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RESEARCH ARTICLE |
1 Department of Sociology, University of Toronto, Canada.
2 Department of Sociology, University of Wisconsin.
3 Department of Sociology, University of Toronto, Canada.
Address Correspondence to Scott Schieman, PhD, University of Toronto, Department of Sociology, 725 Spadina Avenue, Toronto, Ontario M5S 2J4, Canada. E-mail: scott.schieman{at}utoronto.ca
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Abstract |
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Methods. Data are derived from face-to-face interviews with 1,164 adults aged 65 years and older in the District of Columbia and two counties in Maryland in 2000-2001.
Results. With "perceived appropriate weight" as the comparison group, multinomial logistic regression analyses indicate that white adults, women, and high-SES individuals are more likely than black adults, men, and low-SES individuals to describe themselves as overweight or obese. However, these disparities are observed only after statistically adjusting for race, gender, and SES disparities in BMI. Moreover, the positive effect of SES on the likelihood of reporting overweight or obese perceptions is strongest among black women. Among low SES individuals, white women are more likely than men and black women to describe themselves as obese (relative to the "perceived appropriate weight" category).
Discussion. Our observations underscore the importance of taking SES contingencies into account when exploring race-gender differences in perceived body weight. This study further contributes to the literature by documenting the important suppression patterns associated with race, gender, and SES differences in BMI.
INDIVIDUALS maintain different perceptions about their own body weight. Some describe their weight as appropriate, whereas others feel as though they could or should lose a few (or many) pounds; others report the desire to add to their body weight. The central aim of this article is to examine whether there are systematic social status variations in these perceptions. Although the health effects of body mass index (BMI) and its social distribution are well documented, our research contributes to existing knowledge by documenting the intersection of gender, race, and social class—among a socioeconomically diverse sample of older adults—and the ways in which these dimensions of social stratification shape perceptions of body weight in late life. Specifically, we asked: Do women and men differ in their perceptions of their body weight? If so, do these differences vary by race and socioeconomic status (SES) net of relative body weight?
The prevalence of people with high BMI scores (>30) has risen sharply in recent years (Hedley et al., 2004
; McTigue, Garrett, & Popkin, 2002). Estimates from the National Center for Health Statistics (2003) indicate that the percentage of obese American adults increased from 13% to 30% between 1980 and 2000. Recent surveys document that roughly 34% of adult women and 28% of adult men are obese. Those rates increase to 62% and 67% for women and men, respectively, if one combines overweight and obese groups. Moreover, African Americans have a higher rate of obesity compared to other racial/ethnic groups in the United States (Denney, Krueger, Rogers, & Boardman, 2004; Flegal, Carroll, Ogden, & Johnson, 2002). The high level of obesity has emerged as a public health issue because of the associated risks of chronic diseases, functional impairments, mortality, and psychosocial difficulties (Carr & Friedman, 2005; Fabricatore & Wadden, 2004; Ferraro & Kelley-Moore, 2003; Flegal, Graubard, Williamson, & Gail, 2005; Hassan, Joshi, Madhavan, & Amonkar, 2003). Collectively, these health consequences and their links to medical care cost an estimated $75 billion annually in the United States (Finkelstein, Fiebelkorn, & Wang, 2003; Sturm, 2002). Although the prevalence of obesity peeks around ages 50 to 59 and tends to decline in later life, rates are increasing among older adults. Roughly 19.5% of adults aged 65 or older are obese, and that rate has increased from 12% in 1990 (Centers for Disease Control and Prevention, 2005). Roughly 13% of adults older than age 80 are obese (Himes, 2004). Obesity is associated with higher risks of health conditions such as arthritis, diabetes, hypertension, and functional limitations—conditions that are especially relevant in late life (Kahng, Dunkle, & Jackson, 2004; Thorpe & Ferraro, 2004).
The Importance of Perceptions of Body Weight
The study of perceived body weight is important because of the potential implications of perceived body weight for psychological, social, and behavioral outcomes—independently of and in combination with relative body weight. Social differences in perceived body weight are especially relevant given the well-documented racial/ethnic and SES disparities in obesity-related health conditions (Hassan et al., 2003). Moreover, the ways in which individuals evaluate their body weight inform the discussion of gender, race, and SES differences in health lifestyle decisions (i.e., diet, exercise) and persistent gender–race group disparities in health (Cockerham, 2005). Misperceptions may cause individuals to overlook potential problems, thwart motivation to engage in preventive behaviors, or even contribute to actions that cause new health problems (Kuchler & Variyam, 2003).
The processes and consequences of perceptions about body weight connect to an array of psychosocial and mental health outcomes. For example, the rising levels of body dissatisfaction over the past 50 years have occurred in tandem with higher rates of eating disorders, especially among women (Feingold & Mazzella, 1998). To date, however, most studies about perceptions of body weight have examined college students or young adults (Fallon & Rozin, 1985; Milkie, 1999). Less is known about perceptions of weight in late life, perhaps because of an assumption that body issues diminish in importance among elders. To the contrary, evidence suggests that concerns about aging and its effect on body weight and physical appearance are common in late life, particularly among older women (Halliwell & Dittmar, 2003). Allaz, Bernstein, Rouget, Archinard, and Morabia (1998) found that body weight concerns rank second behind memory loss as a central issue among elders. Likewise, Clarke (2002) found that weight-related issues are a major source of dissatisfaction among older women; the increased difficulty of weight loss is highly frustrating.
Dimensions of Social Stratification and Perceptions of Body Weight
Of all of the dimensions of social stratification, gender is central because of its influence on social norms and meanings about physical appearance. Pervasive cultural ideals of female thinness, the stigma associated with being overweight, and traditional gender-role differences in the importance of attractiveness may contribute to women's generally lower levels of satisfaction with their body weight (Reboussin et al., 2000; Rodin, Silberstein, & Striegel-Moore, 1984; Ross, 1994). Studies have shown that women report a lower BMI as the "ideal" (Crawford & Campbell, 1999) and are more likely than men to perceive themselves as overweight even if they are of normal weight, whereas men are more likely to consider themselves as normal weight even if they are overweight (Chang & Christakis, 2003; Kuchler & Variyam, 2002, 2003).
Race represents another core dimension of stratification that influences body weight issues. For example, African Americans are less likely than other racial/ethnic groups to describe themselves as "overweight" (Chang & Christakis, 2003). In addition, Black adults tend to underestimate their body weight and White adults tend to overestimate their weight (Bhuiyan, Gustat, Srinivasan, & Berensen, 2003; Kuchler & Variyam, 2002). Studies also suggest that gender and race intersect to shape perceptions about body weight and size. Compared to their White counterparts, Black adolescent girls and adult women report less social pressure to be slim (Kumanyika, Wilson, & Guilford-Davenport, 1993; Powell & Kahn, 1995), less dissatisfaction with body size and weight, a greater acceptance of overweight (Brown et al., 1998; Miller et al., 2000; Smith, Thompson, Raczynski, & Hilner, 1999), a preference for a larger body shape (Becker, Yanek, Koffman, & Bronner, 1999; Parnell et al., 1996), a higher BMI criterion for body image discrepancy (Fitzgibbon, Blackman, & Avellone, 2000), and a lower risk of eating disorders or unhealthy weight-control methods (Henriques, Calhoun, & Cann, 1996; Neff, Sargent, McKeown, & Jackson, 1997). These processes may be part of a "cultural economy" in which body size and image are salient sources of social status (Chang & Christakis, 2005). Some evidence, however, has indicated that exposure to unrealistic images of African American models is associated with lower levels of body satisfaction among African American undergraduate women (Frisby, 2004).
Despite the valuable information provided by studies of younger samples, Himes (2004) contended that much remains unknown about race differences in late life. The results of the few studies of older adults have tended to replicate patterns observed among younger samples. In a study that compared Black and White women older than age 65, Stevens, Shiriki, Kumanyika, and Keil (1994) documented that overweight Black women are more satisfied with their weight, less likely to feel guilty after overeating, less likely to diet, and more likely to consider themselves attractive than overweight White women. They also found that, among women who are not overweight, White women are more likely than Black women to describe themselves as overweight and report a lower ideal body weight. Similarly, another study that focused on overweight and obese women aged 40 and older found that Black women are more likely than White women to report satisfaction with their body size (Anderson, Eyler, Galuska, Brown, & Brownson, 2002).
Notably, most prior research has focused on comparisons among women only. Moreover, none that we could identify had explicitly assessed the interactive effects of gender, race, and SES. Evidence has consistently shown that higher SES women tend to have a lower risk of obesity than lower SES women, although the SES effects are less definitive among men (Langenberg, Hardy, Kuh, Brunner, & Wadsworth, 2003; Sundquist & Johansson, 1998; Wardle, Waller, & Jarvis, 2002). Despite higher SES individuals' lower risk of obesity, they tend to report a higher likelihood of feeling overweight (Chang & Christakis, 2003) and higher levels of dissatisfaction with their bodies than lower SES groups (Wardle & Griffith, 2001); this is especially true among women (Allaz et al., 1998; McLaren & Kuh, 2004; Ogden & Thomas, 1999). Although these patterns are paradoxical because higher SES women tend to exercise more, eat healthier, and respond faster to weight gain than low-SES women (Jeffery & French, 1996), they are consistent with the positive association between SES and the risk of eating disorders (Gard & Freeman, 1996; Hsu, 1996).
Collectively, these ideas suggest the potential intersection of gender, race, and SES in shaping perceptions about body weight. Yet, few studies (if any) have explicitly tested for Gender x Race x SES interaction effects. One study of female college students, however, provides some clues. Molloy and Herzberger (1998) observed that although low-SES Black women are heavier than high-SES Black women and White women of all SES levels, low-SES Black women rated heavier body types as more attractive than did women in these other groups. Drawing from that research, we suspect that differences between elderly White and Black women in perceived body weight may be greatest at lower levels of SES. Conversely, at higher levels of SES, it is plausible that White and Black women share similar perceptions of their weight—net of gender and race disparities in BMI. In an extension of prior research, we contrast differences among women with an expectation of smaller observed differences between Black and White men in perceptions of weight across BMI and SES levels.
An additional component of our analyses proposes that stratification-based differences in levels of BMI suppress differences in weight perceptions for the following reasons. African Americans have higher levels of BMI than White adults (Chang, 2006; Kahng et al., 2004). Overall, 77% of Black women are overweight, compared to about 57% of White women (Flegal et al., 2002). Given that SES is associated negatively with the likelihood of obesity, it is plausible that these patterns will suppress stratification-based differences in perceived weight. McLaren and Kuh (2004), for example, found that a negative association between SES and a measure of "weight esteem" among women emerged only after they statistically adjusted for BMI. This implies that, at the same level of BMI, women of higher SES tend to report more negative appraisals of their own weight compared to women of lower SES. Building off that research, we sought to elaborate these patterns by assessing if gender–race disparities in BMI level suppress gender–race differentials in perceived weight. For instance, White women's lower average level of BMI might suppress their overall tendency toward more negative appraisals of weight relative to other gender–race groups.
Taken together, prior theoretical and empirical perspectives provide a basis for the following hypotheses: (a) Women are more likely than men to describe their weight as overweight or obese; (b) among women, White women are more likely than Black women to describe their weight as overweight or obese; (c) in addition, SES may modify these effects such that low-SES White and Black women are more different than high-SES White and Black women; (d) White women's lower BMI suppresses these associations such that, at the same level of BMI, White women will be more likely to describe themselves as overweight or obese; and (e) despite race differences in BMI, we see no compelling rationale for expecting substantial differences in perceptions of body weight between White and Black men.
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METHODS |
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Measures
Our question about perceptions of body weight asked, "How would you describe your present weight? Would you say it's about right, you should lose a few pounds, you should lose many pounds, or you should put on some weight?" To simplify the presentation, we refer to "it's about right" responses as perceived appropriate weight, "should lose a few pounds" responses as perceived overweight, "should lose many pounds" responses as perceived obese, and "should put on some weight" responses as perceived underweight. In regression analyses, we compare the appropriate weight category with the perceived overweight, obese, or underweight categories. We acknowledge that this perception implies behaviors related to losing or gaining weight. We infer that if one reports the desire to "lose many pounds" that he or she appraises his or her weight as excessive relative to some standard irrespective of whether that person's BMI is appropriate.
We calculated BMI as weight in kilograms divided by the square of height in meters; this was based on self-reported height and weight. Following National Heart, Lung, and Blood Institute (1998) standards, we created the following categories: BMI < 20.0 = underweight, BMI 20.0 to 24.6 = normal weight, BMI 25.0 to 29.9 = overweight, and BMI 
30.0 = obese. In the descriptive parts of our analyses, we used these categories. However, when we used BMI as a predictor in our analyses, we included it as continuous measure to simplify the presentation and interpretation of the findings. Separate analyses (not shown) found that categorical and continuous versions of BMI as a predictor measure yielded similar results.
We coded gender as binary, with 1 for women and 0 for men; likewise, we coded race as binary, with 1 for African American adults and 0 for White adults. To test for Gender x Race differences, we multiplied gender by race and included this interaction term in our models.
To measure SES, we standardized and then averaged education and income scores. The education categories were eighth grade or less, some high school but did not graduate, high school graduate or general equivalency diploma, specialized (vocational) training, some college but no degree earned, and college graduate or more (coded 1–6). The income item asked for total household income before taxes in the past year, including salaries for everyone in the household, money market funds, Social Security, pensions, real estate, or government entitlements. Response categories were less than $10,000, $10,000 to $19,999, $20,000 to $29,999, $30,000 to $39,999, $40,000 to $49,999, $50,000 to $59,999, $60,000 to $69,999, $70,000 to $79,999, $80,000 to $89,999, $90,000 to $99,999, and $100,000 or more. Analyses of education and income separately revealed redundancy in their predictive effects. Therefore, results are based on the combined SES index. A few additional comments about the SES index are warranted. First, the correlation between education and income was.54. The overall average education was high school, and the average income was in the $40,000 range. Some readers may wonder about the distribution of cases across SES and whether the data contained sufficient cases for adequate gender–race subgroup comparisons. For the purposes of additional analyses to assess this concern, we defined low SES as scores in the lowest quartile and high SES as scores in the highest quartile. In the low-SES group there were 93 Black men, 133 Black women, 46 White women, and 22 White men. In the high-SES group there were 61 Black men, 34 Black women, 71 White women, and 157 White men. More variation is always ideal, especially at the upper end of the SES scale for Black adults and at the bottom end of the SES scale for White adults. However, in no instance did data sparseness appear to be problematic for the estimates that we present in the Results section.
Plan of Analyses
We examined the associations between gender, race, and SES with BMI and perceived body weight as dependent measure. In the analysis of perceived weight, multinomial logistic regression models specified the likelihood of perceived overweight, obese, or underweight versus perceived appropriate weight (the comparison group). To test for suppression effects of BMI, we followed a two-step approach in which the first model excluded BMI and the second model adjusted for it. Suppression effects were evident if we observed an increase in the sizes of the gender, race, and SES coefficients once we included BMI in the model. To assess the potential modifying effects of SES, we multiplied SES by gender and race and included these interaction terms in the models. Modifying effects were evident if we observed that the differences between race–gender groups in perceptions of weight varied across levels of SES (Mirowsky, 1999). All analyses adjusted for age, coded in years; we observed no nonlinear age effects.
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RESULTS |
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In Table 2, we report unadjusted percentages of perceived weight versus actual BMI categories across gender–race groups. The patterns in the table suggest that Black adults, overall, were generally more likely than White adults to underestimate in their reporting (i.e., describe themselves as appropriate weight when in fact they were classified in overweight or obese BMI categories). In contrast, White women in particular were generally more likely than men and Black women to overestimate in their reporting (i.e., describe themselves as overweight when in fact they were classified as normal BMI). Supplementary analyses that used multinomial logistic regression techniques indicated that these race differences in underestimation and Gender x Race differences in overestimation were statistically significant at the p <.01 level (full results available upon request).
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DISCUSSION |
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Prior theory and research has contended that norms about body image are most relevant for White women of higher SES. By contrast, research has often found Black women to be more satisfied with their weight and body size. Our findings challenge the uniformity of those claims and build off of previous work that has implied Gender x Race differences. For example, Black adolescents and adult women report less dissatisfaction with their body or weight than their White counterparts. Moreover, by illustrating the ways that gender–race comparisons are also contingent upon SES, we modify the conclusion that being overweight or obese is uniformly more acceptable among Black adults than White adults. We observed that high-SES Black women are more likely to describe themselves as obese even though SES is associated negatively with actual BMI level. Collectively, these findings reinforce the importance of examining the intersection of dimensions of all three forms of stratification—gender, race, and SES—in analyses of body weight. Moreover, the discovery of the suppression effects of BMI indicates that the same level of BMI has different implications for gender, race, and SES differences. Here, our findings parallel previous evidence that although low-SES Black women have a higher BMI than high-SES Black women and White women, they also tend to perceive heavier body types as more attractive than do women in those other groups (Molloy & Herzberger, 1998). It is important to note the possibility, however, that the perceptions of body weight may have less to do with attractiveness and more to do with health concerns or awareness. High SES may represent greater lifetime access to health information that has encouraged weight loss or a more conscientious approach to weight maintenance and a healthier lifestyle. If so, higher SES individuals, regardless of race, may be more prone to reporting a desire to lose weight than their lower SES peers. Thus, perceptions of weight may contain elements of health-related socialization processes, better access to information, or even social desirability influences.
Misperceptions about the need to gain or lose weight can have deleterious consequences for the motivation to implement weight-change regimens and other health behaviors. These issues are important in late life because overweight, obesity, and underweight statuses can exacerbate or amplify problems with health conditions and functional limitations. Moreover, the psychosocial impact of perceptions of body discrepancies may represent an understudied stressor for older women. Although it is plausible that the cultural ideals associated with female thinness, the stigma associated with being overweight, and traditional gender-role differences in the importance of attractiveness diminish in later life, the evidence we cited earlier implies the opposite. Gender and race differences may persist into late life. As the population ages, weight-related concerns for elders may become an even more salient element of well-being (Himes, 2000, 2004). Nonetheless, it is important for research to consider whether overweight and obesity are associated differently with health risks in older adults. There is some controversy regarding the extent that overweight is positive or negative for health and mortality risk in late life. As we noted, weight gain or loss may be associated with the loss of muscle mass because of chronic diseases. More evidence is needed about the ways in which these processes are relevant for elders' subjective appraisals of body weight and their decisions about weight loss or gain.
Several limitations of our study deserve mention: self-reports and selective survival. Numerous studies have utilized self-reports to measure BMI levels (Boardman, Saint Onge, Rogers, & Denney, 2005; Carr & Friedman, 2005; Chang, 2006; Chang & Christakis, 2005; Crosnoe & Muller, 2004; Eaton, Lowry, Brener, Galuska, & Crosby, 2005; Kuchler & Variyam, 2003), including the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System. Although researchers have argued that self-reports of body weight are highly correlated with scale indicators (e.g., Palta, Prineas, Berman, & Hannan, 1982; Stunkard & Albaum, 1981) and that the bias introduced in self-report data tends to be trivial (Palta et al., 1982), self-reports may be a limitation if elders systematically misrepresent their height and weight. Self-reported weight measures, although often close to objective measures, may be slight underestimates on both ends of the weight distribution (Ferraro & Kelley-Moore, 2003). A study of Australian adults aged 18 and older estimated that 26% of men and 21% of women underreported their weight by 4 pounds or more; likewise, 15% of men and 7% of women overreported their weight by 4 pounds or more (Crawford & Campbell, 1999). The age distribution of these estimates is unclear. Others have shown that individuals aged 65 and older are more likely to believe their weight is healthy or underweight when they are actually obese or overweight (Kuchler & Variyam, 2003). Errors due to underreporting may make estimates conservative (Chang, 2006). To systematically address concern about self-reported BMI, we conducted analyses of the effects of two scenarios that may have biased our estimates. The first scenario assumed that White adults overestimated their weight by 4 pounds, whereas Black adults underestimated their weight by 4 pounds. The second scenario assumed that White women overestimated their weight by 5 pounds, White men overestimated their weight by 2 pounds, Black women underestimated their weight by 5 pounds, and Black men underestimated their weight by 2 pounds. Although other scenarios are possible, we based these values on evidence cited previously. Regression results using BMI scores from these scenarios yielded only a few slight and often trivial changes in some estimates (available upon request). These observations should partially assuage concerns about self-reported BMI.
Selective survival is another issue. Elders with extremely high or low BMI may have had a lower probability of being in our sample because of death, impairment, or institutionalization. Therefore, selection bias may have truncated the range of variation in BMI. If an elder loses weight because of a chronic condition, such as cancer, but remains in the normal weight BMI category, then he or she may still believe that it is necessary to put on a few pounds as a preemptive measure against weight loss or from the desire to regain weight that was lost because of illness. These ideas connect with another limitation of our study: There were too few cases in the underweight BMI and perceived weight groups. The distribution and implications of underweight (perceived and actual) are understudied domains. Most research has focused on obesity despite evidence that being underweight has deleterious effects on health (Flegal et al., 2005).
Body weight concerns remain important into late life, especially among women. Moreover, perceptions about body weight can influence decisions about health lifestyle. Our study has sought to expand on current knowledge by documenting the ways in which gender, race, and SES intersect to influence these perceptions. Although our observations are generally consistent with the notion of women's dissatisfaction with their weight as a "normative discontent" (Rodin et al., 1984), our study has sought to qualify this claim by revealing important stratification differentials and the suppressor role of stratification-based differences in relative body weight.
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Acknowledgments |
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Footnotes |
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Received for publication November 28, 2006. Accepted for publication July 30, 2007.
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