Racial Differences in Selection of Ideal Body Size by Adolescent Females

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1 Racial Differences in Selection of Ideal Body Size by Adolescent Females Diane B. Wilson, *Roger Sargent,?Jim Dim Abstract Cultural differences may partially account for the fact that more black women than white women are overweight in the United States. This study measured perceptions of ideal body size among 93 black and 80 white females, years old, who were randomly selected from three public high schools in a southeastern state. The subjects height and weight were measured along with their estimates of their mother s body size, weight control attitudes, and demographic variables. Blacks preferred a significantly larger body sue than whites when asked to select ideal body size (p0.045). Subjects who estimated their mother s size to be larger, also selected a larger ideal body size (p.047). Those who perceived themselves as too fat were more likely to skip meals to help control their weight, compared with those who perceived themselves as normal or too thin (p=.003). Approximately 30% of the sample was overweight or obese. There were not significant racial differences in weight or BMI. These results suggest that overweight is more acceptable among black females than among white females and may help explain why more black females are obese. Key Words: obesity, ideal body size, adolescents, culture, race (OBESITY RESEARCH 1994;2:38-43) Submitted for publication April Accepted for publication in final form August From The Heart Center. The Medical University of South Carolina, Charleston. SC. *Depsatment of Health Romotion and Education, School of Public Health. University of South Carolina, Columbia, SC. and tthe Department of Biostatistics. Epidemiology and Systems Science. the Medical University of South Carolina, Charleston, SC. Reprint requests to Dr. Wilson, The Heart Center, The Medical University Hosptial of South Carolina, Second Floor. Hospital, 171 Ashley Ave.. Charleston, SC Copyright NAASO. Introduction Currently in the U.S., about twice as many black females as white females are overweight (1,15,20,24). Prevalence data from NHANES I1 ( ) using the 85th percentile of BMI as criteria (about 120% of ideal weight), show that approximately 43% of black females, years old, were overweight while approximately 25% of white females, black males, and white males met this criteria (20). Kumaniyka (15) reports a higher prevalence of overweight, in approximately a 2:l ratio, among black women compared to white women, upon review of data from the National Health Examination Survey, NHANES I and NHANES 11. Prevalence rates of obesity among children 6-11 years old also reflect a racial difference. From the years and , the increase in prevalence of superobesity was 153% among black girls, and 63% among white girls (9). When girls reach years old, 9.6% of white females and 23.7% of black females are overweight (20). Obesity is associated with increased incidence of cardiovascular disease, diabetes, certain types of cancer, hypertension, and joint-skeletal problems (2.5.24). Of these, the incidence of diabetes mellitus and hypertension is more than twice as common in black women than it is in white women (15,24). Among women, those who are poor are more likely to be overweight than those who are affluent (6,7). Since more blacks than whites fall below the poverty line, this may help to explain the overweight prevalence differential in these populations. However, in studies statistically controlling for socio-economic status, a significant difference in prevalence rates remained between the two racial groups of females (1,3,15). Analysis of both NHANES I and NHANES I1 dietary recall data indicates lower mean caloric intakes for black women than for white women (8). NHANES I1 data show no significant differences in reported levels of physical activity between adult black femdes com- 38 OBESITY RESEARCH Vol. 2 No. 1 Jan. 1994

2 Race, Ideal Body Size Perception, Wilson et at. pared to white females (8). Further study is required to clarify the role of diet and exercise, particularly as to how each may contribute to racial differences in prevalence rates of obesity. The fact that both level of overweight and prevalence rates vary according to SES and race indicates the need to examine the condition in a larger context; one which includes cultural and socio-environ.menta1 factors. Culture is acquired through learning patterns of behavior in contrast to biologically determined characteristics (11). Eating behaviors, food choices, as well as norms for health and beauty are culturally-specific. The size of a girl s mother may be an influence on what body size the daughter perceives as ideal body size for females. Black women seem to know the health consequences of being overweight (17). Studies show that they do not experience the same societal pressures to be thin as do white women. Several authors have reported that black females express more satisfaction with body size in general and often describe themselves as attractive while being overweight (4,12,13.16). In addition, there are fewer black women in eating disorder treatment programs perhaps because they do not go to the extremes that white women do in order to be thin (10). This study was undertaken to test whether black females would choose a larger ideal body size compared to white females. Adolescents were selected because this is prior to the life stage when black females demonstrate a significantly higher prevalence of obesity compared to white females (14), yet they have begun to formulate personal opinions on attractive body size. Methods Subjects The sample was composed of 93 black and 80 white female high school students, years old, who were attending one of three public high schools in a southeastern state. Based on the number of students participating in the free school lunch program, it was determined that the schools represented a cross-section of socio-economic strata. School 1 had an enrollment of approximately 500 students with a racial mix of 62% white and 48% black. Twenty-four percent of these students were receiving free or reduced-cost lunches. School 2 had a similar racial mix, an enrollment of 1400 and about 38% receiving free or reduced-rate lunches. The third school had about 430 students with approximately 90% black and 10% white students, 68% receiving free or reduced-rate lunches. According to U.S. census data (23), school 1 was located in a town of about 1,700 people, school 2 town population was about 30,000, and about 500 people lived in the third town. Random numbers were used to select 70 females from each school from all of those who were of appropriate age and race. Thirty-seven subjects selected did not participate, due to scheduling problems, resulting in a final sample size of 173. Data Collection All data were collected in the schools by the senior author and a trained assistant. Participants were notified in advance and appointment times were arranged during the school day. Students were interviewed individually and were asked to answer written questions relating to demographics. size of their hometown, and three questions concerning weight control measures which originated from the Center for Disease Control Youth Risk Behavior Survey. The three questions were: 1. Are you satisfied with your weight? 2. Are you currently trying to lose weight? 3. How often do you skip meals to control your weight? Socio-economic status was determined by using the Meyer and Bean Scale (19) which is based on education completed and occupation of the parents. Incremental levels are given a numerical score; low range scores indicate high SES while high range scores indicate low SES. Ideal body size perceptions were measured using the Body Size Values instrument developed by Massara and Stunkard (18) as a means of quantifying cultural ideals of body size. The instrument consists of a series of nine photographs which were systematically altered to show a female both thinner and heavier than her actual size. An outside panel of experts assessed the percentage of deviation from nod body weight for each photo. An overall inter-rater reliability coefficient of.89 was calculated. Seven of the nine photos were used for this study, ranging from -23% below normal weight to 4% over normal weight. Two of the photos represented body sizes below normal and four photos, body sizes above normal. Of the two photos not used, one was eliminated because it was at the highest level of overweight (+93%) and the other because there was only a 5% difference with the two photos nearest in size. Each subject was handed all of the photographs, which were randomly ordered and asked to select the photo which she considered to be ideal body size. This process was repeated and each was asked to select the photo most similar to her mother s body size. The subject s height and weight were measured without shoes. A portable scale was used, which was calibrated prior to each data collection session. All statistical tests were conducted at the alpha4.05 significance level. The Statistical Package for the Social Sciences was utilized in analysis (21). OBESITY RESEARCH Vol. 2 No. 1 Jan

Race, Ideal Body Size Perception, Wilson et al. Table 1: Demographics for black and white subjects* Blacks Whites n=93 n = 80 Age (Yrs) 15.51 f 1.02 15.40 f 1.13 Weight (lbs) 144.55 f 40.87 137.

3 Race, Ideal Body Size Perception, Wilson et al. Table 1: Demographics for black and white subjects* Blacks Whites n=93 n = 80 Age (Yrs) f f 1.13 Weight (lbs) f f37.89 Height (in) f f 2.15** BMI (kg/m2) f f 6.27 SES*** f f 14.32** *mean f 1SD **p<0.05 ***SES scale ranged from 11 (high SES) to 81 (low SES) Results Table 1 shows the demographic characteristics of the study population. The age of the subjects ranged from years (mean=15.5 f 1.07 years). Weight ranged from pounds (mean=141.1 f lbs.); there were no significant differences in weight by race (two- BMI Table 2 Spearman s rank correlation coefficients for selected variables BMI IBS EMS SES QlO 412 1OOO IBS OOO (172) p=.297 EMS.I OOO (171) (172) p.m* p=.ool* SES OOO (172) (173) (172) p.055 p.142 p=.013* QlO , OOO (172) (173) (172) (173) p.ool* p.238 p.008* p W OOO (170) (171) (170) (171) (171) p.ool* p.372 p.443 p.351 p=.ool* Variables: BMI, Body Mass Index; IBS, Ideal Body Size; EMS, Estimated Size of Mother; SES, Socioeconomic Strata; QlO, Self-perception of Body Size; 412, Meals skipped to lose weight *p<0.05, one-tailed test of significance. sample t-test=1.12, p=0.263, ns) or by school (one-way ANOVA F=5.07, M.338 ns). Mean height was 64.3 k 2.34 inches. Black subjects were about one inch taller than the white subjects (two-sample t-test=2.66, p=.oo4). The mean BMI was k 6.46 kg/m2. Approximately 30% of the sample were either overweight or obese. There were no significant racial differences in BMI (two-sample t-test=0.61, one-tailed ~4.252 ns). Spearman s correlation coefficients are shown in table I1 for the following variables; body mass index (BMI), ideal body size (IBS), estimated size of mother (EMS), socio-economic status (SES), question 10 (perception of own body size, question 12 (number of meals skipped to control weight). BMI was significantly associated with the subject s estimation of their mother s body size (EMS) (Spearman s r=0.1969, 1-tailed p=0.005), with perception of own body size (p=.ool) and with meals skipped to control weight (p=.ool). BMI was not significantly associated with selection of ideal body size (IBS). Mean SES score among the total sample was f Blacks in the sample were of significantly lower SES than the whites (two-sample t-test=1.75, 1-tailed p0.041). SES was inversely associated with the estimated size of the mother, those of lower SES estimated their mother s size to be larger. There were no significant racial differences in response to the question on perception of own body size (QlO), the question asking if they are currently trying to lose or gain weight (Q1 l), or the question on how often do they skip meals to control body weight (412). Ideal body size (IBS) was positively associated with estimated mother s size (Spearman s , 1-tailed p=.ool) and race, but not with SES. Black females selected a significantly larger IBS (Mann-Whitney U=3228, p=0.045). The numbers of blacks and whites were not substantially different in their selection of body size 1 (23% underweight), 2 (11% underweight), or 3 (normal weight). More than twice as many blacks as whites, however, selected #4 (9% overweight) as being ideal size. Figure 1 depicts the number and percent of blacks and of whites who selected ideal body size as underweight (photos 1 or 2), normal weight (photo 3), or overweight (photos 4 or 5). Figure 2 illustrates the number of subjects selecting each body size as the estimation of their mother s size. Over 53% of the sample selected photos of women >28% overweight in estimating their mother s size. The variable EMS was positively associated with the subject s BMI. Spearmans s r=0.1969, 1-tailed p=0.005). Those higher in BMI estimated their mothers to be larger in size. Estimated mother s size was also associated 40 OBESITY RESEARCH Vol. 2 No. 1 Jan. 1994

4 Race, Ideal Body Size Perception, Wilson et al Undetweig ht Normal Ovetweig ht Figure 1: Number of adolescents selecting underweight (23% or 11% underweight), normal weight, or overweight (9% or 28% overweight) photos as their perception of what is ideal body size. (p=.0451) with self-perception of body size (QlO) (Spearman s 1=0.1835, l-tailed p=o.oos) and with SES. Analysis of responses to the question Do you think of yourself as: too thin, about the right weight, or too fat (overweight) shows that about 7% of the total sample considered themselves to be too thin, 62% about right and 31% too fat. Answers to the question Which of the following are you doing about your weight? show that 67% of the subjects were either trying to lose weight or trying to keep from gaining weight (Q 11). Fifty-four percent skipped meals to aid with weight loss. Of those who skipped 7-14 meals per week for this purpose, 73% were white and 27% were black. Self-perception of body size (QlO) and skipping meals to lose weight (Q12) were positively associated, indicating that those who considered themselves too fat were more likely to skip meals for weight control purposes (S~~EUIEUI S , l-tailed p<.oo1). Results of log-linear analyses for higher levels of interaction among variables did not contradict any of the results of the statistical procedures presented. Discussion There were no significant racial differences in body weight or in BMI. This is consistent with Kumaniyka s (14) observation that black and white women show similar rates of obesity until late adolescence. Approximately 30% of the total sample were either overweight or obese, which corresponds with prevalence rates of year-olds reported upon analysis of NHANES I and NHANES II data (5). Black adolescents selected a larger body size as being ideal than did the white subjects. In the overall sample, 80% of the teens chose an ideal body size in the normal weight or in the overweight category, only 20% selected an underweight body size as ideal. This is in contrast to results reported by Storz and Green (22) about their study of white female teenagers. They found that underweight body drawings were overwhelmingly selected as ideal. Twice as many blacks considered themselves to be too thin and more than twice as many blacks as whites reported that they were attempting to gain weight, indicating that larger body size may be more acceptable among the black females studied. This could, in part, explain the increased prevalence of overweight among adults of this race-gender group. This finding is consistent with Hueneman s (12) previous study, which found that black adolescent females were more concerned about being underweight than Caucasian and Oriental teens who were more likely to consider themselves too fat. Recently, Desmond (4) reported that black female adolescents who were overweight or normal weight OBESITY RESEARCH Vol. 2 No. 1 Jan

5 ~ Race, Ideal Body Size Perception, Wilson el al %Under Normal 9% Over 28% Over 45% Over 64% Over Body Size Category Figure 2: Number of adolescents selecting various sized photos ranging from 11% underweight to 64% overweight as their estimation of their mother s body size. (p.053) were more likely to perceive themselves as thinner than their true size. The white teens, however, in Desmond s study who were thin or no& weight more often perceived themselves as heavier than they really were. The size estimation of the subject s mother was related to the selection of ideal body size. The mother s size may serve as a model, and in this way, influence what a daughter considers to be ideal. This variable was also positively associated with the BMI of the subject herself. In addition, EMS was positively associated with the question asking the subject whether her own body size is too thin, about right, or too fat. Those who considered themselves to be too fat, estimated their mothers to be a larger size. In light of the fact that black adolescent females in this study chose a larger body size as ideal than did the white subjects, health educators may need to consider that an overweight black woman may not be as motivated to lose weight. She may not feel that it is important to do so for either appearance or for health reasons, which are common factors cited among white women. Ovenveight is often considered a social disability in the white culture, but it may not carry the same social stigma among blacks (17). Perception of the ideal body size may influence the goals people set for their own body size. Nutrition educators will be challenged by the fact that body-size satisfaction may exist among some overweight women while obesity remains a risk factor for disease. Obesity is a multi-factoral condition that needs to be explored in a broad framework. The results of this study help to establish that sociocultural factors as well as traditional intake-output models, need further examination. In addition, they underscore the need for culturally-specific nutrition education programs. References 1. Bonham GS, Brock DB. The relationship of diabetes with race, sex, and obesity. Am J Clin Nutr. 1985; 41: Bray G. Effects of obesity on health and happiness. In: Brownell K, Foreyt J., eds. Handbook of Eating Disorders. NY Basic Books; 1986: Dawson D. Ethnic differences in female overweight and data from the 1985 National Health Interview Survey. Am J Public Health. 1988;78: Desmond SM, Price JH, Hallinan C, Smith D. Black and white adolescents perception of their weight. Am J School Health. 1989;59: Feinleib M. Epidemiology of obesity in relation to health hazards. Ann Intern Med. 1985;103: OBESITY RESEARCH Vol. 2 No. 1 Jan. 1994

6 Race, Ideal Body Size Perception, Wilson et al. 6. Garn SM, Bailey SM, Cole PE, Higgins, IT. Level of education, level of income, and level of fatness in adults. Am J Clin Nutr. 1977;30: Garn SM. Socioeconomic aspects of obesity. Cont Nutr ;6: Gartside PS, Khoury P, Glueck CJ. Determinants of highdensity lipoprotein cholesterol in blacks and whites: The second National Health and Nutrition Examination Survey. Am Health J. 1984;108: Gortmaker SL, Dietz WH, Sobol AM, Wehler, CA. Increasing pediatric obesity in the United States. Am J Child. 1987; 141 ~ Gray JJ, Ford K, Kelly LM. The prevalence of bulimia in a black college population. Int J Eat Dis. 1987;6: Gudykunst WB. Culture and Intergroup Processes. In: Bond MH. ed. The Cross-Cultural Challenge to Social Psychology. Newbury Park, Ca: Sage Publications; 1988; Harris MB, Walters LC, Waschull S. Gender and ethnic differences in obesity-related behaviors and attitudes in a college sample. J Appl Soc Psychol. 1991;21: Hueneman RI, Shapiro LR, Hampton MC, Mitchell BW. A longitudinal study of gross body composition and body conformation and their association with food and activity in a teenage population. Am J Clin Nutr. 1966; 13~ International Association for the Study of Obesity. Newsletter. Spring, Kumanyika S. Obesity in Black women. Epidemiol Rev. 1987; 9: Kumanyika S, Guilford-Davenport M. Weight-related attitudes and behaviors of Black women. J Am Diet Assoc. 1993;93: Maddox GL, Back KW, Liederman VR. Overweight as a social deviance and disability. J Health Soc Behav. 1968;9: Massara EB, Stunkard AJ. A method of quantifying cultural ideals of beauty and the obese. Int J Obes. 1979;3: Meyer JL, Bean LL. A decade later: A follow-up of social class and mental illness. New York: Wiley Publishing Company, National Center for Health Statistics. Health, United States, DHHS Publication No. (PHS) Government Printing Office, SPSS/PC+ Statistical Package for the Social Sciences. Version 4, Chicago, Illinois. 22. Ston NS, Greene WH. Body weight, body image and perception of fad diets in adolescent girls. J Nutr Ed ; 15: Census Data. Tax Assessor's office, Berkeley County, South Carolina. 24. Van Itallie T. Health implications of overweight and obesity in the U.S. Ann Intern Med. 1985;103: OBESITY RESEARCH Vol. 2 No. 1 Jan

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

Black and White Females Perceptions of Ideal Body Size.and Social Norms Karen A. Kernper, *Roger G. Sargent, *J. Wanzer Drane, *Robert E Valois, *James R. Hussey Abstract Different cultural norms and standards