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

Silhouette showcards confirm altered obesity-associated body image perception in international cohort study of African-origin populations

OBJECTIVES

Given the increasing prevalence of obesity and need for effective interventions, there is a growing interest in understanding how an individual's body image can inform obesity prevention and management. This study's objective was to examine the use of silhouette showcards to measure body size perception compared with measured body mass index, and assess body size dissatisfaction, in three different African-origin populations spanning the epidemiological transition. An ancillary objective was to investigate associations between body size perception and dissatisfaction with diabetes and hypertension.

SETTING

Research visits were completed in local research clinics in respective countries.

PARTICIPANTS

Seven hundred and fifty-one African-origin participants from the USA and the Republic of Seychelles (both high-income countries), and Ghana (low/middle-income country).

PRIMARY AND SECONDARY OUTCOME MEASURES

Silhouette showcards were used to measure perceived body size and body size dissatisfaction. Objectively measured body size was measured using a scale and stadiometer. Diabetes was defined as fasting blood glucose ≥126 mg/dL and hypertension was defined as ≥130 mm Hg/80 mm Hg.

RESULTS

Most women and men from the USA and Seychelles had 'Perceived minus Actual weight status Discrepancy' scores less than 0, meaning they underestimated their actual body size. Similarly, most overweight or obese men and women also underestimated their body size, while normal weight men and women were accurately able to estimate their body size. Finally, participants with diabetes were able to accurately estimate their body size and similarly desired a smaller body size.

CONCLUSIONS

This study highlights that overweight and obese women and men from countries spanning the epidemiological transition were unable to accurately perceive their actual body size. Understanding people's perception of their body size is critical to implementing successful obesity prevention programmes across the epidemiological transition.

Body image and dietary habits in adolescents: a systematic review

CONTEXT

Adolescence is a critical developmental stage in which increasing concerns about body image (BI) coincide with the consolidation of dietary habits (DHs). Multiple studies have sought robust associations between BI and DHs to prevent unhealthy behaviors.

OBJECTIVE

The aim of this systematic review was to examine the available literature on the association between BI perception (BIP) and/or satisfaction (BIS) and DHs in adolescents.

DATA SOURCES

A search was carried out of 5 electronic databases (PubMed, SciELO, Cochrane, Embase, and PsycInfo) using a combination of keywords (and synonyms) related to adolescence, BI, and diet.

DATA EXTRACTION

Data screening, extraction, and quality assessment were performed independently by 2 investigators using the PRISMA and AXIS guidelines.

DATA ANALYSIS

Of 2496 articles screened, 30 articles, published in English or Spanish, that evaluated the relationship between BI and DHs in adolescents aged between 10 years and 18 years, were included. A relationship between accurate BI perception in adolescents and healthy DHs was reported in 5 articles (16.2%). A relationship between overestimation of body weight in adolescents and healthy DHs was reported in 4 articles (13.3%). A relationship between underestimation of body weight and unhealthy DHs was reported in 8 articles (26.7%). In addition, 4 articles (13.3%) reported a relationship between BIS and healthy DHs. The desire to gain weight was associated with unhealthy DHs in 3 (10%) of the articles, while the desire to lose weight was related to healthy DHs in 3 (10%) of the articles and to unhealthy DHs in 3 (10%) other articles. There were also gender differences in the relationship between BIP or BIS and DHs.

CONCLUSION

Adolescents who underestimate their body weight tend to report less healthy DHs than body weight overestimators. Adolescents unsatisfied with their BI and with a drive for thinness frequently engage in DHs linked to losing weight.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42020184625.

Prevalence of body weight dissatisfaction among adolescents: a systematic review

Objective:

To identify the prevalence of weight dissatisfaction among adolescents aged 10-19 years and stratify the analysis by sex.

Data source:

A literature review of cross-sectional studies among healthy adolescents was performed. The U.S. National Library of Medicine/National Institutes of Health (PubMed), Ovid^® (Wolters Kluwer), The Cumulative Index to Nursing and Allied Health Literature (CINAHL), and American Psychological Association (PsycINFO^®) databases were searched between May 2019 and January 2020.

Data synthesis:

Initially, 3,700 records were identified, and 10 papers were obtained through other sources. After the removal of duplicates, 1,732 records were screened based on the titles and abstracts, and 126 were preselected for full-text analysis. After the application of the eligibility criteria, 34 papers were included in the present review. The studies were published between 1997 and 2020. The sample size ranged from <150 to >103,000 adolescents. The prevalence of weight dissatisfaction ranged from 18.0 to 56.6% in both sexes (10.8-82.5% among boys and 19.2-83.8% among girls).

Conclusions:

Based on the findings of the present systematic review, the prevalence of weight dissatisfaction is high among adolescents, especially girls. Such information can contribute to the planning of health and education programs addressing the issue of weight in adolescents.

An exploratory study on excess weight gain: Experiences of Postmenopausal Women in Ghana

INTRODUCTION

Excess weight gain is a problem with a significant impact on health and quality of life as well as the consequent economic burden on human populations. While society advocates preference for excess weight gain, limited evidence exists concerning postmenopausal women's experiences in Ghana.

AIM

The current study explored the experiences regarding excess weight (overweight and obesity) gain among Ghanaian postmenopausal women in Bono East (Techiman) region.

METHODS

This is a qualitative exploratory descriptive study where anthropometric measurements [body mass index (BMI), waist-to-height ratio (WHtR) and waist-to-hip ratio (WHR)] were determined and participants who were identified with excess weight (obesity and overweight) were recruited to participate in a focus group discussion (FGD). Four focus group discussions were held and 24 postmenopausal women (>45 years) in Techiman took part. Discussions were audio-recorded and transcribed for thematic analysis.

RESULTS

From the qualitative analysis of the FGD, three major themes emerged from the study namely, (i) perception of body weight, (ii) measures to reduce body weight, and (iii) support to adhere to the weight management program. Sub-themes revealed that weight gained was viewed as the presence of diseases and admired by society as a culturally accepted body image. Diet-related changes, a combination of diet modification and physical activity, and weight management supplements emerged as measures to reduce excess weight. Support to adhere to the weight program included health education, access, affordable exercise facilities, and social support.

CONCLUSIONS

Sociocultural norms influence the image perception and acceptance of weight gain among postmenopausal women in Ghana, but there is an acknowledgment of the perceived negative health implications of such excess weight. Measures for weight reduction and support to adhere to the weight reduction programme require attention in Ghana.

Utility of silhouette showcards to assess adiposity in three countries across the epidemiological transition

The Pulvers' silhouette showcards provide a non-invasive and easy-to-use way of assessing an individual's body size perception using nine silhouette shapes. However, their utility across different populations has not been examined. This study aimed to assess: 1) the relationship between silhouette perception and measured anthropometrics, i.e., body mass index (BMI), waist circumference (WC), waist-height-ratio (WHtR), and 2) the ability to predict with silhouette showcards anthropometric adiposity measures, i.e., overweight and obesity (BMI ≥ 25 kg/m2), obesity alone (BMI ≥ 30 kg/m2), elevated WC (men ≥ 94 cm; women ≥ 80 cm), and WHtR (> 0.5) across the epidemiological transition. 751 African-origin participants, aged 20-68 years old, from the United States (US), Seychelles, and Ghana, completed anthropometrics and selected silhouettes corresponding to their perceived body size. Silhouette performance to anthropometrics was examined using a least-squares linear regression model. A receiver operator curve (ROC) was used to investigate the showcards ability to predict anthropometric adiposity measures. The relationship between silhouette ranking and BMI were similar between sexes of the same country but differed between countries: 3.65 [95% CI: 3.34-3.97] BMI units/silhouette unit in the US, 3.23 [2.93-3.74] in Seychelles, and 1.99 [1.72-2.26] in Ghana. Different silhouette cutoffs predicted obesity differently in the three countries. For example, a silhouette ≥ five had a sensitivity/specificity of 77.3%/90.6% to predict BMI ≥ 25 kg/m2 in the US, but 77.8%/85.9% in Seychelles and 84.9%/71.4% in Ghana. Ultimately, silhouettes predicted BMI, WC, and WHtR similarly within each country and sex but not across countries. Our data suggest that Pulvers' silhouette showcards may be a helpful tool to predict anthropometric and adiposity measures in different populations when direct measurement cannot be performed. However, no universal silhouette cutoff can be used for detecting overweight or obesity status, and population-specific differences may stress the need to calibrate silhouette showcards when using them as a survey tool in different countries.

Body size preferences for women and adolescent girls living in Africa: a mixed-methods systematic review

OBJECTIVE

To synthesise evidence on body size preferences for females living in Africa and the factors influencing these.

DESIGN

Mixed-methods systematic review including searches on Medline, CINHAL, ASSIA, Web of Science and PsycINFO (PROSPERO CRD42015020509). A sequential-explanatory approach was used to integrate quantitative and qualitative findings.

SETTING

Urban and rural Africa.

PARTICIPANTS

Studies of both sexes providing data on body size preferences for adolescent girls and women aged ≥10 years.

RESULTS

Seventy-three articles from twenty-one countries were included: fifty quantitative, fifteen qualitative and eight mixed methods. Most studies reported a preference for normal or overweight body sizes. Some studies of adolescent girls/young women indicated a preference for underweight. Factors influencing preferences for large(r) body sizes included: socio-demographic (e.g. education, rural residency), health-related (e.g. current BMI, pubertal status), psycho-social (e.g. avoiding HIV stigma) and socio-cultural factors (e.g. spouse's preference, social standing, cultural norms). Factors influencing preferences for slim(mer) body sizes included: socio-demographic (e.g. higher socioeconomic status, urban residency, younger age), health-related (e.g. health knowledge, being nulliparous), psycho-social (e.g. appearance, body size perception as overweight/obese) and socio-cultural factors (e.g. peer pressure, media).

CONCLUSIONS

Preference for overweight (not obese) body sizes among some African females means that interventions need to account for the array of factors that maintain these preferences. The widespread preference for normal weight is positive in public health terms, but the valorisation of underweight in adolescent girls/young women may lead to an increase in body dissatisfaction. Emphasis needs to be placed on education to prevent all forms of malnutrition.

The Accuracy of Self-Perception of Obesity in a Rural Australian Population: A Cross-Sectional Study

Introduction:

Obesity is a major public health concern. Accurate perception of body weight may be critical to the successful adoption of weight loss behavior. The aim of this study was to determine the accuracy of self-perception of BMI class.

Methods:

Patients admitted to the acute medical service in one regional hospital completed a questionnaire and classified their weight as: “underweight,” “normal,” “overweight,” or “obese.” Reponses were compared to clinically measured BMIs, based on the WHO Classification. Patients were also questioned about health-related behavior. Data were analyzed via Pearson’s Chi-squared test.

Results:

Almost 70% of the participating patient population (n = 90) incorrectly perceived their weight category, with 62% underestimating their weight. Only 34% of patients who were overweight and 14% of patients with obesity correctly identified their weight status. Two-thirds of patients who were overweight and one-fifth of patients with obesity considered themselves to be “normal” or “underweight.” Patients with obesity were 6.5-fold more likely to misperceive their weight status. Amongst patients with overweight/obesity, those who misperceived their weight were significantly less likely to have plans to lose weight. Almost 60% had not made any recent health behavior changes. This is one of the first regional Australian studies demonstrating that hospitalized patients significantly misperceive their weight.

Conclusion:

Patients with overweight/obesity had significantly higher rates of weight misperception and the majority had no intention to lose weight or to undertake any health behavior modification. Given the association between weight perception and weight reduction behavior, it introduces barriers to addressing weight loss and reducing the increasing prevalence of obesity in rural Australia. It highlights that doctors have an important role in addressing weight misperception.

Body Positivity, but not for everyone: The role of model size in exposure effects on women's mood, body satisfaction, and food choice

Body Positivity (or 'BoPo') social media content may be beneficial for women's mood and body image, but concerns have been raised that it may reduce motivation for healthy behaviours. This study examines differences in women's mood, body satisfaction, and hypothetical food choices after viewing BoPo posts (featuring average or larger women) or a neutral travel control. Women (N = 167, 81.8 % aged 18-29) were randomly assigned in an online experiment to one of three conditions (BoPo-average, BoPo-larger, or Travel/Control) and viewed three Instagram posts for two minutes, before reporting their mood and body satisfaction, and selecting a meal from a hypothetical menu. Women who viewed the BoPo posts featuring average-size women reported more positive mood than the control group; women who viewed posts featuring larger women did not. There were no effects of condition on negative mood or body satisfaction. Women did not make less healthy food choices than the control in either BoPo condition; women who viewed the BoPo images of larger women showed a stronger association between hunger and calories selected. These findings suggest that concerns over BoPo promoting unhealthy behaviours may be misplaced, but further research is needed regarding women's responses to different body sizes.

Race/ethnicity moderates associations between depressive symptoms and diet composition among U.S. adults

OBJECTIVE

Although depression is associated with poorer overall diet quality, few studies have examined its association with levels of particular macronutrients, and none have examined moderation by race/ethnicity. The present study examined (a) associations between depressive symptom severity and nine indices of diet composition and (b) whether race/ethnicity moderates these associations.

METHOD

Participants were 28,940 adults (mean age = 49 years, 52% female, 52% nonwhite) from NHANES 2005-2018. Depressive symptom severity was measured using the Patient Health Questionnaire-9 (PHQ-9). Nine diet composition indices were derived from the average of two 24-hr dietary recalls (e.g., total energy, total fat, saturated fat, total carbohydrate, sugar, fiber, and protein).

RESULTS

Separate linear regression analyses revealed that PHQ-9 total was positively associated with saturated fat and sugar and negatively associated with protein and fiber. Moderation by race/ethnicity was observed (interaction ps < .05). Among non-Hispanic Whites, PHQ-9 total was positively associated with sugar and negatively associated with protein and fiber. Among non-Hispanic Blacks, PHQ-9 total was positively associated with total energy, total fat, saturated fat, monounsaturated fat, polyunsaturated fat, total carbohydrate, and sugar. Among Mexican Americans, PHQ-9 was positively associated with saturated fat. Among other Hispanics, PHQ-9 total was negatively associated with fiber, protein, and total, monounsaturated, and polyunsaturated fat.

CONCLUSIONS

Findings from this large, nationally representative sample demonstrate that associations between depressive symptom severity and diet composition vary by race/ethnicity. Critically, an unhealthy diet composition pattern may be one mechanism explaining the excess risk of obesity and cardiometabolic diseases in individuals with depression, especially in non-Hispanic Blacks. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Trends in obesity by socioeconomic status among non-pregnant women aged 15-49 y: a cross-sectional, multi-dimensional equity analysis of demographic and health surveys in 11 sub-Saharan Africa countries, 1994-2015

BACKGROUND

Global obesity estimates show a steadily increasing pattern across socioeconomic and geographical divides, especially among women. Our analysis tracked and described obesity trends across multiple equity dimensions among women of reproductive age (15-49 y) in 11 sub-Saharan African (SSA) countries during 1994-2015.

METHODS

This study consisted of a cross-sectional series analysis using nationally representative demographic and health surveys (DHS) data. The countries included were Cameroon, Comoros, Congo, Cote d'Ivoire, Ghana, Kenya, Lesotho, Nigeria, Senegal, Zambia and Zimbabwe. The data reported are from a reanalysis conducted using the WHO Health Equity Assessment Toolkit that assesses inter- and intra-country health inequalities across socioeconomic and geographical dimensions. We generated equiplots to display intra- and inter-country equity gaps.

RESULTS

There was an increasing trend in obesity among women of reproductive age across all 11 SSA countries. Obesity increased unequally across wealth categories, place of residence and educational measures of inequality. The wealthiest, most educated and urban dwellers in most countries had a higher prevalence of obesity. However, in Comoros, obesity did not increase consistently with increasing wealth or education compared with other countries. The most educated and wealthiest women in Comoros had lower obesity rates compared with their less wealthy and less well-educated counterparts.

CONCLUSION

A window of opportunity is presented to governments to act structurally and at policy level to reduce obesity generally and prevent a greater burden on disadvantaged subpopulation groups in sub-Saharan Africa.

Observed magnitude and trends in socioeconomic and geographic area inequalities in obesity prevalence among non-pregnant women in Chad: evidence from three waves of Chad demographic and health surveys

BACKGROUND

While the prevalence of obesity is increasing worldwide, the growing rates of overweight and obesity in developing countries are disquieting. Obesity is widely recognized as a risk factor for non-communicable diseases (NCDs), including diabetes, cancer and cardiovascular diseases. Available evidence on whether obesity has been more prevalent among higher or lower socioeconomic groups, across regions and urban-rural women's are inconsistent. This study examined magnitude of and trends in socioeconomic, urban-rural and sub-national region inequalities in obesity prevalence among non-pregnant women in Chad.

METHOD

Using cross-sectional data from Chad Demographic and Health Surveys (DHSs) conducted in 1996, 2004 and 2014; we used the World Health Organization (WHO) Health Equity Assessment Toolkit (HEAT) to analyze socio-economic, urban-rural and regional inequalities in obesity prevalence among non-pregnant women aged 15-49 years. Inequalities were assessed using four equity stratifiers namely wealth index, educational level, place of residence and subnational region. We presented inequalities using simple and complex as well as relative and absolute summary measures such as Difference (D), Population Attributable Risk (PAR), Population Attributable Fraction (PAF) and Ratio (R).

RESULTS

Though constant pattern overtime, both wealth-driven and place of residence inequality were observed in all three surveys by Difference measure and in the first and last surveys by Ratio measure. Similarly, including the recent survey (D = -2.80, 95% CI:-4.15, - 1.45, R = 0.37, 95% CI: 0.23, 0.50) absolute (in 1996 & 2014 survey) and relative (in all three surveys) educational status inequality with constant pattern were observed. Substantial absolute (PAR = -2.2, 95% CI: - 3.21, - 1.34) and relative (PAF = - 91.9, 95% CI: - 129.58, - 54.29) regional inequality was observed with increasing and constant pattern by simple (D) and complex (PAR, PAF) measures.

CONCLUSION

The study showed socioeconomic and area-based obesity inequalities that disfavored women in higher socioeconomic status and residing in urban areas. Prevention of obesity prevalence should be government and stakeholders' priority through organizing the evidence, health promotion and prevention interventions for at risk population and general population.

Time trends in socio-economic, urban-rural and regional disparities in prevalence of obesity among non-pregnant women in Lesotho: evidence from Lesotho demographic and health surveys (2004-2014)

BACKGROUND

The growing rates of obesity in developing countries are alarming. There is a paucity of evidence about disparities of obesity in Lesotho. This study examined socioeconomic and area-based inequalities in obesity among non-pregnant women in Lesotho.

METHODS

Data were extracted from the 2004, 2009 and 2014 Lesotho Demographic and Health Surveys (LDHS) and analyzed through the recently updated Health Equity Assessment Toolkit (HEAT) of the World Health Organization. Obesity prevalence was disaggregated by four equity stratifiers, namely education, wealth, residence and sub-national region. For each equity stratifier, simple and complex as well as relative and absolute summary measures were calculated. A 95% confidence interval was used to measure statistical significance of findings.

RESULTS

We noticed substantial wealth-driven (D = -21.10, 95% CI; - 25.94, - 16.26), subnational region (PAR = -11.82, 95%CI; - 16.09, - 7.55) and urban-rural (- 9.82, 95% CI; - 13.65, - 5.99) inequalities in obesity prevalence without the inequalities improved over time in all the studied years. However, we did not identify educational inequality in obesity.

CONCLUSIONS

Wealth-driven and geographical inequalities was identified in Lesotho in all the studied time periods while education related inequalities did not appear during the same time period. All population groups in the country need to be reached with interventions to reduce the burden of obesity in the country.

Relationship between body image, anxiety, food-specific inhibitory control, and emotional eating in young women with abdominal obesity: a comparative cross-sectional study

BACKGROUND

Abdominal fat deposition is a key component of obesity, which is associated with an increased risk for a number of mental disorders. The current study aims to explore the relationship between body image, anxiety, food-specific inhibitory control, and emotional eating in young women with abdominal obesity.

METHOD

A total of 224 participants were recruited: 168 were non-abdominal obesity and 56 were abdominal obesity. Participants completed the following questionnaires and behavioral tests: the Body Mass Index (BMI) -based Silhouette-Matching Test (SMT), the State-Trait Anxiety Inventory (STAI), Food Stop Signal Task (SST), the Emotional Eating Scale (EES).

RESULTS

Abdominal obesity women had significantly higher levels of trait anxiety, cognitive difference, expectational difference in body image but lower self-reported emotional eating level compared to the control group. Anxiety mediated the relationship between cognitive difference of body image and depression eating in young females with abdominal obesity. In addition, only among abdominal obesity individuals, expectational difference of body image were significantly and positively correlated with food-specific inhibitory control and trait/state anxiety.

CONCLUSION

The findings suggest it is of critical importance to promote a healthy body image recognition and expectation and improve mood regulation for young females with abdominal obesity high in trait anxiety.

Perceptions of non-Western immigrant women on having breast cancer and their experiences with treatment-related changes in body weight and lifestyle: A qualitative study

BACKGROUND

The number of non-Western immigrants with breast cancer in the Netherlands has increased over the past decades and is expected to triple by 2030. Due to insufficient representation in clinical studies, it is unclear what the specific experiences and needs of these women are. Understanding how culture and religion affect these women's experience of breast cancer and how they deal with chemotherapy and treatment-related changes in body weight and lifestyle is crucial for health care professionals to be able to provide effective support.

METHODS

A qualitative study was conducted using semi-structured interviews with 28 immigrant women with a history of breast cancer treated with chemotherapy.

RESULTS

Women often associated breast cancer with taboo, death or bad luck. Religion offered these women guidance, strength and meaning to the disease, but also limited the women to openly talk about their disease. Women perceived lifestyle factors to have little influence on the development and treatment of cancer. After treatment, however, their thinking changed and these lifestyle factors became of paramount importance to them. They realised that they missed out on information about managing their own diet, exercise and body weight and were eager to share their experiences with other women in their culture with newly diagnosed breast cancer.

CONCLUSION

Women became aware during and after breast cancer treatment that it was difficult for them to actively deal with their illness under the influence of their culture and religion. Based on their own experiences and acquired knowledge, they would like to give advice to newly diagnosed women on how to deal with breast cancer within their own culture and religion. Their recommendations could be used by mosques, churches, support groups and health care professionals, to ensure interventions during breast cancer treatment meet their religious and cultural needs and thus improve their quality of life.

The Development of a BMI-Guided Shape Morphing Technique and the Effects of an Individualized Figure Rating Scale on Self-Perception of Body Size

The creation of personalized avatars that may be morphed to simulate realistic changes in body size is useful when studying self-perception of body size. One drawback is that these methods are resource intensive compared to rating scales that rely upon generalized drawings. Little is known about how body perception ratings compare across different methods, particularly across differing levels of personalized detail in visualizations. This knowledge is essential to inform future decisions about the appropriate tradeoff between personalized realism and resource availability. The current study aimed to determine the impact of varying degrees of personalized realism on self-perception of body size. We explored this topic in young adult women, using a generalized line drawing scale, as well as several types of personalized avatars, including 3D textured images presented in immersive virtual reality (VR). Body perception ratings using generalized line drawings were often higher than responses using individualized visualization methods. While the personalized details seemed to help with identification, there were few differences among the three conditions containing different amounts of individualized realism (e.g., photo-realistic texture). These results suggest that using scales based on personalized texture and limb dimensions are beneficial, although presentation in immersive VR may not be essential.

Weight underestimation and body size dissatisfaction among black African adults with obesity: Implications for health promotion

BACKGROUND

Body image perception has an impact on modifiable cardiovascular disease (CVD) risk, lifestyle and psychological health in many populations.

AIM

To assess weight discordance (underestimating own weight) and body size dissatisfaction (perceiving body size as either 'too small' or 'too large') among overweight and obese South Africans, the associated factors and the implications for health promotion.

SETTING

A rural community and an urban township in two provinces of South Africa.

METHODS

An ancillary study within a prospective cohort involving 920 adults aged 35-78 years. Information on body image perception, anthropometry, risk factors and weight change were obtained on year 4 follow-up. Obesity was described as having a body mass index (BMI) 25 kg/m2. Descriptive and multivariate analyses were undertaken.

RESULTS

Most obese and overweight adults, respectively, underestimated their own weight (85% vs. 79%) and considered their body sizes as either 'too large' (59%) or 'too small' (57%). Those who perceived CVD threat, compared with those who did not, were 3.0 times more likely to be dissatisfied with their body sizes (p 0.0001) and 1.6 times more likely to underestimate their own weight (p 0.001). Those who indicated their willingness to lose weight were seven times more likely to be dissatisfied with their body sizes and unlikely to have discordant weight status (p = 0.0002).

CONCLUSION

Body size dissatisfaction and weight underestimation were influenced by perceived threat of CVD and the willingness to lose weight. Obesity prevention should leverage on perceived CVD threat messaging and self-motivation for attaining a healthy weight.

A Digital Behavioral Weight Gain Prevention Intervention in Primary Care Practice: Cost and Cost-Effectiveness Analysis

Background

Obesity is one of the largest drivers of health care spending but nearly half of the population with obesity demonstrate suboptimal readiness for weight loss treatment. Black women are disproportionately likely to have both obesity and limited weight loss readiness. However, they have been shown to be receptive to strategies that prevent weight gain.

Objective

The aim of this study was to evaluate the costs and cost-effectiveness of a digital weight gain prevention intervention (Shape) for black women. Shape consisted of adaptive telephone-based coaching by health system personnel, a tailored skills training curriculum, and patient self-monitoring delivered via a fully automated interactive voice response system.

Methods

A cost and cost-effectiveness analysis based on a randomized clinical trial of the Shape intervention was conducted from the payer perspective. Costs included those of delivering the program to 91 intervention participants in the trial and were summarized by program elements: self-monitoring, skills training, coaching, and administration. Effectiveness was measured in quality-adjusted life years (QALYs). The primary outcome was the incremental cost per QALY of Shape relative to usual care.

Results

Shape cost an average of US $758 per participant. The base-case model in which quality of life benefits decay linearly to zero 5 years post intervention cessation, generated an incremental cost-effectiveness ratio (ICER) of US $55,264 per QALY. Probabilistic sensitivity analyses suggest an ICER below US $50,000 per QALY and US $100,000 per QALY in 39% and 98% of simulations, respectively. Results are highly sensitive to durability of benefits, rising to US $165,730 if benefits end 6 months post intervention.

Conclusions

Results suggest that the Shape intervention is cost-effective based on established benchmarks, indicating that it can be a part of a successful strategy to address the nation’s growing obesity epidemic in low-income at-risk communities.

Perception of Body Weight Status Is Associated With the Health and Food Intake Behaviors of Adolescents in the United States

The purpose of this study was to determine the associations among body weight status perception, health status, diet quality, and consumption of fruits and vegetables within the adolescent population in the United States. A cross-sectional study was conducted with 1737 adolescents (12-17 years) participating in the Family Life, Activity, Sun, Health, and Eating study, an internet-based survey study sponsored by the National Cancer Institute. Adolescents reported their perception of their weight status, diet quality, health status, and the frequency with which they consumed common fruits and vegetables in a week. Results showed that 62% of the adolescents reported perceiving their weight as "just right," and 10.9%, 22.4%, and 4.7% perceived their weight to be "underweight," "a little overweight," and "very overweight," respectively. Those who perceived their weight status as "just right" also reported their health to be "very good" or "excellent" and that their diet was good. Similarly, adolescents who perceived their weight to be just right consumed significantly more fruits and vegetables than those who perceived their weight as "underweight" or "overweight." Results of this study have important implications for future research on weight and health status, diet quality, and healthy eating behaviors among adolescents.

Relationship Between Body Mass Index and Body Image Disturbances Among South African Mothers and Their Daughters Living in Soweto, Johannesburg

In South African families, a phenomenon of mothers' acceptance of stoutness coexists with their daughters' appreciation for thinness. A sample of N = 615 mother-and-daughter pairs was recruited to conjointly identify the relationships toward body image and body mass index between both groups by assessing body weight satisfaction, body esteem, and eating disorders risk. We observed higher prevalence of obesity in mothers and higher eating disorders risk in daughters, while mother-daughter relationships were identified for body mass index and psychometric dimensions. The high prevalence of obesity in mothers and their tolerance for stoutness could expose their daughters to eating disorders and obesity.

Biocultural determinants of overweight and obesity in the context of nutrition transition in Senegal: a holistic anthropological approach

Senegal is experiencing a rising obesity epidemic, due to the nutrition transition occurring in most African countries, and driven by sedentary behaviour and high-calorie dietary intake. In addition, the anthropological local drivers of the social valorization of processed high-calorie food and large body sizes could expose the population to obesity risk. This study aimed to determine the impact of these biocultural factors on the nutritional status of Senegalese adults. A mixed methods approach was used, including qualitative and quantitative studies. Between 2011 and 2013, fourteen focus group discussions (n=84) and a cross-sectional quantitative survey (n=313 women;n=284 men) of adults in three different socio-ecological areas of Senegal (rural:n=204; suburban:n=206; urban:n=187) were conducted. Dietary intake (Dietary Diversity Scores), physical activity (International Physical Activity Questionnaire), body weight norms (Body Size Scale), weight and health statuses (anthropometric measures and blood pressure) were measured. Middle-aged and older Senegalese women were found to value overweight/obesity more than younger Senegalese in all regions. In addition, young urban/suburban adults had a tendency for daily snacking whilst urban/suburban adults tended to be less physically active and had higher anthropometric means. A binary logistic regression model showed that being female, older, living in urban/suburban areas and valuing larger body size were independently associated with being overweight/obese, but not high-calorie diet. Univariate analyses showed that lower physical activity and higher socioeconomic status were associated with being overweight/obese. Finally, overweight/obesity, which is low in men, is associated with hypertension in the total sample. The nutrition transition is currently underway in Senegal’s urban/suburban areas, with older women being more affected. Since several specific biocultural factors jointly contribute to this phenomenon, the study’s findings suggest the need for local public health interventions that target women and which account for the anthropological specificities of the Senegalese population.

Preferences for physician weight status among women with overweight

BACKGROUND

Women with overweight experience stigma in clinical interactions. Emerging evidence suggests that one near-term approach to offset the negative consequences of weight stigma could be to capitalize on benefits of patient-physician weight concordance. However, it is likely that patient attitudes towards physicians with overweight are complicated and multifaceted and may include stigmatization of providers with overweight.

METHODS

Two-hundred ninety-eight women with overweight completed an online questionnaire and indicated preference for a physician who is 'overweight', 'not overweight', or indicated no preference. Participants provided reasons for their choice and answered questions about their weight-related beliefs and experiences.

RESULTS

The majority of women indicated no weight preference (63%), and a portion (36%) of the sample explicitly preferred physicians who are not overweight. Reasons provided for these preferences were primarily based on stereotyped notions of physician aptitude based on weight. Compared with having no preference, those who preferred physicians who are not overweight had fewer previous negative weight-related physician interactions and had increased beliefs about the controllability of weight.

CONCLUSIONS

These findings elucidate patient attitudes towards physicians with overweight in a sample at increased risk for weight stigmatization. Findings underscore the need for stigma-reducing interventions so that clinical experiences for both women and physicians with overweight can be improved.

Race-Ethnicity, Union Status, and Change in Body Mass Index in Young Adulthood

This study used data from three waves of the National Longitudinal Study of Adolescent to Adult Health (Add Health) and fixed-effects regression to consider whether associations between change in union status and change in BMI were moderated by race/ethnicity. The results indicated that intimate unions were differentially associated with gains in BMI along race/ethnic lines, especially for women. Compared to White women, marriage was associated with larger increases in BMI for Black, Hispanic and Multiracial women, and cohabitation was associated with larger increases for Black and Hispanic women. In contrast, both marriage and cohabitation were associated with less weight gain for Asian compared to White women. Among men, racial/ethnic differences in the relationship between union status and BMI were similarly patterned but less pronounced. The results suggest that, particularly for women, marital status-already its own source of stratification, further exacerbates racial/ethnic disparities in BMI from adolescence to young adulthood.

Perceptual body image and the relationship with weight control across the adult lifespan by sex in Koreans

Background

This study aimed to investigate perceptual body image and the relationship between perceived body image (PBI) and weight control differentiated according to obesity categories across the adult lifespan by sex among Koreans.

Methods

We analyzed data on 10 198 adults aged 25 or older from the Korean National Health and Nutrition Examination Survey of a nationally representative sample of non-institutionalized Koreans.

Results

Significant discordance between PBI and body mass index (BMI) or waist circumference (WC) was found in all age groups in both sexes, and the discordance for obesity grew more severe with age. Linear associations between PBI and BMI or WC were found in normal weight and obese groups in all age groups in both sexes, with relatively greater BMI or WC differences for PBI found in obese men aged ≤64 or ≤44, respectively, and obese women of all ages or aged ≥75, respectively, compared to normal weight. Obese women aged ≥65 (BMI) or ≥75 (WC) and obese men in the 45-54 and 65-74 age groups (BMI and WC) had significant association between PBI and weight control.

Conclusions

Interventions regarding accurate body size perception should be prioritized for obese women aged ≥65 or ≥75 and for obese men aged 45-54 and 65-74.

Discrepancy in Motivation for Weight Loss and Exercise in Rural Patients

OBJECTIVES

We explored the extent to which discrepancy between motivation for weight loss and exercise is related to obesity among rural patients with chronic disease, and identified the psychosocial correlates of this discrepancy.

METHODS

497 patients with diabetes and/or hypertension were recruited from a network of Federally Qualified Health Centers in the rural South and completed a battery of assessments.

RESULTS

Most persons in the sample (83.1%) were overweight and 65.0% were obese. For motivation for change, 70.8% reported being in the Action stage or higher for weight loss, whereas only 24.9% reported being in the Action stage or higher for motivation for exercise. When controlling for age, education level, income, sex, and race/ethnicity, individuals who were motivated for weight loss but not exercise were twice as likely to be obese (p = .005). Race and sex were significantly associated with this discrepancy, with African-American patients 1.7 times as likely (p = .05) and women 2.3 times as likely to be discrepant (p = .001).

CONCLUSIONS

Findings underscore the importance of focusing not simply on weight loss among rural patients with chronic disease, but rather to incorporate specific activities designed to build simultaneous motivation for engaging in exercise.

The effect of a weight gain prevention intervention on moderate-vigorous physical activity among black women: the Shape Program

BACKGROUND

Rates of physical inactivity are high among Black women living in the United States with overweight or obesity, especially those living in the rural South. This study was conducted to determine if an efficacious weight gain prevention intervention increased moderate-vigorous physical activity (MVPA).

METHODS

The Shape Program, a weight gain prevention intervention implemented in community health centers in rural North Carolina, was designed for socioeconomically disadvantaged Black women with overweight or obesity. MVPA was measured using accelerometers, and summarized into 1- and 10-min bouts. We employed analyses of covariance (ANCOVA) to assess the relationship between changes in MVPA over 12 months, calculated as a change score, and intervention assignment (intervention versus usual care).

RESULTS

Participants completing both baseline and 12-month accelerometer assessments (n = 121) had a mean age of 36.1 (SD = 5.43) years and a mean body mass index of 30.24 kg/m² (SD = 2.60). At baseline, 38% met the physical activity recommendation (150 min of MVPA/week) when assessed using 10-min bouts, and 76% met the recommendation when assessed using 1-min bouts. There were no significant differences in change in MVPA participation among participants randomized to the intervention from baseline to 12-months using 1-min bouts (adjusted intervention mean [95% CI]: 20.50 [-109.09 to 150.10] vs. adjusted usual care mean [95% CI]: -80.04 [-209.21 to 49.13], P = .29), or 10-min bouts (adjusted intervention mean [95% CI]: 7.39 [-83.57 to 98.35] vs. adjusted usual care mean [95% CI]: -17.26 [-107.93 to 73.40], P = .70).

CONCLUSIONS

Although prior research determined that the Shape intervention promoted weight gain prevention, MVPA did not increase significantly among intervention participants from baseline to 12 months. The classification of bouts had a marked effect on the prevalence estimates of those meeting physical activity recommendations. More research is needed to understand how to promote increased MVPA in weight gain prevention interventions.

TRIAL REGISTRATION

This study is registered at www.clinicaltrials.gov database (No. NCT00938535. Retrospectively Registered 7/10/2009).

Body Weight Misperception and Dissatisfaction Among Overweight and Obese Adult Nigerians

BACKGROUND

The increase in the prevalence of overweight and obesity in low- and medium-income countries has a negative impact on overall health. Correct perception of one's body weight is a step in seeking healthy help toward weight reduction in overweight and obese individuals.

OBJECTIVE

This study was carried out to assess the body weight misperception and dissatisfaction among overweight and obese adults in an urban African setting.

METHODS

This study was part of a larger cross-sectional study that was designed to plan an intervention for overweight and obese adults in an urban African setting. For this study, we randomly selected only overweight and obese adults (≥18 years old) who consented to participate in the study from 15 enumeration areas in Alimosho Local Government Area of Lagos State, Nigeria. We followed the World Health Organization guidelines for conducting community surveys in recruiting overweight and obese participants. We assessed body weight perception and dissatisfaction through their responses to the following: "How do you describe your weight?" and "I feel bad about myself because of my weight." Data for this study were collected between November 2012 and March 2013.

RESULTS

We recruited 567 participants, of whom more than half (n=304, 53.6%) misperceived their weight as either underweight or normal weight, and 61.2% (n=186) of whom were women. The strength of agreement between the actual body mass index and weight perception was very poor (κ=.032, SE .015, P=.04). The strongest predictor of weight perception was sex (female) with an odds ratio of 1.63 (95% CI 1.13-2.35). About 41.1% (n=233) of the participants were dissatisfied with their weight, of whom 30.0% (n=70) were men. Age (young adult) was a predictor of weight dissatisfaction with an odds ratio of 2.37 (95% CI 1.62-3.46).

CONCLUSIONS

More than half of the participants misperceived their body weight as either underweight or normal weight, and the majority of them were women. More men were not happy with their body weight, and participants in the young adult age group were more dissatisfied with their body weight.

Gender and Ethnic Differences in the Association Between Body Image Dissatisfaction and Binge Eating Disorder among Blacks

BACKGROUND

The research on binge eating has overwhelmingly focused on Whites. We aimed to study gender and ethnic differences in the association between body image dissatisfaction and binge eating in a nationally representative sample of Black adults in the USA.

METHODS

This cross-sectional study used data from the National Survey of American Life (NSAL), 2003-2004. Self-identified Caribbean Black (n = 1621) and African American (3570) adults aged 18 and older were enrolled. The independent variable was body dissatisfaction measured with two items. Using the World Health Organization Composite International Diagnostic Interview (WHO-CIDI), outcome was lifetime binge eating without hierarchy according to the DSM-IV criteria. Covariates included age, socioeconomic factors (i.e., education and marital status), and body mass index. Ethnicity and gender were focal moderators. Logistic regressions were used for data analysis.

RESULTS

Despite comparable prevalence of lifetime binge eating (5 vs 4 %, p > 0.05), African Americans reported higher body image dissatisfaction than Caribbean Blacks (36 vs 29 %, p > 0.05). In the pooled sample, body dissatisfaction was a strong predictor of lifetime binge eating disorders. There was a significant interaction (p = 0.039) between ethnicity and body image dissatisfaction on binge eating, suggesting a stronger association between body image dissatisfaction and lifetime binge eating for Caribbean Blacks (OR = 11.65, 95 % 6.89-19.72) than African Americans (OR = 6.72, 95 % CI 3.97-11.37). Gender did not interact with body image dissatisfaction on binge eating.

CONCLUSION

Ethnic variation in the link between body image dissatisfaction and binge eating may be due to within-race cultural differences in body image between African Americans and Caribbean Blacks. This may include different definitions, norms, and expectations regarding the body size. Findings suggest that ethnicity may bias relevance of body image dissatisfaction as a diagnostic criterion for binge eating disorders among diverse populations of Blacks.

Nutrition Transition and Biocultural Determinants of Obesity among Cameroonian Migrants in Urban Cameroon and France

Native of rural West Cameroon, the Bamiléké population is traditionally predisposed to obesity. Bamiléké who migrated to urban areas additionally experience the nutrition transition. We investigated the biocultural determinants of obesity in Bamiléké who migrated to urban Cameroon (Yaoundé), or urban France (Paris). We conducted qualitative interviews (n = 36; 18 men) and a quantitative survey (n = 627; 266 men) of adults using two-stage sampling strategy, to determine the association of dietary intake, physical activity and body weight norms with obesity of Bamiléké populations in these three socio-ecological areas (rural Cameroon: n = 258; urban Cameroon: n = 319; urban France: n = 50). The Bamiléké valued overweight and traditional energy-dense diets in rural and urban Cameroon. Physical activity levels were lower, consumption of processed energy-dense food was frequent and obesity levels higher in new migrants living in urban Cameroon and France. Female sex, age, duration of residence in urban areas, lower physical activity and valorisation of overweight were independently associated with obesity status. This work argues in favour of local and global health policies that account for the origin and the migration trajectories to prevent obesity in migrants.

Linking patients with community resources: use of a free YMCA membership among low-income black women

Given the increasing interest in expanding obesity prevention efforts to cover community-based programs, we examined whether individuals would access a YMCA for physical activity promotion. We provided a no-cost 12-month YMCA membership to socioeconomically disadvantaged black women who were randomized to the intervention arm of a weight gain prevention trial (n = 91). Analyses examined associations of membership activation and use with baseline psychosocial, contextual, health-related, and sociodemographic factors. Many participants (70.3 %) activated their memberships; however, use was low (42.2 % had no subsequent visits, 46.9 % had one to ten visits). There were no predictors of membership activation, but individuals living below/borderline the federal poverty line were more likely to use the center (1+ visits), as were those who met physical activity guidelines at baseline. More comprehensive and intensive interventions may be necessary to promote use of community resources-even when provided free-among high-risk populations of women with obesity that live in rural areas of the USA.

Development and Validation of the Beliefs About Personal Weight Survey Among African American Women

The purpose of this study was to develop the Beliefs about Personal Weight Survey among African American women. Sixty-five items were developed from literature and sample participants to characterize beliefs about personal weight in 3 domains: descriptors, causes, and consequences. The items were administered to 150 community-dwelling African American women, 18 to 40 years old, recruited from 5 sites. Factor analysis supported a 4-factor solution with the following dimensions: overweight acceptance, overweight concern, conventional weight regulation, and circumstantial weight regulation. These factors were significantly associated with weight management behaviors and body mass index. Profile analysis indicated distinct factor belief profiles by 3 weight categories.

Beliefs About Personal Weight Among African American Women

The rate of obesity within the United States is dropping, yet the prevalence of obesity among young African American women continues to increase. This increase, in part, may be attributable to weight beliefs. The relationship between beliefs about personal weight and body mass index (BMI) was examined among 150 African American women, 18 to 40 years of age using weight descriptive characteristics, causal attributions, consequences, and calculated BMI. Key results show that the majority of participants described their weight as attractive, healthy, and normal despite a sample mean BMI in the obese category. Key beliefs about the causes of personal weight that were associated and predictive of BMI were unhealthy eating behaviors, limited physical activity, weight left from pregnancy, and not knowing how to maintain a healthy weight. Beliefs about the consequences of personal weight were not predictive of BMI. A discussion of study findings provides important implications for clinical practice.

Body Mass Index, Self-Esteem, and Suicide Risk in Clinically Depressed African American and White American Females

Self-esteem and depression, as well as depression and body mass index (BMI), have consistently been found to be significantly associated for African American and White American females. The results are dissimilar when BMI and self-esteem are studied. Historically, the relationship between BMI and self-esteem is weak or nonexistent for African American females; however, for White American females, the relationship is usually significant. The goal of this study was to determine whether clinically depressed, healthy-weight, overweight, and obese females would differ significantly on self-esteem and suicide risk measures. In a voluntary hospital-based inpatient psychiatric unit, 165 clinically depressed females completed the self-esteem rating scale and the suicide risk scale. Healthy-weight, overweight, and obese African American females did not differ significantly on measures of self-esteem and suicide risk. However, depressed, obese White American females had significantly lower self-esteem and increased suicide risk than depressed healthy-weight and overweight White American females. Implications of the current results are discussed.

The Evaluation of a Measurement Model for the Physical Appearance State and Trait Anxiety Scale in a Sample of Young Adult Women of Mexican Descent

The factor structure of the Physical Appearance State and Trait Anxiety Scale (PASTAS) was examined with exploratory (EFA) and confirmatory factor analyses (CFA). The sample consisted of 196 women who self-identified as Hispanic, were low to moderately acculturated, had socioeconomic status levels of semiskilled workers, and had a normal body mass index (BMI). The final factor structure differed from the established factor structures found for Caucasian women. The published two factor structure (weight and nonweight) had a 2 /df ratio of 4.5 (trait) and 5.2 (state) with fit indices ranging from .753 to .795, indicating a poor fit. Anew three-factor solution (weight-related lower torso, weight-related midtorso, and non-weight-related) was found using EFA. After slight modifications, the final model had a 2 /df ratio of 2.6 for both versions with fit indices ranging from .882 to .930. This new model can be used to test body image anxiety among young, English-speaking college women of Mexican descent.

The Evaluation of a Measurement Model for the Body Image Questionnaire and the Eating Attitudes Test in a Hispanic Population

The factor structures of the Body Image Questionnaire (BIQ) and the Eating Attitudes Test (EAT) were examined with confirmatory factor analyses. The sample for the BIQ consisted of 255 Hispanic men and women, and the sample for the EAT consisted of 153 Hispanic women living on the U.S./México border. The final factor structures for the BIQ and the EAT differed from the published BIQ and EAT factor structures found for young Caucasian adults. A four-factor solution (midtorso, extremities, sex organs, and face) using Hispanic men and women resulted in a good fit for the BIQ. A five-factor solution (fear of fat, preoccupation with food, others’ opinions, dieting, and slow eating) using Hispanic women resulted in a moderate fit for the EAT. The modified BIQ can be used reliably to test constructs related to body image and eating behavior among Hispanics living on the U.S./México border. However, the original three-factor EAT structure reported in Caucasian women does not seem to be a reliable measure of attitudes toward eating for Hispanic women living on the U.S./México border. Although a five-factor EAT structure was more reliable for assessing eating attitudes in these women, it is recommended that a new instrument be developed and tailored to young Hispanic women.

Body Image Satisfaction Among Blacks

Satisfaction with body image is a factor related to health outcomes. The purpose of this study is to examine the relationship between body image satisfaction and body size perception in an urban, Black community sample in New Orleans, Louisiana. Only 42.2% of respondents were satisfied with their body image and 44.1% correctly perceived their body size. Most respondents chose an ideal image in the normal body mass index range with over half choosing an ideal image smaller than their actual size. Misperception was greatest among the heaviest respondents. Females, those who overestimated their size, those with an education beyond high school, and those who were active in order to lose weight were less likely to be satisfied ( p < .001). Those who were active but not trying to lose weight were more likely to be satisfied ( p < .001). This suggests that perception of and satisfaction with body size may play a role in health behavior decisions.

Perceptions of body size, obesity threat and the willingness to lose weight among black South African adults: a qualitative study

BACKGROUND

The obesity epidemic is associated with rising rates of cardiovascular disease (CVD) among adults, particularly in countries undergoing rapid urbanisation and nutrition transition. This study explored the perceptions of body size, obesity risk awareness, and the willingness to lose weight among adults in a resource-limited urban community to inform appropriate community-based interventions for the prevention of obesity.

METHOD

This is a descriptive qualitative study. Semi-structured focus group discussions were conducted with purposively selected black men and women aged 35-70 years living in an urban South African township. Weight and height measurements were taken, and the participants were classified into optimal weight, overweight and obese groups based on their body mass index (Kg/m(2)). Participants were asked to discuss on perceived obesity threat and risk of cardiovascular disease. Information on body image perceptions and the willingness to lose excess body weight were also discussed. Discussions were conducted in the local language (isiXhosa), transcribed and translated into English. Data was analysed using the thematic analysis approach.

RESULTS

Participants generally believed that obesity could lead to health conditions such as heart attack, stroke, diabetes, and hypertension. However, severity of obesity was perceived differently in the groups. Men in all groups and women in the obese and optimal weight groups perceived obesity to be a serious threat to their health, whereas the overweight women did not. Obese participants who had experienced chronic disease conditions indicated strong perceptions of risk of obesity and cardiovascular disease. Obese participants, particularly men, expressed willingness to lose weight, compared to the men and women who were overweight. The belief that overweight is 'normal' and not a disease, subjective norms, and inaccessibility to physical activity facilities, negatively influenced participants' readiness to lose weight.

CONCLUSION

Low perception of threat of obesity to health particularly among overweight women in this community indicates a considerable challenge to obesity control. Community health education and promotion programmes that increase awareness about the risk associated with overweight, and improve the motivation for physical activity and maintenance of optimal body weight are needed.

Ideal Body Size as a Mediator for the Gender-Specific Association Between Socioeconomic Status and Body Mass Index

Background. While obesity continues to rise globally, the associations between body size, gender, and socioeconomic status (SES) seem to vary in different populations, and little is known on the contribution of perceived ideal body size in the social disparity of obesity in African countries. Purpose. We examined the gender and socioeconomic patterns of body mass index (BMI) and perceived ideal body size in the Seychelles, a middle-income small island state in the African region. We also assessed the potential role of perceived ideal body size as a mediator for the gender-specific association between SES and BMI. Method. A population-based survey of 1,240 adults aged 25 to 64 years conducted in December 2013. Participants’ BMI was calculated based on measured weight and height; ideal body size was assessed using a nine-silhouette instrument. Three SES indicators were considered: income, education, and occupation. Results. BMI and perceived ideal body size were both higher among men of higher versus lower SES ( p < .001) but lower among women of higher versus lower SES ( p < .001), irrespective of the SES indicator used. Multivariate analysis showed a strong and direct association between perceived ideal body size and BMI in both men and women ( p < .001) and was consistent with a potential mediating role of perceived ideal body size in the gender-specific associations between SES and BMI. Conclusion. Our study emphasizes the importance of gender and socioeconomic differences in BMI and ideal body size and suggests that public health interventions that promote perception of healthy weight could help mitigate SES-related disparities in BMI.

Obesity Among Young Adults in Developing Countries: A Systematic Overview

This article discusses the overweight/obesity situation among young adults in developing countries. For this target population, obesity prevalence ranges from 2.3 to 12 %, and overweight is 28.8 %, mostly affecting females. Weight is now increasing during this life stage of transition at a higher rate, 1 kg/year, than in developed countries. Maternal factors and early childhood socioeconomic status are associated with BMI in young adults along with changing environmental and behavioural factors in some low and middle income countries, brought about by demographic and socioeconomic transitions. Young adults with 'normal weight' obesity need identification using other convenient low cost measures (skin folds or waist circumference) along with BMI. Obesity prevention or management interventions were not identified, but clearly needed to help stem the obesity pandemic. Young people generally give little priority to their future health, so such interventions need to be conducted at some optimal age, be innovative, country specific and culturally acceptable.

Increased Body Mass Index Associated with Increased Risky Sexual Behaviors

STUDY OBJECTIVE

The increasing prevalence of adolescent obesity has led to consideration of the potential effect of obesity on risky sexual behaviors. In the current study we examined whether body mass index (BMI) was related to age at sexual debut, type of sexual behavior, partner number, and condom use in a population of adolescent women at high risk for obesity and risky sexual behaviors.

DESIGN, SETTING, AND PARTICIPANTS

Cross-sectional examination of 860 sexually active, predominantly minority, adolescent women who received medical care at an urban health center from 2007 through 2013.

INTERVENTION AND MAIN OUTCOME MEASURES

Self-reported age at sexual debut, types of sexual intercourse, number of partners and condom use was compared with clinically assessed BMI.

RESULTS

BMI was positively associated with number of sexual partners (P = .001) and history of attempted anal intercourse (P = .002). An inverse association was observed with age at first anal intercourse (P = .040).

CONCLUSION

In this sample of adolescent women, increased BMI was associated with riskier sexual practices at a younger age. Results of this study suggest that overweight and obese adolescents are a vulnerable population who might need targeted sexual health counseling.

Higher Motivation for Weight Loss in African American than Caucasian Rural Patients with Hypertension and/or Diabetes

OBJECTIVE

To examine the relationship between race/ethnicity and motivation for weight loss and motivation for exercise among patients with chronic disease.

DESIGN

Cross-sectional.

SETTING

Our study took place within a network of federally qualified health centers (FQHCs) in the rural southern United States.

PATIENTS OR PARTICIPANTS

463 active FQHC patients with diabetes and/or hypertension identifying as African American, White Hispanic, or non-Hispanic White participated in our study.

MAIN OUTCOME MEASURES

Primary outcomes were assessed using standardized measures of motivation for a) weight loss; and b) hypertension per the Transtheoretical Model.

RESULTS

Multivariate logistic regression revealed that, when controlling for age, sex, education status, employment status, poverty, comorbidity, and weight status, there were no significant differences in motivation for exercise among the different racial/ethnic groups (P=.361). However, when controlling for the same factors, there was a significant difference in motivation for weight loss, with African American participants more than twice as likely as non-Hispanic White participants to be motivated to lose weight (ORADJ = 2.430, P=.002).

CONCLUSIONS

Our study suggests that, among rural patients with obesity-related chronic disease, there is a significant variation in motivation to lose weight between racial/ethnic groups. This underscores the importance of culturally tailoring interventions and in considering motivation for change when promoting weight loss behaviors. Additional implications for intervention development and delivery are discussed.

Body Dissatisfaction in Individuals with Obesity Compared to Normal-Weight Individuals: A Systematic Review and Meta-Analysis

BACKGROUND

Body dissatisfaction has been identified as a psychological correlate of obesity that is related to disordered eating, poor self-esteem, and depression. However, not all individuals with obesity are equally vulnerable to these correlates, and 'normative discontent' is present in individuals with normal weight, too. In this light, the complex relationship of body image and individual weight status seems like a worthwhile direction of research inquiry. As such, this review aims to systematically explore the degree of body dissatisfaction in individuals with obesity compared to normal-weight individuals.

METHODS

A systematic literature search was conducted. All quantitative studies of adult samples reporting results regarding differences in body dissatisfaction between individuals with normal weight and obesity were included.

RESULTS

17 articles were found. Across studies, individuals with obesity reported higher body dissatisfaction than normal-weight individuals (questionnaires: d = 0.89, 95% CI = 0.63-1.16, p < 0.001; silhouette scales: d = 1.41, 95% CI = 0.57-2.25, p < 0.001). Meta-regression revealed a significant association of female gender and higher body dissatisfaction (b = 0.60, p = 0.007).

CONCLUSION

The findings underline the severity of body dissatisfaction among individuals with obesity and especially among women. Future research recommendations are discussed.

Examining childhood obesity and the environment of a segregated, lower-income US suburb

Purpose

– The contribution of the built environment within communities plays a significant role in the higher rates of childhood obesity, particularly among black and Hispanic youth. The purpose of this paper is to investigate neighborhood assets and barriers to nutrition and physical activity in an underserved, majority-minority suburban community in New York State, USA using Photovoice, a community-based participatory research method.

Design/methodology/approach

– Nine local youth took photographs to visually identify the community’s environmental assets and barriers. Through an extensive review and selection of photos and group discussion themes were identified. Final results of the Photovoice project were presented to local policy makers and community members for action.

Findings

– Participants provided complex and insightful perspectives of health inequalities in the suburbs, including limited access to fresh, healthy food, and safe spaces for physical activity. They also understood that improving nutrition and physical activity practices required policy changes and civic engagement.

Research limitations/implications

– This study represented one suburban area of New York, and is not meant to be representative of all suburban areas. However, the findings of environmental barriers to childhood obesity are similar to those found in urban areas, suggesting similarities in low-income communities of color.

Social implications

– This study suggests that Photovoice is an effective way of collaborating between various community stakeholders (particularly youth) in an underserved suburb that can result in community changes.

Originality/value

– Besides achieving all three Photovoice goals – recording and reflection, dialogue, and reaching policymakers – the Photovoice project identified a long-standing environmental hazard as a result of the partnerships established between the youth, academic institution, community-based organizations, and residents. This study also identified factors in the built environment that contribute to health disparities in a racially segregated suburban community.

The relevance of the side-view in body image scales for public health: an example from two African populations

Background

Body size scales are a common method for diagnosing body image disturbances and assessing the cultural valorisation of stoutness, a phenomenon that plays a role in the development of overweight, especially among African populations. Traditionally, body size scales present a front view. In this study, we evaluated a complementary model of representing body shape: the side view of body outlines. In particular, we examined the association between the side-view and a set of bio-anthropometric indices in men and women.

Methods

To cover the inter-ethnic variability in the Niger-Congo area, we selected a balanced sex-ratio sample of 80 Cameroonians and 81 Senegalese. Individuals wearing close-fitting clothes were photographed from the front-and side-view, and measured following a bio-anthropometric protocol synthesizing body shape variation: Body Mass Index, percentage body fat, somatotype profile, waist circumference, waist-to-hip ratio, mean blood pressure and glycaemia. The shape of each front and side body outline was extracted and characterised by Normalized Elliptic Fourier Descriptors (NEFD). Finally, we assessed associations between NEFD and bio-anthropometric indices.

Results

Variation in the shape of both front and side body outlines was associated with all bio-anthropometrics for at least one sex-population combination. Overall, the side view best captured body shape variation related to changes in almost all bio-anthropometrics in both sexes and populations, with the exceptions of female mesomorphy, male blood pressure and glycaemia (in both sexes). We found that the details of the relationship between bio-anthropometrics and body shape differed between the two male populations, a finding that was reflected in side-views for all criteria, but not front-views.

Conclusions

Variation in body shape assessed by several bio-anthropometrics related to health and nutritional status was larger for side than front body outlines. Integrating side views in body size scales would improve the accuracy of body size assessment and thus, the assessment of behaviours leading to overweight, as well as symptoms of body image disturbances, in Africa and potentially in other populations.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-015-2511-x) contains supplementary material, which is available to authorized users.

Development and Validation of the Body Size Scale for Assessing Body Weight Perception in African Populations

Background

The social valorisation of overweight in African populations could promote high-risk eating behaviours and therefore become a risk factor of obesity. However, existing scales to assess body image are usually not accurate enough to allow comparative studies of body weight perception in different African populations. This study aimed to develop and validate the Body Size Scale (BSS) to estimate African body weight perception.

Methods

Anthropometric measures of 80 Cameroonians and 81 Senegalese were used to evaluate three criteria of adiposity: body mass index (BMI), overall percentage of fat, and endomorphy (fat component of the somatotype). To develop the BSS, the participants were photographed in full face and profile positions. Models were selected for their representativeness of the wide variability in adiposity with a progressive increase along the scale. Then, for the validation protocol, participants self-administered the BSS to assess self-perceived current body size (CBS), desired body size (DBS) and provide a “body self-satisfaction index.” This protocol included construct validity, test-retest reliability and convergent validity and was carried out with three independent samples of respectively 201, 103 and 1115 Cameroonians.

Results

The BSS comprises two sex-specific scales of photos of 9 models each, and ordered by increasing adiposity. Most participants were able to correctly order the BSS by increasing adiposity, using three different words to define body size. Test-retest reliability was consistent in estimating CBS, DBS and the “body self-satisfaction index.” The CBS was highly correlated to the objective BMI, and two different indexes assessed with the BSS were consistent with declarations obtained in interviews.

Conclusion

The BSS is the first scale with photos of real African models taken in both full face and profile and representing a wide and representative variability in adiposity. The validation protocol proved its reliability for estimating body weight perception in Africans.

A risk and maintenance model for bulimia nervosa: From impulsive action to compulsive behavior

This article offers a new model for bulimia nervosa (BN) that explains both the initial impulsive nature of binge eating and purging, as well as the compulsive quality of the fully developed disorder. The model is based on a review of advances in research on BN and advances in relevant basic psychological science. It integrates transdiagnostic personality risk, eating-disorder-specific risk, reinforcement theory, cognitive neuroscience, and theory drawn from the drug addiction literature. We identify both a state-based and a trait-based risk pathway, and we then propose possible state-by-trait interaction risk processes. The state-based pathway emphasizes depletion of self-control. The trait-based pathway emphasizes transactions between the trait of negative urgency (the tendency to act rashly when distressed) and high-risk psychosocial learning. We then describe a process by which initially impulsive BN behaviors become compulsive over time, and we consider the clinical implications of our model. (PsycINFO Database Record

The role of body image in prenatal and postpartum depression: a critical review of the literature

Maternal depression increases risk of adverse perinatal outcomes, and recent evidence suggests that body image may play an important role in depression. This systematic review identifies studies of body image and perinatal depression with the goal of elucidating the complex role that body image plays in prenatal and postpartum depression, improving measurement, and informing next steps in research. We conducted a literature search of the PubMed database (1996-2014) for English language studies of (1) depression, (2) body image, and (3) pregnancy or postpartum. In total, 19 studies matched these criteria. Cross-sectional studies consistently found a positive association between body image dissatisfaction and perinatal depression. Prospective cohort studies found that body image dissatisfaction predicted incident prenatal and postpartum depression; findings were consistent across different aspects of body image and various pregnancy and postpartum time periods. Prospective studies that examined the reverse association found that depression influenced the onset of some aspects of body image dissatisfaction during pregnancy, but few evaluated the postpartum onset of body image dissatisfaction. The majority of studies found that body image dissatisfaction is consistently but weakly associated with the onset of prenatal and postpartum depression. Findings were less consistent for the association between perinatal depression and subsequent body image dissatisfaction. While published studies provide a foundation for understanding these issues, methodologically rigorous studies that capture the perinatal variation in depression and body image via instruments validated in pregnant women, consistently adjust for important confounders, and include ethnically diverse populations will further elucidate this association.