Definitions of overweight and obesity among African American women: Overweight is not “too fat”

Prevalence of overweight is higher in African Americans than whites, and African Americans are more likely than whites to underestimate their weight. In obese women, underestimation of body size is associated with greater weight gain over time. It is unknown whether underestimation of weight by African Americans is due to: a) use of different sociocultural definitions of overweight, or b) biased perception due to higher weight. The current study addresses the question of how black women define the terms overweight and obese and whether their own body weight influences those definitions. A figure rating scale was used to elicit definitions of overweight, obese, and “too fat” from 69 African American women with a mean BMI of 31.8. Participants also selected the figure that represents their current body size. Current body size and definitions of overweight, obese, and “too fat” were assessed in relation to participant weight. Definitions of body weight terms did not vary by self-reported weight status of participants. Among the 25% of participants with BMI ≥ 35, 65% did not classify their current body size as obese and 29% did not classify their current body size as overweight. Results suggest that overweight body sizes are not considered too fat and that body sizes are not considered too fat or obese until BMI exceeds 40. Lay definitions of body weight terms may differ dramatically from medical definitions and this difference may serve as a barrier to effective communication between patients and physicians about the health effects of excess adiposity.