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Who's Obese? Patients, Doctors Differ

Obesity Health Warnings Ignore Racial, Cultural Diversity
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WebMD Health News

April 27, 2006 -- When our doctors tell us to lose weight, what we hear may not be a health message.

It's particularly true for black patients, a study from Yale University School of Nursing shows.

The study shows that when doctors talk about a patient's weight, they are talking about body size. But what patients hear is that the doctor has different ideas than they do about things like attractiveness, sexual desirability, body image, strength or goodness, self-esteem, and social acceptability.

Yale doctoral student Maryanne Davidson, MSN, RN, CPNP, and Kathleen A. Knafl, PhD, now at Oregon Health & Science University, report the findings in the May issue of the Journal of Advanced Nursing.

"There is such a disconnect between what we health care providers mean when we talk about obesity and overweight, and what those concepts mean to different people," Davidson tells WebMD. "We say, 'Your health is affected by the size of your body.' But patients don't necessarily connect those terms to the belief that their health is affected."

Blacks, Whites See Size Differently

Davidson and Knafl analyzed 20 papers from 18 different studies on patients' concepts of obesity and analyzed each study.

"I looked at what these researchers found when patients talked to them about obesity and overweight," Davidson says. "I looked at the differences and similarities between the groups and what that might mean for us as health care providers."

The studies consistently showed that larger body sizes are more socially acceptable -- and more desirable -- to black women and men than to white women and men.

"Black men find black women at a larger body size to be attractive, and black women feel attractive at a larger body size," Davidson says. "White women talked about feeling unattractive at a larger body size, and they did not find it socially acceptable."

The finding does not surprise Sheila P. Davis, PhD, professor of nursing at the University of Mississippi Medical Center in Jackson. Davis studies overweight children and their families.

"It seems as if for black women -- and I am a black woman -- obesity doesn't carry the same negative associations as it does for white women, Davis tells WebMD.

University of Cincinnati pediatrician Frank Biro, MD, associate director of adolescent medicine at Cincinnati Children's Hospital, has studied how different cultures see body size differently.

"You see in the scientific literature that African-American women are comfortable with a thicker body shape," Biro says. "That is the specific word they use -- thick. And it's a very good word. If you think about thin, someone could be thicker."

Where races differ less is in relating obesity to health. For both blacks and whites, the message isn't clear.

"When it comes to health, many African-Americans do not associate being overweight or obese with larger body size," Davidson says. "Even with white women, it was minimized. Some did not believe it. It is concerning that is so common, because health care providers only use the terms 'BMI,' 'overweight,' and 'obesity' to talk about body size."

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