BMI, body image, emotional well-being and weight control behaviors in urban African American adolescents

Adolescent obesity is a growing public health concern. Body Mass Indices (BMI) of prepubescent African Americans are comparable to their white peers. Epidemiologic data suggest that racial disparities in weight begin during adolescence. This study was designed to increase the understanding of the association between adolescent weight control, body image, and emotional well-being responses and weight status in African American high school students. The study cohort consisted of 776 students, mean age 15.8 years (+1.2). Data from student Guidelines for Adolescent Preventive Services (GAPS) surveys and anthropometric data were collected from medical records at School-Based Health Centers. Associations between adolescent responses and BMI status (healthy weight: 5th to 85th BMI percentile, overweight: 86th to 95th BMI percentile, obese: >95th BMI percentile) were estimated using logistic regression and dose response plots. There were statistically significant associations between BMI category and responses to weight control (ranging by response from a mean of 4.7 to 7.9 times the risk of obesity), body image (ranging from 3.3 to 11.7 times the risk of obesity), and a 49% (95% CI 1.04, 2.13) increased risk of obesity if students reported dysthymia. There was a dose response observed between obesity and adolescent weight control and body image responses. Overweight and obese African American adolescents are more likely to screen positively on weight control, negative body image, and dysthymia questions. Additional research is needed to explore the association between screening questions and readiness for change to confirm the value of this approach in public health settings.