When Byllye Avery founded the National Black Women’s Health Project (dba Black Women’s Health Imperative [BWHI]) over 40 years ago, she believed “Black women want to feel a sense of community” to address personal, emotional, and health-related issues. Ms Avery created that sense of community, bringing Black women together in “Self-Help” groups that incorporated and promoted the concept that health and well-being include physical, psychological, social, emotional, and spiritual components. They represented a strategy for Black women to empower themselves by acknowledging lived experience, actively pursuing wellness, supporting each other in addressing health issues, and helping each other make healthy decisions. Women told their stories in groups enriched by a vision of self-healing and self-empowerment, with expression of feelings encouraged. BWHI’s High-Touch Coaching adapts self-help values guiding and defining our direct service programs. To provide personalized support, lifestyle coaches learn important things about each participant and what challenges exist for them, including perceived support, selfefficacy, and the woman’s ability to actually make the changes they seek.
As described in the Journal of Women’s Health,1 Ms Avery’s belief was illuminated during the first year of our Centers for Disease Control and Prevention (CDC) partnership. Women were not meeting the 5% weight loss goal, and maintaining fidelity to the CDC curriculum didn’t allow delving into issues that were directly and greatly impacting not only their weight but also their health in general. We created supplemental sessions to address those unique issues. During coach-facilitated sessions, women organically created a sense of community based on a common lived experience that allowed them to support each other not only during the scheduled sessions but also between sessions and after the yearlong program ended. Expressions of personal transformation during those sessions were the motivation for adapting and culturally tailoring diabetes programs appealing to Black women and for creating the first CDC-approved curriculum culturally tailored for Black women.1 Upon further exploration, we learned that Black women had the poorest outcomes in the original Diabetes Prevention Program research study.2 As documented in numerous studies, Black women are more overweight and have greater difficulty maintaining weight loss than do White women. University of Connecticut identified not addressing their unique needs as a reason many programs are not successful for Black women.3
BWHI has learned a great deal from Black women over the past 40 plus years. Program interventions must be culturally relevant. As confirmed in the recent PICORI study, Black women are more successful with culturally tailored weight loss programs.4 Coaches must first create a safe space within the group, helping women develop a sense of connectedness, belonging, and well-being. Black women can thrive in groups where there is trust; they can be themselves, be vulnerable, know that both the coach and other participants “get them,” and they don’t have to explain themselves, their culturally related food preferences, or their religious, spiritual, or health beliefs. Our coaching model expands the general concept of lifestyle coaching, making it more relational and applicable to Black women. What also empowers them and increases self-efficacy is placing equal—and often greater—value on nonscale victories and their emotional wellness. Black women need to understand how their higher levels of cortisol result in chronic stress, greatly impacting their weight and their overall health.5 The group experience helps many women realize they have more authority over their lives than they thought. For some, that means recognizing the need for therapy or other medical intervention. This is a theme often addressed during one-on-one sessions with the coach. Many women indicate that the program is life-saving and that they will be friends with the other women in their groups for life.
As a CDC-designated national training entity for the National Diabetes Prevention Program, BWHI trains lifestyle coaches in our High-Touch model. This is a resource that diabetes care and education specialists affiliated with CDC- recognized organizations can take advantage of to add to their portfolio of care when working with all patients and more specifically with Black women, who may respond more positively when the care is personalized, culturally tailored, and responsive to their unique needs. For more information on High-Touch Coaching and opportunities for training, individuals are encouraged to visit our website: coachtraining.bwhi.org. They can also email our training team at changeagency@bwhi.org with questions regarding future training opportunities.
Angela F. Ford, PhD, MSW is the Executive Vice President, Chronic Disease at the Black Women’s Health Imperative in Atlanta, Georgia.
West DS, Elaine Prewitt T, Bursac Z, Felix HC. Weight loss of Black, White, and Hispanic men and women in the Diabetes Prevention Program. Obesity. 2008;16(6):1413-1420. doi:10.1038/oby.2008.224
Williams A, Ford A, Webb M, Knight M, Costa K, Hinton C. Public-private partnerships to lower the risk of diabetes among Black women using cooperative agreements: the National Diabetes Prevention Program and the Black Women’s Health Imperative. J Womens Health. 2022;31(8):1079-1083. doi:10.1089/jwh.2022.0259
Carr LB. Weight loss plans are less effective for many Black women − because existing ones often don’t meet their unique needs. UConn Today. Published November 22, 2024. Accessed February 20, 2025. https://today.uconn.edu/2024/11/weight-loss-plans-are-less-effective-for-many-black-women-%E2%88%92-because-existing-ones-often-dont-meet-their-unique-needs/
Tucker C, Anton S, Bilello L, et al. Comparing two programs to maintain weight loss among Black women with obesity. Patient-Centered Outcomes Research Institute (PCORI); 2023. doi:10.25302/02.2023
Tipre M, Carson TL. A qualitative assessment of gender- and race-related stress among Black women. Womens Health Rep. 2022;3(1):222-227. doi:10.1089/whr.2021.0041
