When Talking About Body Size, African American Women & Doctors May Be Speaking Different Languages

Research shows potential for misunderstanding between doctors and patients about a critical health issue

Philadelphia, PA, September 10, 2014

African American women and their female children have the highest obesity prevalence of any demographic group and are more likely to underestimate their body weight than white women. Yet, according to new research from Rush University Medical Center, cultural norms for body size may prevent awareness among many African American women about the potential health benefits they and others in their cultural group might achieve through weight loss.

Led by Elizabeth Lynch, PhD, this research recruited African American women in a low-income neighborhood of Chicago. All 69 participants were full-time caretakers of at least one child and the mean age of the subjects was 38 years. For the study, women were asked to use the Body Image Scale to classify figures on the scale as overweight, obese, or too fat and identify their own body size.


Caption: Body image scale. Adapted with permission from Macmillan Publishers, Ltd. Obesity. Pulvers et al. (2004). Development of a culturally relevant body image instrument among urban African Americans. Obesity Res. 2004;12:1641–1651.

Regardless of their weights, women in this study agreed which figures on the Body Image Scale were overweight, obese, and too fat. The majority classified Body Figures 6–9 as overweight and Body Figures 8 and 9 as obese and too fat. Therefore, overweight body sizes were not considered too fat. In fact, having the women classify their own body size according to cultural definitions revealed a large chasm between biomedical and cultural definitions of body size. The 56% of overweight women (BMI 25 or greater) and 40% of obese women (BMI 30 or greater) did not classify their body size as overweight, obese, or too fat. The cultural threshold for overweight was determined to be about a BMI of 35, which is higher than the medical definition of ≥25.

"Interestingly, research suggests that weight threatens mortality at a BMI>35, so perhaps the cultural definition captures some important health effects associated with larger body sizes. But the fact that women felt that overweight body sizes were not too fat suggests that being told they are overweight, even by a physician, may not be sufficient motivation for them to attempt to lose weight," Lynch said.

Although there were limitations to this study, namely self-reporting of height and weight data for BMI calculation, the results further understanding of attitudes among African American women about body weight and image. Specifically, this study goes further than others in identifying the cultural belief that overweight bodies are not too fat. Thus, the researchers believe more effort toward education regarding body size should be exerted, and biomedical definitions of body size should be taught using visual aids.


Notes for editors
"Body Size Perception Among African American Women," by Elizabeth B. Lynch, PhD, and John Kane, MS (DOI: http://dx.doi.org/10.1016/j.jneb.2014.03.002), Journal of Nutrition Education and Behavior, Volume 46/Issue 5 (September/October 2014), published by Elsevier. 

Full text of the article is available to credentialed journalists upon request; contact Eileen Leahy at +1 732-238-3628or jnebmedia@elsevier.com to obtain copies. To schedule an interview with the authors, please contact Kevin McKeough at +1 312-942-7820 or Kevin_McKeough@rush.edu.

An audio podcast featuring an interview with Dr. Elizabeth B. Lynch is located at www.jneb.org/content/podcast. Excerpts from the podcast may be reproduced by the media; contact Eileen Leahy to obtain permission.

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