Body Image Satisfaction Among Blacks

Abstract

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.

Keywords

Black community health health behavior health belief model obesity physical activity

The number of obese adults has risen rapidly in the United States, from 22.9% in 1988 to 1994 to 33.9% in 2007-2008 (Flegal, Carroll, Ogden, & Curtin, 2010; Flegal, Carroll, Ogden, & Johnson, 2002). These trends have significant public health implications, as the association between obesity and hypertension, type 2 diabetes mellitus, and coronary heart disease, as well as many other adverse physical and mental health conditions, is well documented (Field et al., 2001; Must et al., 1999). Blacks are particularly vulnerable to these increased risk factors with obesity prevalence of 37.3% and 49.6% for men and women, respectively, compared to 31.9% and 33.0% for White men and women, respectively (Flegal et al., 2010). Several studies have suggested potential racially dependent factors driving the high prevalence of obese individuals in the Black population. Specifically, these behavioral and social factors include low physical activity (Carter-Nolan, Adams-Campbell, & Williams, 1996; Crespo, Smit, Andersen, Carter-Pokras, & Ainsworth, 2000; S. A. James et al., 1998; Marshall et al., 2007); high-fat, low-fiber diets (Kristal, Feng, Coates, Oberman, & George, 1997); and differences in body size perceptions, relative to other ethnicities (Bhuiyan, Gustat, Srinivasan, & Berenson, 2003; Kronenfeld, Reba-Harrelson, Von Holle, Reyes, & Bulik, 2010).

Research suggests that both Black genders underestimate body size (Schuler et al., 2008; Gregory, Blanck, Gillespie, Maynard, & Serdula, 2008). Both overweight Black men and women were less likely to correctly perceive their overweight status (defined as having a body mass index [BMI] >25) when compared to other races of the same sex (Breitkopf, Littleton, & Berenson, 2007; Dorsey, Eberhardt, & Ogden, 2009; Gregory et al., 2008; Paeratakul, White, Williamson, Ryan, & Bray, 2002; Ver Ploeg, Chang, & Lin, 2008). More generally, Blacks, independent of weight status, were found to be between 1.72 and 2.82 times more likely to misestimate their weight status compared to other races (Bhuiyan et al., 2003; Rahman & Berenson, 2010).

Satisfaction with body image has been linked to better health outcomes, increased physical activity, lower BMI, and higher self-rated health in adult women (Anderson, Eyler, Galuska, Brown, & Brownson, 2002; Blake et al., 2013). Additionally, Kruger, Lee, Ainsworth, and Macera (2008) found that individuals who were more satisfied with their body image were more likely to be physically active, regardless of actual weight.

Yet differences exist between races regarding body image satisfaction. Black women tend to be more satisfied with larger body sizes and find larger body sizes more attractive than their White counterparts (Kronenfeld et al., 2010). Discrepancy scores, the difference between “actual” and “ideal” weight, revealed less body dissatisfaction among Black women than among White women (Kronenfeld et al., 2010; Lynch, Liu, Spring, Hankison, Wei, & Greenland, 2007). Thus, within the Black community, there may be little desire to change body size unless body size is deemed obese (Becker, Yanek, Koffman, & Bronner, 1999; Kronenfeld et al., 2010; Kumanyika, Wilson, & Guilford-Davenport, 1993; Lynch & Kane, 2014). Cultural norms and a lack of strong social pressures for smaller body sizes, combined with relatively positive body image at larger body sizes, may hinder motivation for sustained weight loss attempts among Black women (Kronenfeld et al., 2010; Kumanyika et al 1993).

Theoretically, the health belief model (HBM) helps explain why individuals maintain or change specific health behaviors through several constructs: perceived susceptibility, perceived severity, perceived benefit, perceived barriers, self-efficacy, and cues to action (Champion & Celette, 2008; Hochbaum, Kegels, & Rosenstock, 1952). The HBM has previously been used in several health promotion settings, including weight management (Daddario, 2007). Several of the constructs have implications for body perception and satisfaction and could influence long-term reduction in BMI. Misestimation of weight may indicate low perceived susceptibility. Research conducted with Black women identified that culture can affect perception of weight and the perception of susceptibility (D. C. S. James, Pobee, Oxidine, Brown, & Joshi, 2012). Self-efficacy also affects the way one reacts to potential discrepancies between perceived and actual body size. Valutis et al. (2008) hypothesize that individuals with discrepancies between current and realistic body sizes may have used disengaged coping strategies where little mental energy is put into the issue, often implying low self-efficacy, in a primarily White population.

Existing research has failed to address the potential association between misperception and satisfaction. If adults who underestimate their body size are more likely to be satisfied with their body image than those who correctly or overestimate their body size, traditional interventions attempting to reduce BMI might not be effective. The purpose of this study is to examine the relationship between body image satisfaction and body size perception in an urban, Black community sample.

Method

Sampling and Survey Methodology

A stratified random sample of households in three low-income, primarily Black neighborhoods in New Orleans, Louisiana, was drawn in 2006. Trained interviewers administered a survey covering the community social and physical environment, physical activity, health, interpersonal factors, demographics, height, and weight. Adults between 18 and 70 years who had lived in the neighborhood for at least 3 months were eligible to be interviewed. One respondent meeting these criteria was randomly selected from each household. A total of 497 interviews were completed out of 778 sampled households for a response rate of 64.1%. This study was conducted as part of the Partnership for an Active Community Environment project of the Prevention Research Center of Tulane University. The protocol and survey instrument were approved by the Tulane Institutional Review Board.

Measurement

“Actual” and “ideal” body sizes were assessed separately using the Figure Rating Scale, adapted from Stunkard, Sorensen, and Schulsinger (1983). The body silhouettes were arranged from 1 to 9, with 1 being the thinnest body type and 9 being the most overweight body type with height held constant (Figure 1). Individuals selected the silhouette that best represented their actual body size and then selected the silhouette that represented their ideal body size. BMI was calculated from self-reported weight (kg) divided by self-reported height (m²) and categorized into five weight status categories: (1) underweight: BMI < 18.5, (2) normal weight: BMI 18.5 to 24.9, (3) overweight: BMI 25 to 29.9, (4) obese: BMI 30 to 39.9, and (5) extremely obese: BMI ≥ 40 (Bhuiyan et al. 2003). The silhouettes were grouped into the same categories with (1) underweight = figures 1 and 2, (2) normal weight = figures 3 and 4, (3) overweight = figure 5, (4) obese = figures 6 and 7, and (5) extremely obese = figures 8 and 9 (National Heart Lung and Blood Institute, 1998). The BMI and “actual” silhouette categories were compared to create the variable Body Size Perception, coded “0” for those who underestimated their body size, “1” for those who correctly estimated their body size, and “2” for those who overestimated their body size. To determine if participants were satisfied with their body image, the “actual” and “ideal” choices were compared to see if respondents chose the same silhouette. Those who chose the same silhouette were coded “1” (satisfied) on the outcome variable Satisfied, and those who chose different actual and ideal silhouettes were coded “0” (unsatisfied).

Figure 1.

Body image silhouettes used for self-rated “actual” and “ideal” body image.

Figure 2.

Body image satisfaction.

Figure 3.

Body size perception: Concordance between self-reported BMI category and “actual” body image category (n = 429).

Several independent variables were considered in the analysis. Participants responded to multiple 5-item Likert-type scales, whereby strongly agree was coded 5 and strongly disagree was coded 1. Binary variables were then created by coding scores greater than or equal to 4 as 1 and scores less than 4 as 0. Cronbach’s alpha was estimated for each scale, and a composite score was created as an average of all responses.

General Support contained six items related to general support (free help for cleaning, for making small repairs, when feeling sick, for watching children (if applicable), for moving furniture, with transportation, and with loaning money: α = .86). Physical Activity Support contained four items measuring support for physical activity from (friends and family who live in the respondent’s neighborhood, neighbors, friends and family who live outside of the respondent’s neighborhood, and health care providers: α = 0.73). Health Awareness contained four items related to the benefits of physical activity (reduces the risk of heart disease, helps prevent high blood pressure, reduces the risk of diabetes, and helps prevent obesity: α = 0.83). Positive Health Attitude contained four items measuring the respondent’s attitudes on given claims associated with more physical activity (would have more energy, would look better, would feel better, and would be healthier: α = 0.89)

Other variables included Discussed Nutrition and Discussed PA (physical activity) if individuals participated in discussions related to nutrition and healthy eating habits or physical activity in the past month.

Levels of physical activity were classified according to the U.S. Department of Health and Human Services 2008 Guidelines for Americans, which recommends approximately 150 minutes of activity per week (Physical Activity Guidelines Advisory Committee, 2008). Individuals were deemed to meet the recommendation if they reported participating in one or more of the following activities at least five times a week for more than 30 minutes at a time: walking, walking a dog, jogging/running, riding a bicycle, aerobics, swimming, lifting weights, basketball, golf, tennis, bowling, dancing or second-lining (a New Orleans tradition of dancing and parading through the streets behind a brass band), or karate or other martial arts. Those who achieved recommended levels of activity were coded “1” on the variable Physically Active. Additionally, participants were asked if they engaged in any form of physical activity specifically to lose or maintain weight. Those who did so were coded “1” on Do PA to lose/maintain weight.

Additional variables included in the analysis were age, gender, income (less than $20,000 or greater), education (less than high school, high school graduate or GED, or more), employment (full or part-time vs. none), and BMI (in five categories as mentioned above).

Statistical Analysis

There were 497 individuals who completed the survey. Of these, 93.6% were Black and 4.4% were White. All non-Black participants and those older than 70 years were excluded (n = 53) from subsequent analyses.

All analyses were conducted using SAS software, Version 9.1. Frequencies were computed for all variables for each gender. Pearson chi-square test was used to assess differences between genders. Logistic regression was used to test bivariate associations between the outcome variable, Satisfied, and each independent variable. Those who chose a larger “ideal” than “actual” body size were dropped from the regression analysis because they would be motivated differently than those dissatisfied in the opposite direction. Thus, the regression models are based on a sample of 409.

Interactions between gender and each independent variable were tested. Each significant interaction (p < .05) was added individually to a full multivariable model containing all independent variables. Interactions that remained significant were retained in the final model. Interactions between Physically Active and Do PA to lose/maintain weight were also tested using the same procedures. Odds ratios (ORs), 95% confidence intervals (CIs), and p values are presented for the bivariate and multivariable models.

Results

Females represented 61.8% of the sample (Table 1). Males were more likely to be satisfied with their body image than females (51.8% vs. 36.4%, p < .001). However, there was no statistically significant difference in body size perception between men and women, with 39.0% of the sample underestimating their body size, compared to 44.1% who correctly perceived their size. Physical activity recommendations of 150 minutes per week were met by 62.4%, and 66.1% reported they do physical activity to lose or maintain their weight.

Table 1.

Respondent Characteristics by Gender.

Characteristic	Male, n = 167	Female, n = 277	Total, N = 444
Satisfied,^a %***	51.8	36.4	42.2
Body size perception,^b %
Underestimate	36.5	40.4	39.0
Correctly estimate	47.9	41.9	44.1
Overestimate	15.6	17.7	16.9
BMI categories, %**
Underweight, BMI < 18.5	1.2	1.1	1.2
Normal weight, BMI 18.5-24.9	37.0	25.9	30.2
Overweight, BMI 25-29.9	37.0	32.0	33.9
Obese, BMI 30-39.9	13.3	22.2	18.8
Extremely obese, BMI ≥40	11.5	18.8	16.0
Mean BMI (SD)***	28.0 (5.8)	30.1 (7.7)	28.8 (7.2)
Mean age, years (SD)	44.3 (13.9)	44.4 (14.1)	44.3 (14.0)
Employed full- or part-time, %***	69.1	45.9	54.7
Education, %
Less than HS	19.3	17.8	18.4
HS graduate or GED	46.4	43.3	44.4
Beyond HS	34.3	38.9	37.2
Annual income < $20,000, %*	54.3	65.0	61.4
Health awareness of PA benefits, %	77.8	82.7	80.9
Positive health attitude toward PA, %	85.0	86.6	86.0
Physically active (≥150 minutes/week), %	67.5	59.3	62.4
Do PA to lose/maintain weight, %	64.4	67.1	66.1
General support,^c %	60.5	58.1	59.0
Physical activity support,^d %	25.2	32.9	30.0
Discussed nutrition in past month, %**	49.1	64.0	58.5
Discussed PA in past month*	48.4	61.0	56.4

Note. BMI = body mass index; HS = high school; PA = physical activity.

“Actual” and “ideal body images are the same. ^bComparison between BMI category and “actual” image category. ^cCan get free help with daily living if needed. ^dFriends and family support person’s attempt to be active.

For difference by gender: *p < .05. **p < .01. ***p < .001.

Body Image Satisfaction

Figure 2 graphically represents the distribution of body image satisfaction. The 45° line in the figure represents concordance between “ideal” and “actual” body image. Circles above the 45° line represent those who chose an “ideal” silhouette larger than their “actual” silhouette. Circles below the line represent those who chose an “ideal” silhouette smaller than their “actual” silhouette. The size of the circle is proportional to the number of people in that category.

Those on the 45° line were satisfied with their body image (42.2%). Those above and below were not satisfied, with those above choosing a larger “ideal” than “actual” and those below choosing a smaller “ideal” than “actual.” The distance from the 45° line is the “degree of dissatisfaction,” with those farther from the line more dissatisfied than those closer to the line. The majority (69.2%) of the respondents chose an “ideal” image of either silhouette 3 or 4 on the Stunkard scale (Figure 1), in the normal BMI category and no one chose an ideal silhouette greater than silhouette 6. However, a much larger percentage of the sample (50.6% vs. 7.3%) chose a smaller “ideal” silhouette than a larger “ideal” silhouette, and the degree of dissatisfaction was higher among those who chose a smaller “ideal” (dissatisfaction data not shown).

Body Size Perception

Figure 3 Graphically Represents The Distribution Body Size Perception. The 45° Line Represents Concordance Between Self-Reported Bmi And “Actual” Body Image (Size Perception). Circles Above The 45° Line Represent Those Who Underestimated Their Body Size Bmi (And Report A Larger Bmi Than Image). Circles Below The Line Represent Those Who Overestimated Their Body Size (And Reported A Smaller Bmi Than Image). The Size Of The Circle Is Proportional To The Number Of People In That Category.

Those on the 45° line correctly matched their reported BMI with their chosen “actual” body image (44.1%). Those above (underestimated) and below (overestimated) the line misperceived their body size. The distance from the 45° line can be considered the “degree of misperception,” with those farther from the line having a higher degree of misperception than those closer to the line. A larger percentage of the sample (39.0% vs. 16.9%) underestimated rather than overestimated their size, and the degree of misperception was higher among those who underestimated.

Bivariate and multivariable regression models predicting body image satisfaction (concordance between the “actual” and “ideal” silhouette choices) are shown in Table 2. There was no significant difference between those who underestimated their body size and those who correctly estimated their size. However, in both the bivariate and multivariable models, those who overestimated their body size were less likely to be satisfied than those who correctly perceived their size (OR: 0.24, CI [0.12, 0.48]; final model). Interactions between body size perception and gender were not significant, indicating that there were no differences in the relationship by gender (data not shown).

Table 2.

Logistic Regression Models Predicting Body Image Satisfaction (n = 409).

	Bivariate models^a		Multivariate model^a
Variable	OR	95% CI	OR	95% CI
Body size perception^b
a. Underestimate	0.79	[0.51, 1.21]	0.77	[0.47, 1.24]
b. Overestimate	0.28***	[0.15, 0.51]	0.24***	[0.12, 0.48]
Female	0.49***	[0.30, 0.68]	0.43***	[0.27, 0.68]
Age	0.99	[0.98, 1.00]	—	—
Employment	0.96	[0.64, 1.42]	—	—
Education
a. High school or GED	0.59	[0.34, 1.02]	0.66	[0.36, 1.23]
b. Beyond high school	0.42**	[0.24, 0.73]	0.46*	[0.24, 0.88]
Income	0.75	[0.49, 1.17]	—	—
Health awareness of PA benefits	0.63	[0.38, 1.06]	—	—
Positive health attitude toward PA			0.31***	[0.16, 0.61]
a. Men	0.91	[0.35, 2.39]	—	—
b. Women	0.17****	[0.06, 0.38]	—	—
Physically active (≥150 minutes/week)	1.99***	[1.32, 3.00]	NA	NA
Do PA to lose/maintain weight	0.48***	[0.33, 0.76]	NA	NA
General support^c	1.48	[0.99, 2.21]	—	—
Support for PA^d	0.65	[0.43, 1.01]	—	—
Discussed nutrition	0.70	[0.47, 1.05]	—	—
Discussed PA	0.67*	[0.45, 0.99]	0.70	[0.44, 1.11]
Physically active × PA to lose
a. Active and doing PA to lose weight			0.29***	[0.15, 0.56]
b. Not active and doing PA to lose weight			0.98	[0.47, 2.06]
c. Doing PA to lose: Active (yes vs. no)			1.42	[0.80, 2.52]
d. Not doing PA to lose: Active (yes vs. no)			4.76***	[2.16, 10.51]

Note. OR = odds ratio; CI = confidence interval; PA = physical activity; NA = not applicable to interpret as term is significant in interaction.

Logistic regression models predicting satisfaction between “actual” and “ideal” body shape images. ^bComparison between body mass index category and “actual” image category. ^cCan get free help with daily living if needed. ^dFriends and family support person’s attempt to be active.

p < .05. **p < .01. ***p < .001.

In the multivariable model (Table 2), only variables significant in the bivariate models were included. Results were similar to the bivariate model with gender, education beyond high school, positive attitudes toward PA (full sample), participating in 150 or more minutes of physical activity per week, and participating in physical activity to lose or maintain weight all being significantly associated with body image satisfaction, with very similar magnitudes as in the bivariate models. The interaction between healthy attitudes and gender, significant in the bivariate model, was not significant in the multivariate model.

Women (OR: 0.43, CI [0.27,0.68]), those with an education beyond high school (OR: 0.46, CI [0.24, 0.88]), and those with positive health attitudes toward PA (OR: 0.31, CI [0.16, 0.61]) were less likely to be satisfied with their body image than men, those with less than a high school education, and those with negative health attitudes toward PA, respectively.

Among those who were being active, those who reported doing PA to lose weight were less satisfied than those who did not (OR: 0.29, CI [0.15, 0.56]) and those who were not doing activity to lose weight were 4.76 (CI [2.16, 10.51]) times more likely to be satisfied with their body image than those who were not active. Among those who were not active, there was no association between reporting doing PA to lose weight and satisfaction.

Additional models were tested for improved fit. An ordinal logistic regression model was tested to see if any of the parameter estimates changed dramatically when accounting for the degree of dissatisfaction, not just the dichotomized version of satisfaction. Because BMI might have an effect on satisfaction, a model that controlled for BMI was tested. In neither case did the amended specification improve the fit of the model.

Discussion

This research explores the relationship between body image satisfaction and body size perception in an inner-city, Black sample. Less than half (44.1%) correctly perceived their body size by reporting a BMI that matched the same category of their chosen “actual” image size. Satisfaction was low as only 42.2% of all respondents chose an actual body image silhouette concurrent with their ideal body image. Additionally, over half (50.6%) desired an ideal image smaller than their actual image. Although a large majority of individuals had misperceptions of their body size, those who underestimated their body size were no more satisfied than those who correctly perceived their size. However, those who overestimated their body size were much less likely to be satisfied compared to those who correctly perceived it (p < .001). Body image satisfaction was evident in those who were physically active (≥150 minutes per week) and not doing physical activity for the purpose of losing weight (p < .001).

The goal of trying to lose weight is inherent in dissatisfaction with weight (Anderson et al., 2002). Yet the ability to correctly identify one’s own obesity status may be related one’s motivation and self-efficacy for losing weight (Lynch et al., 2007; Truesdale & Stevens, 2008; Valutis et al., 2008). Correct identification of obesity status has been found to be problematic in those who are obese compared to normal weight individuals (Bennett & Wolin, 2006; Truesdale & Stevens, 2008). Our findings, as well as others’, have shown that people misperceive their weight status (Burke, Heiland, & Nadler, 2010; Flynn & Fitzgibbon, 1998; Ver Ploeg et al., 2008; Yancy, Simon, McCarthy, Lightstone, & Fielding, 2006).

The present study found the majority of Blacks identify an ideal body size in the normal BMI category and desire a smaller ideal than then their actual image. This is in contrast to other studies showing Black women accepting of large body sizes (Befort, Thomas, Daley, Rhode, & Ahluwalia, 2008; Parnell et al., 1996; Smith, Thompson, Raczynski, & Hilner, 1999). Additionally, those in heavier BMI categories underestimated or misperceived their body image, and the degree of misperception was greater among those who underestimated their body image. This underscores work by Truesdale and Stevens (2008) and Bennet and Wolin (2006) who found that few people who are obese correctly identified their weight category. In those studies, participants were asked to identify with words such as overweight and obese that may have cultural and other implications involving personal embarrassment or normative judgments that were unexplored (Gray et al., 2011). An additional body of literature suggests that Black women are particularly sensitive to value-laden words like obese (Thomas et al., 2009), which may influence their perceived susceptibility to chronic diseases related to obesity (D. C. S. James et al., 2012). We avoided any classifications using words.

Misperception of body size has major public health implications. Burke et al. (2010) noted a shift in norms related to fewer people self-classifying as overweight than just 10 years previously even though objective measures of overweight have been increasing. The construct of perceived susceptibility, a main tenant of the HBM, suggests that individuals are not likely to change behaviors if they do not perceive a problem. This suggests including a stronger component of personal awareness in public health messaging than currently exists. Interestingly, a positive attitude toward physical activity was found to be inversely related to body image satisfaction, where attitude may influence self-efficacy, a construct of the HBM. This complex relationship suggests that positive, gain-framed messages do not encourage prevention behaviors and that the prevention behaviors may be related to other aspects of health behavior theory (Berry & Carson, 2010; Okeefe & Jensen, 2007). Incorporation of regular physical activity in daily life is a recommendation for optimal health (Kumanyika et al., 2008). However, making that a reality may be difficult as motivation for physical activity has been found to vary by racial group (Mattfeldt-Beman et al., 1999; Kumanyika et al., 2008).

Having a lifestyle that includes physical activity other than to change weight status was found as the key to satisfaction with body image. All other significant variables showed an inverse relationship with satisfaction. Although previous research has shown body size satisfaction to be associated with physical activity regardless of weight status (Kruger et al., 2008), those measures did not determine satisfaction by comparing actual and ideal body images as was done in the present study. It is important to note that there are additional benefits achieved through a physically active lifestyle beyond body size satisfaction, including better mental health, better overall health, reduced mortality and chronic disease risk, and higher overall health-related quality of life (Bize, Johnson, & Plotnikoff, 2007; Blair, 2009; Centers for Disease Control and Prevention, 2011; Haskell, Blair, & Hill, 2009; Kim et al., 2012).

National surveys have found Black women to be less physically active and more likely overweight or obese than women of other racial groups (Crespo, Keteyian, Heath, & Sempos, 1996; Ogden et al., 2006). Compounded with a misperception of actual weight status, Blacks face a challenge in addressing the problem of obesity. Recognizing the ideal image and proportion of weight to height is not the issue for the majority, but the ability to self-identify weight status is. Previous research has suggested that Blacks, women specifically, may need help in assessing their weight in the context of their health risks (D. C. S. James et al., 2012).

The study has limitations that should be noted. The silhouettes used have a limited number of drawings and a restricted range of sizes, as well as a constant height across figure options (Gardner, Friedman, & Jackson, 1998). Issues of cultural relevance and the ability of urban Blacks to effectively use and relate to the Stunkard scale have also been raised (Pulvers et al., 2004). However, the scale is widely used and has been shown to be valid as indicators of BMI (Bhuiyan et al., 2003; Fallon & Rozin, 1985; Smith et al., 1999; Tehard, Van Liere, Nougue, & Clavel-Chapelon, 2002).

Self-reported weight and height are often misreported and could lead to inaccuracies in BMI (Brunner Huber, 2007; Meyer, McPartlan, Sines, & Waller, 2009). Earlier work found both genders underreported weight and overreported height and underestimated their image in relation to their BMI (Bhuiyan et al., 2003). This would attenuate the relationship as lower reported weights would show less of a difference between reported actual image and BMI.

The study has strengths that should be noted. Few studies focus on low-income Black men and women in an urban community environment. Differences between ideal and actual body image in relationship to weight status combined with a measure of physical activity, the assessment of support systems, health awareness, and attitudes toward physical activity lend the ability to describe a fuller picture of the factors related to body image satisfaction.

Conclusions

The present study highlights perception of body size as a factor related to satisfaction that other studies do not. Constructs from the HBM help explain how perception of body size and satisfaction may play a role in health behavior decisions. Improved satisfaction may lead to increased levels of physical activity, which in turn could lead to lower levels of obesity when paired with good nutrition and portion control. Public health messaging could focus more on correct awareness of body size and what a healthy body size looks like especially for Blacks, and use constructs from the HBM to create appropriate messaging. Additionally, practitioners and clinicians should focus on the language they use in counseling patients who are overweight or obese. Because it is often considered an insult to be called obese, it may be more appropriate to tell a patient he or she had been diagnosed with obesity than to label them as obese.

Footnotes

Acknowledgements

The authors wish to thank the Partnership for an Active Community Environment steering committee for their dedicated time to the project.

Authors’ Note

The content is solely the responsibility of the authors and does not necessarily represent the official views of the Centers for Disease Control and Prevention.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was part of the core research project of the Prevention Research Center at Tulane University School of Public Health and Tropical Medicine and was funded by Centers for Disease Control and Prevention Cooperative Agreement 1-U48-DP-000047.

References

Anderson

L. Y.

Eyler

A. A.

Galuska

D. A.

Brown

D. R.

Brownson

R. C.

(2002). Relationship of satisfaction with body size and trying to lose weight in a national survey of overweight and obese women aged 40 and older, United States. Preventive Medicine, 35, 390-396.

Becker

D. M.

Yanek

L. R.

Koffman

D. M.

Bronner

Y. C.

(1999). Body image preferences among urban African Americans and whites from low income communities. Ethnicity & Disease, 9, 377-386.

Befort

C. A.

Thomas

J. L.

Daley

C. M.

Rhode

P. C.

Ahluwalia

J. S.

(2008). Perceptions and beliefs about body size, weight, and weight loss among obese African American women: A qualitative inquiry. Health Education & Behavior, 35, 410-416.

Bennett

G. G.

Wolin

K. Y.

(2006). Satisfied or unaware? Racial differences in perceived weight status. International Journal of Behavioral Nutrition and Physical Activity, 3, 40. doi:10.1186/1479-5868-3-40

Berry

T. R.

Carson

(2010). Ease of imagination, message framing, and physical activity messages. British Journal of Health Psychology, 15, 197-211.

Bhuiyan

A. R.

Gustat

Srinivasan

S. R.

Berenson

G. S.

(2003). Differences in body shape representations among young adults from a biracial (Black-White), semirural community: The Bogalusa Heart Study. American Journal of Epidemiology, 158, 792-797.

Bize

Johnson

J. A.

Plotnikoff

R. C.

(2007). Physical activity and levels of health-related quality of life in general adult population: A systematic review. Preventative Medicine, 45, 401-415.

Blair

S. N.

(2009). Physical inactivity: The biggest public health problem of the 21st century. British Journal of Sports Medicine, 43, 1-2.

Blake

C. E.

Hebert

J. R.

Lee

D. C.

Adams

S. A.

Steck

S. E.

Sui

. . . Blair

S. N.

(2013). Adults with greater weight satisfaction report more positive health behaviors and have better health status regardless of BMI. Journal of Obesity, 2013, 1-13.

10.

Breitkopf

C. R.

Littleton

Berenson

(2007). Body image: A study in a tri-ethnic sample of low income women. Sex Roles, 56, 373-380.

11.

Brunner Huber

L. R.

(2007). Validity of self-reported height and weight in women of reproductive age. Maternal and Child Health Journal, 11, 137-144.

12.

Burke

M. A.

Heiland

F. W.

Nadler

C. M.

(2010). From “overweight” to “about right”: Evidence of a generational shift in body weight norms. Obesity, 18, 1226-1234.

13.

Carter-Nolan

P. L.

Adams-Campbell

L. L.

Williams

(1996). Recruitment strategies for black women at risk for noninsulin-dependent diabetes mellitus into exercise protocols: A qualitative assessment. Journal of the National Medical Association, 88, 558-562.

14.

Centers for Disease Control and Prevention. (2011). Physical activity and health: The benefits of physical activity. Retrieved from http://www.cdc.gov/physicalactivity/everyone/health/index.html

15.

Champion

V. L.

Celette

S. S.

(2008). The health belief model. In Glanz

Rimer

B. K.

Viswanath

(Eds.), Health behavior and health education: Theory, research, and practice (4th ed., pp. 45-66). San Francisco, CA: Jossey-Bass.

16.

Crespo

C. J.

Keteyian

S. J.

Heath

G. W.

Sempos

C. T.

(1996). Leisure time physical activity among US adults: Results from the third National Health and Examination Survey. Archives of Internal Medicine, 156, 93-98.

17.

Crespo

C. J.

Smit

Andersen

R. E.

Carter-Pokras

Ainsworth

B. E.

(2000). Race/ethnicity, social class and their relation to physical inactivity during leisure time: Results from the Third National Health and Nutrition Examination Survey, 1988-1994. American Journal of Preventative Medicine, 18, 46-53.

18.

Daddario

D. K.

(2007). A review of the use of the health belief model for weight management. Medsurg Nursing, 16, 363-366.

19.

Dorsey

R. R.

Eberhardt

M. S.

Ogden

C. L.

(2009). Racial/ethnic differences in weight perception. Obesity, 17, 790-795.

20.

Fallon

A. E.

Rozin

(1985). Sex differences in perceptions of desirable body shape. Journal of Abnormal Psychology, 94, 102-105.

21.

Field

A. E.

Coakley

E. H.

Must

Spadano

J. L.

Laird

Dietz

W. H.

. . . Colditz

G. A.

(2001). Impact of overweight on the risk of developing common chronic diseases during a 10 year period. Archives of Internal Medicine, 161, 1581-1586.

22.

Flegal

M. K.

Carroll

M. D.

Ogden

C. L.

Curtin

L. R.

(2010). Prevalence and trends in obesity among US adults, 1999-2008. Journal of the American Medical Association, 303, 235-241.

23.

Flegal

M. K.

Carroll

M. D.

Ogden

Johnson

(2002). Prevalence and trends in obesity among US adults, 1999-2000. Journal of the American Medical Association, 288, 1723-1727.

24.

Flynn

K. J.

Fitzgibbon

(1998). Body images and obesity risk among black females: A review of the literature. Annals of Behavioral Medicine, 20, 13-24.

25.

Gardner

R. M.

Friedman

B. N.

Jackson

N. A.

(1998). Methodological concerns when using silhouettes to measure body image. Perceptual and Motor Skills, 86, 387-395.

26.

Gray

C. M.

Hunt

Lorimer

Anderson

A. S.

Benzeval

Wyke

(2011). Words matter: A qualitative investigation of which weight status terms are acceptable and motivate weight loss when used by health professionals. BMC Public Health, 11, 513. doi:10.1186/1471-2458-11-513

27.

Gregory

C. O.

Blanck

H. M.

Gillespie

Maynard

L. M.

Serdula

M. K.

(2008). Health perceptions and demographic characteristics associated with underassessment of body weight. Obesity, 16, 979-986.

28.

Haskell

W. L.

Blair

S. N.

Hill

J. O.

(2009). Physical activity: Health outcomes and importance for public health policy. Preventive Medicine, 49, 280-282.

29.

Hochbaum

Kegels

Rosenstock

(1952). Health belief model. Washington, DC: U.S. Public Health Service.

30.

James

D. C. S.

Pobee

J. W.

Oxidine

Brown

Joshi

(2012). Using the health belief model to develop culturally appropriate weight-management materials for African-American women. Journal of the Academy of Nutrition and Dietetics, 122, 664-670.

31.

James

S. A.

Jamjoun

Raghunathan

T. E.

Strogatz

D. S.

Furth

E. D.

Khazanie

P. G.

(1998). Physical activity and NIDDM in African-Americans: The Pitt County Study. Diabetes Care, 21, 555-562.

32.

Kim

Y. S.

Park

Y. S.

Allegrante

J. P.

Marks

Cho

K. O.

Garber

C. E.

(2012). Relationship between physical activity and general mental health. Preventative Medicine, 55, 458-463.

33.

Kristal

A. R.

Feng

Coates

R. J.

Oberman

George

(1997). Associations of race/ethnicity, education, and dietary intervention with the validity and reliability of a food frequency questionnaire: The Women’s Health Trial Feasibility Study in Minority Populations. American Journal of Epidemiology, 146, 856-869.

34.

Kronenfeld

L. W.

Reba-Harrelson

Von Holle

Reyes

M. L.

Bulik

C. M.

(2010). Ethnic and racial differences in body size perception and satisfaction. Body Image, 7, 131-136.

35.

Kruger

Lee

C.-D.

Ainsworth

B. E.

Macera

C. A.

(2008). Body size satisfaction and physical activity levels among men and women. Obesity, 16, 1976-1979.

36.

Kumanyika

S. K.

Obarzanek

Stettler

Bell

Field

A. E.

Fortmann

S. P.

. . . Poston

W. C.

II . (2008). Population-based prevention of obesity: The need for comprehensive promotion of healthful eating, physical activity, and energy balance: A scientific statement from American Heart Association Council on Epidemiology and Prevention, Interdisciplinary Committee for Prevention (formerly, the Expert Panel on Population and Prevention Science). Circulation, 118, 428-464.

37.

Kumanyika

S. K.

Wilson

J. F.

Guilford-Davenport

(1993). Weight-related attitudes and behaviors of black women. Journal of the American Dietetic Association, 95, 416-422.

38.

Lynch

Liu

Spring

Hankison

Wei

G. S.

Greenland

(2007). Associations of ethnicity and socioeconomic status with judgments of body size: The Coronary Artery Risk Development in Young Adults (CARDIA) study. American Journal of Epidemiology, 165, 1055-1062.

39.

Lynch

E. B.

Kane

M. S.

(2014). Body size perceptions among African American women. Journal of Nutrition Education and Behavior, 46, 412-417.

40.

Marshall

S. J.

Jones

D. A.

Ainsworth

B. E.

Reis

J. P.

Levy

S. S.

Macera

C. A.

(2007). Race/ethnicity, social class, and leisure-time physical inactivity. Medicine & Science in Sports & Exercise, 39, 44-51.

41.

Mattfeldt-Beman

M. K.

Corrigan

S. A.

Stevens

V. J.

Sugars

C. P.

Dalcin

A. T.

Givi

M. J.

Copeland

K. C.

(1999). Participants’ evaluation of a weight loss program. Journal of the American Dietetic Association, 99, 66-71.

42.

Meyer

McPartlan

Sines

Waller

(2009). Accuracy of self-reported weight and height: Relationship with eating psychopathology among young women. International Journal of Eating Disorders, 42, 379-381.

43.

Must

Spadano

Coakley

E. H.

Field

A. E.

Colditz

Dietz

W. H.

(1999). The disease burden associated with overweight and obesity. Journal of the American Medical Association, 282, 1523-1529.

44.

National Heart Lung and Blood Institute. (1998). Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: The evidence report (Report No. 98-4083). Washington, DC: National Institutes of Health.

45.

Ogden

C. L.

Carroll

M. D.

Curtin

L. R.

McDowell

M. A.

Tabak

C. J.

Flegal

K. M.

(2006). Prevalence of overweight and obesity in the United States, 1999-2004. Journal of the American Medical Association, 295, 1549-1555.

46.

Okeefe

D. J.

Jensen

J. D.

(2007). The relative persuasiveness of gain-framed and loss-framed messages for encouraging disease prevention behaviors: A meta-analytic review. Journal of Health Communication, 12, 623-624.

47.

Paeratakul

White

M. A.

Williamson

D. A.

Ryan

D. H.

Bray

G. A.

(2002). Sex, race/ethnicity, socioeconomic status, and BMI in relation to self-perception of overweight. Obesity Research, 10, 345-350.

48.

Parnell

Sargent

Thompson

S. H.

Duhe

S. F.

Valois

R. F.

Kemper

R. C.

(1996). Black and white adolescent females’ perceptions of ideal body size. Journal of School Health, 66, 112-118.

49.

Physical Activity Guidelines Advisory Committee. (2008). Physical activity guidelines advisory committee report, 2008. Washington, DC: US Department of Health and Human Services.

50.

Pulvers

K. M.

Lee

R. E.

Kaur

Mayo

M. S.

Fitzgibbon

M. L.

Jeffries

S. K.

. . . Ahluwalia

J. S.

(2004). Development of a culturally relevant body image instrument among urban African Americans. Obesity Research, 12, 1641-1651.

51.

Rahman

Berenson

A. B.

(2010). Self-perception of weight and its association with weight-related behaviors in young, reproductive-aged women. Obstetrics & Gynecology, 116, 1274-1280.

52.

Schuler

P. B.

Vinci

Isoaari

R. M.

Philipp

S. F.

Todorovich

Roy

J. L.

Evans

R. R.

(2008). Body-shape perceptions and body mass index of older African American and European American Women. Journal of Cross Cultural Gerontology, 23, 255-264.

53.

Smith

D. E.

Thompson

J. K.

Raczynski

J. M.

Hilner

J. E.

(1999). Body image among men and women in a biracial cohort: The CARDIA study. International Journal of Eating Disorders, 25, 71-82.

54.

Stunkard

A. J.

Sorensen

Schulsinger

(1983). Use of the Danish Adoption Register for the study of obesity and thinness. Research Publications—Association for Research in Nervous and Mental Disease, 60, 115-20.

55.

Tehard

Van Liere

M. J.

Nougue

C. C.

Clavel-Chapelon

(2002). Anthropometric measurements and body silhouette of women: Validity and perception. Journal of the American Dietetic Association, 102, 1779-1784.

56.

Thomas

J. L.

Stewart

D. W.

Lynam

I. M.

Daley

C. M.

Befort

Scherber

R. M.

. . . Ahluwalia

J. S.

(2009). Support needs of overweight African American women for weight loss. American Journal of Health Behavior, 33, 339-352.

57.

Truesdale

K. P.

Stevens

(2008). Do the obese know they are obese? North Carolina Medical Journal, 69, 188-194.

58.

Valutis

S. A.

Goreczny

A. J.

Wister

J. A.

Newton

Popp

Vavrek

(2008). Relationship among coping, weight preoccupation, and body image in college undergrads. Journal of Psychiatry, Psychology and Mental Health, 2, 1-11.

59.

Ver Ploeg

M. L.

Chang

H. H.

Lin

B. H.

(2008). Over, under of about right: misperceptions of body weight among food stamp participants. Obesity, 16, 2120-2125.

60.

Yancy

A. K.

Simon

P. A.

McCarthy

W. J.

Lightstone

A. S.

Fielding

J. E.

(2006). Ethnic and sex variations in overweight self-perception: Relationship to sedentariness. Obesity, 14, 980-988.