TABLE 2—

Themes With Representative Quotations and Potential Intervention Foci

	Representative Quotations	Potential Intervention Focus
Failure of weight maintenance	“I’ve never been able to do the maintenance. I am pretty good with losing the weight, and Ican discipline myself enough to do it . . . if you don’t get on the maintenance, then yougain it back, plus extra.”—55-year-old White woman with high-school diploma “The one thing I find with the [weight-loss] programs is, it’s good to help you lose weight, but the problem is they really don’t teach you how to maintain.” —36-year-old African American woman with high-school diploma	Incorporate maintenance strategies in formal weight-loss programs.
Psychological and spiritual approaches	“This is about the biggest struggle I have in my life—weight loss. . . . I tend to pray a lot and fast a lot. When I want changes in my life, that’s what changes it.”—54-year-old African American woman with master’s degree “I get frustrated because I have the information [about weight loss]. It’s not that I lack information.”—50-year-old White woman with college degree “It’s a double-edged sword. I’m overweight, and I want to do something about it, but then I have a long way to go, and then it doesn’t happen, and I get discouraged.”—37-year-old African American woman with college degree “I think for me the spiritual piece is very important. Without it, any weight-loss program is not gonna work. You need a dual program.”—52-year-old African American woman with high-school diploma	Include a body/mind/spirit approach to weight loss.
Family influence and societal expectations	“For most of my life, through various sources of input, I’ve had a negative body image. . . . They [my grandparents] would tease me: ‘You’re fat,’ ‘You’re never going to be anybody if you’re fat,’ and then that would just make me feel bad about myself ”—37-year-old African American woman with college degree “One thing was always told to me: ‘We’re a big-boned family. Child, you are always gonna be big. Don’t worry about it. You will never be small because it’s just the way this family is built.’”—36-year-old African American woman with high-school diploma “I think that I’ve sort of been this way. I’m too self-aware, sort of like ashamed over how I look.”—50-year-old White woman with college degree	Encourage parents and adults to give positive messages to children regarding weight, eating, and exercise habits.
African American subculture hinders weight management	“It’s eating and cooking and sharing, that’s a Black thing, particularly in the churches.” —54-year-old African American woman with master’s degree “Church is our life, it’s our outlet. Where the world may go to the clubs and go to bars, food is our outlet. If you want people to come out, you better tell them there’s going to be some food.”—47-year-old African American woman with high-school diploma “One of our [African American women] downfalls is cultural. Yes, the southern cooking. I’ll start with collard greens and put in fat meat, hog maws or ham hocks, in there.” —36-year-old African American woman with high-school diploma	Promote healthy food preparation and eating habits in cultural and social gatherings.
Affordability concerns limit weight-management efforts	“To have foods that I have no idea what they are, no idea where you can buy them, and no idea how to prepare them. And it’s cost prohibitive. Some of that stuff is really expensive”—50-year-old White woman with high-school diploma “If you are not consistent in being there [Weight Watchers program], you may not always have $8 at that moment. I mean I don’t always have [it], or it has to go to something else at that time”—44-year-old African American woman with high-school diploma “You know, 3 boxes of macaroni and cheese for a dollar as opposed to buying chicken breasts that are, you know, 10 bucks, if you get 2 of them”—36-year-old White woman with high-school diploma	Educate women of low socioeconomic status on cost-effective ways to eat healthy and engage in physical activity.
Racial differences in ideal weight-loss methods	“Food that tastes good as opposed to bland, flavorless food, food with various textures, and what have you.”—47-year-old African American woman with master’s degree “Exercise; you have to move, you have to move. I don’t think [a weight-loss program] will work without it.”—51-year-old White woman with college degree	Devote more attention to taste and cultural appropriateness of recommended foods.