BMI, Body Image, Emotional Well-Being and Weight-Control Behaviors in Urban African American Adolescents
Keywords:Obesity, overweight, weight control behaviors, African American.
Importance: While urban African American adolescents face significant health disparities associated with overweight and obesity that follow them into adulthood; there is limited data on body image, emotional well-being, and weight control behaviors in this population to design effective public health interventions.
Objective: This study was designed to understand the association of weight status to adolescent weight control, body image, and emotional well-being responses, in African American high school students.
Design/Setting/Participants: The study cohort consisted of 776 students, mean age 15.8 years (Â±1.2). Data from Guidelines for Adolescent Preventive Services (GAPS) student surveys and anthropometric studies were collected at School-Based Health Centers.
Main Outcome Measures: Associations between adolescent responses on the GAPS and body mass index (BMI) status (healthy weight: 5th to less than 85th percentile, overweight: 85th to less than 95th percentile, obese: 95th percentile or greater) were estimated using logistic regression and dose- response plots.
Results: There were statistically significant associations between BMI category and weight control (ranging from a mean 5.18 to 7.68 odds of obesity) and body image (3.40 to 13.26 odds of obesity) responses. Responses to weight control and body image questions exhibited a dose- response for odds of overweight and obesity. Feelings of depressed mood were associated with obesity (1.47 times the odds of obesity compared to students who did not endorse depressed mood; 95% CI, 1.01 to 2.13) but not overweight status.Conclusion and Relevance: Overweight and obese urban African American adolescents are more likely to screen positively on weight control risk behaviors and negative body image questions than their normal weight peers. The weight control and body image measures on the GAPS may provide information to identify youth in need of services and those motivated for brief school-based weight control interventions.
 Hedley AA, Ogden CL, Johnson CL, Carroll MD, Curtin LR, Flegal KM. Prevalence of overweight and obesity among US children, adolescents, and adults, 1999-2002. JAMA 2004; 291(23): 2847-2850.
 Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011-2012. JAMA 2014; 311(8): 806-814.
 Rudolf M, Christie D, McElhone S, et al. WATCH IT: a community based programme for obese children and adolescents. Arch Dis Child 2006; 91(9): 736-739.
 Centers for Disease Control and Prevention, Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion. Childhood Obesity Facts 2014; http://www.cdc.gov/obesity/ data/childhood.html. Accessed 10/11/2014, 2014.
 Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA 2003; 289(1): 76-79.
 Freedman DS, Dietz WH, Srinivasan SR, Berenson GS. The relation of overweight to cardiovascular risk factors among children and adolescents: the Bogalusa Heart Study. Pediatrics 1999; 103(6 Pt 1): 1175-1182.
 Sugiyama T, Xie D, Graham-Maar RC, Inoue K, Kobayashi Y, Stettler N. Dietary and lifestyle factors associated with blood pressure among U.S. adolescents. J Adolesc Health 2007; 40(2): 166-172.
 U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion Healthy People 2020. 2010; http://www.healthypeople.gov/2020/topics-objectives/topic/nutrition-and-weight-status/objectives. Accessed 10/10/2014, 2014.
 Ogden CL, Carroll MD, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011-2012. JAMA 2014; 311(8): 806-814.
 Center for Disease Control and Prevention. CDC Health Disparities and Inequalities Report — United States, 2013. Atlanta, GA: Centers for Disease Control and Prevention; 2013.
 Office of Minority Health. Obesity and African Americans. 2013; http://minorityhealth.hhs.gov/omh/browse.aspx?lvl= 4&lvlID=25. Accessed 9/27/2014, 2014.
 Whitaker RC, Orzol SM. Obesity among US urban preschool children: relationships to race, ethnicity, and socioeconomic status. Arch Pediatr Adolesc Med 2006; 160(6): 578-584.
 Kimm SY, Barton BA, Obarzanek E, et al. Racial divergence in adiposity during adolescence: The NHLBI Growth and Health Study. Pediatrics 2001; 107(3): E34.
 Herget S, Rudolph A, Hilbert A, Bluher S. Psychosocial Status and Mental Health in Adolescents before and after Bariatric Surgery: A Systematic Literature Review. Obesity Facts 2014; 7(4): 233-245.
 Ali MM, Minor T, Amialchuk A. Estimating the biases associated with self-perceived, self-reported, and measured BMI on mental health. PloS One 2013; 8(12): e81021.
 Witherspoon D, Latta L, Wang Y, Black MM. Do depression, self-esteem, body-esteem, and eating attitudes vary by BMI among African American adolescents? J Pediatr Psychol 2013; 38(10): 1112-1120.
 Lincoln KD, Abdou CM, Lloyd D. Race and socioeconomic differences in obesity and depression among Black and non-Hispanic White Americans. J Health Care Poor Underserved 2014; 25(1): 257-275.
 Powell-Young YM, Zabaleta J, Velasco-Gonzalez C, Sothern MS. A cohort study evaluating the implications of biology, weight status and socioeconomic level on global self-esteem competence among female African-American adolescents. JNBNA 2013; 24(1): 1-8.
 Whaley AL, Smith M, Hancock A. Ethnic/racial differences in the self-reported physical and mental health correlates of adolescent obesity. Journal of Health Psychology 2011; 16(7): 1048-1057.
 Thompson SH, Rafiroiu AC, Sargent RG. Examining gender, racial, and age differences in weight concern among third, fifth, eighth, and eleventh graders. Eat Behav 2003; 3(4): 307-323.
 Gluck M, Geliebter A. Racial/ethnic differences in body image and eating behaviors. Eating Behaviors 2002; 3: 143-151.
 Neumark-Sztainer D, Croll J, Story M, Hannan PJ, French SA, Perry C. Ethnic/racial differences in weight-related concerns and behaviors among adolescent girls and boys: findings from Project EAT. Journal of Psychosomatic Research 2002; 53(5): 963-974.
 Franko DL, Striegel-Moore RH. The role of body dissatisfaction as a risk factor for depression in adolescent girls: are the differences Black and White? J Psychosom Res 2002; 53(5): 975-983.
 Field AE, Aneja P, Austin SB, Shrier LA, de Moor C, Gordon-Larsen P. Race and gender differences in the association of dieting and gains in BMI among young adults. Obesity. 2007; 15(2): 456-464.
 Botta RA. The Mirror of Television: A Comparison of Black and White Adolescents’ Body Image. Journal of Communication 2000; 50(3): 144.
 Slater JM, Guthrie BJ, Boyd CJ. A feminist theoretical approach to understanding health of adolescent females. J Adolesc Health 2001; 28(6): 443-449.
 Johnson-Askew WL, Fisher R, Henderson K, Schwartz M. Attitudes of African American advocates toward childhood obesity. Ethnicity & Disease 2011; 21(3): 268-273.
 Flynn KJ, Fitzgibbon M. Body images and obesity risk among black females: a review of the literature. Ann Behav Med 1998; 20(1): 13-24.
 Sivalingam SK, Ashraf J, Vallurupalli N, Friderici J, Cook J, Rothberg MB. Ethnic differences in the self-recognition of obesity and obesity-related comorbidities: a cross-sectional analysis. Journal of General Internal Medicine 2011; 26(6): 616-620.
 Fan M, Jin Y, Khubchandani J. Overweight Misperception among Adolescents in the United States. Journal of Pediatr Nurs 2014; pii So882-5963(14)00204-8
 Trent M, Jennings JM, Waterfield G, Lyman LM, Thomas H. Finding targets for obesity intervention in urban communities: school-based health centers and the interface with affected youth. J Urban Health 2009; 86(4): 571-583.
 Klein JD, Slap GB, Elster AB, Cohn SE. Adolescents and access to health care. Bull NY Acad Med 1993; 70(3): 219-235.
 Nihiser AJ, Lee SM, Wechsler H, et al. Body mass index measurement in schools. J Sch Health 2007; 77(10): 651-671.
 Stata Intercooled: Release 13 [computer program]. College Station, TX2013.
 Edwards NM, Pettingell S, Borowsky IW. Where perception meets reality: self-perception of weight in overweight adolescents. Pediatrics 2010; 125(3): e452-458.
 Gonsalves D, Hawk H, Goodenow C. Unhealthy weight control behaviors and related risk factors in massachusetts middle and high school students. Maternal and Child Health J 2014; 18(8): 1803-1813.
 Li F, Harmer P, Cardinal BJ, Bosworth M, Johnson-Shelton D. Obesity and the built environment: does the density of neighborhood fast-food outlets matter? American J Health Promot 2009; 23(3): 203-209.
 Owen N, Leslie E, Salmon J, Fotheringham MJ. Environmental determinants of physical activity and sedentary behavior. Exerc Sport Sci Rev 10/2000 2000; 28(4): 153-158.
 Gomez JE, Johnson BA, Selva M, Sallis JF. Violent crime and outdoor physical activity among inner-city youth. Prev Med 2004; 39(5): 876-881.
 Whitaker D, Milam AJ, Graham CM, Cooley-Strickland M, Belcher HM, Furr-Holden CD. Neighborhood environment and urban schoolchildren's risk for being overweight. American Journal of Health Promot 2013; 27(6): 410-416.
 Substance Abuse and Mental Health Services Administration. Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings. Rockville, MD: Substance Abuse and Mental Health Services Administration 2013.
 Taveras EM, Gortmaker SL, Mitchell KF, Gillman MW. Parental perceptions of overweight counseling in primary care: the roles of race/ethnicity and parent overweight. Obesity 2008; 16(8): 1794-1801.
 Gortmaker SL, Must A, Perrin JM, Sobol AM, Dietz WH. Social and economic consequences of overweight in
adolescence and young adulthood. N Engl J Med 1993; 329(14): 1008-1012.
 National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division for Adolescent and School Health, Youth Online, http://www.cdc.gov/nchhstp/. Accessed, 1/4/15.
 Obama M. Let's Move. 2010; http://www.letsmove.gov/. Accessed 10/22/2014, 2014.
Policy for Journals/Articles with Open Access
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are permitted and encouraged to post links to their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work
Policy for Journals / Manuscript with Paid Access
Authors who publish with this journal agree to the following terms:
- Publisher retain copyright .
- Authors are permitted and encouraged to post links to their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work .