Association of body image dissatisfaction, behavioral responses for healthy eating, and cardiovascular health in African-American women with overweight or obesity: A preliminary study

Abstract

Background: African-American (AA) women have the lowest prevalence of ideal categorizations of diet and body mass index (BMI), as defined by the American Heart Association (AHA) Life's Simple 7 (LS7) cardiovascular health (CVH) components compared to other racial/ethnic groups, regardless of sex/gender. There is limited research exploring the interplay of unique psychosocial influences on CVH such as body image dissatisfaction (BID) and behavioral responses for healthy eating among AA women with overweight or obesity.

Objective: This study aimed to assess the association of BID with behavioral responses for healthy eating and LS7 components.

Methods: A cross-sectional analysis of baseline data was conducted among 32 AA women with overweight or obesity from a larger, community-based participatory research study. Self-reported measures were used to assess BID and behavioral responses to healthy eating (diet self-regulation to reduce fat or caloric intake and motivation for healthy eating [intrinsic motivation and integrated regulation]) using previously validated instruments. The LS7 components (e.g., BMI, diet, etc.) and composite score were evaluated using the AHA LS7 metrics rubric.

Results: Women with no or lower BID had greater diet self-regulation to reduce fat or caloric intake (mean, 3.5 vs 3.0; P=.05), intrinsic motivation for healthy eating (mean, 5.3 vs 4.2; P=.01), and integrated regulation for healthy eating (mean, 5.3 vs 3.7; P=.002) than those with higher BID. These significant differences remained after adjustment for BMI. Women with higher BID had a higher proportion of BMI within the obesity range compared with those with no or lower BID (94.4% vs 57.1%, P=.03). BID was not significantly associated with other LS7 components or composite score.

Conclusion: BID and other psychosocial influences for healthy eating are potential targets for culturally tailored lifestyle interventions among AA women.

Keywords: AA, African-American; AHA, American Heart Association; African-American women; BID, body image dissatisfaction;, BMI, body mass index; Body image dissatisfaction; CVD, cardiovascular disease; CVH, cardiovascular health;, FAITH!, Fostering African-American Improvement in Total Health; Cardiovascular health; Healthy eating; LS7, Life's simple 7; Obesity; SCT, Social Cognitive Theory; SDT, Self-Determination Theory.

Fig. 1

Central Illustration. Proposed biobehavioral mechanism of interactions between psychosocial influences, behavioral responses for healthy eating, and consequent biologic responses, and their aggregate deleterious effects on BMI and CVD among African-American women with overweight or obesity. The psychosocial influence, BID, is suggested to be compounded by weight stigma, the Superwoman syndrome unique to African-American women, and African-American cultural identity and diet. Increased BID is shown to influence health behavior responses, in this case, decreased diet self-regulation and motivation for healthy eating. These behavioral responses may then exacerbate BID and its related factors due to a decreased sense of self-efficacy. Without intervention, this loop may continue and heighten physiologic dysregulation due to stress, with subsequent increases in BMI and CVD risk. Abbreviations: BID, body image dissatisfaction; BMI, body mass index; CVD, cardiovascular disease; HPA, hypothalamic-pituitary-adrenal; SAM, sympathoadrenal–medullary.