Lori Carter-Edwards, PhD

1. 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 Medicine Duke University Medical Center Durham, NC 12th Annual CDC Maternal and Child Health Epidemiology Conference Atlanta, GA 07 December 2006 Sponsor: National Institute of Diabetes, Digestive, and Kidney Diseases (NIDDK) [R01DK64986]

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

3. Presentation Overview • Background • Purpose • Methods • Results • Strengths and Limitations • Conclusions • Implications

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.

5. Background (cont.) • Body image unclear among overweight or obese postpartum women • Body image unclear among those engaged in behavior modification • Similar postpartum body area dissatisfaction exists by race. • The magnitude of dissatisfaction is greater among Caucasians than African Americans.

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.

7. Methods • 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

8. Methods (cont.) • 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

9. Methods (cont.) • Active Mothers Postpartum (AMP) Study • Measurements • Baseline • 12 months • 18 months • 24 months • 6 months, intervention group only

10. Methods (cont.) • Study Sample • Intervention Group - Exclusions • Loss to follow-up (n=31) • Strollers only (n=5) • Race other than African American or Caucasian (n=9) Study Sample Size = 180

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

12. Methods (cont.) • Figure Rating Scale “Desired” Shapes “Actual” Shapes • 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

13. Results Table 1. Demographics (n=180) * Statistically significant difference by race (using t-test and chi-square tests). ** n=172 respondents

14. Results Table 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.

15. 3.3 3.6 3.6 3.8 African American P=0.012 P=0.225 Caucasian Results (cont.) Mean Distribution of Body Image Factors at 6-Months Postpartum by Race and Weight Status Shape that is Most Attractive By Race - BMI>30 (n=89) By Race - Total (n=153)

16. 3.4 3.8 3.8 4.2 African American P=0.011 P=0.048 Caucasian Results (cont.) Mean Distribution of Body Image Factors at 6-Months Postpartum by Race and Weight Status Shape You Would Like to Look Like By Race - BMI>30 (n=89) By Race - Total (n=153)

17. 2.8 3.1 3.1 3.2 African American P=0.044 P=0.496 Caucasian Results (cont.) Mean Distribution of Body Image Factors at 6-Months Postpartum by Race and Weight Status Shape Women Find Most Attractive By Race - BMI>30 (n=89) By Race - Total (n=153)

18. 2.9 3.3 2.7 3.1 African American P=0.006 P=0.039 Caucasian Results (cont.) Mean Distribution of Body Image Factors at 6-Months Postpartum by Race and Weight Status Shape Men Find Most Attractive By Race - BMI>30 (n=89) By Race - Total (n=153)

19. 3.8 4.5 4.1 4.6 African American P<0.001 P=0.017 Caucasian Results (cont.) Mean Distribution of Body Image Factors at 6-Months Postpartum by Race and Weight Status Shape of an Ideal Mother By Race - BMI>30 (n=89) By Race - Total (n=153)

20. 5.8 6.1 6.2 6.5 African American P=0.189 P=0.212 Caucasian Results (cont.) Mean Distribution of Body Image Factors at 6-Months Postpartum by Race and Weight Status Your Shape Once Baby Was Born By Race - BMI>30 (n=89) By Race - Total (n=153)

21. 5.5 5.5 6.0 6.1 African American P=0.841 P=0.699 Caucasian Results (cont.) Mean Distribution of Body Image Factors at 6-Months Postpartum by Race and Weight Status Shape You Look Like Now By Race - BMI>30 (n=89) By Race - Total (n=153)

22. 4.7 4.7 5.2 5.4 African American P=0.936 P=0.459 Caucasian Results (cont.) Mean Distribution of Body Image Factors at 6-Months Postpartum by Race and Weight Status Pre-Pregnancy Shape By Race - BMI>30 (n=89) By Race - Total (n=153)

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)

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.

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.