Racial Differences in Selection of Ideal Body Size by Adolescent Females

Changes in the association between overweight and depression across three major ethnic groups, 2005-2018

BACKGROUND

The relationship between body weight and depression may have changed along with the climbing trend of obesity prevalence, but most previous studies examined the association with a single cross-sectional survey. The present study assessed the change in the association between depression and body weight, measured and perceived from 2005 to 2018, among three major racial/ethnic groups.

METHODS

We analyzed the data of 27,387 adults aged ≥18, collected in the National Health and Nutrition Examination Survey. Surveys from 2005 to 2010 were combined as the early period and the surveys from 2011 to 2018 as the recent period.

RESULTS

A switching pattern was observed among white women. In the 2005-2010 survey period, only self-perceived overweight was significantly associated with depression [Odds ratio (OR) = 3.25 (95% confidence interval = 1.33, 7.90)]. However, in the 2011-2018 survey period, self-perceived overweight was not associated with depression anymore [1.32 (0.72, 2.41)], but obesity measured directly was significantly associated with depression [2.59 (1.04, 6.48)]. Among white men, self-perceived overweight and obesity measured directly were significantly associated with depression only in 2011-2018; [2.57 (1.18, 5.58)] and [0.29 (0.10, 0.80)], respectively. Obesity directly measured consistently associated with increased odds of depression among black men. No significant associations were observed in Hispanic and black women in any survey period.

CONCLUSION

Significant gender and ethnic differences exist, and the associations between body weight and depression have evolved in sex-race-specific trajectories. The interventions must be consistently fine-tuned following the dynamics of the relationship between body weight and overall well-being.

Perceived Discrimination and Binge Eating Disorder; Gender Difference in African Americans

Environmental stressors, such as perceived discrimination (PD), are linked to Binge Eating Disorder (BED). The current study investigated the association between PD and BED among African Americans, and the variation in such an association based on gender. Data of the National Survey of American Life (NSAL), 2001⁻2003, with a nationally-representative sample of African American adults, were used (n = 3516). The independent variable in the study was PD. The dependent variable was BED, measured using the Composite International Diagnostic Interview (CIDI). Socio-demographics (age, education, employment, and marital status) were covariates, and gender was the moderator variable. Survey logistic regressions with and without gender × PD interaction terms were used for data analysis. In the pooled sample, PD was associated with higher odds of BED, net of socio-demographic factors. Models also showed a significant gender × PD interaction term suggesting a stronger association between PD and BED for women, compared to men. Gender specific models showed an association between PD and BED among female, but not male, African Americans. Although a link may exist between PD and BED among African Americans, the magnitude of this association depends on gender, with a stronger association among females than males. This finding is in line with the literature that has shown gender-specific consequences of environmental stress for African Americans.

The relation between obesity and depressed mood in a multi-ethnic population. The HELIUS study

PURPOSE

To examine the association between obesity and depressed mood in a large multi-ethnic population and check for consistency in this association across six ethnic groups.

METHODS

Data of 21,030 persons (18-70 years) were sourced from the HELIUS study. Cross-sectional relationships between obesity measures [body mass index (kg/m²) and waist circumference (cm)] and depressed mood (PHQ-9 score ≥ 10) were analysed. Consistency of associations was investigated across ethnic groups by interaction terms (ethnicity*obesity measures) in basic (age, sex, education) and fully (health behaviours and somatic health) adjusted models.

RESULTS

Obesity was prevalent in all ethnic groups, but varied substantially. After sociodemographic adjustment, obesity measures were associated with increased odds of depressed mood but this was inconsistent across ethnic groups. Obesity (BMI ≥ 30 or highest waist circumference quartile) was strongly and significantly associated with depressed mood in the Dutch [Odds Ratio (OR) = 1.72; 95% Confidence intervals (CI) 1.24-2.40, and OR = 1.86; 95% CI 1.38-2.50], respectively, and African Surinamese (OR = 1.60; 95% CI 1.29-1.98 and OR = 1.59; 95% CI 1.27-2.00, respectively) but had a weaker, non-significant association in other ethnic groups (South-Asian Surinamese, Ghanaian, Moroccan, Turkish groups). Adjustment for health behaviours and somatic health had limited effect on this pattern.

CONCLUSION

Obesity was associated with a higher risk of depressed mood. However, ethnic differences were found: the obesity-depressed mood association was strong in the Dutch and African Surinamese populations, but not in other ethnic groups. Future studies should explore whether differential normative values or pathophysiology across ethnic groups explain why the obesity-depression association is inconsistent across ethnic groups.

Discrepancy between Actual and Perceived Weight Status in Rural Patients: Variations by Race and Gender

The study's goal was to determine if differences in weight misperception by race and/or gender occur within a sample of economically disadvantaged rural patients with diabetes and/or hypertension. Diabetic and hypertensive patients were enrolled in the study from a network of federally qualified health centers (FQHCs) in the rural South. Multivari-ate logistic regression analysis suggests that, even when controlling for age, education level, employment status, and poverty, rural African American patients with chronic disease are more likely than their White counterparts to misperceive their weight status (OR = 1.709, p = .037). This difference in perceived weight occurred despite the absence of an underlying difference in actual weight status between African American and White patients (p = .171). In addition, rural men were much more likely than rural women to misperceive their weight status (OR = 2.688, p < .001). Implications for intervention development and implementation are discussed.

Mediating Effect of Perceived Overweight on the Association between Actual Obesity and Intention for Weight Control; Role of Race, Ethnicity, and Gender

Background:

Although obesity is expected to be associated with intention to reduce weight, this effect may be through perceived overweight. This study tested if perceived overweight mediates the association between actual obesity and intention to control weight in groups based on the intersection of race and gender. For this purpose, we compared Non-Hispanic White men, Non-Hispanic White women, African American men, African American women, Caribbean Black men, and Caribbean Black women.

Methods:

National Survey of American Life, 2001–2003 included 5,810 American adults (3516 African Americans, 1415 Caribbean Blacks, and 879 Non-Hispanic Whites). Weight control intention was entered as the main outcome. In the first step, we fitted race/gender specific logistic regression models with the intention for weight control as outcome, body mass index as predictor and sociodemographics as covariates. In the next step, to test mediation, we added perceived weight to the model.

Results:

Obesity was positively associated with intention for weight control among all race × gender groups. Perceived overweight fully mediated the association between actual obesity and intention for weight control among Non-Hispanic White women, African American men, and Caribbean Black men. The mediation was only partial for Non-Hispanic White men, African American women, and Caribbean Black women.

Conclusions:

The complex relation between actual weight, perceived weight, and weight control intentions depends on the intersection of race and gender. Perceived overweight plays a more salient role for Non-Hispanic White women and Black men than White men and Black women. Weight loss programs may benefit from being tailored based on race and gender. This finding also sheds more light to the disproportionately high rate of obesity among Black women in US.

Visual perceptions of male obesity: a cross-cultural study examining male and female lay perceptions of obesity in Caucasian males

Background

Obesity is now common and this may have altered visual perceptions of what constitutes a ‘normal’ and therefore healthy weight. The present study examined cross-cultural differences in male and female participants’ ability to visually identify the weight status of photographed Caucasian males.

Methods

Five hundred and fifty three male and female young adults from the US (high obesity prevalence), UK and Sweden (lower obesity prevalence) participated in an online study. Participants judged the weight status of a series of photographed healthy weight, overweight and obese (class I) Caucasian males and rated the extent to which they believed each male should consider losing weight.

Results

There was a strong tendency for both male and female participants to underestimate the weight status of the photographed overweight and obese males. Photographed males were frequently perceived as being of healthier weight than they actually were. Some modest cross-cultural differences were also observed; US participants were worse at recognising obesity than UK participants (p < 0.05) and were also significantly more likely to believe that the photographed obese males did not need to consider losing weight, in comparison to both the UK and Swedish participants (ps < 0.05). No cross-cultural differences were observed for perceptions or attitudes towards the photographed healthy weight or overweight males.

Conclusions

The weight status of overweight and obese (class I) Caucasian males is underestimated when judged by males and females using visual information alone. This study provides initial evidence of modest cross-cultural differences in attitudes toward, and the ability to recognise, obesity in Caucasian males.

Do you see what I see?: An exploration of inter-ethnic ideal body size comparisons among college women

The present study explored African American (n=16) and European American (n=19) college women's ideal body size perceptions for their own and the other ethnic group along with reasons behind their selections. Respondents completed an ethnically-neutral figure rating scale and then participated in ethnically-homogenous focus groups. European Americans mostly preferred a curvy-thin or athletic ideal body while most African American students resisted notions of a singular ideal body. European Americans suggested that African Americans' larger ideal body sizes were based on greater body acceptance and the preferences of African American men. African Americans used extreme terms when discussing their perceptions of European Americans' thin idealization, celebrity role models, and weight management behaviors. African Americans' perceptions of European Americans' body dissatisfaction were also attributed to the frequent fat talk they engaged in. Implications for promoting the psychosocial well-being of ethnically-diverse emerging adult females attending college are discussed.

Body Size Perceptions and Eating Attitudes in Elderly Men

The majority of studies on eating attitudes, dieting and body size perceptions have focused on young adults and women. This study examined these attitudes in 334 black and white men, ages 55 to 98 years, who were members of the Charleston Heart Study cohort. Associations of the eating attitude variable with race, education and weight status were examined. Eighty-two percent of the overweight white men studied had dieted to lose weight, whereas only 49% of slimmer white men had dieted. In contrast, overweight black men did not diet more than slimmer black men. Overall black men dieted less than white men (37% reported dieting). Black men who were high school graduates were 1.3 times more likely to have dieted than were less educated black men. Overweight white men were over twice as likely as slimmer white men to feel guilty after overeating. This difference was not found in overweight versus slimmer black men. Education was not associated with measured body mass index (BMI) or perceived or ideal body size. However, there were some racial differences in these variables. White men preferred to be slightly thinner than black men (ideal BMI 25.6 vs. 26.1 kg/m2), and the difference between actual and desired BMI was 0.6 kg/m2 greater in white than in black men. These results indicate that effects of race and weight status on eating restraint and body size perceptions seen in younger subjects and in women are also present, at least to some degree, in elderly men.

Black and White Females' Perceptions of Ideal Body Size and Social Norms

Different cultural norms and standards for appropriate female body size might contribute to the disparity in obesity rates between black and white adult females (46.0% and 24.6% respectively). The purpose of this study was to measure adolescents' perceptions of ideal size and social norms regarding female body size as well as adolescents' perceptions of significant others' evaluation and expectations of the adolescents' body size. Subjects included 437 adolescent girls (247 white and 190 black) aged 13 to 19 (x = 14.9, SD = .979) from six randomly selected public schools. The subjects, heights and weights were measured. Responses to a body image questionnaire and a series of nine female body drawings (arranged ordinally, 1 to 9, from thinnest to heaviest) were analyzed using the General Linear Model and Logistic Regression. The female body size considered ideal by black females was significantly larger than the size selected as ideal by white females (x = 3.47 and x = 3.13 respectively, p < 0.001). Black females were two times more likely than white females to describe themselves as thinner than other girls their age (O.R. = 2.01, 95% C.I. 1.34, 3.01) and seven times as likely to say that they were not overweight (O.R. = 7.08, 95% C.I. 3.72, 13.45). White females wanted to be a smaller size than they currently were and felt encouraged by significant others to lose weight or reduce their size. Black females did not indicate as great a desire as whites to be smaller and they tended to feel that their size was considered satisfactory by significant others. Only subjects from the low SES group perceived that significant others wanted them to gain weight. The differences between black and white subjects' beliefs and perceptions about body size norms may explain, in part, why heavier body weights persist in some cultural groups.

Is ideal body image related to obesity and lifestyle behaviours in African American adolescents?

BACKGROUND

Childhood obesity epidemic has become a public health issue in the USA, especially among African American youths. Research on the association between ideal body image (IBI) and obesity and related lifestyle factors among African American children and adolescents is limited.

METHODS

Data collected from 402 low-income African American adolescents aged 10-14 years in four Chicago public schools were used. Questionnaires were used to assess IBI, weight perception, weight control practices, and self-efficacy towards food and physical activity. Body mass index was calculated using measured weight and height. Associations between IBI and weight perception, overweight/obesity and lifestyle behaviours were assessed using linear and logistic regression models.

RESULTS

The most frequently chosen ideal body size was the fourth of eight silhouettes (from thinnest to heaviest) for boys (55%) and girls (49%). Overweight and obese girls selected larger ideal body figures than the others (trend test: P < 0.001). Compared with those with middle ideal body figures, girls who selected smaller ones were twice as likely to have an unhealthy diet as indicated by less fruit and milk consumption; the odds ratios (ORs) and 95% confidence intervals (95% CIs) were 2.40 (1.15-5.02) for fruits intake (<once/week) and 2.13 (1.06-4.29) for milk consumption (<once/day), respectively. Boys with larger IBI were less likely to eat snack often [≥once/day; OR = 0.11 (0.02-0.50)]. Girls with larger IBI were less likely to spend more screen time [OR = 0.12 (0.02-0.70)] and reported better food choice intentions (P < 0.05). Overweight and obese boys and girls appeared to have better food choice intentions and food self-efficacy than their non-overweight peers (trend test: both P < 0.01).

CONCLUSIONS

Ideal body image is associated with weight status, food self-efficacy and lifestyle behaviours among low-income African American adolescents.

Measured body mass index, body weight perception, dissatisfaction and control practices in urban, low-income African American adolescents

BACKGROUND

Current understanding of the associations between actual body weight status, weight perception, body dissatisfaction, and weight control practices among low-income urban African American adolescents is limited. The knowledge can help direct future intervention efforts.

METHODS

Cross-sectional data including measured weight and height and self-reported weight status collected from 448 adolescents in four Chicago Public Schools were used.

RESULTS

The prevalence of overweight and obesity (BMI > or = 85th percentile) was 39.8%, but only 27.2% considered themselves as obese, although 43.4% reported trying to lose weight. Girls were more likely to express weight dissatisfaction than boys, especially those with BMI > or = 95th percentile (62.9% vs. 25.9%). BMI > or = 85th percentile girls were more likely to try to lose weight than boys (84.6% vs. 66.7%). Among all adolescents, 27.2% underestimated and 67.2% correctly judged their own weight status. Multinomial logistic models show that those with BMI > or = 85th percentile, self-perceived as obese, or expressed body dissatisfaction were more likely to try to lose weight; adjusted odds ratios and 95% confidence intervals were 4.52 (2.53-8.08), 18.04 (7.19-45.30), 4.12 (1.64-10.37), respectively. No significant differences were found in diet and physical activity between those trying to lose weight and those not trying, but boys who reported trying to lose weight still spent more television time (P < 0.05).

CONCLUSION

Gender differences in weight perception, body dissatisfaction, and weight control practices exist among African American adolescents. One-third did not appropriately classify their weight status. Weight perception and body dissatisfaction are correlates of weight control practices. Adolescents attempting to lose weight need be empowered to make adequate desirable behavioral changes.

Health Implications of Body Size Perception and Weight Tolerance in Older Adults

Obesity is a well-recognized risk factor for Type II diabetes and cardiovascular disease. In this study a high percentage of older adults were either overweight or obese. The aims were to assess older adults' tolerance for excess weight, and to compare self-perceptions of an acceptable weight with national guidelines. Participants were 76 males and females aged between 65 and 97 years. Results indicated that 60 per cent accurately identified their own body size. Further, participants were more tolerant of excess weight in males compared to females, regardless of age. It was concluded that this cohort remains vulnerable to weight-related illnesses.

Are There Ethnic Differences in Positive Body Image Among Female British Undergraduates?

Numerous studies have examined ethnic differences in body image, although the literature has tended to focus on a negative orientation toward one’s body. The present study examined whether there were differences in positive body image among 131 Caucasian, 122 South Asian, 67 African Caribbean, and 67 Hispanic female undergraduates in Britain. Participants completed several scales measuring body appreciation, societal influence on body image, and self-esteem. Results showed that, after controlling for age, Hispanic women had the highest body appreciation scores, followed by African Caribbean, Caucasian, and South Asian women, respectively. Results also showed that Hispanics had the lowest score on media influence and the highest self-esteem. Finally, regressional analyses showed that self-esteem was a strong predictor of body appreciation, over-and-above ethnic affiliation. These results are discussed in relation to the extant literature on ethnic differences in body image.

Health perceptions and demographic characteristics associated with underassessment of body weight

OBJECTIVES

To describe the relationship between BMI and perceived weight status and to determine how underassessment of weight status is associated with demographic characteristics, self-reported general health, and perceived health risk in relation to one's body weight.

METHODS AND PROCEDURES

In the 2004 Styles surveys, 3,888 US adult participants described their current weight status (underweight, about right, slightly overweight, very overweight), which we compared with self-reported BMI in order to determine concordance. We used multivariable logistic regression to evaluate associations between underassessment of body weight and characteristics of interest.

RESULTS

Among persons with a BMI>or=25, women were more likely than men to recognize their overweight status (slightly or very overweight; 93.0% of women vs. 73.5% of men) and the extent to which they were overweight: 70.4% of obese women vs. 49.5% of obese men described themselves as very overweight. Among the overweight and obese of both sexes, disagreement with regard to current weight as a health risk was associated with underassessment of weight. Additional factors associated with underassessment were education and race/ethnicity among overweight women; race/ethnicity among overweight men; household income and self-rated health among obese women; and self-rated health among obese men (P<0.05).

DISCUSSION

While most of the obese participants recognized that they were overweight, many of them, particularly among the men, did not realize the extent to which they were overweight. Public health messages may be more effective if they are specifically tailored to target audiences, besides emphasizing the health risks associated with excess body weight.

BMI percentiles and body image discrepancy in black and white adolescents

The purpose of this study was to investigate the relationship between body image discrepancy (BID) and weight status as measured by BMI percentiles (BMI%) among adolescents. A cross-sectional survey was conducted among 265 adolescents at an urban clinic (females: 116 blacks and 63 whites; males: 62 blacks and 24 whites). BID was the difference between ideal and current body images selected from a 13-figure rating scale, and BMI% were calculated from measured weight and height. Regression analyses were conducted separately for girls and boys. Over half of the female and one-third of male adolescents wanted a thinner body. BID was positively related to BMI% with a one-unit increase in BID associated with a 4.84-unit increase in BMI% among females and a 3.88-unit increase in BMI% in males. Both female and male adolescents reported BID beginning at a BMI% corresponding to a normal weight. At zero BID, white females had a BMI% of 62.6, statistically different from black females (BMI% 69.7). At zero BID, white males had a mean BMI% of 69 and black males at a BMI% of 75.8, not statistically different. While black and white differences exist in BID, black female adolescents like their white counterparts are reporting BID at a weight range that is within the "normal". Our study portends the increase in BID with the increasing prevalence of obesity and highlights the need for interventions to help adolescents develop a healthy and realistic body image and healthy ways to manage their weight.

Community and family perspectives on addressing overweight in urban, African-American youth

OBJECTIVE

To assess weight-related beliefs and concerns of overweight urban, African-American children, their parents, and community leaders before developing a family-based intervention to reduce childhood overweight and diabetes risk.

DESIGN

We conducted 13 focus groups with overweight children and their parents and eight semistructured interviews with community leaders.

PARTICIPANTS AND SETTING

Focus group participants (N = 67) from Chicago's South Side were recruited through flyers in community sites. Interview participants (N = 9) were recruited to sample perspectives from health, fitness, education, civics, and faith leaders.

RESULTS

Community leaders felt awareness was higher for acute health conditions than for obesity. Parents were concerned about their children's health, but felt stressed by competing priorities and constrained by lack of knowledge, parenting skills, time, and financial resources. Parents defined overweight in functional terms, whereas children relied upon physical appearances. Children perceived negative social consequences of overweight. Parents and children expressed interest in family-based interventions to improve nutrition and physical activity and offered suggestions for making programs interesting.

CONCLUSIONS

This study provides insights into the perspectives of urban, African-American overweight children, their parents, and community leaders regarding nutrition and physical activity. The specific beliefs of these respondents can become potential leverage points in interventions.

The Effects of Weight Management Programs on Self-Esteem in Pediatric Overweight Populations

OBJECTIVE

Review published findings on self-esteem and pediatric overweight, and changes in self-esteem subsequent to weight management programs.

METHODS

We used PsycInfo and MedLine searches to identify peer-reviewed journal articles examining self-esteem changes following participation in weight management programs.

RESULTS

Data regarding the relationship between self-esteem and obesity is mixed. Factors that place overweight children "at-risk" for low self-esteem include early adolescence, female gender, identification with majority cultural standards of body shape, exposure to teasing and peer victimization, a history of greater parental control over feeding, and internal attributions about weight status. Data from intervention studies suggest positive effects on self-esteem across settings. Components related to self-esteem improvements include weight change, parent involvement, and group intervention format.

CONCLUSIONS

Well-designed, longitudinal studies using multidimensional measures of self-esteem, and following CONSORT guidelines are needed to confirm and expand these findings. Emphasis should be placed on examining mediators and moderators of self-esteem change.

Preferences for Female Body Weight and Shape in Three European Countries

Abstract. Body mass index (BMI) and body shape as measured by the waist-to-hip ratio (WHR) are important components in judgments of women's bodily attractiveness. The relative importance of each of these cues was examined in three countries: Britain, Spain, and Portugal. Male participants from Britain, Spain, and Portugal, respectively, were asked to rate a set of images of real women with known BMI and WHR. The results showed that, regardless of the cultural setting, BMI was the primary determinant of women's physical attractiveness, with consistent preferences for relatively slender women. WHR emerged as a significant predictor of attractiveness judgments for the Spanish and Portuguese groups (with preferences for low WHRs, indicative of a curvaceous female body), but not the British group. These findings are discussed in terms of the different cultural values ascribed to participants in the three countries.

Psychological status and weight-related distress in overweight or at-risk-for-overweight children

OBJECTIVE

To associate psychological status, weight-related distress, and weight status during childhood in overweight or at-risk-for-overweight children.

RESEARCH METHODS AND PROCEDURES

We associated self-report of depression, trait anxiety, and weight-related distress (body size dissatisfaction and weight-related peer teasing after controlling for the effects of weight) in 164 children (black 35%; age 11.9 +/- 2.5 years; girls 51%) who were overweight or at-high-risk-for-overweight and were not seeking weight loss.

RESULTS

Overall, heavier children reported more psychological and weight-related distress. Black children reported more anxiety and body size dissatisfaction than white children, despite equivalent weights. However, psychological distress was not significantly associated with weight in white children. Girls reported more weight-related distress than boys. Depression was associated with weight-related teasing in all predictive models, except in the model using only black subjects. Trait anxiety was associated with report of peer teasing when using all subjects. Depression was also significantly associated with children's report of body size dissatisfaction in models using all subjects, only girls, or white subjects, but not in analyses using only boys or black subjects. For boys peer teasing was associated with body size dissatisfaction. In models including only black children, depression and trait anxiety were not significantly associated with either report of peer teasing or body size dissatisfaction.

DISCUSSION

Regardless of race or sex, increasing weight is associated with emotional and weight-related distress in children. However, associations of psychological status, weight, and weight-related distress differ for girls and boys, and for black and white children.

Psychological adjustment of obese youth presenting for weight management treatment

OBJECTIVE

To determine the prevalence of psychological maladjustment in clinic-based treatment-seeking obese children and adolescents (BMI > or = 95th percentile) and the degree to which maternal, demographic, and youth factors correlate to the youths' psychological adjustment.

RESEARCH METHODS AND PROCEDURES

Anthropometrics, demographics (race, sex, insurance status), measures of youth psychological adjustment (self- and mother-report; Behavior Assessment System for Children), and maternal self-report of psychological distress (Symptom Checklist 90-Revised) were collected from 121 obese children and adolescents (55% white, 45% black) and their mothers.

RESULTS

Approximately one-third of youths self-reported some psychological maladjustment, but two-thirds of youth were described by their mothers as experiencing some degree of psychological maladjustment. Adjustment difficulties were specific to social functioning, low self-esteem, and internalizing symptoms. Forty-one percent of mothers of child participants and 56% of mothers of adolescent participants reported clinically significant psychological distress. Youth self-report and mother-report of youths' psychological difficulties were often most strongly associated with mothers' level of psychological distress and/or family socioeconomic status rather than to youth characteristics (e.g., percent overweight, race).

DISCUSSION

Psychological maladjustment levels among obese youth and their mothers were higher in this clinic-based sample than in treatment research-based samples. Present correlate findings extended to obese adolescents and reaffirm a potent association between youth self-report of their own psychological adjustment and their mother's level of psychological distress. Demographic characteristics and youth weight status were not consistent correlates of youths' psychological functioning. Findings have implications for the translation of empirically supported pediatric obesity interventions to clinic-based treatment samples.

Discrepancies in body image perception among fourth-grade public school children from urban, suburban, and rural Maryland

OBJECTIVE

The objective of this study was to determine whether there is an association between body image perception and weight status as measured by the body mass index among a group of fourth graders in Maryland.

DESIGN

Cross-sectional data on height, weight, and body image were collected in the classroom. At risk for being overweight and being overweight designations were assigned to participants with body mass index (BMI) percentile values for age and sex of >/=85 to <95 and BMI >/=95, respectively. Students selected a figure (range 1 to 7) to represent their current and ideal images.

SUBJECTS

The subjects of this study were 524 fourth-grade public school students (54% girls; 61% white; mean age, 9.2 years) from three geographically distinct regions in Maryland (38.6% urban, 30.7% suburban, 30.7% rural). Statistical analyses chi(2) tests were used to compare weight status with sex, race, geographic location, and body image discrepancy categories. One-way analysis of variance was used to compare BMI and body image scores with sex and race/ethnicity to geographic location.

RESULTS

Thirteen percent of students were overweight, and 15% were at risk of overweight. There was no association between weight status and race, body image perception, or geographic location. African Americans chose larger figures than whites and other races to represent their current and ideal images and were most satisfied with their body size.

CONCLUSIONS

Perceptions of body image are formed early in life. Dietitians can provide guidance on appropriate weight and body size to children, parents, and school professionals. Dietitians can also use their influence to secure funding for nutrition education programs.

Body dissatisfaction among White and African American male and female college students

Body size perception has been shown to be highly influenced by cultural factors including race. This study assessed body size perceptions of a convenience sample of college students (N=630). Included in a paper-and-pencil survey were current height and weight (body mass index (BMI)=wt [kg]/ht(2) [m]), perceived BMI, desired MI and perceptions of BMIs desired by others. Also assessed were perceptions of underweight, acceptable weight and overweight/obesity. African American females were found to have a higher current BMI than Whites (P< or =.001), higher desired BMI (P< or =.001) and higher BMI perceived to be desired by others (P< or =.001). African American and White males did not differ on any of these measures. Most (83%) underweight (BMI<19) African American females perceived themselves as underweight while only about one-half of underweight (56%) White females perceived themselves as underweight. Almost half (43%) of White females and about a fourth (27%) of African American females of acceptable BMI range (BMI=19-25) desired to be in the underweight range. Of those who were overweight (BMI=25-30), 20% of the Whites and only 3.0% of the African Americans chose an underweight silhouette as being desired. While African Americans and White males tended to have similar perceptions that there remains sociocultural influences in African American females regarding acceptance of a large body size.

Body image, weight, and food choices of Latina women and their young children

OBJECTIVE

To investigate body image perceptions of women about themselves and their young children and their relationship to their food choices and those of their children.

DESIGN

Descriptive and correlational study.

PARTICIPANTS AND SETTING

187 low-income, Latina women and their children, ages 5 to 7 years and 52% female, in New York City.

VARIABLES MEASURED

Body image, food frequency, body mass index (BMI) of mothers and children, and food choice criteria of mothers for their children.

ANALYSIS

Descriptive statistics and correlations.

RESULTS

All of the women selected a relatively thin body image as the most desirable, attractive, fit, and healthy (about 2.5 on a scale of 1-7). Body size dissatisfaction or wish to be thinner was significantly associated with more healthful diets. Tertiles (thirds) of children at the 50th and 75th mean BMI-for-age percentiles were thought to be too thin to be attractive or healthy and the third of children with a mean above the 97th percentile only barely too large. Mothers with the highest body mass indices may make the least healthful choices for their children.

CONCLUSIONS AND IMPLICATIONS

These Latina women preferred a thin figure for themselves but a plumper figure for their children. Culturally competent nutrition education incorporating body image issues needs to assist mothers in understanding the health consequences of childhood obesity, recognizing when their children are overweight, and understanding the importance of healthful food choices for their children.

The role of acculturative stress and body dissatisfaction in predicting bulimic symptomatology across ethnic groups

OBJECTIVE

This study examines the interactive effects of acculturative stress and body dissatisfaction in prediction of bulimic symptoms, particularly in non-White females.

METHOD

We administered questionnaires to White, Black, and Hispanic females on acculturative stress, body dissatisfaction, and bulimic symptoms.

RESULTS

Our results show that among minority women who report low levels of acculturative stress, body dissatisfaction and bulimia were not correlated. However, among minority women who reported high levels of acculturative stress, body dissatisfaction and bulimia were highly and significantly correlated.

DISCUSSION

The combination of acculturative stress and body dissatisfaction may render minority women more vulnerable to bulimic symptoms; the absence of acculturative stress among minority women may buffer them against bulimic symptoms, even in the presence of body dissatisfaction.

Why don't low-income mothers worry about their preschoolers being overweight?

CONTEXT

Mothers are in an important position to prevent obesity in their children by shaping early diet and activity patterns. However, many mothers of overweight preschool children are not worried about their child's weight.

OBJECTIVE

To explore mothers' perceptions about how they determine when a child is overweight, why children become overweight, and what barriers exist to preventing or managing childhood obesity.

DESIGN

Three focus groups with 6 participants in each. Participant comments were transcribed and analyzed. Themes were coded independently by the 6 authors who then agreed on common themes.

SETTING

A clinic of the Special Supplemental Nutrition Program for Women, Infants, and Children in Cincinnati, Ohio.

PARTICIPANTS

Eighteen low-income mothers (13 black, 5 white) of preschool children (mean age of 44 months) who were at-risk for later obesity. All but 1 mother had a body mass index (BMI) >/=25 kg/m(2), and 12 mothers had a BMI >/=30 kg/m(2). All but 1 child had a BMI >/=85th percentile for age and sex, and 7 had a BMI >/=95th percentile. Results. Mothers did not define overweight or obese in their children according to how height and weight measurements were plotted on the standard growth charts used by health professionals. Instead, mothers were more likely to consider being teased about weight or developing limitations in physical activity as indicators of their child being overweight. Children were not believed to be overweight if they were active and had a healthy diet and/or a good appetite. Mothers described overweight children as thick or solid. Mothers believed that an inherited tendency to be overweight was likely to be expressed in the child regardless of environmental factors. In trying to shape their children's eating, mothers believed that their control over the child's diet was challenged by other family members. If a child was hungry, despite having just eaten, it was emotionally difficult for mothers to deny additional food.

CONCLUSIONS

Health professionals should not assume that defining overweight according to the growth charts has meaning for all mothers. Despite differing perceptions between mothers and health professionals about the definition of overweight, both groups agree that children should be physically active and have healthy diets. Health professionals may be more effective in preventing childhood obesity by focusing on these goals that they share with mothers, rather than on labeling children as overweight.

Children's body image concerns and eating disturbance: a review of the literature

In recent years a large number of studies have examined body image concerns, and early symptoms of eating disturbance among children. However, to date there has been no synthesis or evaluation of these studies. The purpose of the present article is to review and evaluate the research that has examined body image concerns, and eating attitudes and behaviors among children 6 to 11 years of age. The instruments used to assess body image concerns and eating disturbance in children closely resemble those used with adolescents and adults. Overall, the psychometric data for these instruments are very good and there is sufficient evidence indicating that they can be used reliably and validly. In addition, similar variables to those studied in adolescent and adult samples have been found to be associated with children's body image concerns and early eating disturbance. These include gender, age, body mass index, race, sociocultural pressures, and self-concept. Our understanding of the development of body image concerns and eating disturbance in children is limited, however, by the fact that most of the research in this field has been based on cross-sectional data, and the studies have focused almost exclusively on weight loss cognitions and behaviors.

The "good enough" body size as judged by people of varying age and weight

OBJECTIVE

To examine the concept of the "good enough" body size acceptability across a wide range of ages and weight status.

RESEARCH METHODS AND PROCEDURES

Subjects were 303 children, 427 adolescents, 261 young adults, and 326 middle-age adults who selected acceptable body sizes from an array of drawings representing their own age and gender. They also selected body sizes representing their own actual and ideal size.

RESULTS

A large majority (87%) of subjects considered their own body size socially acceptable. This finding applied to both genders in all age groups and to underweight, normal weight, and overweight subjects. Even among obese subjects, 48% considered their own body size socially acceptable. For the large percentage of subjects who reported a discrepancy between their actual and ideal body sizes, most considered their own body size acceptable. This finding also applied to both genders in all age groups and to underweight, normal weight, and overweight subjects.

DISCUSSION

Most male and female subjects across a wide range of ages and status considered their own body size to be within the range of socially acceptable body sizes even though, for many, it did not match their ideal. The implications of expanding body size research to include the conceptual framework of body size acceptability is discussed in terms of contributing to a paradigm of positive psychology.

Continuity and change in the evaluation of ideal and acceptable body sizes across a wide age span

OBJECTIVE

Continuity and change in the evaluation of ideal and acceptable body sizes across a wide subject age span were examined.

METHOD

Ratings of ideal and socially acceptable body sizes were elicited from 303 children, 427 adolescents, 261 young adults, and 326 middle-age adults. Line drawing arrays of babies, children, young adults, middle-age, and older adults were portrayed, ranging in size from very thin to very obese.

RESULTS

All subject groups selected, in all arrays, similar ideal body sizes, rated sizes in the midrange of fatness as socially acceptable, and were least accepting of very thin and obese body sizes. Tolerance for body size variations increased with subject age.

DISCUSSION

Continuity throughout a wide subject age span was observed in evaluations of body sizes. However, adults were more accepting of body size variations than younger subjects, especially children. Implications of endorsing midrange body sizes for the fashion industry are discussed.

Using 3 data sources and methods to shape a nutrition campaign

The first objective of this research was to define a target population of African-American women more clearly. The second was to provide specific information about the needs and preferences of that population in order to design an effective, culturally relevant, community-based communications campaign to promote more healthful lifestyles. Data collection and analysis included the following: interviews with 10 community nutritionists and the director of the State Office of Nutrition, 6 focus groups with a total of 47 members of the target population, and direct observation and documentation of key community resources. This approach, called "triangulation," permits more in-depth understanding of issues, provides different perspectives on the problem, and helps ensure accuracy of conclusions. Interviews with nutritionists identified young African-American women as the appropriate target population for the campaign. These interviews and the focus-group discussions confirmed the acceptability of higher weight and better body-esteem among African-American women than among white women. Both the nutritionists and the focus-group members identified the need and desire for information and skills related to food preparation and provided specific direction for program content. Community observation confirmed the need for food markets with merchandise of consistently high quality, especially in the fresh and frozen produce sections. Observation also helped identify community services and programs. The 3 sets of data, which augmented a comprehensive literature review, provided a firm foundation for the campaign's design and development. Dietitians and nutritionists working in community settings can use triangulation to gain a better understanding of their populations in order to develop more effective interventions.

Weight-related attitudes and behaviors in fourth grade American Indian children

OBJECTIVE

American Indian children have a high prevalence of obesity, yet little is known about weight-related attitudes and the prevalence of dieting in this population. This study assessed weight concerns, body size perceptions, weight reduction attempts, and weight loss methods in fourth grade American Indian children.

RESEARCH METHODS AND PROCEDURES

Participants (n = 304) attended one of eight schools in the Pathways Feasibility Study. Question and answer choices were read to children by trained staff, and children marked their own answers.

RESULTS

Thirty-eight percent of the children reported that they had tried to lose weight. The most common strategy for weight reduction was exercising more. Girls were more likely than boys to be dissatisfied with their body size (48% of girls vs. 34% of boys desired a slimmer body size; 22% of girls vs. 15% of boys desired a larger body size; p<0.001). Children who had tried to lose weight were more likely to indicate that the size they most desired and the most healthy size were smaller than their perceived size (p<0.001). Children who reported trying to lose weight were also more likely to want to be skinnier and to be unhappy about their weight than were children who did not report trying to lose weight (p<0.001 for both).

DISCUSSION

We conclude that weight loss attempts and weight-related concerns are prevalent in American Indian children at a young age.

Body images and obesity risk among black females: a review of the literature

The prevalence of obesity among Black women has reached epidemic proportions. Some researchers have suggested that the body images of Black females may contribute to their high risk for obesity by inhibiting motivation for weight control. While a number of empirical studies have examined the body images of Black females, findings are complex and at times, inconsistent. For example, some studies show that Black females consider overweight bodies more attractive, while other studies show that Black females prefer normal-weight bodies. Divergent findings may be due, in part, to the multidimensional nature of body image. Inconsistencies may also be due to differences between the Black females sampled. Methodological problems, including the use of measures that have been validated among Black females, the use of various weight-for-height standards, and the inconsistent analyses of or lack of physiological data, also may contribute to conflicting results. This review addresses the complexity of body image findings among a heterogeneous Black female population and the relationship between their body images and obesity risk. Implications for effective obesity treatment programs and suggestions for improvements in future body image studies are also discussed.

Black-white differences in body size perceptions and weight management practices among adolescent females

OBJECTIVE

This study compares body size perceptions and weight management practices of black and white adolescent females.

DESIGN

Subjects were selected through a statewide, three-stage sampling procedure designed to provide a sample statistically representative of high school students in South Carolina.

SUBJECTS

Participants included black (n = 1824) and white (n = 2256) females, 14-18 years of age, enrolled in South Carolina public high schools.

METHODS

Respondents were asked to assess their perceived body size as overweight, underweight, or about right. Self-reported weight management practices included dieting (reducing caloric intake), exercise, and other methods (including diet pills and vomiting). Chisquare analysis was used to assess the differences in body size perception and weight management behaviors. Polychotomous logistic regression was performed to examine association while controlling for socioeconomic status.

RESULTS

Forty-one percent of the white adolescents and 29% of the black adolescents perceive themselves as overweight (p < 0.005). In the week prior to the survey, 28% of the white adolescents and 13% of the black adolescents reported dieting 34% of the while versus 23% of the black adolescents reported exercising to lose weight; and 45% of the white and 16% of the black students reported both dieting and exercising. Polychotomous logistic regression analysis showed that white adolescent girls were almost twice as likely to perceive themselves as overweight as black adolescent girls. The white students had 6.04 [95% confidence interval (CI), 1.77, 20.67] times the odds of using pills and vomiting and 3.76 (95% CI, 2.99, 4.72) times the odds of engaging in dieting and exercising as methods of weight management compared to the black students.

CONCLUSIONS

These findings suggest that white adolescents are more likely to perceive themselves as overweight than black adolescents and are more likely to engage in unhealthy weight management practices than black adolescents.

Comparison of attitudes and behaviors related to nutrition, body size, dieting, and hunger in Russian, black-American, and white-American adolescents

Attitudes and behaviors related to nutrition are known to differ between white-American and black-American adolescents, however, little is known about teenagers from Russia. We hypothesized that, compared with white-American or black-American teenagers, Russian teenagers would prefer a larger body size, be less likely to diet, and be less concerned about being overweight. Self-administered questionnaires were completed by 196 students in Moscow, 326 white-American, and 239 black-American adolescents who attended school in North Carolina (mean age = 16). Ideal body mass index (BMI) was calculated from measured height and the response to the question, "What do you consider to be your ideal weight?" Mean ideal BMI was higher in black-American boys (25.1) and girls (21.4) than in white-American boys (22.1) and girls (19.2), and Russian boys (21.8) and girls (19.1). After controlling for BMI, black-American girls were less than half as likely to report dieting compared with white-American girls. There were no significant differences among white-American girls and Russian girls, and there were no ethnic differences between boys in the prevalence of dieting. White-American girls and black-American girls were much more likely to identify being overweight as an important nutritional concern than were Russian girls (odds ratios > 10), and there were no ethnic differences among boys. We conclude that preferences for body size, the prevalence of dieting, and concerns about being overweight were similar in Russian and white-American teens, with the exception of Russian teenaged girls who were less likely than American girls to identify being overweight as an important concern. Overall, weight-related attitudes and behaviors in Russian teenagers were more similar to those of white-American teenagers than those of black-American teenagers.

A longitudinal study of the dietary practices of black and white girls 9 and 10 years old at enrollment: the NHLBI Growth and Health Study

PURPOSE

To determine whether there are racial differences in the frequency with which black and white girls engaged in eating practices commonly targeted for modification in weight reduction programs.

METHODS

This is part of the NHLBI Growth and Health Study, a longitudinal study of preadolescent girls designed to examine the factors associated with development of obesity, and its later effects on cardiovascular risk factors. Black and white girls ages 9-10 years at entry (n = 2,379) were recruited at three clinical sites. Racial differences were examined in 11 "weight-related" eating practices such as eating with TV, eating while doing homework, and skipping meals. Multiple logistic regression analyses were then conducted for each of the dependent variables.

RESULTS

Black girls were more than twice as likely as white girls to frequently engage in the targeted weight-related eating practices. The odds of a study girl frequently engaging in most of these eating practices decreased with an increase in parents' income and education level. However, even when controlling for socioeconomic and demographic effects, black girls remained more likely to engage in these eating practices than white girls. For most of the behaviors, girls who frequently practiced a behavior had higher energy intakes compared to those who practiced it infrequently.

CONCLUSIONS

The finding that black girls at an early age more frequently engage in eating practices associated with weight gain may have significant implications for obesity development. For both young black and white girls, early education efforts may be necessary in helping develop good eating habits. Since it appears that black girls have a higher risk of developing adverse weight-related eating practices, culturally appropriate education materials may be required.

Nutritional status outcomes for children: ethnic, cultural, and environmental contexts

The objective of this literature review was to explore the relationship between nutritional status outcomes among ethnically diverse children and cultural and environmental contexts. Articles form the literature on anthropometric/body composition measure, diet, and physiologic outcomes among ethnically diverse children were identified through on-line literature searches and references from articles reviewed. These studies were critically reviewed and selected if they reported findings resulting from use of accepted methodologies. Explanations consistent with evaluation of results from the studies and reports were developed by synthesis of the findings. Children from underserved, ethnically diverse population groups were at increased risk for obesity, increased serum lipid levels, and dietary consumption patterns that do not meet the Dietary Guidelines for Americans. More than 80% of all US children consume more than the recommended amount of total fat and saturated fat. These factors, which were noted during childhood, may track into adolescence, placing these children at increased risk for the early onset of chronic diseases such as non-insulin-dependent diabetes mellitus, cardiovascular disease, hypertension, and some forms of cancer. Although federally funded food assistance programs are changing rapidly, currently they provide foods that, when eaten as recommended, exceed the Dietary Guidelines for these children. Future interventions to improve the health and nutritional status of our nation's children, especially those from underserved, ethnically diverse groups, should be culturally appropriate and implemented at the levels of individuals, families, and communities.

Self-esteem and change in body mass index over 3 years in a cohort of adolescents

Self-esteem has been hypothesized to be lower in obese adolescents relative to their normal weight peers and to be an important factor in preventing or reversing obesity. The present study examined the relationship between obesity and self-esteem cross-sectionally and prospectively over three years in a cohort of 1278 adolescents in grades 7 to 9 at baseline. Cross-sectional analyses revealed an inverse association between physical appearance self-esteem and body mass index in both males and females. In females, body mass index was inversely associated with global self-esteem, close friendship, and behavioral conduct self-esteem. In males, body mass index was inversely associated with athletic and romantic appeal self-esteem. Prospectively, in females, physical appearance and social acceptance self-esteem at baseline were inversely related to body mass index three years later. Baseline self-esteem was unrelated prospectively to change in body mass index in males. All associations were modest in magnitude. These results suggest that in a middle class white sample of adolescents, self-esteem specific to physical appearance is modestly associated with body mass index. Low self-esteem does not appear to predict the development of obesity over time.

Ethnic/racial and socioeconomic differences in dieting behaviors and body image perceptions in adolescents

This study examined differences in perceptions of body weight, dieting, unhealthy eating behaviors, and weight control methods among adolescent males and females of various racial/ethnic and socioeconomic (SES) subgroups. Data were derived from a comprehensive health survey administered to 36,320 students in grades 7 through 12 in Minnesota. Differences among ethnic/racial and SES groups were assessed using multivariate logistic regression controlling for grade and body mass index (BMI). Results showed that unhealthy weight control behaviors are not confined to upper SES white females. Compared to white females, Hispanic females reported greater use of diuretics; Asians reported more binge eating; and blacks reported higher rates of vomiting. Black and American Indian females were more likely to be satisfied with their body. Among males and females, higher SES was associated with greater weight satisfaction and lower rates of pathological weight control behaviors. Findings from this study suggest that future research should focus on the validity of self-reports of dieting and weight control behaviors in different ethnic subgroups.

Self-esteem and obesity in children and adolescents: a literature review

The relationship between self-esteem and obesity has not received a great deal of empirical evaluation using strong research methodologies. Thus, it is not clear whether self-esteem is consistently related to obesity, whether the relationship is global or specific to physical appearance, whether the relationship differs by demographic variables such as age, gender or race/ethnicity, or whether self-esteem moderates weight changes during weight loss treatment programs. This review examines these questions using empirical evidence from 35 studies on the relationship between self-esteem and obesity in children and adolescents. Thirteen of 25 cross sectional studies clearly showed lower self-esteem in obese adolescents and children. Five of the six cross-sectional studies that included a measure of body esteem found lower body esteem in obese compared to normal weight children and adolescents. Results from two prospective studies examining initial self-esteem and later obesity were inconsistent. Results from six of eight treatment studies showed that weight loss treatment programs appear to improve self-esteem. However, it is unclear whether increases in self-esteem are related to enhanced weight loss. Many studies were methodologically weak primarily due to small and select samples and lack of appropriate comparison groups. Implications for prevention and treatment of childhood obesity are discussed.

Body size preferences and desired weight of patients who have received obesity surgery and of comparison adults

Patients who had received obesity surgery (n = 144) and comparison adults (n = 72) selected the most attractive male and female size and the same-sex size they most wanted to look like from an array of 15 outline drawings. Subjects also reported their height, and current and desired weights (transformed into body mass index units [BMI]). There was a remarkable consensus on the sizes considered most attractive: Two male sizes were chosen by 78% of all subjects, and two female sizes by 83%. The hypothesis that adults who had obesity surgery would idealize thin sizes and, therefore, select thinner sizes and lower weights than comparison adults was not supported. Not only did patients and comparison adults select the same desired size, but women patients desired significantly larger BMIs than comparison women. There was a large range of desired BMIs associated with each desired size; the correlation between desired BMI and desired size was significant for women but not for men. It was speculated that subjects' desired size reflected cultural norms while subjects' desired BMI was a function of their current weight. Health professionals working in weight loss and/or physical fitness areas need to help clients understand weight-size relationships so that clients can have both realistic weight and realistic size goals.