Marian L. Fitzgibbon

Body images and obesity risk among Black females: A review of the literature

The prevalence of obesity among Black women has reached epidemic proportions. Some researchers have suggested that the body images of Black females may contribute to their high risk for obesity by inhibiting motivation for weight control. While a number of empirical studies have examined the body images of Black females, findings are complex and at times, inconsistent. For example, some studies show that Black females consider over-weight bodies more attractive, while other studies show that Black females prefer normal-weight bodies. Divergent findings may be due, in part, to the multidimensional nature of body image. Inconsistencies may also be due to differences between the Black females sampled. Methodological problems, including the use of measures that have not been validated among Black females, the use of various weight-for-height standards, and the inconsistent analyses of or lack of physiological data, also may contribute to conflicting results. This review addresses the complexity of body image findings among a heterogeneous Black female population and the relationship between their body images and obesity risk. Implications for effective obesity treatment programs and suggestions for improvements in future body image studies are also discussed.

Prevalence of binge eating disorder, obesity, and depression in a biracial cohort of young adults

This article examined the prevalence of binge eating disorder (BED), obesity, and depressive symptomatology in a biracial, population-based cohort of men and women participating in a longitudinal study of cardiovascular risk factor development. The Revised Questionnaire on Eating and Weight Patterns was used to establish BED status among the 3,948 (55% women, 48% Black) participants (age 28–40 years). Body mass index (BMI: kg/m2) was used to define overweight (BMI>-27.3 in women and ≥27.8 in men). Depressive symptomatology was assessed with the Center for Epidemiologic Study Depression Scale. Prevalence of BED was 1.5% in the cohort overall, with similar rates among Black women, White women, and White men. Black men had substantially lower BED rates. Depressive symptomatology was markedly higher among individuals with BED. Among overweight participants, BED prevalence (2.9%) was almost double that of the overall cohort. There were no differences in BED rates between overweight Black and White women. Thus, BED was common in the general population, with comparable rates among Black women, White women, and White men, but low rates among Black men. Obesity was associated with substantially higher prevalence of BED. Treatment studies that target obese men and minority women with BED are indicated.

Correlates of binge eating in Hispanic, Black, and White women

OBJECTIVE We sought to compare the severity and correlates of binge eating in White, Black, and Hispanic women. METHOD Our sample consisted of 351 (55 White, 179 Black, and 117 Hispanic) women who were assessed on three proposed factors associated with binge eating (weight, depression, and ideal body image). RESULTS Our results showed that binge eating symptoms were more severe in our sample of Hispanic versus Black or White women. Across all ethnic groups, women who binged more were heavier, more depressed, and preferred a slimmer body ideal. Binge eating severity was predicted by weight and depression in Hispanics and by depression in Whites. None of the proposed factors significantly influenced binge eating in Blacks. DISCUSSION These results show ethnic differences in the correlates of binge eating and highlight the need for further comparative research on aberrant eating patterns.

Hip-Hop to Health Jr., an obesity prevention program for minority preschool children: baseline characteristics of participants

BACKGROUND The prevalence of obesity in the United States is a significant public health problem. Many obesity-related risk factors are more prevalent in minority populations. Given the recalcitrant nature of weight loss interventions for adults, prevention of overweight and obesity has become a high priority. The present study reports baseline data from an obesity prevention intervention developed for minority preschool children. METHODS Hip-Hop to Health Jr. is a 5-year randomized controlled intervention that targets 3- to 5-year-old minority children enrolled in 24 Head Start programs. Our primary aim is to test the effect of the intervention on change in body mass index. Data were collected on sociodemographic, anthropometric, behavioral, and cognitive variables for the children and parents at baseline. RESULTS Participants included 416 black children, 337 black parents, 362 Latino children, and 309 Latino parents. Using body mass index for age and sex > or = the 95th percentile as the definition of overweight, 15% of the black children and 28% of the Latino children were overweight. More than 75% of the parents were either overweight or obese. DISCUSSION The development of interventions to effectively prevent or control obesity early in life is crucial. These data highlight the escalating problem of weight control in minority populations.

The clinical significance of binge eating in an obese population: Support for bed and questions regarding its criteria

The present study examined the prevalence of binge eating disorder (BED) among 192 obese individuals seeking treatment in a university-based eating disorders program. Subjects responded to a self-report questionnaire on the presence and severity of binge eating and were divided into two groups: (a) 48 non-binge eaters and (b) 144 binge eaters, 72 of whom met criteria for BED. Binge eaters reported earlier onset of obesity, higher levels of psychopathology, and less competence in relation to weight control. Comparison between the 72 individuals diagnosed with BED and the 72 binge eaters not meeting BED criteria indicated that the former group evidenced more severe binge eating and a higher level of depression. Given the differences across a range of psychological variables between binge eaters and non-binge eaters, these findings support the clinical and research value of BED as a new diagnostic category. However, they also indicate that severity of binge eating, regardless of frequency and associated behavioral features, is the most important distinguishing characteristic. Further research is needed to determine the most appropriate threshold for BED diagnosis.

Heterogeneity of clinical presentation among obese individuals seeking treatment

This study provides a test for the assumption of psychological homogeneity among 60 individuals who sought treatment for obesity and were referred for cognitive-behavioral group treatment. Subjects were divided along the dimension of severity of psychopathology and were assessed on subjective distress, binge eating, coping ability, and a variety of historical and demographic dimensions. Twenty-three percent of the sample scored in a range indicative of significant personality disturbance on the Borderline Syndrome Index. This distressed group did not differ from the less distressed cohort in weight, but reported more extensive symptoms of psychopathology, more chaotic eating patterns, more binge eating, and evidenced less effective coping skills. These findings provide support for the importance of a thorough assessment prior to initiating treatment for obesity.

An obesity prevention pilot program for African-American mothers and daughters

Abstract This study examined the effects of an obesity prevention program on eating-related knowledge and behavior. Subjects included 24 African-American women and their preadolescent daughters living in a low-income urban housing complex. The dyads were randomly assigned to the treatment or control group. The 6-week treatment addressed the identification of high- and low-fat foods, how to read food labels and calculate percentage of fat in calories in food, risks of high-fat eating, low-fat food planning and preparation, and the problems associated with obesity in general and within the African-American community in particular. Pre- and post-treatment measures included assessment of nutrition knowledge, nutrition attitudes, and food intake. Results showed that the treatment group, compared to controls, decreased their intake of fat in grams and in percentage of total calories. Additionally, differences within dyads showed that the mothers significantly improved their eating patterns (fat gram and fat percentage intake), more so than the daughters. A significant increase over time in nutrition knowledge was noted for the treatment group. Furthermore, although not significant, a trend for a greater increase in knowledge for the treatment group, as compared to the control group, was observed. These preliminary findings support the importance and effectiveness of parent-child prevention programs in high-risk communities.

Distressed binge eaters as a distinct subgroup among obese individuals

This study was conducted to examine the degree to which binge eating and psychological distress among obese adults are associated with a variety of behavioral patterns and competencies that could substantially affect weight control. Subjects were 167 obese people who sought help in a long-term cognitive behavioral treatment program. Subjects were divided into three groups depending on their level of psychological distress and severity of binge eating. Subjects were also assessed on coping style, subjective distress, weight history, and exercising and eating patterns. Results demonstrated substantial differences between those reporting relatively few problems with binge eating or psychological distress as opposed to those with noteworthy problems in both. The presence of either severe binge eating or psychological distress was associated with problems in regulating food-related behavior and, more generally, to problematic coping styles. These findings support the importance of in-depth assessment when treating obesity, more intensive treatment for some subgroupings, and long-term studies that incorporate comprehensive pretreatment process measure of eating style and psychological distress.

Current Practice of Psychological Assessment

A survey was conducted to evaluate current psychological testing practice in acute care inpatient settings. Findings indicated that psychologists typically continue to use the standard test battery developed by Rapaport, Gill, and Schafer in the 1940s. We outline an alternative problemoriented approach to assessment that seems better suited for short-term care settings. In this model the primary assessment strategy emphasizes rapid assessment of symptoms and problem areas rather than comprehensive personality assessment. The aims and procedures of psychological testing have been matters of dispute for many years (Meehl, 1954). Authors have presented differing views regarding the importance of assessing situational versus intrapsychic determinants of behavior (Mischel, 1968), the use of a standard battery versus tests selected to focus on a patients presenting problems (Schafer, 1967), and the relative value of objective versus projective tests (Megaree, 1966). The most common ideological differences about the aim of assessment have centered on whether to construct a comprehensive personological description of the patient or to describe overt problems. We advocate the use of the latter for short-term inpatient psychiatric hospitalizations. A model focusing on the description of overt problems and symptomatology is potentially more beneficial to a patient than are the results of a comprehensive test battery. A focused problem-oriented assessment is a more efficient use of what typically is limited professional staff time and is focused on the immediate clinical problems that require hospital care.

Binge eating disorder and bulimia nervosa: Differences in the quality and quantity of binge eating episodes

OBJECTIVE This study sought to examine the differences in the quantity and quality of binges between binge eating disorder (BED) and bulimia nervosa. METHOD Patients (N = 77) seeking treatment for eating disorders were assessed on binge content. RESULTS Results suggest no differences in binge quantity with BED and bulimia, but there were differences in the binge quality. The binges of bulimics were higher in carbohydrates and sugar than those with BED. DISCUSSION The higher levels of obesity of our BED individuals may account for the lack of differences between those with bulimia and BED. The importance of increasing our knowledge of the continuum of weight and binging is discussed.