JOURNAL

10.1177/0095798404266062
Alleyne,
LaPoint
OF BLACK
/ BLACK
PSYCHOLOGY
ADOLESCENT
/ AUGUST
GIRLS 2004

Obesity Among Black Adolescent Girls:

Genetic, Psychosocial, and Cultural Influences
Sylvan I. Alleyne
Velma LaPoint
Howard University
This article focuses on the causes, consequences, and prevention of obesity
among a subgroup of the American population, Black adolescent girls. Using an
ecological perspective on obesity among Black adolescent girls, including
feminist-womanist perspectives and historical and medical sociological perspectives, the authors discuss genetic, psychosocial, and cultural factors that
may influence the propensity of Black adolescent girls susceptibility to obesity
and to diabetes, one of the major complications of obesity. Prevention strategies,
including individual and structural interventions, are illuminated.
Keywords: Black adolescent girls; obesity; ecological perspectives

Obesity among the U.S. population represents a major health risk for individuals. The sequelae include disease, disability, and premature death, all of
which affect the family, community, and society. Researchers, policy makers,
practitioners, and advocates in fields such as public health, medicine, nutrition, nursing, psychology, sociology, education, social work, and law have
sounded alarms that obesity rates and associated health risks have reached an
epidemic among both children and adults in academic publications as well as
the media. The impact of obesity on the nations health was highlighted in the
Healthy People 2010 report, which focused on the importance of healthy
weight, the burden of poor weight management and subsequent illnesses and
reductions in quality of the life and life expectancy, the difficulties in weight
control, and health targets to be achieved by the year 2010 (U. S. Department
of Health and Human Services, 2000).
JOURNAL OF BLACK PSYCHOLOGY, Vol. 30 No. 3, August 2004 344-365
DOI: 10.1177/0095798404266062
2004 The Association of Black Psychologists

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The article offers an ecological perspective on obesity among a subgroup

of the American population, Black adolescent girls. This group warrants our
attention for at least three reasons. First, the prevalence of obesity has
increased from 11% during the years from 1988 to 1994 to 15.5% among 12to 19-year-olds nationally during 1999 and 2000 (Odgen, Flegal, Carroll, &
Johnson, 2002). Obesity rates are growing significantly higher among
Black children and other children of color as compared to their White
counterpartsanother example of racial and ethnic disparities. Research
also indicates that Black adolescent girls may be more sedentary than their
male counterparts. Moreover, Black youth may be more likely to be exposed
to the marketing of low-nutrition foods (LaPoint, 2003a). Childrens exposure to marketing and advertising also may play a role in obesity and other
health problems (American Psychological Association [APA], 2004).
Second, given the theme of this Journal of Black Psychology special issue,
a critical analysis of obesity among Black adolescent girls relates to the continuing concern for the well-being of Black girls, who become women, in the
context of their families. Healthy Black women, like women in all families
who are able to perform productive family, work, community, and other
roles, are central to the well-being of families and communities. To the extent
that the life cycle approach, as a part of an ecological perspective on human
development, is appropriate for considering the health of individuals, it is
logical to focus on the health of Black adolescent girls. Their behavior,
health, and social conditions will, in large measure, determine how they function as adults. The topic of obesity among Black adolescent girls also should
be examined from a Black feminist-womanist framework. Collins (1998)
asserts a need for intersectionality, namely, how the intersection of race,
social class, gender, and nation collectively shapes the outcomes of Black
girls and women. Similarly, Thomas (1994) suggests that the conditions of
girls and womens lives enhance or undermine health where the nexus of
race, gender, and social class form structural forces to affect the health of
Black girls and women. As a result, Black girls and women often do not
engage in risky health behaviors because of their free will and personal
choices per se, but instead, societys historical, cultural, and structural components affect their health beliefs, attitudes, behaviors, and status.
Third, historical and medical sociological perspectives exist on genetic,
psychosocial, and cultural factors that may influence the propensity of Black
adolescent girls susceptibility to obesity. This view is based on research on
diabetes, one of the major complications of obesity. Another view is that
Black adolescents and adults may have differing and more tolerant attitudes
toward themselves and others being overweight and obese. These attitudes
may have a role in obesity rates among Black adolescent girls and need to be

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JOURNAL OF BLACK PSYCHOLOGY / AUGUST 2004

explained from a contextually situated Black female perspective as suggested earlier.

In our examination of obesity among Black adolescent girls, we cover several major areas: (a) conceptualizations, definitions, and prevalence of obesity; (b) causes and consequences of obesity; (c) prevention policies and their
approaches to obesity; and (d) implications for Black adolescent girls, with a
focus on culturally responsive prevention issues. In focusing on Black adolescent girls, we use general and specific approaches to draw on selected
research from child and adolescent groups, other racial and ethnic groups,
and sometimes from adults because data may not always be available on
Black adolescent girls. At the same time, many of the physiological findings
and explanations may have applications for this group. Wherever possible,
we cite developmental data on Black children and adolescents. Finally, we
draw comparisons between Black adolescent girls and their White counterparts to illustrate the early onset of racial and ethnic health disparities.

CONCEPTUALIZATIONS
AND DEFINITIONS OF OBESITY
There are several complicated definitions and conceptualizations of obesity. One simple and accurate definition of obesity is that it is the result of an
energy imbalance where energy intake has exceeded energy expenditure over
a considerable period (World Health Organization [WHO], 1997). Physical,
social, and other environmental factors influence behavior. A combination of
behavioral, genetic, and hormonal factors determines excessive dietary intake and low physical activity, both of which result in the energy imbalance
that causes obesity as shown in Figure 1.
It is essential to have measures of obesity that can be compared internationally and also be used to identify groups and individuals who may be at
risk of increased morbidity and morality. There are essentially two measures
commonly used to define obesity. The first is the Body Mass Index (BMI),
the weight in kilograms divided by the square of the height in meters. The
normal range for adults is between 18.5 and 24.9, and any value above 25 is
regarded as overweight and preobese; obesity is classified as a BMI equal to
or greater than 30. There is increasing interest in the use of waist circumference adjusted to local norms of a given country as a measure of obesity
because it has been suggested that many of the complications of obesity are
strongly correlated with high rates of abdominal fat (WHO, 1997). The second way to define obesity is the use of the waist:hip ratio (WHR), the ratio of

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ENVIRONMENTAL
Social

Genetics

Hormonal

Physical

BEHAVIOR

Excessive
Dietary
Intake

Low
Physical
Activity

Energy Imbalance

OBESITY

Figure 1: Model of an Ecological Perspective on Obesity

347

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JOURNAL OF BLACK PSYCHOLOGY / AUGUST 2004

a persons waist circumference to the hips circumference. A WHR above 1.0

is regarded as overweight.
Defining obesity among children is complicated because the BMI, for
example, changes with age. Thus, the BMI has to be related to the specific
age of the child (WHO, 1997). The ecology of obesity in any specific group
must be seen in the context of the phenomenon occurring in the general population and over time. Thus, cultural norms, within time periods, influence
definitions and conceptualizations of obesity. Historically, overweight or
obese children were considered healthychildren who could survive the
vicissitudes of harsh environmental conditions and diseases such as famine,
undernourishment, and infection (Ebbeling, Pawlak, & Ludwig, 2002). This
standard has changed in recent times as excessive weight and obesity have
become major public health risks among children and adults (Cutler,
Whitaker, & Kodish, 2003).
Among Black Americans, it has been theorized that women may have
developed a more socially tolerant attitude toward obesity because of the relatively high prevalence of obesity seen among them (Kumanyika, Wilson, &
Guilford-Davenport, 1993). This tolerance for so-called large-sized women
may have evolved from one of the standards of beauty among females in
some west African countries where most Black Americans originated
(Gaston & Porter, 2003). Among many Black adolescents and even Black
adults, there are terms such as phat, big boned, healthy, thick, and brick house
that refer to ideal physiques for Black adolescent girls and women (Alleyne,
2004). Illustrating this issue, MoNique, a Black female comedian, wrote a
book that focused on her own acceptance, celebration, and strategies for coping with obesity (Imes & McGee, 2003). MoNique seems to accept obesity as
fate, celebrating the big-is-beautiful phenomenon; in the United States, for
example, this physique is marketed, standardized, institutionalized, and celebrated with its own elements such as models, celebrities, fashion and retail
venues, and magazines and books. The comedian seems to mock and criticize commercially driven, media-saturated images of the White female
model of thinness as she attempts self-empowerment and group empowerment in being overweight and obese. However, messages and activities that
accept and celebrate obesity are irresponsible and dangerous given the
serious health consequences of obesity.
Two Black female health professionals, one a psychologist and the other
a physician, issued a press release and attempted to access some Blackoriented media networks to respond to and protest the books messages. They
were unable to access media venues for their response, apparently because
the media representatives views of the comedians celebrity and popularity
outweighed the professionals concerns about health (M. H. Gaston & G. K.

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Porter, personal communication, April 15, 2003). This situation can occur
when Black advocates criticize and protest commercial messages or products
that they deem inappropriate for Black consumers. Often, these kinds of
actions are viewed as Black people airing dirty linen or as Black-on-Black
criticism and may be met with varying degrees of resistance by marketers,
corporate owners, and celebrity endorsers of products, as well as by Black
community members and leaders (LaPoint, 2004). Socially tolerant attitudes
toward overweight and obese women may influence attitudes of Black adolescent girls toward acceptingboth in themselves and in othersbeing
overweight and obese. The challenge for Black adolescent girls, women,
their families, health professionals, and other stakeholders is to reduce obesity and its health consequences without creating unhealthy views of body
image, attitudes toward food, and eating patterns (Baskin, Ahluwalia, &
Resnicow, 2001).

PREVALENCE OF OBESITY
The prevalence of obesity increases with age, particularly among women
(Williamson, Kahn, Remington, & Anda, 1990). Recent data showed that the
prevalence of obesity rose from 19.8% to 20.9% of American adults between
2000 and 2001, and currently, more than 44 million Americans are obese
(Centers for Disease Prevention and Control, 2003). Blacks had higher rates
of obesity (31.1%) than did members of other ethnic groups (Mokdad et al.,
2003). Of particular relevance is that obesity is more prevalent among Black
women, with evidence coming from successive National Health and Nutrition Examination Surveys conducted in 1976 through 1980, 1988 through
1994, and 1999 through 2000. The prevalence rates for Black adult females
20 years and older for the three surveys were 31.0%, 39.1%, and 50.8%,
respectively. For White adult females, for the same periods, percentages were
15.4%, 23.3%, and 30.6% (National Center for Health Statistics, 2002).
Children have not escaped this epidemic, and data show an alarming prevalence of obesity in preschool children (Ebbeling et al., 2002). Using the 85th
percentile of triceps skin-fold thickness as a measure of child obesity in the
late 1960s, rates were 27.1% for children ages 6 to 11 and 21.9% for those
ages 12 to 17. Twenty years later, the prevalence of obesity in the adolescents
had increased to 39%, and overall, the children were heavier (Gortmaker,
Dietz, Sobol, & Wehler, 1987). Between 1986 and 1998, being overweight,
defined as a BMI greater than the 95th percentile for age and sex, increased
significantly among Black children. By 1998, the prevalence had increased

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to 21.5% among Black children and with 12.3% for non-Hispanic White
children. Not only was there a difference between the two time points, but in
1998, the overweight children were significantly heavier as compared to
those in 1986. Thus, the number of overweight children is increasing rapidly,
particularly among Black children of both sexes (Strauss & Pollack, 2001).
One of the most extensive reviews describing obesity among girls comes
from the Bogalusa Heart Study (Freedman, Kettel-Khan, Srinivasan, &
Berenson, 2000). They conducted a cross-sectional analysis of various characteristics of 4,542 Black and 4,542 White girls, ages 5 to 17 years between
1973 and 1994. Black girls, on average, were 1 to 3 kilograms heavier than
were White girls of similar ages, but when these findings were adjusted for
height, the mean relative weight of Black girls was significantly greater than
that of White girls only after they had passed the age of 13. It is mainly after
Black girls enter adolescence that the weight differential with their White
counterparts appears. This does not, in any way, negate the well-cited research that individuals who are obese in childhood are more likely to remain
obese through adolescence and adulthood.
Another study also reports this phenomenon for children and adolescents
(Kimm et al., 2001). However, this study showed a significant difference
between Black and White youth starting from age 9 through age 19. These
two data sets were collected on different samples using different methods.
The Freedman et al. (2000) study consisted of seven cross-sectional studies
of school children from 1973 to 1994 in a rural population from southern
states. The Kimm et al. (2001) study was a longitudinal (panel) study of participants ages 9 to 10 at first visit (1987 and 1988) with annual measurements
for 10 years (1996 and 1997) in urban and suburban communities. Using the
Black:White ratio of the percentage of obesity in Black and White adolescent
females from the Freedman and the Kimm studies, Black adolescent females
were more obese than White adolescent girls. Black females in the age group
of 12 to 19 years are consistently more obese than their White counterparts
across five time periods from 1963 to 2000 (National Center for Health Statistics, 2002).

CAUSES OF OBESITY
The determinants of being overweight and obese must clearly examine the
reasons why the body takes in more energy than it consumes. There is considerable debate over the roles of specific hormones that may alter appetite and,
thus, lead to continued overintake. We focus on the most important determi-

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351

nants of these energy intake and output regulators as being genetic traits and
the social environment. It must be clear, however, that obesity cannot be considered to be the result of either genetic or social factorsobesity is a complex interplay between them.
GENETIC FACTORS

The hereditability of human obesity is perhaps no more than 33%, which

leaves two thirds of the causality for social and environmental factors
(Stunkard, 2000). Considerable emphasis has been placed on genetic factors
involved in energy use. When energy metabolism was measured in Black and
White males and females, energy expenditure while sleeping was less in
Blacks. Their sleeping metabolic rates were significantly lower than that of
Whites (Weyer, Snitker, Bogardus, & Ravussin, 1999). There are similar
findings for obese children and adolescents. Resting energy expenditure was
lower in girls than it was in boys, and it was significantly lower in Blacks as
compared to Whites (Tershakovec, Kuppler, Zemel, & Stallings, 2002).
It has been speculated that the genetic basis for obesity and diabetes may
be related to the presence of a so-called thrifty gene (Neel, 1962). The metabolism of humans evolved over centuries, and, in our early history, energy and
fat had to be conserved in times of food scarcity. Populations experienced
alternate famished and plentiful food supply periods. To adapt to these extreme environmental changes, humans developed a thrifty gene that allowed
them to store energy as fat in times of plenty so that they would not starve and
die in times of famine. In modern society, where food is usually plentiful and
there is less physical activity, it is easy to become obese if one is thrifty with
energy. Thus, a protective mechanism has become a source of negative metabolic consequence. The thrifty gene has been identified in Native American
and Canadian populations that have very high levels of obesity and diabetes
(Hegele, Cao, Harris, Hanley, & Zinman, 1999; Ravussin & Bogardus,
1990).
The thrifty gene thesis may be relevant to Black people who live throughout the Diaspora and, perhaps, should have retained some genetic characteristics related to their origins. It is noteworthy that obesity and other related
chronic diseases follow an east-to-west gradient, with American Blacks being most disadvantaged, Caribbean Blacks intermediate, and prevalence
least in west Africa, which was the origin of much of the slave trade (Luke,
Cooper, Prewitt, Adeyemo, & Forrester, 2001). The theory is that dilution of
the thrifty or similar gene produces the gradient, or perhaps there is a common genetic susceptibility. However, Western dietary and social habits lead

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to increasing weight gain and obesity among those Black people who crossed
the ocean (Wilks et al., 1996).
But not all the evidence points in this direction. Investigation of families
of obese European and Black women suggests that there is a similar level of
hereditability of obesity in the two groups (Price, Reed, & Guido, 2000). The
relative importance of genetic, social, and environmental causes of obesity is
more than a matter of scientific curiositya predominance of the former factors will make efforts at control that much more difficult. Despite our insistence on obesity resulting from an interplay of genetic and social factors, the
rapid increase in the prevalence of obesity in recent years, which is too short a
time for significant genetic modification in populations, must focus more on
the role of the social and environmental factors, factors that obviously can
change more rapidly.
SOCIAL AND SOCIOECONOMIC FACTORS

Several social and socioeconomic factors have been associated with obesity. Thus, it seems relevant to cite social and economic factors relating obesity and Black adolescent girls, especially because one third of Black children live in poverty (LaPoint, 2003a). Findings vary considerably on the
relationship between socioeconomic status and obesity. Sobal and Stunkard
(1989) found only a weak correlation between socioeconomic status (SES)
and obesity generally. Women of higher SES were less obese in developed
countries, whereas in developing countries, there was a positive correlation
between SES and obesity. The relationship between SES and obesity in adolescent girls comes from a comprehensive analysis of the National Longitudinal Study of Adolescent Health, where data were collected from 13,113
adolescents. Changes in family income had a limited effect on the disparities
in overweight prevalence between Black and White adolescent girls. Overweight prevalence decreased as SES increased in White girls; among Black
girls, it remained elevated or tended to increase.
The disparity in overweight prevalence increased as the populations improved their SES. The interpretation of these and similar studies indicates
that in wealthier homes, there was more obesity among Black females as
compared with White females. This finding may be related to the perception
of ideal body size and efforts to attain it among different ethnic groups.
Young Black females report fewer eating disorders and are less likely to diet
because of concerns with obesity and body shape than their White counterparts (White, Kohlmaier, Varnado-Sullivan, & Williamson, 2003). However,
there may be a gradient effect among Black females who are, in fact, heterogeneous. One study of young Black girls showed that those females in higher

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353

socioeconomic groups were more concerned with being overweight than

those in lower socioeconomic groups (Robinson, Chang, Haydel, & Killen,
2001). Black girls, adolescents, and women may have differing and even tolerant attitudes toward themselves and others classified as overweight and
obese, and these attitudes may be influenced by African and African American culture, as cited earlier. There may be within-group differences, depending on variations in perception and gradients of internalization of Black standards of beauty (Falconer & Neville, 2000). They also found that among
Black college women, greater BMI scores were related to less positive evaluations of overall appearance but more satisfaction with specific body areas.
STRESS FACTORS

Studies on stress in relation to obesity have focused almost predominantly

on mechanisms by which food intake is increased and, to a much less extent,
on the factors that influence output. One comprehensive review, encompassing 30 years of clinical and experimental research, showed that stressful life
events leading to emotional eating was a common phenomenon. Such eating
behavior was present in all social classes, and the eating tended to be episodic
and related to specific times and incidents of stress or tension (Ganley, 1989).
However, stress may not only occur episodically as a result of a domestic crisis, for example, but may also be chronic as a result of persistent environmental stressors. It is the more chronic type of repeated stress, where the individuals capacity to cope is overwhelmed, that will lead to negative health
consequences such as overeating and obesity (McEwen, 2003). The effects
of stress on diet and weight are cited in research where short-term stressors
produced not only increases in blood pressure but enhanced preference for
and increased intake of sweet, high-fat foods and more energy-dense meals
(Oliver, Wardle, & Gibson, 2000). Thus, both quantity and quality of food
choices are influenced by stress.
Stress is almost a fact of life for Black Americans, and its causes are multifaceted. However, the most pervasive causes are poor SES, social inequalities, and persistent racism, whether overt or covertall of which lead inexorably to poor health outcomes and poor self-reported health status (Schulz,
Israel, Williams, Parker, Becker, & James, 2000). These persistent, chronic
stressors contribute to the inability of some Black women to control their
weight. One study found that 50% of Black women attributed their inability
to control their weight and their obesity to the stresses of work as well as to
those derived from social inequality and racial discrimination (WalcottMcQuigg, 1995). Stress, through stimulation of the hypothalamic-pituitary
adrenal axis, produces a complex hormonal response that involves overpro-

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duction of cortisol from the adrenal gland. The end result is a metabolic syndrome that includes resistance to insulin and increase in abdominal obesity
(Bjorntorp & Rosmund, 2000). Given the prevalence of abdominal obesity in
Black Americans, it is tempting to speculate on the relevance of these findings to that group. There is evidence, however, that this phenomenon exists in
Afro-Caribbean women where internalized racism, with attendant stress, is
associated with increases in blood pressure and abdominal obesity (Tull
et al., 1999).
The response to acute stress stimulates emotions that induce increased
intake of food generally as well as food that is more likely to cause obesity.
More chronic stress may result in increased food intake as well as difficulty
with weight control. In addition, there is a complex hormonal response to
stress that results in abdominal obesity with higher risk of cardiovascular disease and diabetes. This discussion is also applicable to Black adolescent
girls. Adolescence is a stressful transitional life stage during which many
biological and psychosocial changes occur. Black adolescent girls often experience stress related to structural barriers of race, SES (Dixon, 1996), and
gender similar to Black women. These stressful life conditions could lead to
overeating and subsequent overweight and obesity.
NUTRITIONAL FACTORS

Nutritional factors related to dietary intake may be controlled by hormones. The hormone leptin, which is secreted by fat cells, may regulate body
weight and energy expenditure through direct action on the central nervous
system. Leptin levels are higher in obese people, suggesting a resistance to
hormonal action. Leptin levels are higher in Blacks than in Whites in a population sample, but for equal degrees of obesity, there is no difference in these
levels between the two groups (Danadian, Suprasongsin, Janosky, &
Arslanian, 1999; Ruhl & Everhart, 2001). Other factors may affect excessive
dietary intake. These include children consuming less when they are allowed
to serve themselves versus when served by others (Fisher, Rolls, & Birch,
2003); children consuming more because of supersized food portions served
in homes and restaurants, especially in fast-food venues (Nielsen & Popkin,
2003); and childrens exposure to a variety of negative food marketing practices (Center for Science in the Public Interest [CSPI], 2003).
PHYSICAL ACTIVITY FACTORS

As indicated earlier, young Blacks have a lower resting metabolic rate

and, as a result, energy intakes similar to that of Whites would likely result in

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355

weight gain. However, the situation is compounded by the fact that they also
indulge in less physical activity. The daily leisure physical-activity time was
measured (Kimm et al., 2002) prospectively in Black girls and White girls,
ages 9 to 10 years to 18 to 19 years. Activity declined with time in both
groups but was significantly greater in the Black girls. By the time they had
reached adolescence, 56% of the Black girls and 31% of the White girls
reported no habitual leisure-time activity. As expected, the degree of overweight was greater among less active girls (Kimm et al., 2002). Another
important finding was that pregnancy was a significant contributor to the
decrease in physical activity in Black girls. An additional finding was a significant difference in television viewing, with Black youth watching television or videos for an average of 20.4 hours weekly as compared to 13.1 hours
for White youth (Gordon-Larsen, McMurray, & Popkin, 1999). This differential may mean that Black youth are exposed to more commercial advertising for unhealthy products, including low-nutrition foods (LaPoint, 2003a).

CONSEQUENCES OF OBESITY
The most important sequelae of the overweight are the noncommunicable
diseases: non-insulin-dependent diabetes mellitus, cardiovascular disease,
and hypertension. The extent to which the relative risk for these diseases is
increased with obesity is fairly constant throughout the world. However, data
indicate that Black people have a higher prevalence, particularly those with
Type 2 diabetes. The risk of other diseases, such as cardiovascular disease
and stroke is also higher, and the risk of these diseases increases steadily with
the degree of obesity.
DIABETES MELLITUS RISKS

Between 1991 and 2001 there has been an increase of obesity and diabetes
in the United States by 74% and 61%, respectively, indicating the strong correlation between obesity and diabetes (Mokdad et al., 2003). Black adults are
2 to 3 times more likely to develop diabetes than are White adults. The distribution of fat is also related to the risk of developing diabetes. Fat above the
waist is a stronger risk factor than fat below the waist, and Blacks tend to
develop upper-body fat that increases their risk of diabetes. Obesity may only
be a part of the answer for diabetes in Blacks because when compared with
Whites with the same levels of obesity, age, and SES, Blacks still have higher

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prevalence rates of diabetes (National Institute of Diabetes and Digestive and

Kidney Diseases, 2004).
CARDIOVASCULAR DISEASE RISKS

Obesity is associated with increased prevalence of cardiovascular disease

risk factors leading to increased morbidity and mortality (Freedman, Dietz,
Srinivasan, & Berenson, 1999). Because obesity is more prevalent among
Blacks, increased prevalence of cardiovascular risks also exists. An increased clustering of cardiovascular risk factors is found in both Black and
White boys and girls (Morrison, Barton, Biro, Daniels, & Sprecher , 1999).
Indeed, there is increased mortality with obesity, and this has been clearly
demonstrated in a longitudinal study of female nurses (Manson, Willett, &
Stamfer, 1995).
PSYCHOSOCIAL RISKS

It is assumed that childhood obesity may have harmful psychosocial risks

for children given Western societys stigmatization of obesity (Kimm et al.,
1997). Children and adolescents may be teased and bullied about their weight
status from peers as well as from parents and other family members, and this
includes reports on Black children (Dixon, 1996; Eisenberg, NeumarkSztainer, & Story, 2003). Research indicates that childhood obesity may have
harmful psychosocial risks for children. However, the prevalence and magnitude of risks are inconclusive, especially as related to minority populations
where conceptual and methodological challenges may exist.
Eisenberg et al. (2003) conducted a study on weight-based teasing on
4,746 ethnically and economically diverse adolescents in Grades 7 through
12. Adolescents were teased by peers and by their family members. Teasing
from peers and family members was consistently associated with low body
satisfaction, low self-esteem, high depressive symptoms, and thinking about
and attempting suicide. These relationships held for adolescents across
racial, ethnic, and weight groups. Rumpel and Harris (1994) conducted a
study on the influence of weight on the self-esteem of 936 adolescents identified as White, Black, and other. Findings indicated that adolescent selfesteem, locus of control, and BMI were unrelated. They concluded that
although some subgroups of obese children may be vulnerable to decreased
self-esteem, there might not be significant problems for the general population of obese children.
Kimm et al. (1997) conducted a study to examine the effect of adiposity
and other environmental factors on measures of perceived competence and

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357

self-adequacy among 2,205 Black and White girls ages 9 and 10. Obesity was
assumed to have a negative impact on self-esteem, given the social stigma it
carries in Western society. They found that adiposity had a negative impact
on the level of self-esteem in girls as young as 9 to 10 years and significant
racial differences in these relationships with the magnitude of the effect of
adiposity less in Black girls (Kimm et al., 1997). They found a more pronounced racial difference on one of their psychosocial measures, social
acceptance, and an absence of variation in the scores across the entire range
of adiposity among Black girls as compared to a significant inverse relationship among White girls (Kimm et al., 2002). They suggested that this apparent absence of perceived social rejection because of obesity was consistent
with the hypothesis that there exists, among Black people, a tolerance toward
obesity. They also cautioned researchers to use measures that are valid and
reliable in measuring self-esteem among populations of color (Kimm et al.,
2002).

THE CASE FOR OBESITY PREVENTION

Overweight and obesity risks are not new. Decades ago, professionals in
several fields sounded the alarm that the United States and the world would
face an obesity epidemic (Nestle & Jacobson, 2000). Initially, the emphasis
was mainly on individual treatment, and even today, there is a very large
global dieting industry for weight reduction ( The Atkins economy, 2003).
Individual treatment for obese individuals involves a host of dietary, pharmacological, surgical, and psychotherapeutic measures (WHO, 1997). However, the case for the prevention of obesity is equally, if not more, important,
given two important facts: (a) the rapid growth of the obesity epidemic
among children who will become obese adults and (b) treatment appearing to
be effective for relatively few individuals (Cutler et al., 2003).
The prevention approach to obesity for children and adults is essentially
based on two premises. First, it is still important to address individualsneeds
and to direct attention to them. Second, there is increasing emphasis on structural approaches that address obesity through interventions that reduce or
eliminate individuals volition and focus more on the environment in which
individuals function. These two approaches still take into account the basic
cause of obesitythe balance between energy intake and physical activity. A
recent editorial on obesity policy characterizes these approaches as active or
passive (Cutler et al., 2003), and a modification of their thesis is shown in a
model in Figure 2.

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STRUCTURAL
INTERVENTION

Commercial
Regulation

ENVIRONMENT

Public Health
Info rmation on
Lifestyle

Social
Marketing

BEHAVIOR

Recreation
Opportunities

INDIVIDUAL
INTERVENTION

Family
Support

Decrease
Dietary
Intake

Increase
Physical
Activity

Energy Balance

PREVENTION/REDUCTION
OF OBESITY

Figure 2:

A Model of the Prevention of Obesity

Structural interventions can be viewed as modification of the environment

by a series of policy actions that influence the behavior of whole populations
(i.e., the publics health). These policy approaches to prevent obesity among
children might include limiting televisions viewing, banning television
advertisements for unhealthy foods targeted to children, promoting healthy
school lunch programs, using appropriate labeling of foods, encouraging
outdoor play, encouraging breast feeding, limiting the consumption of soft
drinks, and mandating physical education in schools (Cuttler et al., 2003;
Dietz, Bland, Gortmaker, Molloy, & Schmid, 2002; Whitaker, 2003). Many

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of these policies fall under the heading of commercial regulation as shown in

the model in Figure 2.
The Surgeon General recognized the national responsibility for the prevention of obesity, stating in Healthy People 2010 that Americans have to
balance healthful eating with regular physical activity. Nestle and Jacobson
(2000) cited several measures that could halt the obesity epidemic, including
governmental policies and programs that could affect low-nutrition diets and
sedentary lifestyles. Several societal and community institutions such as
schools, faith-based communities, the workplace, health and human service
centers, and many others are subject to governmental regulations that could
be modified to facilitate environmental changes to be more conducive to
healthful diet and physical activity. They suggest a host of policy recommendations that could reduce and prevent obesity in areas such as education, food
labeling and advertising, heath care and training, and federal government
policy. The appropriate social marketing of these policies and strategies will
be critical to ensure acceptance of these structural approaches to modify the
environment, as is shown in Figure 2. The emphasis at the individual level has
been the more traditional one and has involved targeting messages to induce
individuals to change their behavior. The public health sector, with its
emphasis on prevention, will be important as well with its successes in
promoting healthy and reducing unhealthy behaviors.

IMPLICATIONS FOR OBESITY PREVENTION

AMONG BLACK ADOLESCENT GIRLS
Policies and programs to prevent obesity are clearly needed for Black adolescent girls. However, policy makers and practitioners, including advocates,
need to take into account the status of Black adolescent girls, who represent
an ethnic and gender group that is disproportionately poor and continues to
bear the consequences of structural barriers relating to racism, sexism, and
classism, as cited earlier. These structural barriers need to be identified and
resolved at all levelswith local and national leadership and community
stakeholders. It is also important to recognize how these barriers intersect
with and affect personal values, attitudes, and behaviors about health.
Schools, especially public schools, are logical intervention sites for prevention programs to reduce obesity among Black adolescent girls. Effective
school and family interventions to maintain healthy weight among youth
depend on a number of factors and are difficult for a number of reasons.
These interventions depend on educators and school personnel resources,

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knowledge, motivation, and action to implement appropriate programs as

well as the same for students, parents, and families. Also, they take considerable time to develop, implement, evaluate, and obtain effective weight reduction (Chomitz, Collins, Kim, Kramer, & McGowan, 2003).
Evaluation of one school-based program, using physical activity, eating
patterns, self-perception, and BMI as a means of obesity prevention among
adolescent girls, revealed a positive impact on behavioral changes in physical activities among girls in the intervention program at 3-month postintervention assessment. However, there were no differences in BMI and
weight control between girls in the intervention and control groups. These
findings indicate the difficulty of measuring program effectiveness and suggest longer and more intensive interventions (Neumark-Sztainer, Story,
Hannan, & Rex, 2003). There is evidence that a school-based health behavior
intervention program, Planet Health, decreased obesity among 1,295 ethnically diverse girls in Grades 6 through 8 (Gortmaker et al., 1999). It is possible that school-based interventions at the elementary or middle school level
can be very important in preventing obesity at an older age.
Policies and programs to prevent obesity among Black adolescent girls
should be a priority. In the area of structural interventions, prevention policies and programs should be culturally responsive to Black adolescent girls,
families, and communities. Black professionals and professionals who have
effectively worked with Black adolescent girls and their families should be
prominently involved as leaders in research, policy, programs, and advocacy
activities. Their participation can enhance culturally responsive program
development, implementation, and evaluation. Community-based organizations such as schools, faith-based communities, health and human service,
and business and civic organizations should be examined to determine how
Black adolescent girls can be reached in obesity prevention programs.
Some organizations in Black communities are prime sites for obesity prevention strategies for Black adolescent girls. As cited earlier, schools, especially at the middle and high school levels, show promise in reducing obesity
among students. School-based food programs and community programs that
serve food as a part of their activities need to be evaluated to make sure they
are promoting healthy diets and physical activities. Many child development
experts have voiced concern and opposition to corporate contracts in schools
for soda machines as a means of generating revues for schools because they
contribute to childrens poor health, including obesity and cavities (American Academy of Pediatrics, 2004). Many school systems have reduced or
deleted physical education programs, which require physical activity, from
school programs, often in response to budget cuts, academic programs, and

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361

cocurricular programs. Faith-based communities may be another promising

intervention site for obesity prevention among Black adolescent girls.
Social marketing and public health information related to obesity prevention need to be culturally responsive. Information should emphasize the cultural assets of Black adolescents, families, and communities, such as communal network institutions. The role of media is important because Black
youth are heavy consumers of television, radio, video, and movies. On one
hand, strategies to use these venues for social marketing to promote healthy
behaviors should be explored; yet on the other hand, these venues are commercially owned and operated, so consumer activism is needed to promote
prosocial behavior in media venues.
Commercial regulation is also needed. There is a need for Black parents,
family members, and professionals, across varying disciplines and settings,
to be informed about commercial environments and their influence on Black
youth. There is growing professional and community action to reduce and
prevent these toxic influences on children and families (LaPoint, 2003a). The
authors of this article have conducted and are conducting research on commercial influences on childrens development in the areas of dress and behavior and, more recently, of food and behavior. Marketers often produce advertisements where low-nutrition foods are cross-marketed with other products
such as fashion, music videos, movies, and toys. Black celebrities and models and other elements of Black culture are used in these commercial messages (LaPoint 2003a, 2003b). Many child development experts and advocates hail the APAs report that indicates that advertising to children under the
age of 8 should be banned (APA, 2004).
Finally, neighborhoods should be examined for their safety and design to
support routine, high-quality physical activities, both indoors and outdoors
(e.g., recreational centers and walking and biking trails). Recreation facilities
should have extended hours with adequate staffing and support. In another
area, high-nutrition food should be available in quality grocery stores, coops,
farmers markets, and other venues within Black communities.
The traditional approach has used public health information to affect lifestyle and individual behavior. However, it is important to use both the structural intervention and the individual intervention to affect behavior. Black
family and community support are crucial to developing and implementing
these strategies to decrease dietary intake while increasing physical activity.
It is through families that we may change the perception of being overweight
and being obese as being normal or desired. The combination of structural
and individual interventions can modify behavior for the reduction and prevention of obesity among Black adolescent girls.

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