Obesity rates are alarmingly high in the United States. Altogether, overweight and obesity rates exceed 70% of the U.S. adult population according to the Centers for Disease Control and Prevention. This figure comes with staggering health care costs, as obesity is known to heighten the risk of several chronic diseases including hypertension, type 2 diabetes, and certain forms of cancer. Obese individuals also experience a decreased quality of life and a higher mortality rate. These negative health consequences are pronounced among minority populations who often have less access to health care along with a higher rate of obesity-related comorbidities.
African Americans are disproportionately affected by obesity. According to the American Heart Association, 77% of African American women and 63% of African American men are overweight or obese. Within African American faith-based communities, health education programs remain limited despite substantial evidence from the literature indicating its advantages. Significant barriers contribute to a low utilization of health promotion programs in African American faith-based communities. According to a systematic review in Obesity Reviews, some of these barriers include scheduling conflicts with church activities and keeping the interest of participants. Nonetheless, the same study concludes that health programs focused on weight management and weight-related behavior in African American churches can effectively help address the obesity issue.
The NWEP Project
The Nutrition and Wellness Education Program (NWEP) was a pilot study led by a team of two student nurses and one faculty to provide health education in the All Nations Church of God in Christ, which is a predominately African American congregation located in North Richmond, California. The program was conducted during the fall of 2016 and consisted of a series of six workshops of about two hours each facilitated by the team of student nurses. The workshops consisted of teaching using PowerPoints and handouts; group activities, such as modifying recipes and building shopping planners; and recipes/cooking demonstrations. The NWEP aimed to provide the participants with the knowledge, resources, and tools to access and select healthier food options in order to sustain positive nutritional outcomes. This program provided nutrition education regarding the basic food groups, the properties of food items, the benefits of eating certain foods, and hands-on demonstrations of healthier meal preparations. Furthermore, participants learned how to select healthier foods in groceries and restaurants within a limited budget.
The Significance of Nutrition Education
Education plays a crucial role in providing disadvantaged communities with the essential resources needed to make better lifestyle choices. Although obesity originates from a complex interplay of genetic, environmental, and behavioral factors, poor dietary habits remain an important contributor to this health issue.
Nutrition education is an integral part of reducing excessive body weight since it can increase knowledge about food and cost-effective approaches to eating healthy. In this regard, NWEP aimed to bridge the knowledge gap and stimulate the adoption of healthier dietary habits among the program’s participants. The NEWP was an eye-opening experience for the women who participated in the program. They lacked basic nutrition literacy, such as the five food groups, or the information contained on nutrition facts labels. They expressed reactions that ranged from surprise and disbelief to apprehension as they grasped the notion of added salt and sugar in food items.
For example, when the workshop facilitators showed the amount of sugar in an eight-ounce soft drink, one participant exclaimed: “Oh, that is a lot of sugar! I would have never imagined this is the amount of sugar I get from one can of Coke.” Similarly, when the facilitators demonstrated that in certain brands of chips, a single bag could contain more than the recommended daily intake of sodium, their reactions were indicative of the fact that they lacked the basic knowledge to make informed dietary choices. Other fundamental nutrition concepts covered in the program were calories and nutrients in foods. This allowed the participants to differentiate between high-calorie, nutrient-poor foods versus low-calorie, nutrient-rich foods and the benefits of incorporating more of the latter into one’s diet.
Moreover, participants had to practice the lessons learned during the workshops. Each participant was invited to explore strategies that fit their individual needs and circumstances. Most of them agreed that cooking at home allowed for a better control over their food’s quality because fast food contains a higher amount of salt, sugar, and fat. Throughout the workshops, the facilitators presented ideas for improving the nutritional qualities of their foods. These included swapping ingredients, lightening the seasoning, and improving the flavors with alternatives such as herbs and spices instead of butter or cheese. Other suggestions included using weekly meal planning, consuming in-season, fresh fruits and vegetables instead of canned foods, and baking in place of deep frying.
Nonetheless, one cannot ignore that increased knowledge alone is insufficient in achieving behavior and dietary change. In the Annals of Global Health, Himmelfarb and colleagues argued that knowledge is not everything as far as behavior modification is concerned. It is necessary to reinforce the skills of these participants and to provide them with support resources (e.g.,regular dietary counseling) to reach the goal of adopting and sustaining healthier dietary habits.
Observations and Feedback
The participants of the NWEP demonstrated a strong interest in the topics covered during the workshops. They could relate to the content of the lessons since it provided relevant information to improve their diets. These women acknowledged the importance of eating a healthy diet and the potential of this pilot program to help them make a positive impact on their health and that of their families since they were generally the primary grocery shoppers and cooks in the household. During the workshop sessions, they actively engaged in the activities, participated in the discussions, asked questions, and shared their challenges in adopting a healthier diet. This enthusiasm was indicative of the need and importance of health promotion program in this faith-based community. The women gave positive feedback overall and reported that they would be interested in staying in the program if it was extended. It was also a good opportunity to address some of their misconceptions about food properties, such as the characteristics of whole-grain foods. Beyond the learning experience of the NWEP, the participants developed a fellowship and camaraderie. They often stayed on the premises of the church and engaged in long, lively conversations at the end of the sessions. This act of bonding could be used as a support system to sustain the desired lifestyles change.
Lessons Learned and Recommendations for Future Projects
The NWEP underscores the challenges and opportunities for implementing health education programs in a faith-based environment. This study highlights the importance of nutrition education because a limited understanding of nutrition and diet also accounts for poor food choices and dietary habits. Improving nutritional literacy is a critical component of health education because it can initiate a behavior modification. The interest the participants displayed during the workshops is a clear indication of the need for health literacy and health promotion programs. Such programs should be implemented over a longer period and should be expanded to provide substantial support and sustain healthy lifestyles such as physical activity, dietary counseling, or health monitoring. Training lay-health educators among church members offers an efficient and inexpensive means to reach a wider audience within the community for a longer duration of time.
Despite its success, there were several challenges encountered while running this pilot program. Ongoing communication between facilitators and faith-based organizations will help ensure efficient workshop sessions. Also, providing the participants with monetary incentives, such as paying for their transportation or offering grocery gift certificates, may increase participants’ attendance. Using innovative technology such as text message reminders could also boost the attendance rate. Substantial financial support is equally critical for the success of such programs because the host community may lack basic equipment including a kitchen, a projector, and internet access, to facilitate the program.
The NWEP helped identify strategies to improve health outcomes in underserved communities. Health education in African American faith-based communities holds the potential to improve access to preventive care services. Despite its promise to reach a large number of individuals in underserved populations, health education programs in faith-based communities are limited. The NWEP attempts to address this gap by focusing on nutrition, which is a crucial component of health. Nutrition is a major part of health care and dietary modification is an essential, primary intervention in improving the overall health of disadvantaged populations.
Kalea Vo, BSN, RN, is a new graduate from the Valley Foundation School of Nursing and currently works as a staff nurse in a major hospital in San José.
Constance Hill, PhD, RN, is an assistant professor at the Valley Foundation School of Nursing at San José State University.