Who's Obese? Patients, Doctors Differ
Obesity Health Warnings Ignore Racial, Cultural Diversity
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
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
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
"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
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."