Two doctors point the way to better heart health for midlife black women
Spend a little time with Marilyn Gaston, M.D., and Gayle Porter, Psy.D., and it’s not hard to guess they’ve been pals for a long time—42 years to be exact. They finish each other’s sentences, can tell you everything about the other’s family and friends. They even live together in Florida part of the year—their happy little revolt, they say, against the biting winters of the northeast.
But Gaston, 81, a physician, and Porter, 74, a clinical psychologist, are hardly just wiling away their days strolling the sunny beaches of retirement land. The two are professional partners on a mission—to help black women in midlife make their health a priority—and they are as focused on that work today as they were when they started 20 years ago.
“So many of our women don’t even know their health is in crisis,” Gaston says. “They’re the matriarchs of their community, the role models, the people everybody turns to, but they are not taking care of themselves. In fact, they are dying—of heart attacks, stroke, hypertension—at rates higher than any other group of women.”
“And stress and depression play a big role in that,” Porter adds.
It’s why, in 2002, the two women founded The Gaston and Porter Health Improvement Center, Inc., a Washington, D.C.-based organization committed to teaching black women 40 to 75 years old what it really means to get healthy and stay healthy. To get the ball rolling, the doctors wrote a book, Prime Time: The African-American Woman’s Complete Guide to Midlife Health and Wellness. And that led to the phenomenon now driving their effort: a 12-week health and wellness curriculum taught to small groups of women who form what Gaston and Porter call Prime Time Sister Circles®.
Since the doctors began their work, more than 3,000 women have joined dozens of Sister Circles across the country–in churches, public housing projects, recreation centers. And because the progress of each group is measured and evaluated by outside researchers, Gaston and Porter say they now have a pretty good idea about what’s working.
In a word: lots.
“The women see major changes in their stress levels, how they manage it, but they also see major changes in their blood pressure, and in their weight. And they’re exercising more, and consistently,” Porter says.
This year NHLBI Director Gary Gibbons took notice, and in a nod to Gaston and Porter’s good works, honored them with NHLBI’s 2020 Healthy Heart Award. At the Woman’s Day Red Dress Awards event in New York last week, Gibbons said the two women have long known what researchers continue to document in their own work—"that having social support and personal networks makes it much easier to make and maintain heart- healthy lifestyle changes.”
In using that knowledge to help vulnerable women in the prime of their lives, Gibbons went on, the doctors have tapped into a profound need. “Women come away from these 12-week interventions with real tools to prioritize and improve their health,” he said.
The midlife blues
Gaston and Porter are the first to acknowledge that most women in midlife, no matter their race, could use the support. Raising children, navigating relationships, holding down jobs, caring for aging parents, dealing with loss—the challenges abound, they say, which is why they are slowly expanding their efforts to include women of all races. But black women, the doctors explain, still stand at the center of their attention because of issues that challenge them disproportionately: being unmarried and without a steady partner, having to raise grandchildren alone, facing job and social discrimination, dealing with extreme financial burdens.
The stress that comes along with all that, they say, is in large part why some 44 percent of black women struggle with hypertension, 13 percent with diabetes, and nearly 80 percent with obesity and overweight. The evaluations of their own Sister Circles bear that out, they note.
Yet, Porter says, many women do not see the connections at first—how, for example, the stress of raising young grandkids at age 60 can lead to emotional eating, which can lead to obesity, which is a major risk factor for heart disease. When gathering medical histories at the start of the Sister Circles, Porter says it is not uncommon for a woman who is morbidly obese “to not even mention weight as an issue at all.”
So Gaston and Porter have taken a holistic approach to their work—getting experts (also midlife black women) to talk first about the different mental and physical changes that happen when the body is under stress, then “pulling each apart, one by one” to explain them in depth, then developing individualized plans to help the women improve their fitness, nutrition, stress levels, weight and heart health. As a friendly add-on, each woman also gets a blood pressure monitor and cuff and a lesson on how to use it. “The whole point is to make these changes life-long habits of health,” Gaston says.
Decades of community work
In conceiving the “sister circles” idea, the women drew from decades of combined experience: Gaston had spent years working with disadvantaged communities in various game-changing roles in medicine and research, including at NIH. She also was an Assistant Surgeon General and director of HHS’s Bureau of Primary Health Care in Health Resources and Services Administration. There she administered federal programs serving 12 million underserved, poor, and disadvantaged people. Porter was the first black woman psychologist on the psychiatry faculty of Johns Hopkins and led two outpatient mental health centers for the Washington, D.C. Commission on Mental Health Services. She also was the first full time director of what has become a nationally known, school-based mental health program for Johns Hopkins University/Hospital in Baltimore.
Their professional networks have served them, as operating the circles is largely dependent on private and public funding. And because some of those funding organizations prefer to target particular populations of black women, many of the circles have been uniquely focused. For example, recent circles in Philadelphia were formed with women recovering from opioid addiction, while two in Washington, D.C. involved women who had been incarcerated. In March, a 5-year grant from NIH, in partnership with Johns Hopkins University, will fund circles in Baltimore that focus on women with uncontrolled hypertension.
Whatever the particular health, social and economic histories of the women, Gaston and Porter say they’ve found that talking about legacy—“Do you want to stay around for your granddaughter? Do you want your granddaughter to die from heart disease?”—get the women motivated to make change. But it’s the women themselves and the “straight talk” they give to each other, the doctors say, that really makes the difference. “They get very close, and they keep each other accountable,” Gaston notes.
Reach one, teach one.
The women influence each other, too. Over the years Gaston and Porter have heard multiple stories about the ripple effect the circles have had in families and communities. One woman told of how her grandson stopped her from buying her favorite chips after she’d taught him how to read food labels. “Nana, this has too much sodium!” the grandson warned. Another told how her live-in adult son “came down two shirt sizes” after the woman dramatically changed her cooking habits. “She said it helped save her life and her son’s,” Porter recalls. Still another woman was courageous enough to confront her pastor to tell him the food being served at the church did not reflect what she was learning about healthy eating. The pastor soon announced to the congregation that while he could not bring himself to ban potato salad, “We’re not eating any more fried food in fellowship hall!”
The doctors say they understand how that kind of inspiration works: After all these years, they’re still helping each other practice what they preach. When in Florida the two walk and exercise together most days. They eat their veggies, cravings for ice cream notwithstanding. They take time to be still, despite all the work that beckons. And when they need help, they get it. Porter, for example, is not shy about telling others about the “tremendous gift” professional therapy has been for her—it’s her way, she says, of helping lessen the stigma around it in the black community.
“In so many ways we’re just like anybody else,” Gaston says. “We have our challenges, but we just keep working at them—one day at a time.”