Given the burden of obesity disproportionately affecting African American youth and the serious health consequences, a study by Dr. Janet Tomiyama and her team is timely in bringing to light an important variable to consider in addressing this major public health concern.
Using data from the National Heart, Lung, and Blood Institute’s Growth and Health Study, Dr. Tomiyama of the University of California, Los Angeles, and her colleagues described the relationship between chronic perceived stress and body mass index over a 10-year period. They concluded that a correlation exists between cumulative stress and weight gain that is significantly stronger in black females aged 10-19, compared with white females in the same age group (Ann. Behav. Med. 2012 [doi:10.1007/s12160-012-9398-x]).
Dr. Gail A. Mattox
There are some limitations to the study. However, these findings are significant and add to our knowledge base. Other studies focusing on African American females suggest that black women in general are more accepting of a range of body types and that body satisfaction in African American adolescents is reportedly higher, compared with white adolescents. It also has been suggested that inaccurate body perception might contribute directly to obesity in African American female adolescents.
We should be cautious, however, in attributing the disproportionate rate of obesity among African American females to differences in ideal body weight preferences or inaccurate body weight perception.
First, we must strive to better understand contributing factors affecting ideal body image among African American female adolescents. Such youth are constantly bombarded with European images to which they are unable to relate. Positive images of African American female adolescents are limited in mainstream media. Families also struggle to instill a positive sense of self and self-esteem and resiliency during this critical developmental stage as a buffer to a society that might not consistently value and embrace racial and ethnic diversity.
Additionally, if we incorporate a biopsychosocial approach to understanding obesity in the African American community, we must look at other factors. The food marketing environment is a major environmental factor contributing to the obesity epidemic (Appetite 2012;58:396-9). The number of fast-food restaurants and convenience stores, coupled with limited exercise facilities, is striking in many African American communities, and this contributes significantly to health disparities.
Further research studies exploring these factors, resiliency factors, the association between ideal body image and obesity, the impact of chronic stress, and factors such as weight-based victimization and the psychological impact of obesity are needed.
Also, further research exploring the benefit of targeted educational intervention strategies will enhance the ability of physicians to effectively intervene. This will place us one step closer to the mission of Healthy People 2020, which is to increase public awareness and understanding of the determinants of health, disease, and disability with the ultimate goal of achieving health equity and eliminating health disparities and improving the overall health of all.
Dr. Mattox is a child, adolescent, and adult psychiatrist and professor of clinical psychiatry in the department of psychiatry and behavioral sciences at the Morehouse School of Medicine in Atlanta.