Ethnic differences in eating attitudes, body image and self-esteem among adolescent females living in urban South Africa

Abstract

Objective: To examine differences between black and white female adolescents in eating attitudes, body image perceptions, and self-esteem, and the association of these with body mass index (BMI). Methods: A cross-sectional survey of 340 urban South African adolescent girls aged 13, 15 and 17 years, attending private and government (public) high schools. EAT26, body image and self-esteem questionnaires were administered, and height and weight was measured to determine BMI. The associations between BMI and EAT-26, body image perceptions, and self-esteem scores were determined in the different ethnic and age groups. Results: There was a significant difference in eating attitudes, body image perceptions, and self-esteem between the ethnic groups (P<0.05). Significantly more black girls (31.2%) reported an EAT-26 score ≥ 20 (predisposition to an eating disorder) compared to white girls (19.7%) even though the prevalence of overweight/obesity among the white girls was higher (29.5%) than in their black peers (25.1%) (P=0.37). White girls had a higher BMI and lower self-esteem, yet better body image score compared to their black peers. Black girls exhibited a greater tendency to control what they ate compared to white girls, while more white girls had a desire to be thinner compared to black girls. Conclusion: The results suggest that exposure of Western norms of thinness in a multiethnic and cultural urban setting is influencing both eating attitudes and behaviour. These findings are highly relevant for all African countries undergoing transition, and important in the development of interventions to optimise adolescent health prior to adulthood.