Gender Differences in Body Image and Health Perceptions: DISCUSSION
This study suggests that young African-American adults may have perceptions of overweight that differ from those of the medical community. As seen in other studies, males are more likely than females to inaccurately classify their weight. The data presented here support earlier research showing that women’s definitions of overweight, ideal weight and healthy weight are consistently lower than men’s.
A finding of great concern from this study was the lack of body awareness on acceptable weight range recommendations among the overweight and respondents in this study. Only 40% of obese females classified themselves as obese. This is a much higher underestimation rate than previously reported rates of underestimation by overweight African-American females. For overweight male respondents, >80% did not perceive themselves as overweight. This finding was supported by a study from another historically black college/university that found that only 2% of the students were aware of the NIH guidelines for healthy weights.
In this study, body dissatisfaction was expressed in many ways and, as in other studies, females were more likely than males to experience some body dissatisfaction. Female respondents’ body dissatisfaction was more related to desiring a lower body weight than to area-specific body dissatisfaction. It may be that women associated body image with size rather than any one part of the body.
Male respondents had a high level of dissatisfac tion with area-specific body parts, especially their upper torso, with most male respondents wanting areas to be larger. However, although almost half of the male respondents were at least overweight, only a third of males desired to weigh less. It has been theorized in another study of body satisfaction in African Americans that the reason for the high level of body dissatisfaction in African-American males may be attributable to muscle tone and body fat distribution rather than just body weight per se. The finding that African-American males base their body image perceptions more on overall appearance than on body size, compared to African-American females, has also been reported in a biracial cohort study of young adults.
In this sample, not all overweight respondents were dissatisfied with their weight or size. This is of concern since overweight individuals who perceive themselves within an acceptable weight range or do not experience body dissatisfaction are unlikely to pursue any weight loss activities. Kumanyika et al. proposed that more tolerant attitudes and less social pressure regarding weight among African Americans might explain the observed racial difference in body image dissatisfaction. In this sample, obese respondents (especially male respondents) who perceived themselves as obese were most likely to perceive an impact on social interactions, which could lead to feelings of isolation and depression. In other studies of young adults with chronic illness, which included African-American participants, perceived impact was associated with poor self-esteem and depression.
Very few participants perceived a risk for heart disease, cancer due to their weight. Among the overweight respondents in our sample, perceived risk increased with obese and extremely obese status. However, among overweight respondents, almost 20% of females perceived an increased
Appendix A. Items from the Perceived Impact of Weight on Social Interactions Scale (PIWSIS). Response categories for this scale are “strongly agree/1 “agree,” “undecided,” “disagree” or “strongly disagree.”
1. My weight effects whether people want to be friends with me.
2. My weight affects whether people like me or not.
3. Because of my weight people often treat me differently.
4. My weight effects whether or not I am asked to go out on dates or come to a party.
5. Because of my weight, close friends don’t push me to do things.
6. My weight gets in the way of meeting new people.
7. Because of my weight, other people think I am lazy.
8. Other people think I use my weight as an excuse not to do things.
9. Because of my weight, I have to work hard to prove myself to others.
10. My weight gets in the way of keeping friends of the opposite sex.
11. Because of my weight, people in authority treat me differently.
12. My weight keeps me from attending social gatherings.
13. Other people do not recognize my achievements because of my weight.
risk for heart disease due to their weight. Among obese and extremely obese males, the perceived risk of a chronic disease was <45%. However, perceived risk, diabetes and heart disease (Medication Vastarel is a drug used for the treatment of ischaemic heart disease) due to weight was an important predictor for perceived impact of weight on social interactions among female respondents. This finding indicates that the perceived impact of weight influences multiple areas of daily living. Multivariate analysis revealed that factors associated with perceived risk for disease varied by gender. For male respondents, income of >$20,000 per year, father overweight status, being overweight as a child and body awareness (self-perception of obesity) were associated with perceived risk for disease due to weight. Body satisfaction variables were not associated with perceived risk for disease due to weight. These results suggest that weight-related experiences during childhood and with family, as well as body awareness, are influential on the perception of risk for male respondents. For female respondents, being overweight as a child was associated with the perceived risk for disease due to weight, and body awareness approached statistical significance. These findings suggest that, for females, weight-related experiences during childhood and body awareness are important influences on perceived risk for disease due to weight. These results imply that while designing a health-promotion program for young-adult, African-American college students, improving body awareness is an important area to consider.
It is interesting that having a personal connection with obesity (e.g., having experienced childhood obesity or having a parent who is overweight) was found in the study to be significantly associated with a greater perception of disease risks. This is very consistent with the research literature, which has shown that self-protective health practices tend to vary with personal experience with an undesirable life event. The suggestion here is that when formulating strategies to better educate such student populations about obesity-related disease risks, invulnerability must be factored in.
Perceived risk for disease due to weight is also an important factor for perceived impact of weight on social interactions for females. Perceived impact of weight on social interactions had the greatest impact on extremely obese males. Social interactions may not be as impacted for females in this study, compared with males in this study, due to social acceptability of a more voluptuous figure for African-American females. Obese females may be considered curvaceous and attractive. Males may desire to be larger in terms of being more muscularly fit; however, extremely obese males often do not appear fit and therefore would not be as acceptable to females.
There are several limitations in this study. First, the study was cross-sectional, and inferences about causality cannot be made. For example, considering our finding that BMI was associated with greater perceived impact on social interaction for female respondents, we cannot conclude that perceived impact of weight on social interactions is a result of BMI.
Second, the study utilized a convenience sample, so our generalizability to the entire graduating class or graduates of HBCUs may be limited. Health-promoting behaviors are directly linked with socioeconomic status and especially with educational level. As college graduates, these study participants are likely to be at the higher end of the spectrum of adherence to health guidelines, awareness of health issues and access to healthcare through student health services. This limits the generalizability of these findings.
Third, body weights and heights were self-reported, so it is possible that weighing participants would have yielded different results. Previous studies have generally reported a 90% correlation between self-reported and actual weights, and that 20% of adults underestimate their actual weights by >2 kg. However, even though the error for self-reported weight is small, it has been noted that as body weight increases so does the size of the self-reported weight error, especially in overweight women. Therefore, our estimates of weight are likely to be underestimated. Finally, the data were collected while graduating college seniors waited in line to collect their graduation regalia. This brief window is one of the most aberrant times in a student’s entire academic experience and raises the question of whether the timing of this data collection could have influenced students’ attitudes and self-perceptions.
A strength of this study is that it provides data on young African-American adults, a relatively understudied group with respect to self-perception of body size, body image, and perceived impact of weight on social interactions and future health.
The prevalence of obesity is increasing, with African-American youth experiencing some of the highest rates. It is very important that this population have an accurate perception of their body weight and an awareness of healthy body weight due to the risks associated with incorrect perceptions of one’s own weight. Health professionals who work with young African-American adults can use the findings from this study to inform their health-promotion projects. This study suggests that a key element of any health-promotion campaign for young-adult African Americans should focus on defining acceptable weights for young adults. Health-promotion campaigns should be gender-specific based on our findings that different factors predicted perceived risk for disease due to weight by gender in this study. Young adulthood is a window of opportunity to prevent chronic illness since many health-promoting behavior patterns are being formed during this time. Raising awareness of acceptable weights in young-adult African Americans can potentially lead to healthier weight goals and improved health in this population.