 10% Calories 11% Calories OverPolyunsaturated Fat

No Daily Target or Limit

9% Calories No Daily Target or Limit

Monounsaturated Fat

No Daily Target or Limit

17% Calories No Daily Target or Limit

Linoleic Acid (g)*** 12 g 39 g OKLinoleic Acid (% Calories)***

5 - 10% Calories

8% Calories OK

α-Linolenic Acid (% Calories)***

0.6 - 1.2% Calories

0.7% Calories OK

α-Linolenic Acid (g)***

1.1 g 3.4 g OK

Omega 3 - EPA No Daily Target 74 mg No Daily Target


or Limit or LimitOmega 3 - DHA No Daily Target

or Limit259 mg No Daily Target

or LimitCholesterol < 300 mg 1082 mg OverMinerals Target Average Eaten StatusCalcium 1000 mg 954 mg UnderPotassium 4700 mg 4997 mg OKSodium** < 2300 mg 8229 mg OverCopper 900 µg 2317 µg OKIron 18 mg 21 mg OKMagnesium 320 mg 457 mg OKPhosphorus 700 mg 2150 mg OKSelenium 55 µg 203 µg OKZinc 8 mg 14 mg OKVitamins Target Average Eaten StatusVitamin A 700 µg RAE 1723 µg RAE OKVitamin B6 1.3 mg 4.1 mg OKVitamin B12 2.4 µg 5.5 µg OKVitamin C 75 mg 178 mg OKVitamin D 15 µg 4 µg UnderVitamin E 15 mg AT 15 mg AT OKVitamin K 90 µg 829 µg OKFolate 400 µg DFE 1019 µg DFE OverThiamin 1.1 mg 3.2 mg OKRiboflavin 1.1 mg 3.1 mg OKNiacin 14 mg 40 mg OKCholine 425 mg 827 mg OKInformation about dietary supplements.

** If you are African American, hypertensive, diabetic, or have chronic kidney disease, reduce your sodium to 1500 mg a day. In addition, people who are age 51 and older need to reduce sodium to 1500 mg a day. All others need to reduce sodium to less than 2300 mg a day.

*** Nutrients that appear twice (protein, carbohydrate, linoleic acid, and α-linolenic acid) have two separate recommendations:

1) Amount eaten (in grams) compared to your minimum recommended intake. 2) Percent of Calories eaten from that nutrient compared to the recommended range.

You may see different messages in the status column for these 2 different recommendations.


Health status disparities

African Americans are disproportionately affected by obesity, hypertension,

diabetes, cardiovascular diseases, cancer, other chronic illnesses related, in part, to

dietary factors. This population urgently needs interventions to improve their dietary

practices in order to reduce morbidity and mortality from diet-related diseases.

Interventions must be culturally sensitive. In order to enhance the impact and relevance

of an intervention, the intervention(s) should incorporate into their design, experiences,

values, behavioral patterns, norms, environmental and social influences on behavior (Di

Noia et al., 2013).

Higher incidents of chronic illnesses have been linked to a diet high in saturated

fat, sodium, refined grains, and sugar. Nutrients such as complex carbohydrates, fiber,

and EPA (Omega 3) are generally consumed below the recommended levels to

maintain health for African Americans (Di Noia et al., 2013).

In recent years, obesity rates have risen to alarming rates in the United States. In

fact, many developing countries as they become more industrialized are seeing growing

numbers of obesity. An increase in the availability of calorie-dense food coupled with

sedentary lifestyles has significantly contributed to the rise in obesity in the United

States and around the world. Obesity is described as a chronic illness resulting from

environmental and genetic factors. Environmental factors may include a combination of

behavioral, cultural, social, and physiological influences. While genetics may contribute


to overweight or obesity, ultimately an individual’s body weight is determined by

their diet and activity level. A family history of obesity may increase ones chance of

becoming obese by roughly 30 percent. Obesity risk factors such as diet and the

activity level are often times influenced by an individual’s family as well . Over the long

term, obesity, which is defined as a chronic illness, can result from consuming

excessive calories, leading a sedentary lifestyle, or a combination of both.

Obesity and diets high in saturated fats have been linked with nutritionally related

chronic illnesses such as cardiovascular disease (CVD), diabetes mellitus,

hypertension, high cholesterol and certain types of cancers. Unfortunately, Americans

including the African American population are eating out more than ever. Fast-food

restaurants are now offering a wide variety of high-fat and high-calorie menu items.

Fast-food restaurants are popping up everywhere and “supersizing” menu items have

become the norm. Many of these establishments are offering bigger portions in an

effort to attract customers. Unfortunately, bigger doesn't always mean better, and in

these instances is usually doesn't. Even the foods prepared in the home are high in fat

and calories contributing to the obesity and other chronic illnesses. Other ethnicities

that have migrated to the United States and adopted the typical American diet (a diet

high in fat and calories) have seen an increase in chronic illnesses. In other words, as

time in the country increase, their rates of many diet- and physical-activity-

related chronic illnesses such as heart disease and several cancers have increased

(Hensrud, 2002).

Nutrition


African Americans are more likely to have poor diets resulting from lower intakes

of vegetables and dairy products, and higher intake of sodium. Moreover, African

Americans have reported to have higher intakes of fat which is consistent with that of

the typical U.S. diet. Fried foods, high meat intake and the consumption of fast foods

are all major factors contributing to the higher intake of fats among this population.

Seventy-seven percent of African American women, middle aged, were reported as

having consumed over 30% of their daily calories from fat while sixty-one percent

reported consuming over 10% of total calories from saturated fats. Other studies

conducted on middle-aged African American women found higher intake of cholesterol

within their diets (Kittler et al., 2012).

There are numerous nutritional deficiencies among African Americans that are

living in poverty especially older adults. African Americans eat fewer servings of

vegetables, dairy and fruit than whites according to a recent survey. The African

American diet is insufficient in the minerals iron, calcium and low in vitamins D, B6, as

well as E (potassium, copper, zinc and selenium). A study of adolescents found a

significant amount of African-American adolescents were overweight. This may be due

in part to social economic status, or a more permissive attitude regarding body shape,

and obesity in general. Another factor contributing to high obesity rates among African

Americans is the environment in which many live that tends to promote high intake of

fast foods. Limited access to healthy foods must also be considered when discussing

factors for obesity in this ethnic group. African Americans are less likely to not equate

being overweight with unattractiveness which may explain disordered eating is less


common in this group (Kittler et al., 2012). Additionally, obesity during adolescents

predicts obesity in adulthood.

Hypertension is common among African Americans. Roughly 43% of African

American women and 39% of African American men have high blood pressure.

Hypertension is considered a risk factor for Coronary Heart Disease (CHD) and stroke.

African American women have higher rates of CHD than whites. Black men, however,

have a lower incidence of CHD than white men. Unfortunately, blacks have higher rates

of stroke than whites likely due to higher rates of high blood pressure (hypertension)

(Kittler et al., 2012).

Cardiovascular disease is the leading cause of death for all Americans, but

significant racial and ethnic disparities exist in the onset of CVD and outcomes in

African Americans (Fulp, Rachael, McManus, & Johnson, 2009).

African Americans experience a poorer overall health status than White

Americans and bear a disproportionate burden of chronic disease and other illnesses.

Moreover, decades of research consistently document the inverse relationship between

cardiovascular disease risk and socioeconomic status between overall mortality and

living in an economically disadvantaged neighborhood (Fulp et al., 2009).

Health promotion

As mentioned earlier, African Americans suffer from disproportionately higher

rates of chronic illnesses such as hypertension and cardiovascular disease.

Psychosocial stress in addition to lifestyle may contribute to the pathogenesis of

hypertension and cardiovascular disease. In a study conducted by Howard University in

Washington, DC, and Maharishi University of Management Research Institute (MUMRI)


in Maharishi Vedic City, Iowa, the effects of stress reduction and lifestyle modification

on blood pressure, in African Americans, were evaluated. The study consisted of Forty-

eight African American men and women diagnosed with stage I hypertension who had

also participated in a larger randomized controlled trial volunteered for this substudy.

These subjects participated in either a basic health education course, an extensive

health education program (EHE) for 16 weeks, or stress-reduction program (SR) with

the Transcendental Meditation technique.

The primary outcome was clinical blood pressure and the secondary outcomes

were psychosocial stress factors, dietary intake, physical activity and body mass index

(BMI). During this study, both men and wen also experienced a decrease in systolic

blood pressure in both the stress-reduction based program (SR) and extensive health

education program (EHE) group; however, according to this study, there were no

significant difference in the change between the groups. Both groups reported a

significant lifestyle changes related to blood pressure such as consuming lower levels of

sodium intake (300-600mg/day), and a reduction in protein intake to 12-14 g/day. The

health education group, however, showed a greater number of dietary changes such as

lower intakes of calories, fat, and carbohydrates than the stress-reduction (SR) group.

These dietary changes may have been the result of more education and active

reinforcement during the study on lifestyle modifications (Duraimani et al., 2015).

Linking coaching to training

Effective change management should involve having someone else give you

specific behavioral advice on how to improve. It may be difficult to know or access how

well the new skills acquired are being enacted. In short, a coach is needed. For


instance, a good health coach watches and then advises on what need to change to

affect the result.

Finally, to help reiterate training skills, it’s a good idea to make use of cues. For

example, putting up charts that summarize training skills around the home or at the

office will help participants remember to utilize skills learned during training or an

educational class. Carrying summary cards around will also help participants remember

to utilize their new skills. Putting electronic devices to work is another great idea to

help. For example, create reminders that pop up every morning or afternoon reminding

participant to utilize their training skills. Supporters can send video clips reminding the

training participant of the skills learned or maybe video clips that even teach a subtle

variation on the theme. Building tools and reminders that are tailored specifically to the

skills learned during training or during an educational class will help reinforce new skills

or ideas introduced during these classes or training.

Global outlook

In order to successfully address dietary concerns among this ethnic group, early

intervention is necessary (Randel et al., 2012). Interventions targeting the home food

environment are likely to improve overall diet quality in overweight African Americans

populations with low-income (Hartman et al., 2015). Assessing the needs of this

priority population is very important. Community empowerment which encourages

people to take ownership of their health issues and use resources as well as their ability

to create solutions is needed in order to change communities, not just individuals.

Health promotion/education programs should be developed to assess the needs of this

target population. A well conducted and well conceived needs assessment can


determine if a health program is justified and appropriate for its target audience

(Randall, Girvan, & Mckenzie, 2012).

After a needs assessment has been conducted, intervention strategies should

then be developed in order to help this ethic group modify dietary behaviors.

Socioeconomic status, low education, and access to healthier food choices are, often

times, barriers preventing this ethnic group from choosing and preparing healthier

foods. After intervention strategies are developed, implementation of a health program

should begin (Randall et al., 2012). Health education specialist must become more

actively involved in the African American community if there is going to be lasting

change in dietary behavior among this ethnic group.

The ability to achieve dietary recommendations on an individual level is of great

public concern. Numerous intervention studies focused on individual-level behavior

changes have not resulted in long-term dietary changes that would reduce the risk of

chronic illnesses diseases such as CVD. Individual motivation to change health

behavior is influenced significantly by the social environment which includes community

norms and cultural practices. Interrelated cultural practices that impact health behavior

include, but are not limited to, culturally specific health and illness beliefs, religiosity,

spiritual beliefs and values, social support, and culturally competent and satisfactory

health services (Fisher et al., 2005).

A significant challenge facing healthcare professionals is trying to encourage

individuals to change their diet, and assist them maintaining that change. Incorporating

cultural preferences for food has been noted as an important factor for interventions that


are designed to influence food choice and reduce risks for chronic disease (Fulp et al.,

2009).

In order to fully understand African America culture, one must be willing to use a

lens that enables appreciation for this ethnic community’s cultural heritage through

sociohistorical contexts of the painful experiences of slavery, resilience, community

bonding, and spiritual and religious beliefs (Burke, Joseph, Pasick, & Barker, 2009).

Health administration

Some of the challenges of training or educational courses whether it be a 2-hour

wellness course or a week seminar sponsored and paid for by an employer, the hope

following any training, or educational course is to ensure that participants use the

valuable information shared at these events. The term used most often when referring

to one’s ability to utilize the information gained is known as Change Management.

Change Management encourages individuals to implement strategies to ensure that

change and development are implemented successfully. The ability to transfer

knowledge and skills learned during training or an educational course is not an easy

task. For example, the training finishes, participants leave, and as a result of their busy

lifestyles, they’re immediately pulled in a dozen different directions—none of which are

designed to assist with implementing what they’ve just learned into part of their daily

routine. Unfortunately, many training or educational courses are designed to help

individuals learn the material, but unfortunately, participants do not implement the

material soon after completing the course.

Without skill transference, training of any kind is merely wasted effort for many

hoping to modify their behavior. Motivating and enabling a genuine change in behavior


is no easy task, and ensuring that learning translates into action, can require a

significant amount of effort. The real challenge begins with manipulating the forces

that seem to draw people away from adopting new skills. Anyone teaching a wellness

class, for example, must understand that learning is not enough. The presenter or

instructor of a training course needs to find ways to ensure that attendees implement

the knowledge gained, new ideas, or skills shortly after the training ends.

The Influencer Model is used, often times, to supplement the learning

experience. This is a multi-faceted Change Management plan. Using the Influencer

Model, skill transference is gained by combining multiple sources of influence into a

cohesive change strategy. This strategy should, not only motivate, but should enable

individuals to adopt skills taught in training. In addition to training, Influencer tactics will

help to develop a successful change strategy (Patterson, 2012).

Enlist informal support

An effective formal review process will help reinforce new ideas, and skills that

are taught in training, and educational classes. For example, a formal review process

may include a follow up call or meeting with attendees of a seminar or education class

to reiterate skills taught during the training, or a survey may be re-administered two

months later. Formal review paperwork might be distributed to these individuals,

again, reiterating the specific skills taught during the seminar or class. A performance

system should be established linking formal rewards to changes in behavior. If

participants have started using the skills learned during a class or training, this will

typically be revealed during a follow-up call, or survey. Change must be measured.

Creating a formal reward system will send a message to participants that the training is


not some sort of informal training, but that it is important, and can be life changing if

skills are implemented. Not only will participants learn valuable information and

implement the skills taught during the class or training-they will also be rewarded.

It is important to ensure that rewards are aimed at the target behaviors. This is

best done by enlisting spouses, family and friends of the participant. Spouses, family

members and friends should discuss the new behaviors, and watch to see if the

participant does what he/she has been taught. If so, the participant should be praised

for their progress.

People often underestimate the importance delivering praise when encouraging

new behavior. When offering praise, it is very clear that a good word from a spouse,

family member, friend or colleague, goes a long way to ensure that the participant

continues the new behavior. A “Way to go!” is often viewed as more meaningful and

sincere than more formal means of praise. Supporters may brainstorm different ways to

offer informal praise.

Individuals must understand the “why” behind targeted behaviors. These “whys” usually

connect to their core values—or at least they should.

For instance, a wellness class encouraging better nutrition might emphasis core values.

Doing so, may lead people to make better choices regarding their health.

Unfortunately, the idea of discussing values is often times far from the minds of

instructors/trainers whose typically focus on numbers and charts. As a result,

instructors/trainers miss an important opportunity to discuss what people truly care

about. People do not connect strongly to figures, logic, charts, and facts. Instead, most


people connect to personal stories, vicarious experiences, and of course, deeply held

values.

When an instructor/trainer explains how the skills and concepts links in to

participants core values, the trainer/instructor breathes life into their behaviors.

Instructors/trainers should never be afraid to talk about skills, theories, and values.

Turning knowledge into action is not an easy task. It requires ideas to be shaped into

behaviors. This requires deliberate practice. And as the old adage says,” practice

doesn’t make perfect, perfect practice makes perfect” (Patterson, 2012).

Access to healthcare

With the passage of the affordable care act, many African Americans gained

access to healthcare. Historically, African-Americans were among those without

healthcare coverage, and African-American women, in particular, lacked prenatal care.

African American babies born are more likely than other ethnicities to be born with low

birth weights and other health issues due to a lack of access to healthcare, especially in

underserved areas. With the passage of the ACA, many Americans, including African

Americans have gained access to healthcare.

African-Americans are more likely to postpone treatment or seek treatment after

an illnesses has develop rather than seek preventative care. This occurs primarily due

to concerns with medical coverage, or lack thereof (Berkowitz, 2011).

Conclusion

In summary, today’s African Americans still consume foods eaten by their

ancestors which include elements of West African culture. Traditional food habits and

meal patterns have changed among African Americans due to pressures of a fast-paced


society (Kittler et al., 2012). Contemporary diets are generally low in micronutrients

such as calcium, iron and vitamin D, and often times exceed recommendations for

macronutrients such as carbohydrates, fat, saturated fat and protein (Kittler et al.,

2012).

African Americans celebrate major holidays such as Thanksgiving, Christmas,

Easter and New Years. They continue to prepare Sunday dinners, a practice continue

since emancipation. Kwanza and Juneteenth are holidays celebrated by African

Americans commemorating emancipation of the slaves and unity of people of African

heritage. Food is an integral part of holidays as it considered an important factor in the

cohesiveness of the African American community (Kittler et al., 2012).

Blacks have higher incidents of obesity, cardiovascular disease (CVD), diabetes,

and hypertension when compared to whites. The African American diet, high in fat,

saturated fats, sodium and refined grains is, in part, a contributing factor to higher

incidents of chronic illnesses among this population. The African American diet is also

low in vegetables, fruits, and whole-grain products also playing a significant role in

higher incidents of chronic illnesses (Kittler et al., 2012).

African American women are more likely to be overweight or obese that whites.

Children and adolescents are also at risk for obesity (Kittler et al., 2012). A sample diet

an African American female between the ages of 40-45 was observed. The dietary

analysis report determined that African American women who consume traditional foods

on a consistent or regular basis are likely exceeded dietary recommendations for

macronutrients, and exceed recommendations for caloric and sodium intake.

Intervention is necessary if dietary behaviors are to change within this ethnic group.


Psychosocial stressors in addition to lifestyle may contribute to the pathogenesis

of hypertension and cardiovascular disease among African Americans. Strong

evidence suggests that psychosocial and environmental stress contribute to

disproportionate rates of hypertension and CVD among this ethnic group. Lifestyle

modifications such as aerobic exercise, salt restriction, weight loss and the use of

Conventional Alternative Medicine, (CAM) such as Transcendental Meditation

techniques have been shown to be effective in lowering high blood pressure among this

target group (Duraimani et al., 2015).

Without skill transference, wellness training of any kind is merely wasted effort for

many hoping to modify their behavior. Motivating and enabling a genuine change in

behavior is not an easy task that will likely require the support of family members, or

even a health coach to ensure that learning translates into action. Change

Management encourages individuals to implement strategies to ensure that change and

development are implemented successfully. Finally, the passage of the Affordable

Care Act, many African Americans gained access to healthcare. African Americans are

more likely to give birth to babies with lower birth weight, and to postpone treatment

until their condition requires immediate care. If the initiatives of this law are successful,

African Americans will gain better access to healthcare including preventative care,

minimize the risk of developing chronic illnesses (Berkowitz, 2011).

Dietary and fitness recommendations

A sedentary lifestyle is more common among African Americans regardless of

education level, marital status, income, or other factors regarding social status (Kittler,

et al., 2012). According to Turley and Thompson (2013), Individuals should participate


in moderate to vigorous physical activity for 30 minutes a day minimally to maintain

health. Recommendations from MyPlate encourage individuals to balance calories,

and avoid overeating. It also encourages people to make half of their plate fruits and

vegetables. Half of the grains consumed should be whole grains, and individuals should

switch from whole or 2% milk to fat-free or 1% milk. MyPlate also recommends

individuals compare food labels, and chose foods with lower sodium. It is also

suggested that people drink water instead of sugary drinks. Finally, MyPlate

recommends a caloric intake level be determined in order to establish a food pattern

that will promote moderation, variety, balance, adequacy, and calorie control (Turley &

Thompson, 2013).

Recommendations for a diet using nonhydrogenated/unsaturated fats as the

predominant form of dietary fat, whole grains as the primary form of carbohydrates, a

substantial amount of fruits and vegetables, and sufficient omega-3 fatty acids should

be encouraged for African Americans as following these recommendations can protect

against heart disease as well as other chronic illnesses (Fulp et al., 2009).


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