A Client-Centred Weight Management Intervention for Black Women from Sub-Saharan Africa with Overweight and Obesity in the UK

Obesity poses a critical public health challenge, significantly reducing life expectancy by 5–20 years and heightening the risk of common non-communicable diseases (Ataey et al., 2020; Dee et al., 2014). Globally, Black African women experience disproportionately high rates of obesity, with over 30% classified as obese (Smith et al., 2016). In the UK, the prevalence is higher among Black African women, reaching 37%, compared to other ethnic groups (HSE, 2019). These disparities arise from complex interactions between genetic, ethnic, and environmental factors, further compounded by the obesogenic nature of local environments and the effects of migration, such as dietary changes and reduced physical activity. Migrants from socio-economically disadvantaged backgrounds are especially vulnerable to obesity, facing barriers like limited participation in interventions, lack of culturally tailored programs, time constraints, and social stressors (Resnicow et al., 1999; Kumanyika, 2004). Client-centred counselling, rooted in motivational interviewing, presents a promising approach to addressing these barriers through culturally responsive strategies (Miller & Rollnick, 2012). The socio-ecological model also highlights the importance of multi-level interventions that account for intrapersonal, social, environmental, and policy influences (Sallis & Owen, 1999). However, evidence for culturally relevant interventions targeting Black African populations in the UK remains sparse. This PhD research aimed to develop a culturally sensitive, client-centred intervention to improve dietary behaviours and facilitate weight management among Black women from Sub-Saharan Africa with overweight and obesity in the UK. The research employed a multi-method, sequential explanatory design, integrating five empirical studies. The systematic review (Study 1) which included 22 experimental studies, revealed the effectiveness of culturally adapted, client-centred counselling delivered face to face or through hybrid modes. Studies that were grounded in theoretical underpinnings, and employed a combination of cultural adaptations, including language considerations and socio-cultural values, were more likely to achieve positive outcomes. Study 2, a quantitative study with 112 participants, focused on modifying and validating the European Prospective Investigation of Cancer (EPIC) Food Frequency Questionnaire (FFQ) for this population, ensuring its validity in capturing dietary intake. Study 3, a quantitative cross-sectional study involving 112 participants, investigated dietary patterns among Black African women in the UK revealing consumption relatively high intake of fruits and vegetables and rich in whole grains; however, they exhibit a high intake of red meat and processed foods with increased risk of many chronic diseases. Socio-demographic influences included migration status, length of stay, education and acculturation. Principal Component Analysis (PCA) identified four dietary patterns—"Western," "African Style," "Plant-Based and Sugar," and "Meat-Centric", reflecting a blend of traditional and Western eating habits. Study 4, a qualitative study with 15 women, explored in-depth factors influencing variation in the degree of continuity and change in dietary practices among Black African immigrant women living in the UK through the use of one-on-one interviews. Four main categories were constructed with sub-categories: individual characteristics (health orientation and personal food preferences), cultural and social influences (family dynamics and cultural eating as part of identity), acculturation (adaptation of food habits, psychological impact, and shift in food preparation responsibilities), and barriers to healthy eating (cost and availability, and work/living constraints). Study 5 involved the development of the Black African Lifestyle and Nutrition Change for Empowerment and Development (BALANCED) a co-designed, theory- and evidence-based program addressing overweight and obesity among Black African women in the UK, using the Behaviour Change Wheel and COM-B model. The intervention targeted the primary, modifiable risk behaviours associated with overweight and obesity, specifically diet and elements of physical activity based on formative research and community input including webinar sessions with health professionals and in-depth interviews with Black African women. The BALANCED program is culturally tailored and incorporated educational modules and culturally sensitive cooking workshops designed to enhance participants' knowledge and skills in preparing healthier versions of traditional African dishes. Additionally, it emphasises on the use of client-centred counselling/motivational interviewing principles and peer support in its delivery, fostering a more collaborative and empowering approach. The thesis emphasises the importance of tailored public health strategies, recommending culturally adapted programs informed by socio-demographic factors and dietary acculturation. The BALANCED intervention proposed in the thesis exemplifies a potential, culturally relevant solution, requiring collaboration with community leaders, flexible delivery formats, and long-term follow-up to sustain outcomes and promote health equity.