body image and weight status among african american and caucasian overweight postpartum women...

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 MedicineDuke University Medical Center

Durham, NC

12th Annual CDC Maternal and Child Health Epidemiology ConferenceAtlanta, GA

07 December 2006

Sponsor: National Institute of Diabetes, Digestive, and Kidney Diseases (NIDDK) [R01DK64986]

LCE_97877_CDCConfPres_061207 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

LCE_97877_CDCConfPres_061207 3

Presentation Overview

Purpose

Methods

Results

Conclusions

Strengths and Limitations

Background

Implications

LCE_97877_CDCConfPres_061207 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.

LCE_97877_CDCConfPres_061207 5

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

Background (cont.)

LCE_97877_CDCConfPres_061207 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.

LCE_97877_CDCConfPres_061207 7

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 > 25)

Two-arm, unblinded, randomized trial

Methods

LCE_97877_CDCConfPres_061207 8

Active Mothers Postpartum (AMP) Study Intervention (n=225) – 8-10 months

Health magazine subscription Education manual Group diet and physical activity sessions Phone counseling sessions Jogging stroller (6 months postpartum)

Control (n=225) Health magazine subscription

Methods (cont.)

LCE_97877_CDCConfPres_061207 9

Active Mothers Postpartum (AMP) Study Measurements

Baseline 12 months 18 months 24 months

6 months, intervention group only

Methods (cont.)

LCE_97877_CDCConfPres_061207 10

Study Sample Intervention Group - Exclusions

Loss to follow-up (n=31) Strollers only (n=5) Race other than African American or Caucasian (n=9)

Methods (cont.)

Study Sample Size = 180

LCE_97877_CDCConfPres_061207 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

LCE_97877_CDCConfPres_061207 12

Methods (cont.)

Figure Rating Scale

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

“Desired” Shapes “Actual” Shapes

LCE_97877_CDCConfPres_061207 13

ResultsTable 1. Demographics (n=180)

* Statistically significant difference by race (using t-test and chi-square tests).** n=172 respondents

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 <0.001

% College or College Grad 44.0 76.0 <0.001

% Annual Household Income >= $30,000** 57.6 88.9 <0.001

% Primiparous 37.3 44.8 0.320

LCE_97877_CDCConfPres_061207 14

ResultsTable 2. Weight Characteristics (n=179)

* Statistically significant difference by race (using t-tests and chi-square tests).** Chi-square test of trend of BMI group by race.

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 (BMI<25) 0 16.2 <0.001**

% Overweight (25<BMI<30) 33.3 37.1 --

% Obese (BMI>30) 66.7 46.7 --

Mean BMI Overweight 27.7 27.8 0.918

Mean BMI Obese 38.7 35.5 0.038

LCE_97877_CDCConfPres_061207 15

Results (cont.)

Mean Distribution of Body Image Factors at 6-Months Postpartum by Race and Weight Status

Shape that is Most Attractive

African American

Caucasian

P=0.0123.3 3.6

By Race - Total (n=153) By Race - BMI>30 (n=89)

P=0.2253.6 3.8

LCE_97877_CDCConfPres_061207 16

Results (cont.)

Mean Distribution of Body Image Factors at 6-Months Postpartum by Race and Weight Status

African American

Caucasian

P=0.0113.4 3.8

By Race - Total (n=153) By Race - BMI>30 (n=89)

P=0.0483.8 4.2

Shape You Would Like to Look Like

LCE_97877_CDCConfPres_061207 17

Results (cont.)

Mean Distribution of Body Image Factors at 6-Months Postpartum by Race and Weight Status

African American

Caucasian

P=0.0442.8 3.1

By Race - Total (n=153) By Race - BMI>30 (n=89)

P=0.4963.1 3.2

Shape Women Find Most Attractive

LCE_97877_CDCConfPres_061207 18

Results (cont.)

Mean Distribution of Body Image Factors at 6-Months Postpartum by Race and Weight Status

African American

Caucasian

P=0.0062.9 3.3

By Race - Total (n=153) By Race - BMI>30 (n=89)

P=0.0392.7 3.1

Shape Men Find Most Attractive

LCE_97877_CDCConfPres_061207 19

Results (cont.)

Mean Distribution of Body Image Factors at 6-Months Postpartum by Race and Weight Status

African American

Caucasian

P<0.0013.8 4.5

By Race - Total (n=153) By Race - BMI>30 (n=89)

P=0.0174.1 4.6

Shape of an Ideal Mother

LCE_97877_CDCConfPres_061207 20

Results (cont.)

Mean Distribution of Body Image Factors at 6-Months Postpartum by Race and Weight Status

African American

Caucasian

P=0.1896.15.8

By Race - Total (n=153) By Race - BMI>30 (n=89)

P=0.2126.56.2

Your Shape Once Baby Was Born

LCE_97877_CDCConfPres_061207 21

Results (cont.)

Mean Distribution of Body Image Factors at 6-Months Postpartum by Race and Weight Status

African American

Caucasian

P=0.8415.55.5

By Race - Total (n=153) By Race - BMI>30 (n=89)

P=0.6996.16.0

Shape You Look Like Now

LCE_97877_CDCConfPres_061207 22

Results (cont.)

Mean Distribution of Body Image Factors at 6-Months Postpartum by Race and Weight Status

African American

Caucasian

P=0.9364.74.7

By Race - Total (n=153) By Race - BMI>30 (n=89)

P=0.4595.45.2

Pre-Pregnancy Shape

LCE_97877_CDCConfPres_061207 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)

LCE_97877_CDCConfPres_061207 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.

LCE_97877_CDCConfPres_061207 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.