RESUMEN

Purpose: Body image affects health practices. With acculturation superimposed on globalization, 21st century body size preferences of African immigrants, one of the fasting growing populations in the United States, are unknown. Therefore, in African immigrants living in America we assessed: 1) body size preference; and 2) body size dissatisfaction. Methods: Participants chose two silhouettes from the Stunkard Figure Rating Scale: one for body size preference and one for perceived body size. Each silhouette corresponds to a BMI category: (a) Underweight: 1 and 2; (b) Normal weight: 3 and 4; (c) Overweight: 5, 6 and 7; (d) Obesity: 8 and 9. Dissatisfaction was defined as the difference between silhouette numbers for perceived and preferred body size. Results: Characteristics of the 412 participants were: women: 42% (174/412), age 40±11y (mean±SD), range 20-69 y, BMI 27.9±4.6, range 19.5-47.3 kg/m2. As a body size of preference, no one (0/412) chose obese silhouettes. Normal weight silhouettes were chosen as their body size of preference by 75% (131/174) of women and 60% (143/238) of men. Overweight silhouettes were chosen as their preferred body size by 11% (19/174) of women and 26% (62/238) of men. Combining normal and overweight silhouettes into one group, 86% (150/174) of women and 86% (205/238) of men preferred to be either normal or overweight. Underweight silhouettes were preferred by 14% (24/174) of women and 14% (33/238) of men. Dissatisfaction because body size was too large occurred in 78% (135/174) of women and 53% (126/238) of men. Dissatisfaction because body size was too small occurred in 6% (11/174) of women and 16% (38/238) of men. Conclusion: African immigrants prefer body sizes which are normal or overweight. However, and presumably attributable to the combined influence of globalization and acculturation, a worrisome fraction of African immigrants favor an underweight silhouette.

Understanding the attitudes of Africans towards body size is important because these attitudes affect health behaviors. The 20th century consensus was that Africans viewed large body sizes as a sign of the health, beauty, fertility, and prosperity. In addition, underweight silhouettes were viewed with fear and considered to be a sign of poverty, malnutrition, and HIV infection. In the 21st century, African attitudes towards body size are unknown. African immigrants are a rapidly growing segment of the American population. Their attitudes toward body size are influenced by both globalization and acculturation. In our cohort, we found 86% of the Africans living in America wanted to be either normal or low range overweight. However, and very concerning, 14% of African immigrants chose underweight silhouettes to represent their body size of preference. As weight loss programs are brought forward in and by African communities living in the United States, the emphasis must be on achieving a healthy weight and not glorification of underweight silhouettes.