BMI-based norms for a culturally relevant body image scale among African Americans
Introduction
Body image is an important factor influencing weight related perceptions and activities (Fitzgibbon et al., 2000, Grabe and Hyde, 2006, Kronenfeld et al., 2010, Roberts et al., 2006). Therefore, there is a need for reliable and valid measures of body image, especially among African Americans who experience high rates of obesity (Pan et al., 2009). A culturally relevant body image tool for African American men and women was developed in 2004, demonstrating strong psychometric properties and cultural acceptability among African Americans (Pulvers et al., 2004). Although silhouette scales have limitations compared to multi-dimensional body image scales, the simplicity, brevity, and minimal literacy requirements offer practical benefits for community based assessment. Anchors for interpreting body image scores enhance the usefulness of such scales. The purpose of the present study is to provide BMI standards for interpreting body image scores for African American men and women.
The study presents descriptive data on current body size among African American adult men and women, with separate age group norms. Average BMI is provided for men and women choosing each current body size figure. Furthermore, descriptive data is presented on current body size based on ratings from independent observers for two reasons. First, the original scale development study showed that individual raters' figure choice was more strongly associated with objective markers such as BMI than participants' figure choice (Pulvers et al., 2004). Second, previous research has shown differences in body figure perceptions between objective raters and individuals (Pulvers et al., 2008). Therefore, concordance between participant and independent raters' figure choice is evaluated, and best fit prediction models of overweight status using figure ratings are made. All data is drawn from the same sample upon which the original scale development article was based (Pulvers et al., 2004).
Section snippets
Material and methods
Data were collected as part of a health behavior change trial in nine public housing developments in the greater Kansas City metropolitan area. The detailed methods for this trial are described in Pulvers et al. (2004). Participants were presented with the gender-appropriate version of the random-order body image instrument and asked to select the figure that most closely resembled them currently. Three research staff rated the residents' body size using a sheet containing a set of male figures
Analytic approach
Current figure norms were developed by calculating means and standard deviations on the BMI associated with each figure size. This was done independently for men and women, and by age group. Furthermore, this was done separately based on participant and rater selection of figure size. A composite rater size was created by averaging the figure selected by the three raters. Kendall's coefficient of concordance was used to estimate agreement between participants' and raters' figure choice by
Norms
Table 1A, Table 1B provide the number of individuals by age group (women and men, respectively) who chose each figure, along with their measured mean BMI, for the full sample. The use of traditional BMI category definitions (underweight = < 18.5; normal = 18.5–24.9; overweight = 25–29.9; obese I = 30–34.9; obese II = 35–39.9; obese III = ≥ 40) (National Institutes of Health, 1998, World Health Organization, 2000) provided an anchor for the weight classification of participants choosing each figure. Among
Discussion
The present study provides BMI-based norms for interpreting scores on a culturally sensitive figural scale among African American men and women. Validity of participant self-ratings is supported given significant correlations with BMI and accuracy in predicting overweight status in ROC analyses. Also noteworthy is the incremental validity of raters' figure selection and higher specificity of raters' figure selection for predicting overweight status. Therefore, investigators may also consider
Role of funding sources
Dr. Ahluwalia is supported by the National Institute for Minority Health Disparities (NIMHD/NIH — 1P60MD003422). Dr. Guo is supported by a grant from the National Center for Research Resources (award number UL1RR033183). Dr. Pulvers and Dr. Nollen were supported by the University of Minnesota for writing the manuscript.
Contributors
KP designed the study and wrote a first draft of the manuscript. JB conducted literature searches, wrote summaries of previous research studies, and conducted statistical analyses. HG conducted statistical analyses and wrote interpretations of the results. NN and JA provided input on the conceptualization and writing of the manuscript and interpretation of the results. All authors contributed to and have approved the final manuscript.
Conflict of interest
All authors declare that they have no conflicts of interest.
Acknowledgments
We thank the Kansas City, KS and Kansas City, MO Housing Authority, participating housing development managers and residents, health fair staff, University of Kansas Medical Center family medicine physicians, registered dietitians, and research staff, and Swope Health Central patrons and research staff. This study was supported by a grant from the NIH (R01 CA 85930).
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