Obese White Women Research Articles

Endometrial cancer complications and survival in morbidly obese African American and white women

Endometrial cancer complications and survival in morbidly obese African American and white women

Women weigh in: obese African American and White women's perspectives on physicians' roles in weight management.

There is little qualitative research on the type of weight loss counseling patients prefer from their physicians and whether preferences differ by race. This qualitative study used semistructured, in-depth interviews of 33 moderately to severely obese white and African American women to elucidate and compare their perceptions regarding their primary care physician's approach to weight loss counseling. Data were analyzed using a grounded theory approach and a series of immersion/crystallization cycles. White and African American women seemed to internalize weight stigma differently. African American participants spoke about their pride and positive body image, whereas white women more frequently expressed self-deprecation and feelings of depression. Despite these differences, both groups of women desired similar physician interactions and weight management counseling, including (1) giving specific weight loss advice and individualized plans for weight management; (2) addressing weight in an empathetic, compassionate, nonjudgmental, and respectful manner; and (3) providing encouragement to foster self-motivation for weight loss. While both African American and white women desired specific strategies from physicians in weight management, some white women may first need assistance in overcoming their stigma, depression, and low self-esteem before attempting weight loss.

A Mixed Methods Comparison of Perceived Benefits and Barriers to Exercise Between Obese and Nonobese Women

Obese women have lower levels of physical activity than nonobese women, but it is unclear what drives these differences. Mixed methods were used to understand why obese women have lower physical activity levels. Findings from focus groups with obese white women age 50 and older (N = 19) were used to develop psychosocial items for an online survey of white women (N = 195). After examining the relationship between weight group (obese vs. nonobese) and exercise attitudes, associated items (P < .05) were tested for potential mediation of the relationship between weight and physical activity. Obese women were less likely than nonobese women to report that they enjoy exercise (OR = 0.4, 95% CI 0.2-0.8) and were more likely to agree their weight makes exercise difficult (OR = 10.6, 95% CI 4.2-27.1), and they only exercise when trying to lose weight (OR = 3.8, 95% CI 1.6-8.9). Enjoyment and exercise for weight loss were statistically significant mediators of the relationship between weight and physical activity. Exercise interventions for obese women may be improved by focusing on exercise enjoyment and the benefits of exercise that are independent of weight loss.

HPV Vaccine Status and BMI Correlation

Obese women are at increased risk of death from cervical cancer compared to non-obese women. Yet, research indicates a lower rate of cervical cancer screening among obese women, especially severely obese white women. Cited reasons for delaying screening include embarrassment, perceived weight stigma, lack of appropriately sized examination equipment and poor patient-provider communication. Parental acceptance of the Human Papillomavirus (HPV) vaccine for overweight adolescent females may decrease the incidence of cervical cancer among obese women in later years. This study seeks to determine the Human Papillomavirus (HPV) vaccination status of females, ages 11 to 21 years, in a university-based pediatric practice and to determine the correlation between HPV vaccine status and body mass index (BMI). Methods: We reviewed 800 randomly selected paper medical charts of females, ages 11 to 21 years, enrolled in a university-based pediatric practice as of October 31, 2008. Data collected included age, height, weight, BMI, race, insurance carrier, immunizations, sexually transmitted infections (STIs) and documentation of STI prevention counseling. Statistical analysis was performed to determine associations among risk factors and outcome variables. Results: 800 charts reviewed; 91 were incomplete due to missing documentation of immunizations. The remaining 709 charts included 338 (48.2%) African Americans; 302 (43.1%) Whites; 26 (3.7%) Hispanics; and 35 (5%) other. Approximately 28.2% had current HPV vaccine status. There was no correlation between HPV vaccination status and BMI (p >0.05).

Body Mass Index and Colon Cancer Screening: A Systematic Review and Meta-Analysis

Obesity is associated with increased colon cancer mortality and lower rates of mammography and Pap testing. We conducted a systematic review to determine whether obesity is associated with lower rates of colon cancer screening. We searched the PubMed, CINAHL, and Cochrane Library databases. Two investigators reviewed citations, abstracts, and articles independently. Two investigators abstracted study information sequentially and evaluated quality independently using standardized forms. We included all studies in our qualitative syntheses. We used random effects meta-analyses to combine those studies providing screening results by the following body mass index (BMI) categories: Normal, 18.5-24.9 kg/m(2) (reference); overweight, 25-29.9 kg/m(2); class I obesity, 30-34.9 kg/m(2); class II obesity, 35-39.9 kg/m(2); and class III obesity, ≥ 40 kg/m(2). Of 5,543 citations, we included 23 articles. Almost all studies were cross-sectional and ascertained BMI and screening through self-report. BMI was not associated with colon cancer screening overall. The subgroup of obese white women reported lower rates of colon cancer screening compared with those with a normal BMI with combined ORs (95% CI) of 0.87 (0.82-0.93), 0.80 (0.65-0.99), and 0.73 (0.58-0.94) for class I, II, and III obesity, respectively. Results were similar among white men with class II obesity. Overall, BMI was not associated with colon cancer screening. Obese white men and women may be less likely to undergo colon cancer screening compared with those with a normal BMI. Further investigation of this disparity may reduce the risk of obesity-related colon cancer death.

Body weight and wages: Evidence from Add Health

This note uses data from the National Longitudinal Study of Adolescent Health to examine the relationship between body weight and wages. Ordinary least squares (OLS) and individual fixed effects estimates provide evidence that overweight and obese white women are paid substantially less per hour than their slimmer counterparts. Two-stage least squares (2SLS) estimation confirms this relationship, suggesting that it is not driven by time-variant unobservables.

Cancer Screening Patterns by Weight Group and Gender for Urban African American Church Members

Obese white women have lower rates of cancer screening compared to non-obese women. This study will determine if a relationship exists between weight and adherence to cancer screening guidelines among African Americans. We used multivariate logistic regression to examine the relationship between being up-to-date with cancer screening (colorectal, breast, cervical, and prostate) and weight group (normal, overweight, obese I, obese II+) using data from older (age 50+) members (N=955) of 20 African American churches in Michigan and North Carolina. CRC testing rates were examined using multiple definitions to account for differences in screening rates vs. polyp surveillance rates. After adjusting for confounders, we found relationships between weight group and up-to-date CRC (P=0.04) and PSA (P=0.004) testing for men and mammography (P=0.03) for women. Compared to normal-weight men, obese I men were more likely to be up-to-date with CRC (OR 2.35, 95%CI 1.02-5.40) and PSA (OR 4.24 95%CI 1.77-10.17) testing. CRC screening rates were lower when individuals with polyps were excluded from the analysis; however, patterns by weight remained the same. Contrary to previous research, we did not find lower rates of cancer screening among obese African Americans. Instead, we found that normal-weight African American men had lower screening rates than any other group. As we did not consistently find lower screening rates among obese African Americans, targeting this group for increased screening promotion may not be the most effective way to reduce weight-related cancer disparities.

Contribution of Adipose Tissue to Plasma 25‐Hydroxyvitamin D Concentrations During Weight Loss Following Gastric Bypass Surgery

Roux-en-y gastric bypass (RYGB) surgery is associated with dramatic improvements in obesity-related comorbidity, but also with nutritional deficiencies. Vitamin D concentrations are depressed in the severely obese, but the impact of weight loss via RYGB is unknown. We determined associations between adiposity and systemic 25-hydroxyvitamin D (25(OH)D) during weight loss and the immediate and longer-term effects of RYGB. Plasma 25(OH)D concentrations and fat mass (FAT) were determined by immunoassay and air displacement plethysmography, respectively, at 0 (before RYGB surgery), and at 1, 6, and 24 months in severely obese white and African American (AA) women (n = 20). Decreases in adiposity were observed at 1, 6, and 24 months following RYGB (P < 0.05). Plasma 25(OH)D concentrations increased at 1 month (P = 0.004); a decreasing trend occurred over the remainder months after surgery (P = 0.02). Despite temporary improvement in vitamin D status, a high prevalence of vitamin D insufficiency was observed (76, 71, 67, and 82%, at baseline, 1, 6, and 24 months, respectively), and plasma 25(OH)D concentrations were lower in AA compared to white patients (P < 0.05). Strong positive baseline and 1 month cross-sectional correlations between FAT and plasma 25(OH)D were observed, which remained after adjustment for age and race subgroup (β = 0.76 and 0.61, respectively, P = 0.02). In conclusion, 25(OH)D concentrations increased temporarily and then decreased during the 24 months following RYGB. The acute increase and the positive associations observed between adipose tissue mass and systemic 25(OH)D concentrations suggest storage in adipose tissue and release during weight loss.

Evaluation of Bone Mineral Density Loss in Morbidly Obese Women After Gastric Bypass: 3-Year Follow-Up

Studies that evaluate the influence of gastric bypass (RYGP) on bone mass are limited to short-term follow-up. We analysed changes in bone mineral density (BMD) three years after surgery and evaluated the main determinants of the development of bone disease. Prospective study of 59 morbidly obese white women aged 46 ± 8 years. BMD scanning using DEXA and plasma determinations of calcium, parathyroid hormone, 25-hydroxyvitamin D and insulin-like growth factor-I were made prior, at 12 months and 3 years after surgery. In the first postoperative year BMD decreased at femoral neck (FN) 10.2 % and in the lumbar spine (LS) 3.2 %, in the third year it additionally decreased 2.7 % and 3.1 %, respectively. BMD at both sites remained above the values of women of the same age. In the follow-up, 1.7 % developed osteoporosis at FN and 6.8 % at LS. Patients with bone disease were older, the percentage of women with menopause was greater in this group and had lower initial and final values of lean mass. The percentage of BMD loss at FN remained positively associated with the percentage of lean mass loss [β 0.304, p=0.045], and menopause [β 0.337, p=0.025]. Major osteoporotic fracture and hip fracture risk was low even in menopausal patients (3.1 % and 0.40 %, respectively). After RYGP menopausal women and those with greater lean mass loss are at higher risk of BMD loss but progression to osteoporosis is uncommon and the risk of fracture is low.

Genomic predictors of the maximal O2 uptake response to standardized exercise training programs

Low cardiorespiratory fitness is a powerful predictor of morbidity and cardiovascular mortality. In 473 sedentary adults, all whites, from 99 families of the Health, Risk Factors, Exercise Training, and Genetics (HERITAGE) Family Study, the heritability of gains in maximal O(2) uptake (VO(2max)) after exposure to a standardized 20-wk exercise program was estimated at 47%. A genome-wide association study based on 324,611 single-nucleotide polymorphisms (SNPs) was undertaken to identify SNPs associated with improvements in VO(2max) Based on single-SNP analysis, 39 SNPs were associated with the gains with P < 1.5 × 10(-4). Stepwise multiple regression analysis of the 39 SNPs identified a panel of 21 SNPs that accounted for 49% of the variance in VO(2max) trainability. Subjects who carried ≤9 favorable alleles at these 21 SNPs improved their VO(2max) by 221 ml/min, whereas those who carried ≥19 of these alleles gained, on average, 604 ml/min. The strongest association was with rs6552828, located in the acyl-CoA synthase long-chain member 1 (ACSL1) gene, which accounted by itself for ~6% of the training response of VO(2max). The genes nearest to the SNPs that were the strongest predictors were PR domain-containing 1 with ZNF domain (PRDM1); glutamate receptor, ionotropic, N-methyl-D-aspartate 3A (GRIN3A); K(+) channel, voltage gated, subfamily H, member 8 (KCNH8); and zinc finger protein of the cerebellum 4 (ZIC4). The association with the SNP nearest to ZIC4 was replicated in 40- to 65-yr-old, sedentary, overweight, and dyslipidemic subjects trained in Studies of a Targeted Risk Reduction Intervention Through Defined Exercise (STRRIDE; n = 183). Two SNPs were replicated in sedentary obese white women exercise trained in the Dose Response to Exercise (DREW) study (n = 112): rs1956197 near dishevelled associated activator of morphogenesis 1 (DAAM1) and rs17117533 in the vicinity of necdin (NDN). The association of SNPs rs884736 in the calmodulin-binding transcription activator 1 (CAMTA1) locus and rs17581162 ~68 kb upstream from regulator of G protein signaling 18 (RGS18) with the gains in VO(2max) in HERITAGE whites were replicated in HERITAGE blacks (n = 247). These genomic predictors of the response of Vo(2max) to regular exercise provide new targets for the study of the biology of fitness and its adaptation to regular exercise. Large-scale replication studies are warranted.

Maternal Obesity and Breast‐feeding Practices Among White and Black Women

Despite the increase in obesity among women of reproductive ages, few studies have considered maternal obesity as a risk factor for breast-feeding success. We tested the hypothesis that women who are obese (BMI = 30-34.9) and very obese (BMI >or=35) before pregnancy are less likely to initiate and maintain breast-feeding than are their normal-weight counterparts (BMI = 18.5-24.9) among white and black women. Data from 2000 to 2005 South Carolina Pregnancy Risk Assessment Monitoring System (PRAMS) were used. The overall response rate was 71.0%; there were 3,517 white and 2,846 black respondents. Black women were less likely to initiate breast-feeding and breast-fed their babies for a shorter duration than white women. Compared to normal-weight white women, very obese white women were less likely to initiate breast-feeding (odds ratio: 0.63; 95% confidence interval (CI) = 0.42, 0.94) and more likely to discontinue breast-feeding within the first 6 months (hazard ratio (HR) = 1.89; 95% CI: 1.39, 2.58). Among black women, prepregnancy BMI was neither associated with breast-feeding initiation nor with breast-feeding continuation within the first 6 months. Because very obese white women are less likely to initiate or continue breast-feeding than other white women, health professionals should be aware that very obese white women need additional breast-feeding support. Lower rates of breast-feeding among black women suggest that they should continue to be the focus of the programs and policies aimed at breast-feeding promotion in the United States.

Evaluation of Bone Disease in Morbidly Obese Women After Gastric Bypass and Risk Factors Implicated in Bone Loss

In patients undergoing gastric bypass, massive weight loss and impairment of calcium intake and absorption in the duodenum and proximal jejunum may increase the risk of bone mass loss and fractures. However, few data are available regarding the impact of this surgery on the skeleton. The aim of our study was to examine the skeletal changes in a cohort of morbidly obese Caucasian women during the first year after gastric bypass and to analyse the factors implicated in the development of bone loss. Sixty-two morbidly obese white women aged 45.3 +/- 8.9 years were studied. Anthropometric measurements, bone mineral density (BMD) screening using dual-energy X- ray absorptiometry and plasma determinations of calcium, phosphorus, parathyroid hormone (PTH), 25-hydroxyvitamin D [25(OH) D(3)] and insulin-like growth factor-I (IGF-I) were made prior to and 12 months after surgery. A year after surgery, BMD significantly decreased at the femoral neck (10.2 +/- 5.7%) and at the lumbar spine (3.2 +/- 4.4%). In the follow-up, 16.1% of women had osteopenia at the femoral neck and 19.3% at the lumbar spine, and 1.6% developed osteoporosis at the lumbar spine. Patients with bone disease were significantly older; the percentage of women with menopause was greater in this group and had lower initial and final values of lean mass. However, no differences in body mass index, weight loss, fat mass, calcium, PTH, 25(OH) D(3) or IGF-I values were found between groups. In the logistic regression analysis, lean mass 12 months after surgery and menopause were found to be the main determinants of osteopenia after adjusting for age with odds ratios of 0.82 and 9.13, respectively. There is a significant BMD loss at the femoral neck and lumbar spine a year after gastric bypass. Menopausal patients and those with greater lean mass loss are at greater risk and, consequently, should be closely followed up with periodic densitometries.

Relationship Between Body Mass Index, Alcohol Use, and Alcohol Misuse in a Young Adult Female Twin Sample

The aim of this study was to examine the relationships between body mass index (BMI) and alcohol use and misuse in young adulthood in a sample of black and white female twins. Cox proportional hazards and logistic regression models were used to examine the relationships between BMI category and first alcohol use, current weekly alcohol use, and current weekly heavy episodic drinking in 3,514 (14.06% black) young adult female twins. Analyses were conducted separately in black and white women. After adjusting for relevant covariates, in white women obesity was protective against alcohol use (hazard ratio = 0.83; 95% confidence interval [CI]: 0.73-0.93) and against weekly drinking (odds ratio [OR] = 0.36; 95% CI: 0.24-0.53) and weekly heavy episodic drinking (OR = 0.51; 95% CI: 0.31-0.82) among ever drinkers compared with women of ideal weight. Overweight women living with their parents were less likely to be weekly drinkers (OR = 0.31; 95% CI: 0.16-0.61), whereas overweight women who were not living with their parents were less likely to be weekly heavy episodic drinkers (OR = 0.51; 95% CI: 0.31-0.82). Among black women, obesity was not associated with any of the drinking outcomes; however, black women who were overweight and who reported that the majority of their friends were not weekly drinkers had greater odds of reporting weekly drinking than those of ideal weight (OR = 2.91; 95% CI: 1.33-6.39). Obese white women were less likely to ever use alcohol, be weekly drinkers, or be weekly heavy episodic drinkers than their ideal-weight peers. Body weight may affect drinking behavior in young women, and this effect may differ by race. Future research is needed to identify mediators and moderators of this relationship as well as to explore racial differences in the effect of body weight on drinking behavior.

Acute Effects of Exercise on Blood Lipids and Lipoproteins in Obese Women

Acute exercise reduces triglycerides (TG) and increases high-density lipoprotein cholesterol (HDL-C) and HDL2-C in both men and women. However, data are sparse in obese women who might benefit more from the effects of exercise, since they are more likely to have higher TG and lower HDL-C. PURPOSE: To investigate the acute effects of moderate intensity walking on blood lipid and lipoprotein profiles of obese women. METHODS: Twenty-four premenopausal and eumenorrheic sedentary obese white (n=9) and black (n=15) women (age = 24.5 ± 4.8 yrs; BMI = 33.5 ± 3.7 kg/m2; body fat = 48.3 ± 5.3%) walked on a treadmill at 70 ± 5% VO2peak to expend 300 and 500 kcal. Fasted blood samples were collected before (baseline), immediately post, 24, and 48hrs after exercise and were analyzed for total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), TG, HDL-C, HDL2-C, and HDL3-C. RESULTS: No significant differences were found in TC, LDL-C, HDL-C, HDL2-C and HDL3-C over time between the two exercise sessions. During the 300 kcal session TG had a non-significant increase from baseline to immediately post exercise and then a 20.1% significant (p <0.05) decrease at 48hrs post exercise (values are means ± SD; Baseline: 57.3 ± 16.4; immediately post: 69.0 ± 18.6;24hrs: 55.8 ± 20.2; 48hrs: 55.1 ± 19.3 mg-dL1). During the 500 kcal session TG significantly increased by 30.1% from baseline to immediately post and then significantly decreased by approximately 36% at 24 and 48hrs post exercise (Baseline: 60.5 ± 24.6; immediately post: 86.8 ± 39.8; 24hrs: 55.2 ± 20.2; 48hrs: 55.0 ± 19.3 mg-dL1). During the 500 kcal session TG were elevated more immediately post exercise when compared to the 300 kcal session. CONCLUSION: Blood HDL-C and HDL2-C of obese women seem to be resistant to the increase usually observed with acute exercise in non-obese women. Furthermore, the obese women of this study responded with increased TG immediately post exercise. The response of blood lipid and lipoprotein metabolism to exercise may be influenced by obesity. Supported by Dissertation Grants from Florida State University and University of Botswana.

Body mass index and use of mammography screening in the United States

Background. Obese and underweight women may be less likely to seek cancer screening because of health status, self-perception, and body image related to non-desirable weight. This study examined the relationship between body mass index (BMI) and mammography screening, using the data from the year 2000 United States National Health Interview Survey. Methods. This study included 7692 white and 1496 black female participants aged 40–80, who were randomly selected. Body mass index (kg/m 2), based on self-reported weight and height, was compared between women with and without a mammogram in the past 2 years using logistic regression. Results. Compared to women with normal body mass index, underweight and extremely obese women were more likely to have no screening mammograms in the past 2 years (odds ratio (OR) = 1.8, 95% confidence interval (CI), 1.2–2.6 for underweight women; odds ratio = 1.3, 95% confidence interval, 1.0–1.8 for extremely obese women). When data were analyzed by race, the odds ratio estimates were 1.8 for underweight white women (95% confidence interval, 1.3–2.7) and 1.4 for extremely obese white women (95% confidence interval, 1.0–1.9). The corresponding odds ratio estimates were close to 1.0 for black women. Conclusions. Underweight and extreme obesity may increase the risk of underusing screening mammography. The association between body mass index especially underweight and underuse of mammography might exist primarily in white women.

The interrelationship between ethnicity and obesity on obstetric outcomes

The purpose of this study was to evaluate the interrelationship between ethnicity and obesity on obstetric outcomes. This was a retrospective study examining the interaction between ethnicity and obesity for obstetric outcomes. Statistical methods included univariate and multivariate regression models. In this study population of 22,658 women, 2150 (9.4%) were obese (body mass index [BMI] >29). Obesity increased the rate of cesarean delivery, gestational diabetes, preeclampsia, and macrosomia in each ethnic group. When compared with obese white women, higher rates of cesarean delivery were noted in obese African American (odds ratio [OR] 1.50, P < .05) and Asian (OR 1.73, P < .05) women. Gestational diabetes was increased twofold in obese Latina (OR 1.94, P < .05) and Asian (OR 2.20, P < .05) women, while preeclampsia was increased only in obese Latina (1.93, P < .05) women. Obesity increases the risk of cesarean delivery, gestational diabetes, preeclampsia, and macrosomia, but this effect varies among different ethnicities. The biometrics of different ethnicities and associated obstetric outcomes needs further exploration.

BMI and Cervical Cancer Screening among White, African‐American, and Hispanic Women in the United States

We examined cervical cancer screening by BMI in white, African-American, and Hispanic women and explored women's reasons for not undergoing screening. We used logistic regression to examine Pap testing in the preceding 3 years across BMI groups for white (n = 6419), African-American (n = 1715), and Hispanic women (n = 1859) age 18 to 75 years who responded to the 2000 National Health Interview Survey. We used bivariable analyses to describe women's reasons for not undergoing testing and examined whether unscreened women received physician recommendations for screening. Of 12,170 women, 50% were normal weight, 26% were overweight, and 21% were obese. The proportion who reported Pap testing in the last 3 years was 86% in whites, 88% in African Americans, and 78% in Hispanics. After adjustment for sociodemographics, health care access, and illness burden, severely obese white women (BMI = 40+ kg/m2) were significantly less likely to undergo Pap testing (relative risk, 0.92; 95% CI, 0.83 to 0.99) compared with normal weight women. BMI was not associated with screening in African Americans or Hispanics. A higher proportion of obese white women than normal weight women cited putting off the test or embarrassment or discomfort as the primary reason for not undergoing screening. Among the unscreened, obese women were as likely as normal weight women to receive a physician recommendation to undergo screening. Disparities in cervical cancer screening by body weight persist for white women with severe obesity. Disparities were not explained by differences in the rate of physician recommendations for screening, but obese white women may be more likely to delay screening or to find screening painful, uncomfortable, or embarrassing than normal weight white women. Efforts to increase screening among obese women should address women's reservations about screening.

Analysis of weight loss outcomes using VLCD in black and white overweight and obese women with and without metabolic syndrome

To evaluate the efficacy of very low calorie diet (VLCD) in black and white obese women. Changes in weight, metabolic profile, and body composition are assessed. Patients are enrolled in a self-paid, university-based, outpatient weight loss program. All are prescribed VLCD (500-800 Cal/day), an exercise regimen, and group behavioral counseling. Black and white patients are matched for age, weight, body mass index, and by metabolic syndrome (MS) status. A total of 304 black and white women (152 in each group) were included the analysis. Approximately 40% of patients had MS (white women: 39.5%; black women: 41.2%). Mean baseline weights were similar. After 12 weeks, weight reduction of 9.97% was seen in white women and 9.02% drop was seen in black women (both P<0.0001). However, the degree of weight change was not different between the groups (P = 0.244). Marked improvements in fasting glucose, total cholesterol, LDL, triglyceride, and blood pressures (BP) were observed (all P<0.01); however, no difference between cohorts were seen. Patients with MS had higher baseline weight, BP, glucose and triglyceride levels when compared to patients without MS (all P<0.01). Significant reductions in % body fat were seen in white and black patients, independent of MS status. Obese patients, independent of race, were able to achieve significant weight loss when enrolled in a structured outpatient program. Weight loss significantly correlated with all aspects of MS. Our results suggest that differences seen in past studies may be influenced by socioeconomic and behavioral factors rather than differences in physiological response to dieting.

Emic Perspectives of Body Weight in Overweight and Obese White Women with Limited Income

Objective The purpose of this study was to develop an understanding of body weight from emic perspectives of limited-income overweight and obese white women. Design In-depth individual interviews, including the use of contour drawings and body dissatisfaction parameters. Setting All methods were conducted in the homes of the research participants. Participants A purposeful sample of limited-income white women (N = 25), ages 19 to 44 years. Phenomena of Interest Personal perceptions of attractiveness, health, body weight, and body dissatisfaction. Analysis Transcripts were analyzed using content analysis. Triangulation of data was achieved by comparing data elicited by different methods in different sections of the interview. Results Disordered eating habits were common and considered consequences of social, economic, and familial pressures. Food was often used as a means of coping with life pressures. Social and economic barriers were identified as impeding the adoption of more healthful lifestyles. Weight loss was a low priority owing to financial, emotional, familial, and health care constraints. Conclusions and Implications Multidisciplinary programs addressing financial, emotional, and nutritional concerns may be the most effective for weight management among white limited-income women. Additional research is necessary to verify the results of this study with larger samples.

Toward an understanding of health services use in women with binge eating disorder.

This study examined health services use in community samples of 102 white and 60 black women with binge eating disorder (BED), 164 white and 85 black healthy comparison women, and 86 white and 21 black women with a noneating Axis I psychiatric disorder. Participants were matched on age, ethnicity, and education and were asked about their use of emergency room visits, outpatient physician visits for medical care, outpatient psychotherapy visits, and days spent in the hospital over the previous 12 months. Total health services use was computed. There were no between-group differences in outpatient physician visits or inpatient hospital days. Relative to healthy comparison women, women with BED and women with other Axis I disorders had increased total health services use, psychotherapy visits, and emergency department visits. Relative to women with noneating Axis I disorders, women with BED had less use of psychotherapy visits. Although obese white women were more likely to report emergency department visits than obese black women were, nonobese white women were less likely to report emergency department visits than nonobese black women were. That health services use by women with BED compared more with that of women with other Axis I disorders than with that of healthy women suggested that BED has clinical significance and is not benign in terms of its impact on the health care system. It appeared, however, that despite the availability of effective treatments, few women with BED received psychotherapy.