Body Image and Weight Status among African American and Caucasian Overweight Postpartum Women Participating in a Weight Loss Intervention

1
Body Image and Weight Status among African
American and Caucasian Overweight Postpartum
Women Participating in a Weight Loss
Intervention

• Lori Carter-Edwards, PhD

Department of Community and Family Medicine Duke
University Medical Center Durham, NC
12th Annual CDC Maternal and Child Health
Epidemiology Conference Atlanta, GA 07 December
2006
Sponsor National Institute of Diabetes,
Digestive, and Kidney Diseases (NIDDK)
R01DK64986
2
Collaborating Team
Duke University Medical Center (Durham, NC) Truls
Ostbye, MD, PhD Lori Bastian, MD Jessica Revels,
BA
University of North Carolina (Greensboro,
NC) Holiday Durham, MS
Shaw University (Raleigh, NC) DaJuanicia Holmes,
MS M. Ahinee Amamoo, MS
3
Presentation Overview

• Background

• Purpose

• Methods

• Results

• Strengths and Limitations

• Conclusions

• Implications

4
Background

• Racial differences exist in postpartum weight and
  weight retention.

• Postpartum body image may influence adoption and
  maintenance of healthy lifestyle behaviors.

• Body image may differ by race.

5
Background (cont.)

• Similar postpartum body area dissatisfaction
  exists by race.
• The magnitude of dissatisfaction is greater among
  Caucasians than African Americans.

• Body image unclear among overweight or obese
  postpartum women
• Body image unclear among those engaged in
  behavior modification

6
Purpose

• To examine whether body image and weight status
  differ by race among a sample of African American
  and Caucasian overweight postpartum women
  participating in a weight loss intervention.

7
Methods

• Study Sample
• Derived from the Active Mothers Postpartum (AMP)
  Study
• Effectiveness of a diet and physical activity
  intervention on reducing weight among 450
  overweight postpartum women (BMI gt 25)
• Two-arm, unblinded, randomized trial

8
Methods (cont.)

• Active Mothers Postpartum (AMP) Study
• Intervention (n225) 8-10 months
• Health magazine subscription
• Education manual
• Group diet and physical activity sessions
• Phone counseling sessions
• Jogging stroller (6 months postpartum)
• Control (n225)
• Health magazine subscription

9
Methods (cont.)

• Active Mothers Postpartum (AMP) Study
• Measurements
• Baseline
• 12 months
• 18 months
• 24 months
• 6 months, intervention group only

10
Methods (cont.)

• Study Sample
• Intervention Group - Exclusions
• Loss to follow-up (n31)
• Strollers only (n5)
• Race other than African American or Caucasian
  (n9)

Study Sample Size 180
11
Methods (cont.)

• Variables
• Predictor Variables
• Race
• BMI group
• Outcome Variable
• Body Image
• Figure Rating Scale (Stunkard et al., 1980)
• Range 1-9
• 8 characteristics about shape

12
Methods (cont.)

• Figure Rating Scale

Desired Shapes
Actual Shapes

• Most attractive
• Would like to look like
• Women find most attractive
• Men find most attractive
• An ideal mother

• Once baby was born
• Look like now
• Pre-pregnancy

13
Results
Table 1. Demographics (n180)
Characteristic African American Caucasian P-value
N 75 105 --
Mean Age at Baseline (yrs) 29.8 (6.2) 32.4 (4.8) 0.016
Married 49.3 93.3 lt0.001
College or College Grad 44.0 76.0 lt0.001
Annual Household Income gt 30,000 57.6 88.9 lt0.001
Primiparous 37.3 44.8 0.320
Statistically significant difference by race
(using t-test and chi-square tests). n172
respondents
14
Results
Table 2. Weight Characteristics (n179)
Characteristic African American Caucasian P-value
N 75 104 --
Mean BMI at 6 Months Postpartum 35.0 (8.2) 30.1 (6.4) 0.021
Mean Weight at 6 Months Postpartum (lbs) 210.4 (49.9) 181.9 (36.9) 0.005
Normal Weight (BMIlt25) 0 16.2 lt0.001
Overweight (25ltBMIlt30) 33.3 37.1 --
Obese (BMIgt30) 66.7 46.7 --
Mean BMI Overweight 27.7 27.8 0.918
Mean BMI Obese 38.7 35.5 0.038
Statistically significant difference by race
(using t-tests and chi-square tests).
Chi-square test of trend of BMI group by race.
15
Results (cont.)
Mean Distribution of Body Image Factors at
6-Months Postpartum by Race and Weight Status
Shape that is Most Attractive
By Race - BMIgt30 (n89)
By Race - Total (n153)
16
Results (cont.)
Mean Distribution of Body Image Factors at
6-Months Postpartum by Race and Weight Status
Shape You Would Like to Look Like
By Race - BMIgt30 (n89)
By Race - Total (n153)
17
Results (cont.)
Mean Distribution of Body Image Factors at
6-Months Postpartum by Race and Weight Status
Shape Women Find Most Attractive
By Race - BMIgt30 (n89)
By Race - Total (n153)
18
Results (cont.)
Mean Distribution of Body Image Factors at
6-Months Postpartum by Race and Weight Status
Shape Men Find Most Attractive
By Race - BMIgt30 (n89)
By Race - Total (n153)
19
Results (cont.)
Mean Distribution of Body Image Factors at
6-Months Postpartum by Race and Weight Status
Shape of an Ideal Mother
By Race - BMIgt30 (n89)
By Race - Total (n153)
20
Results (cont.)
Mean Distribution of Body Image Factors at
6-Months Postpartum by Race and Weight Status
Your Shape Once Baby Was Born
By Race - BMIgt30 (n89)
By Race - Total (n153)
21
Results (cont.)
Mean Distribution of Body Image Factors at
6-Months Postpartum by Race and Weight Status
Shape You Look Like Now
By Race - BMIgt30 (n89)
By Race - Total (n153)
22
Results (cont.)
Mean Distribution of Body Image Factors at
6-Months Postpartum by Race and Weight Status
Pre-Pregnancy Shape
By Race - BMIgt30 (n89)
By Race - Total (n153)
23
Strengths and Limitations

• Nested within a weight-loss intervention
• Examined postpartum body image by race and weight
  status
• Modest sample size
• Body image figure rating scale may not be
  culturally representative
• No information on weight change (beyond study
  scope)

24
Conclusions

• A greater proportion of African-American compared
  to Caucasian women
• Were larger at 6 months.
• Had larger desired shapes.
• Obese postpartum women differed by race in
• Desired shape for themselves.
• Desired shape perceived by men.
• Desired shape of an ideal mother.
• There were no significant racial differences in
  perceptions of actual shape.

25
Implications

• There are cultural differences in perceptions of
  attractiveness based on shape.
• Future behavior modification programs may need to
  account for potential racial differences in body
  image when designing postpartum weight loss
  interventions.