Case Study 03 | Danielle Furci Braxt

CASE STUDY 03

DESIGNING FOR RESILIENCE: TESTING A STRESS-RESPONSIVE WEIGHT-LOSS EXPERIENCE FOR SEVERELY OBESE AFRICAN AMERICAN WOMEN

A user-centered analysis revealing how stress, environment, and social context uniquely shape the lived experiences of severely obese vs. overweight African American women in the rural South.

Overview

Background & Problem Statement

Many behavioral weight loss (BWL) programs underperform for African American women with severe obesity due to a lack of cultural relevance and their failure to address the unique psychosocial and physical challenges faced by those with severe obesity.

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Background

Approach

To close that gap, this research sought to determine whether integrating stress-management and culturally relevant strategies into an evidence-based behavioral weight-loss framework could enhance feasibility, acceptability, and early outcomes among African American women with severe obesity. By testing this approach through a randomized controlled pilot study, the project aimed to generate actionable insight into how psychosocial and contextual factors can be embedded into the design of more equitable and effective health-behavior interventions.

Research Goal

The primary goal of this research was to evaluate the feasibility and preliminary effectiveness of a culturally tailored behavioral weight-loss intervention for African American women with severe obesity. Specifically, the study aimed to determine whether integrating stress-management strategies into a standard behavioral weight-loss program would improve participant engagement, satisfaction, and short-term weight-loss outcomes. Through this pilot randomized controlled trial, the research sought to identify practical and psychosocial factors that could inform the design of more responsive, sustainable, and culturally relevant health interventions for underserved populations.

Research Process

Randomized Control Trial

Method Description

This study used a randomized controlled pilot design to evaluate the feasibility of a culturally tailored behavioral weight-loss intervention for African American women with severe obesity. Participants (n = 40) were randomly assigned to one of two 24-week group-based programs: a standard behavioral treatment (ST) or an enhanced version that incorporated stress-reduction strategies (ST + SR).

Quantitative measures included weight, attendance, and psychosocial questionnaires assessing stress and eating behaviors, while qualitative data were gathered through focus groups and participant feedback surveys. The combination of quantitative outcomes and qualitative insights allowed for a comprehensive understanding of participant engagement, acceptability, and contextual factors influencing program success.

Participants were 40 African American women aged 35–65 years with severe obesity (BMI ≥ 40 kg/m²) recruited from community and faith-based organizations in central North Carolina. Data collection included baseline and post-intervention assessments of anthropometric, behavioral, and psychosocial measures, complemented by qualitative feedback to capture participants’ lived experiences and perceptions of program relevance.

Quantitative data were analyzed using descriptive and inferential statistics to examine feasibility indicators and preliminary outcomes, while qualitative data were coded thematically to identify patterns in motivation, barriers, and user experience. Together, these methods provided a multidimensional understanding of how culturally grounded, stress-sensitive design elements shaped engagement and feasibility.

All Survey Tools for CS #03

Key Results

Both intervention groups achieved modest but meaningful weight loss over the 24-week program, demonstrating the overall feasibility of delivering a structured behavioral weight-loss intervention to African American women with severe obesity. Participants in the enhanced stress-reduction group (ST + SR) reported higher satisfaction, stronger perceived group support, and greater relevance of the program content to their daily lives compared to those in the standard treatment group.

Attendance and retention rates indicated strong engagement across both groups, while qualitative feedback highlighted the importance of addressing psychosocial stress, cultural identity, and self-care within weight management programs.

Collectively, these findings suggest that integrating culturally grounded stress-management strategies can improve participant experience and inform the design of more inclusive, user-centered health behavior interventions.

Randomized Control Trial

All Data Tables for CS #03

Conclusion

In sum, this research project had a meaningful impact on how researchers and practitioners approach weight-loss interventions for African American women with severe obesity. Your findings highlighted how chronic, culturally grounded stressors—particularly Role Overload (RO) and the Superwoman Role (SR)—contribute to weight-related behaviors, disordered eating, and barriers to physical activity and healthy diet. This research confirmed that African American women who are severely obese experience unique stress and health behavior patterns distinct from those who are overweight or moderately obese, deepening understanding of how psychosocial and contextual factors interact with obesity risk .

The dissertation’s impact lies in expanding the evidence base for culturally tailored behavioral weight-loss (BWL) interventions. It demonstrated the feasibility and acceptability of incorporating stress-reduction and social support components into weight-management programs, and it offered concrete guidance for improving retention and engagement—such as adjusting program structure, increasing contact intensity, and addressing practical barriers like scheduling and transportation .

Overall, the work advanced the field by reframing obesity treatment for African American women through a contextually and culturally informed lens, emphasizing the importance of addressing psychosocial stress and systemic barriers alongside traditional diet and exercise strategies .