title: African American women exhibit similar adherence to intervention but lose less weight due to lower energy requirements.
abstract: BACKGROUND
  African American (AA) women have been shown to lose less weight than Caucasian women in response to behavioral interventions. Our objective was to examine adherence to intervention and metabolic factors that may explain this difference.
  
  
  METHODS
  We examined longitudinal changes in body weight and energy expenditure (EE), and objective assessment of physical activity (PA) and energy intake (EI) during 6 months of a weight-loss intervention program, including prescribed calorie restriction and increased PA in 66 Caucasian and 39 AA severely obese women. Comparisons were also made in 25 Caucasian and 25 AA women matched for initial body weight.
  
  
  RESULTS
  The AA women lost 3.6 kg less weight than Caucasian women. Total daily EE (TDEE) and resting metabolic rate (RMR) adjusted for fat free mass (FFM) were significantly lower in the AA women, whereas the decrease in RMR in response to weight loss was greater in Caucasian women. Adherence to the prescribed PA and change in PA in response to intervention were similar in AA and Caucasian women. Prescribed EI (1794±153 and 1806±153 kcal per day) and measured EI during intervention (2591±371 vs 2630±442 kcal per day) were nearly identical in matched AA and Caucasian women. However, the AA women lost significantly less body weight due to lower energy requirements (2924±279 vs 3116±340 kcal per day; P<0.04), resulting in a lower energy deficit (333±210 vs 485±264 kcal per day).
  
  
  CONCLUSIONS
  Adherence to the behavioral intervention was similar in AA and Caucasian women. However, neglecting to account for the lower energy requirements in AA women when calculating the energy prescription resulted in a lower level of calorie restriction and, hence, less body weight loss. Therefore, to achieve similar weight loss in AA women, the prescribed caloric restriction cannot be based on weight alone, but must be lower than in Caucasians, to account for lower energy requirements.
authors.affiliation: Division of Endocrinology and Metabolism, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: J P
authors.initials: JP
authors.lastname: DeLany
authors.affiliation: Department of Health and Physical Activity, Physical Activity and Weight Management Research Center, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Jakicic
authors.affiliation: Division of Endocrinology and Metabolism, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: J B
authors.initials: JB
authors.lastname: Lowery
authors.affiliation: 1] Division of Endocrinology and Metabolism, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA [2] Department of Health and Physical Activity, Physical Activity and Weight Management Research Center, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: K C
authors.initials: KC
authors.lastname: Hames
authors.affiliation: Division of Endocrinology and Metabolism, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: D E
authors.initials: DE
authors.lastname: Kelley
authors.affiliation: Division of Endocrinology and Metabolism, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: B H
authors.initials: BH
authors.lastname: Goodpaster
mesh_terms: D015502:Absorptiometry, Photon; D001741:Black or African American / Q000706:statistics & numerical data*; D001481:Basal Metabolism; D001521:Behavior Therapy / Q000379:methods; D001823:Body Composition; D015992:Body Mass Index; D031204:Caloric Restriction / Q000379:methods*; D004734:Energy Metabolism; D015444:Exercise; D005260:Female; D006801:Humans; D008875:Middle Aged; D009767:Obesity, Morbid / Q000208:ethnology* / Q000378:metabolism / Q000517:prevention & control; D010349:Patient Compliance; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D015431:Weight Loss / Q000208:ethnology*; D061217:Weight Reduction Programs / Q000379:methods; D044465:White People / Q000706:statistics & numerical data