Emic perspectives of body weight in overweight and obese white women with limited income

Obesity, Body Image Dissatisfaction, and Sexual Dysfunction: A Narrative Review

With approximately two-thirds of the United States adult population classified as overweight or obese, obesity remains a critical public health concern. Obesity not only contributes to several health complications including type 2 diabetes mellitus and cardiovascular disease, but the condition is also associated with sexual dysfunction in both women and men. Despite evidence linking obesity and its concomitant pathophysiology to sexual problems, the potential roles of psychosocial factors such as body image are understudied. This narrative review evaluates the research linkages between obesity and sexual dysfunction, with particular attention to the potential effects of body image dissatisfaction. A literature search of biomedical and psychological databases was used to identify research pertaining to obesity, sexual function, and/or body image constructs. The pathophysiological effects of obesity on sexual function are well-documented in mechanistic studies and animal trials, often with corroboration in human clinical samples. However, very few studies examine obesity, body image, and sexual function in tandem. Body image dissatisfaction appears to independently impinge upon the sexual response cycle and mental health outcomes, irrespective of body weight. While obesity is often associated with negative body image appraisal, it is unclear whether these constructs exert additive, synergistic, or antagonistic effects on sexual responsivity. Additionally, overweight/obese individuals who exhibit higher levels of body image satisfaction or self-confidence appear to be protected from the deleterious effects of obesity on sexual satisfaction, at least to some extent. Greater reliance upon conceptual/theoretical models from the body image literature may better clarify the relationships between these constructs.

Being Successful and Being Thin: The Effects of Thin-Ideal Social Media Images With High Socioeconomic Status on Women's Body Image and Eating Behaviour

Social media has outpaced traditional media to be the most popular sociocultural channel to transmit thin-ideal images, an established trigger for body image concerns and disordered eating in women. With an experimental design, the present research first demonstrated that exposure to thin images on social media threatened women's body image and increased their unhealthy food consumption (Study 1). However, given that thin images posted on social media are usually from wealthier people, the present research hypothesised that it may not be the body shape but the perceived socioeconomic status (SES) of images that indeed have negative effects on women. By manipulating the perceived SES of thin images and incorporating a baseline control group (Study 2), the present research provided causal evidence for the hypothesis by indicating that viewing thin images with parallel-perceived SES could significantly buffer undesirable thin-ideal effects on self-objectification and food intake. Therefore, future research needs to pay more attention to the role of SES in the thin media images literature.

Does concern motivate behavior change? Exploring the relationship between physical activity and body mass index among low-income housing residents

OBJECTIVE

To explore relationships between concerns and physical activity and body mass index (BMI) among a racially/ethnically diverse low-income population.

METHOD

A cross-sectional survey documented behavioral risks among racially/ethnically diverse low-income residents in the Boston area (2005-2009). Multivariable logistic regressions were conducted in 2012 for each concern, using SAS version 9.2.

RESULTS

Those very/moderately concerned about weight were more likely to have higher BMIs, be in the preparation/action stage, received behavioral counseling, participated in a weight management program, and be interested in participating in one in the future. Those very/moderately concerned about physical activity were more likely to have higher BMIs, received behavioral counseling, and participated in a physical activity program.

CONCLUSION

Individuals with elevated BMIs or low levels of physical activity are concerned. While level of concern is important, these findings suggest that it is not likely to be a sufficient catalyst to behavior change.

Are social relationships a healthy influence on obesogenic behaviors among racially/ethnically diverse and socio-economically disadvantaged residents?

OBJECTIVE

To examine associations between social support and ties (family, friend, and neighbors) individually and jointly with diet and physical activity among an ethnically-diverse, low-income population.

METHODS

The Health in Common study (2005-2009) was designed to examine risk factors among individuals residing in low-income housing in the Boston, MA area. Cross-sectional surveys (n = 828) were administered in residents' homes. Linear/logistic multivariable analyses were employed with clustering of individuals within housing sites controlled as a random effect.

RESULTS

In multivariable analyses, total social support was significantly associated with higher red meat consumption per day (p = 0.029). Having more friends was significantly associated with more daily fruit and vegetable intake (p = 0.007) and higher levels of daily vigorous physical activity (p = 0.011). Those who reported having a greater number of family ties also reported higher daily consumption of sugary drinks (p = 0.013) and fast food (p = 0.011). More neighbor social ties were associated with more fast food per day (p = 0.024).

CONCLUSIONS

Social relationships can have both positive and negative associations with health behaviors. Understanding these relationships could help to inform the design of interventions that promote healthy behavior change among vulnerable populations.

Time use and food pattern influences on obesity

The rise of obesity in the United States over the past 25 years has resulted in an increase in the number of research studies published related to the causes, consequences, and possible solutions to the problem. Most would agree that obesity is a multi-dimensional problem that requires a range of solutions related to individual diet and activity, food and built environment, and public policy. Examination of complex relationships between food choice, time use patterns, sociodemographic characteristics and obesity has been limited by data availability and disciplinary focus. Using the theory of the production of health capital, this paper links empirical data from the Consumer Expenditure, Current Population, and American Time Use Surveys to provide estimates of the impacts of food expenditure and time use patterns on obesity in single female headed households of 31-50 years of age.

Design and outcomes of a Mothers In Motion behavioral intervention pilot study

OBJECTIVE

This paper describes the design and findings of a pilot Mothers In Motion (P-MIM) program.

DESIGN

A randomized controlled trial that collected data via telephone interviews and finger stick at 3 time points: baseline and 2 and 8 months post-intervention.

SETTING

Three Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) sites in southern Michigan.

PARTICIPANTS

One hundred and twenty nine overweight and obese African-American and white mothers, 18-34 years old.

INTERVENTION

The 10-week, theory-based, culturally sensitive intervention messages were delivered via a series of 5 chapters on a DVD and complemented by 5 peer support group teleconferences.

MAIN OUTCOME MEASURES

Dietary fat, fruit, and vegetable intake; physical activity; stress; feelings; body weight; and blood glucose.

ANALYSIS

General linear mixed model was applied to assess treatment effects across 2 and 8 months post-intervention.

RESULTS

No significant effect sizes were found in primary and secondary outcome variables at 2 and 8 months post-intervention. However, changes in body weight and blood glucose showed apparent trends consistent with the study's hypotheses.

CONCLUSIONS AND IMPLICATIONS

The P-MIM showed promise for preventing weight gain in low-income overweight and obese women. However, a larger experimental trial is warranted to determine the effectiveness of this intervention.

Childhood nutrition: perceptions of caretakers in a low-income urban setting

The incidence of overweight and obese children, especially those from low-income and minority backgrounds, continues to rise. Multiple factors contribute to the rising rates. In order to gain an understanding of factors contributing to obesity in low-income families, a qualitative study was conducted with the purpose of gaining knowledge of low-income urban caretakers' understanding and attitudes regarding children's nutrition. A focused ethnography was used as a means of understanding behavior within the context of a person's cultural environment. The sample was 17 caretakers of children in the 1st-3rd grades. Four focus groups were conducted. Two themes emerged from caretakers' perceptions: knowing the right things children should eat and balancing healthy nutrition with unhealthy choices. Four categories emerged regarding influences on food choices: tradition, finances, time constraints, and role models. Lastly, five barriers and three facilitating factors emerged. Implications of the study findings for school nurses include the need, when implementing healthy eating programs for school children, to gain information from caretakers about their perceptions of childhood nutrition.

Motivators and barriers to healthful eating and physical activity among low-income overweight and obese mothers

Low-income women who are overweight and obese are at high risk for long-term retention of weight gain during pregnancy, in part because they may have poor diets and inadequate physical activity, both of which may be exacerbated by stressful situations. This study identified motivators and barriers to healthful eating and physical activity among low-income overweight and obese non-Hispanic black and non-Hispanic white mothers. Qualitative data were collected via eight focus group interviews. Eighty low-income overweight and obese non-Hispanic black (n=41) and non-Hispanic white (n=39) mothers, age 18 to 35 years, were recruited from the Special Supplemental Nutrition Program for Women, Infants, and Children sites in six counties in Michigan. Personal appearance, fit in clothes, inability to play with their children, and social support were motivating factors for healthful eating and physical activity. Stressful experiences triggered emotional eating and reduced participants' ability to practice these behaviors. Other factors-for example, wanting quick weight-loss results-made it difficult for these mothers to follow recommended healthful lifestyle practices. Nutrition educators can address these concerns by including information about ways to deal with stress and emotional eating and emphasizing the benefits of healthful eating and physical activity in their program plans.

Growing up poor: Long-term implications for eating patterns and body weight

This study aimed to understand how poverty-associated food deprivation in childhood contributes to the well-known relationship between low socioeconomic status (SES) in childhood and obesity in the adult years. Thirty low-income, rural women with at least one child were followed for over three years with annual semi-structured interviews collecting quantitative and qualitative data. For the quantitative portion, the measures of interest were body mass index (BMI), food insecurity, eating patterns, and SES. For the qualitative portion, text from the interviews was analyzed using the constant comparative method. Growing up in a poor household was associated with increased risk of overweight and obesity in adulthood. Experiences of poverty-associated food deprivation in childhood appeared to super-motivate some women to actively avoid food insecurity in adulthood. It also influenced the women's current food preferences. Tremendous excitement accompanied the availability of food after periods of deprivation in both the women and their children. Some women had used food to meet emotional needs in childhood and overeating had become a generalized response to negative emotional states in the adult years. Food deprivation in childhood and associated attitudes and behaviors towards food are one possible mechanism for explaining the association between childhood poverty and adult obesity.

Weight loss programs for urban-based, postpartum African-American women: perceived barriers and preferred components

OBJECTIVES

There are currently 1.85 million reproductive-aged women in the United States with diabetes or glucose intolerance. While it is known that postpartum weight retention can lead to obesity and diabetes, particularly among African-American women, little is known about African-American women's preferences for postpartum weight loss programs. Our objective was to explore urban-based African-American women's attitudes toward weight gain, perceived barriers to postpartum weight loss, and preferences for weight intervention strategies.

METHODS

Focus groups of pregnant African-American women (n = 22) were conducted by a race-concordant moderator. Open-ended questions were posed to stimulate discussions which were audio taped and transcribed verbatim. Transcriptions were independently reviewed by two investigators who extracted quotations and coded each statement to identify major themes.

RESULTS

The median age of participants was 26 years. Median pre-pregnancy or first trimester body-mass index was 31 kg/m(2). Fifty-seven percent of the women were multiparous and 68% were Medicaid recipients. We identified 16 themes with the majority of participant comments focused on: (1) effect of postpartum depression on motivation to lose weight; (2) strong desire to lose weight; (3) knowledge of adverse effects of obesity; (4) costs of weight loss programs; (5) negative impact of media coverage of successful celebrity postpartum weight loss; (6) limitations of childcare on ability to exercise; and (7) family-centered lifestyle behaviors that promote unhealthy eating.

CONCLUSIONS

Weight loss interventions for African-American women with postpartum obesity should address psychological effects of childbearing, affordability, and perceptions of body image. Interventions should incorporate family-centered approaches and weight loss maintenance strategies.