Body Dissatisfaction Among Overweight Black and White Girls

The increasing trend toward obesity among American children is a true public health concern. Results of one 2010 study noted that more than a third of children between the ages of 6 and 11 years in the U.S. are currently overweight (body mass index [BMI, kg/m²]) for age ≥ 85^th percentile (JAMA 2010; 303:242). Along with the increased weight come not only significant physical health problems but risk factors for body dissatisfaction and other eating problems.

A recent study assessed racial differences in body dissatisfaction among Black and White girls in a randomized trial (Body Image 2011; 8:379). Authors N.R. Kelly, C.M. Bulik, and S.E. Mazzeo of Virginia Commonwealth University, Richmond, and the University of North Carolina, Chapel Hill, note that since pediatric obesity is more common among black children in the U.S. than among their white peers, one might expect overweight black girls to report greater dissatisfaction with body size. Yet, historically this has not been the case; instead, black girls typically endorse a larger ideal body size and have greater body satisfaction than their white counterparts.

The authors assessed racial differences in BMI percentile, body size perceptions and ideals and body dissatisfaction among girls participating in the Nourishing Our Understanding of Role Modeling to Improve Support and Health (NOURISH) study, an intervention for overweight children. Using the body silhouette method, Dr. Kelly and colleagues recorded body dissatisfaction and body size perceptions among 58 girls. The girls were 6 to 11 years of age, and 66% were black and 34% were white. The Silhouette method includes 9 ranked drawings of male and female figures that incrementally increase from underweight to overweight.

The participants were instructed to select their current and ideal silhouettes from the 9 choices. Body dissatisfaction was then calculated by ascertaining the absolute differences between participants’ current and ideal silhouettes. Height and weight were measured in a private room, and used to calculate BMI percentile. Height was measured by trained staff to the nearest ¾ in., using a stadiometer and weight was measured to the nearest ¾lb, using a medical balance beam scale. On a demographic questionnaire, parents or caregivers were asked to provide the child’s age, race, and gender.

Body size perceptions, ideal size, and dissatisfaction did not differ

Unlike earlier studies, there was no significant difference in body dissatisfaction between white and black girls. Only one girl from the entire group was satisfied with her body, and all others selected a smaller ideal silhouette than their current one. Although the difference was not statistically significant, black girls selected a silhouette to represent their current body size that was one size larger than the white girls’ choice; consistent with this pattern, the average BMI for the black girls was higher (98.1 percentile) than the white girls (96.8.1 percentile).

This is the first study to suggest that both black and white girls seeking weight-loss intervention report similarly high levels of body dissatisfaction. The authors feel that this strengthens an emerging argument that despite an overall preference for a larger body size, this cultural tolerance for size diversity might not extend to the higher end of the BMI spectrum, especially among persons seeking weight loss treatment. Also, although black girls in the study preferred a larger body size than did their white peers, their average ideal silhouette was significantly smaller than that reported by black youth in the community. This finding might have significant clinical implications for racially diverse girls enrolled in weight-loss intervention programs, given the noted association between drive for thinness and body dissatisfaction.

99% of girls preferred a smaller body size

As the authors noted, 99% of girls in their study preferred a smaller body size than their current one. This is consistent with a recent study of body dissatisfaction among children enrolled in a weight management trial (Zeller et al., 2010), but contrasts with community-based studies, where only between 52% and 63% of overweight youth preferred a smaller body. And, as in earlier studies, overweight girls underestimated their body size. These body size misperceptions could be related to trends in BMI in the U.S. Since most of the girls in this study were black, it might be that the body size of the girls in this sample was relatively normal with respect to their peer group.

Drs. Kelly, Bulik, and Mazzeo caution that since the study sample was exclusively composed of overweight girls who agreed to participate in the NOURISH program, a pediatric obesity intervention, results from the study can’t be generalized to other children who are not seeking treatment for obesity. Additional research will be needed to explore the mechanisms behind and implications of overweight children’s expectations and misperceptions of losing weight. Finally, the authors note that greater attention needs to be paid to risk factors for eating disorders among racially diverse, overweight children who are seeking treatment.