Children who now spend more time in front of a screen (usually snacking) than on the playground can’t help but pack on the pounds, and reports of childhood obesity have reached epidemic proportions.
The statistics are especially dismal for African-American teen girls; studies show they start out life at the same weight as their white counterparts but see their body mass index blossom in adolescence.
African-American women between the ages of 12 and 19 are nearly 60 percent more likely to be overweight; less likely to eat fruits, vegetables and whole grains; and less likely to be physically active than white women in the same age group.
And the long-term results can be deadly. An overweight child has an 80 percent chance of becoming an overweight adult, and with that comes an increased risk for diabetes, heart disease and other weight-related problems.
Responding to the overall fattening of American grocery stores, food manufacturers, restaurants and public service announcements promote the importance of healthy choices and getting active — messages that for many African-American teen girls, at least, seem to be falling on deaf ears. Researchers see the problem but admit they have little hard data explaining this paradox.
Listening Beyond the Evidence
Finding out whom these overweight African-American girls are listening to, and in what context, was the challenge of researchers at The Institute for Health, Social and Community Research at Shaw University in Raleigh, N.C. — the oldest historically black university or college in the South.
Their findings were published in the Centers for Disease Control and Prevention’s April 2008 issue of Preventing Chronic Disease and later were featured in the Agency for Healthcare Research and Quality’s September newsletter.
“We did this project with a small group of girls as a pilot study, hoping to learn enough information to allow us to conduct a study on a larger population,” explained biostatistician Yhenneko J. Taylor, who analyzed the Shaw study data.
The shorthand version of the findings: African-American teen girls are influenced primarily by the opinions and experience of people closest to them. In addition, the food/eating patterns of the immediate family, the traditions of the community and culture and the opinions and beliefs of friends are more highly valued — and followed — than are those of public service announcements, celebrities or other external messages.
Taylor says that teen study participants were chosen from a Raleigh hospital diabetes prevention program, and most came from low-income families. While none of the girls had a diagnosis of diabetes, they were all considered overweight. Two groups of teens — ages 12 to 14 years and 15 to 18 years — and their mothers were interviewed separately, for 10 weekday sessions.
According to the study guidelines, the interviews were designed to “elicit perceptions and attitudes contributing to the girls’ food choices” and their “willingness to engage in exercise/physical activity.” Questions covered the following key areas: a personal definition of health, dietary and physical activity habits, the individual girl’s concept of personal health and body image, social support and other cultural and environmental factors.
The researchers cited evidence from three major categories — body image, food choices and activity — in creating a picture of the most important factors these girls used in making decisions.
Being Big Is OK
In its family guide to healthy eating, the Substance Abuse & Mental Health Services Administration cites the current epidemic of obesity but also cautions against the dangers of dieting by young teens who aspire to the body images of red-carpet celebrities and magazine models as the benchmark of perfection.
Yet in this particular study, the teens used a variety of terms to describe body size and preferred a “continuum of acceptable body sizes rather than an ideal.” But there were some conflicting comments.
On one hand, the girls were asked about body image and how they saw their size. They said that acceptable healthy body size was determined by oneself, rather than based on a subjective ideal. Yet this “acceptable” parameter may reflect the size of the other immediate female family members as a point of reference. In other words, if grandmother, mother or aunt were of similar body size, this influenced the girls' perception of acceptable size.
One notable study finding is that the girls said they are generally “more satisfied with their body image and larger body size” — a sharp contrast to the attitude of many white teen girls who in other studies are reported as using risky or fad diet programs and/or starving themselves to reach a state of ideal, externally defined thinness.
This contrasts a little with an analysis put out by the federal Office on Women’s Health, which acknowledges cultural preferences for “larger body sizes” but also states that, “as Black girls approach adolescence, they become more concerned with thinness.
"Studies indicate that when African American girls experience social pressure to be thin, they express the same type of body dissatisfaction and drive for thinness as White girls. Adolescents from middle-class African American families may be particularly vulnerable to the influence of the White beauty ideal.”
In the Shaw study group, the concept of “being skinny” was out, and having large breasts and buttocks was in, as some quotes from the study demonstrate:
I got one friend, she be complaining, she be like, “I wish I had a big butt.”
And she be stuffing her bra ... she be trying to wear jeans to make her butt big.
As most of the girls had been overweight since early in childhood, the study said that they had been “conditioned against hurtful or weight-related comments, and that they were neither bothered by them nor motivated to make substantial changes to their nutrition and physical activity habits.”
However, they expressed sensitivity — “He lowers my self-esteem” — to male peers who teased or critiqued their body size or parts. (This comment is consistent with SAMHSA's caution for parents to look beyond size and provide positive emotional and healthy eating support.)
Being Hungry Is Not ...
When it comes to food, researchers report that the girls' preferences were based on appearance, taste, texture and, very importantly, being satisfied and full. The teens believed the food choices of their white peers at school were healthy, but they were nonetheless dismayed at these choices, perceiving them to be skimpy and unfilling:
(White girls) eat nutrient bars, or they bring their lunch, have their little Juicy Juice and granola bars. I know cause ... I watch them eat lunch and I be like, “How do you all get full?” There’s nothing there.
They’ll have this little wheat bread sandwich, that’s all.
The girls acknowledged the relationship between food and being healthy but were less likely to use willpower or self-management to “say no.” This was particularly true in family situations where both traditional African-American foods and their preparation — especially in the southeastern U.S. — featured unhealthy levels of sodium, grease or fats. Sunday dinner was one example:
Who’s going to pass up their Grandma’s cooking? She’s cooking like Sunday … chicken, collard greens, corn bread, and you know, it’s your Grandma.
Overall, the perception of being full, choosing familiar foods and conforming to family food traditions superceded the girls' willingness to eat a “healthy” diet, which they perceived as unfilling, uninteresting and lacking in flavor or taste.
The Beauty Cost to Activity
Shaw investigators said topics of physical activity met with little enthusiasm in the discussion sessions. While the girls expressed more interest for group activities such as “basketball or dance teams,” they also said many schools did not offer these activity options, or there were more people than the programs could accommodate. They also talked of not being eligible to participate in school-based activities, citing their inability to meet criteria of weight and blood pressure standards. They also cited concerns about their safety while being active outdoors, whether after school or in their neighborhoods — factors that some otherwise-promising programs must overcome.
Another deterrent to physical activity was the “beauty cost” of exercise and sports. These were referenced in terms of “other” people, rather than themselves, but they spoke of girls who didn’t want to “get their hair messed up,” or if “they break their nails, it’s a crisis.”
For these girls, exercise was not a culturally valued practice but a low-value, “I’ll do it later” optional behavior.
No Celebrity Influence
Delivering media messages to teens by credible African-American female role models to influence behavior change seems like a good idea, but this group was dismissive of most high-profile media icons. Researchers were surprised at this finding, but it was clear the girls felt that the impact of celebrities — actresses, talk show hosts, entertainers — on their beliefs about healthy weight, diet and food choices was, in fact, negligible.
Teens said that celebrities who counseled good health and promoted their shed pounds or exercise regimen were “unrealistic” models for them. Criticism came down to celebrities having financial incentives, access to personal trainers and full-time kitchen staff to create proper meals — which lessened the persuasiveness of their health messages to this predominantly low-income group.
The consensus for overweight African-American teens, at least, is that family and best friends determine most food choices, influence most body image perceptions, influence beliefs about what is healthy and set examples of the appropriate level of physical activity. Despite the small study sample, Taylor said these findings provide sufficient evidence to warrant additional study on a broader basis.
“We need to learn how African-American teens will buy into positive messages for better health,” she said.
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