At 6 months postpartum, racial differences existed in the perceptions of ideal BI and BI of the ideal mother. African American and white women were both dissatisfied with their current image, yet they were less dissatisfied with their image in the context of the ideal mother. The level of dissatisfaction was significantly greater for white than for African American women. Although the previous study by Walker et al.11
reported racial differences in BI in women at 6 months postpartum, our study is the first to report both general BI and BI of the perceived ideal mother among overweight postpartum women.
The finding in our study that the two race groups had similar perceptions of their current BIs, despite significant differences in measured weight, may be due to differences in how they estimate their own weight. Previous studies indicate that African American women tend to underestimate their weight, whereas white women either slightly underestimate or overestimate their weight.22–24
For African American women, it is speculated that underestimates of weight may be due to the high prevalence of overweight and obesity in the African American population, where weight is not readily connected to health.24
The connection may occur after manifestation of weight-related diseases, which would be late for implementing measures of primary, or possibly secondary, prevention.25
If there is a disconnection between weight and health, however, simply telling the women to lose weight without an understanding of the reasons for this disconnect may not effectively lead to behavior change.
Our results confirm prior research that ideal BI is larger for African American than white women.21
However, the ideal image ratings were slightly higher than in previous studies of BI in general populations of women,18
suggesting possible changes in what is considered ideal during this stage of women's lives, that is, transition into motherhood. Interestingly, for both race groups, the image of the ideal mother was larger, indicating some distinction of an ultimate ideal image and an acceptance of a larger shape for a mother. This may be particularly true for the African American participants, a concept supported by findings in literature indicating a positive relationship between obesity and attractiveness in African American women.5,26,27
Body dissatisfaction among white women is well documented,28
and there is increasing evidence that African American women also exhibit some level of body dissatisfaction and a desire for a smaller body size.15
Reasons why both groups of women may be dissatisfied with their bodies (or desire a smaller body size) may be influenced differently and by different factors. African American women may view their bodies differently from white women because of the cultural environment and the broader media (e.g., television, magazines). In one study, African American women were found to be more flexible than their white counterparts in their concepts of beauty and spoke about “making what you've got work for you.”25
In contrast, many white adolescent females expressed dissatisfaction with their body shape and were found to be rigid in their concepts of beauty. Among African American women, social support provided by family and friends may take on a level of protectiveness in the context of self-esteem, which may reduce prioritization of overweight as a health issue.15,29
Conversely, for white women, the media (and even the support network) may serve as a barrier to positive weight attitudes via rigid expectations of thinness.
One potential limitation of this study is that the Stunkard Figure Rating Scale may not be culturally sensitive in assessing African American women's BI.15
Also, these women were participating in a weight loss intervention trial; although they all received the same intervention and should not have been affected differentially in that regard, that they agreed to participate could indicate greater interest in losing weight and, by extension, greater body dissatisfaction. Despite these limitations, however, the results are consistent with those in the general population and, with the results on the ideal mother, provide new evidence on the perceptions of overweight postpartum women.
Our findings imply that prevention and treatment strategies should be developed that account for cultural differences in BI. In his article on the obesogenic environment, Ard30
provides a model that suggests varying directions in cultural influences for African Americans and whites (). African Americans may be more accepting of heavier sizes and may not be driven by the same mechanisms as whites to make lifestyle changes. Early interventions may require a better understanding of African American women's perception and satisfaction with their weight. If they are comfortable with their size, a weight-driven approach to health behavior change (i.e., one that relies on motivation to lose weight to promote behavior change) may not be the most effective strategy. It is important to better understand why African American women are more comfortable with their image. In the context of the ideal mother, the larger ideal image selected by African American women may even be related to their greater weight retention postpartum. At the same time, approaches may require targeting other aspects of their lives that hold greater value for realistic behavior change. From a clinical perspective, simply understanding and respecting that these racial differences exist is the first step.
FIG. 2. Confluence of obesogenic environment and cultural influence. Black cultural influence has an additive interaction with the overall obesogenic environment further promoting obesity among black women. Conversely, white cultural influence acts as a counterweight (more ...)