To address the high prevalence of overweight among youth, investigators have called for consideration of youths' perceptions (26
) in addition to other factors. This pilot study explored and identified important weight-related perceptions and attitudes among a sample of overweight African American girls. Pertinent findings were that 1) weight and body size preferences are personally determined attributes that are less influenced by the opinions of those outside of one's social circle; 2) food choices depend on texture, taste, appearance, and context of the food; 3) engagement in physical activity is influenced by social and environmental factors such as time constraints imposed by school and extracurricular activities; 4) participation in structured physical activity is limited because of the cost in time related to maintenance of personal aesthetics (hair and nails); and 5) some celebrities are not realistic models for diet and physical activity habits. In this sample of girls, these findings suggest that weight-related behaviors and attitudes are influenced by culturally based perceptions as well as contexts.
Previous studies of African American girls document a preference for larger body size, which is often supported by positive reinforcement from adults (5
). This study further adds that body size was perceived to be related to a specific stage of life. In their discussions, participants specifically contrasted their weight in elementary school with their current weight and noted that weight was stage-dependent, implying that as one matures in age, one is supposed to progress to a larger body size and weight. Additionally, as with previous findings in adult females, the girls in this study conceptualized body size and weight on a normative, culturally based scale (32
) and mentioned family and friends as their body size references. This finding suggests that weight and body size are socially comparative attributes in this sample and further illustrates how culture affects girls' values and their self-estimations of their bodies.
Personally oriented values such as physical attractiveness, personal satisfaction, self-esteem, and comfort were consistently expressed by participants in their descriptions of body size, dietary preferences, and thoughts about other cultural groups. For example, nutrition and weight habits of white girls were perceived to be externally motivated and the cause and evidence of low self-esteem, therefore, an undesirable behavior. The participants stated they valued physical satiety over others' opinions and consequently evidenced personal responsibility for their own healthy sense of self. Incidentally, studies comparing black and white women report that despite experiencing comparable displeasure at negative comments, black women's self-esteem is not influenced by general positive or negative social feedback (33
). In addition, Patterson (34
) posits that among African American females, relevant "others" serve as the source of self-estimations and enable them to be rooted against negative self-estimations (34
). Because the girls in our study indicated that the relevant people in their lives were their African American friends and families, these people could be integral to the success of efforts targeting weight reduction in this population.
The physical characteristics of food and contextual challenges related to dietary choices were mentioned as hindrances in the pursuit of healthy nutrition habits. Participants had adequate knowledge of healthy nutrition but perceived a lack of self-management and negotiation skills. Their expressed desire to acquire these skills indicated a willingness to take responsibility for their choices and suggested that efforts focusing on self-efficacy may be highly beneficial in this sample of girls.
Limitations to engagement in physical activity included the amount of time already taken up with school and extracurricular activities, limited access to opportunities for exercise, time and beauty cost, and lack of safety. Collectively, these challenges signal interplay between personal factors and global societal factors over which these girls lack control. Furthermore, the challenges suggest potential areas for creative explorations for public health interventions. For example, approaches favoring school- or home-based physical activities have not been well explored in this population and may be useful for these girls, who perceived lack of opportunities because of limited access to activities and because of unsafe neighborhoods. Furthermore, concerns about personal aesthetics indicate that activities perceived as less disruptive might be more easily adopted than those perceived to be aesthetically costly.
The negligible impact of celebrities on diet and physical activity behaviors was an unexpected finding. Specific African American celebrities discussed were Oprah Winfrey, Toni Braxton, and Mo'Nique ("Nicky Parker"). Although the girls admired and mentioned these women because of their past or current weight issues, the perceived impact of these women varied. Weight-related messages from Oprah Winfrey and Toni Braxton were seen as irrelevant because the women were perceived to have assets not available to the girls. In contrast, Mo'Nique, the largest of the three celebrities, who embraces and positively promotes her large size, was admired and perceived as a realistic role model and a testament that one can be successful despite one's large size. For these girls, Mo'Nique may be a more relevant "other" because her attitude is in accord with their cultural values of weight and body size. Moreover, her self-affirmations coupled with her personal success also affirm their expressed desire to be responsible for their own healthy internal and external sense of self. These findings are informative because they highlight that public health interventions must consider both the delivery and the content of health messages targeting these girls. Hence, efforts that tap into personal values and enhance self-esteem may be more favorably perceived and potentially more relevant than celebrity-endorsed messages not reflecting the realities of the girls' daily lives.
One major determinant of chronic diseases is the environment and its influence on lifestyle behaviors (30
). In North Carolina, African Americans are poorer, underemployed, more sedentary, and consume less than the recommended intake of fruits and vegetables than do whites (35
). This environmental context and the behaviors reported in this study suggest that this study's findings may differ from findings in other regions of the United States.
Though the small sample size limits the study's generalizability, the perceptions and attitudes documented point to key areas for further inquiry. Overall, the findings are informative and suggest that future intervention efforts should assess girls' knowledge, perceptions, and self-efficacy levels related to nutrition and physical activity to inform program design. Assessments should specifically target identifying girls' perceptions of context-specific barriers (availability, cost, access, safety, health status) and facilitators (preferred foods, activities, role models) of adopting healthy behaviors. Furthermore, program effectiveness and sustainability can be enhanced by engaging, as change facilitators, role models who influence girls' weight-related perceptions and behaviors. Finally, program messages and offerings should be context-specific to promote ease of adoption and sustainability in this population.