Factors related to obesity and overweight among Black adolescent girls in the United States

Megan R. Winkler, Gary G. Bennett, Debra H. Brandon
2016 Women & health  
In the United States, Black adolescents have the highest prevalence of pediatric obesity and overweight among girls. While Black girls are disproportionately affected, the reasons for this health disparity remain unclear. The authors conducted a systematic review to investigate the factors related to obesity and overweight among Black adolescent girls. The authors searched four databases for relevant English-language publications using all publication years through 2015. Fifty-one studies met
more » ... e inclusion criteria and were used for this review. Using a configuration approach to synthesis, three categories were identified, paralleling the bioecological theory of human development: (1) individual, (2) interpersonal, and (3) community and societal factors. A description of each factor's association with obesity among Black adolescent girls is presented. From this review, the authors identified a diverse and vast set of individual, interpersonal, and community and societal factors explored for their relationship with obesity and overweight. Given the insufficient repetition and limited significant findings among most factors, the authors believe that multiple gaps in knowledge exist across all categories regarding the factors related to obesity and over-weight among Black adolescent girls. To improve the quality of research in this area, suggested research directions and methodological recommendations are provided. overweight classification (Ogden et al. 2014). Further, Black females demonstrate the highest risk of developing obesity/overweight in adolescence (Huh et al. 2012) , and 95% of adolescent Black females with obesity remain obese in adulthood (Gordon-Larsen, The, and Adair 2010). This persistence of obesity, along with 82% of Black women meeting the CDC overweight classification (Ogden et al. 2014), suggests that focusing on the adolescent period is important to our understanding of the prevention of childhood and adult obesity among Black females. To date, few interventions to address this disparity have produced meaningful reductions in weight or obesity at the individual or population level (Kumanyika, Whitt-Glover, and Haire-Joshu 2014). At the individual level, prevention and treatment interventions using family involvement or out-of-school time approaches have yielded unchanged or undesired changes in body mass indexes (BMIs; Barr-Anderson et al. 2013 . At the population level, obesity rates continue to climb among Black females (Flegal et al. 2012; Madsen, Weedn, and Crawford 2010), indicating that the most important obesity drivers may yet to be targeted through previous intervention and policy efforts. The authors suggest that to design more effective approaches aimed at closing this significant health disparity, a comprehensive evaluation of the multidimensional factors contributing to obesity among Black adolescent females is an essential first step. Therefore, the purpose of this critical, systematic review was to examine the factors related to obesity and overweight among Black adolescent girls in the United States (hereafter referred to as Black girls). The authors defined factors related to obesity and overweight to include broadly: (1) studies that addressed associated factors, covariates, and other statistical descriptions (e.g., prevalence of factor by weight status, bivariate analyses) that have been related to obesity, overweight, and/or increases in BMI or adiposity in Black girls, and (2) studies that reported individuals' understanding and/or experience of factors related to obesity, overweight, and weight gain among Black girls. As qualitative reports using interviews and thematic analysis approaches often produce findings similar in interpretive depth to the descriptive findings in quantitative reports, the authors definition appropriately promoted the inclusion of both quantitative and qualitative investigations (Voils et al. 2008). Methodology Search strategy We searched four databases (PubMed, CINAHL, PsychInfo, and SocINDEX) to identify relevant articles from any publication year through August 2015 (Figure 1 ). Search terms were identified in response to each database's article indexing vocabulary (Figure 1 ). Limits to language, sex, and age were applied as available. We included the 6-12-year age range in addition to the 13-18-year range to capture the entire adolescent age group. Articles using any childhood obesity definition (e.g., BMI-for-age, percent body fat, and skin fold measurements) were included. After duplicates were removed, titles and abstracts were screened for relevance. The majority of articles excluded were reporting results from studies of an inappropriate age group or did not include obesity, overweight, or increases in BMI or adiposity as an outcome of interest. We further scrutinized 283 articles by review of the full text and excluded studies examining consequences of obesity (comorbidities) and other Winkler et al. Results Across the 51 included studies, a variety of methodologies were employed: six used a qualitative design and 45 studies used a combination of quantitative descriptive, comparative, and correlational non-experimental designs (Table 1) . Less than one-fifth (n = 8) of the studies provided longitudinal findings, and 27 studies used large national or state datasets. Thirty-eight articles measured heights and weights during recruitment or data collection, and methods for assessing factors included physiologic instrumentation; individual-or group-interviews; and self-, parent-, teacher-, and interviewer-reported questionnaires. Sample size ranged from n = 7 to n = 31,122 adolescents, and the percentage of Black female participants also varied from 4%-100%. Winkler et al. Dietary practices: Five types of dietary practice factors-including food types; macronutrients; eating occasions, locations, and patterns; dietary knowledge, attitudes, and beliefs; and other dietary behavior-were examined for their relationship to obesity and overweight among Black girls. While Black girls with an overweight status described consuming sugary beverages and "unhealthy" foods (Cassidy et al. 2013), only lower intakes of the food type fruits and vegetables were significantly associated with obesity (Brogan et al. 2012). Among Winkler et al. Psychosocial factors-A variety of psychosocial factors were explored for their relationship to obesity and overweight among Black girls, and were divided into the following factor types: body image, weight perceptions, and weight intentions; self-esteem; depression and suicidal ideation; stress, emotions, and emotional expressions; perceived health; interpersonal skills; and other psychosocial factors. Among body image, weight perception, and weight intention factors, Black girls with obesity and overweight accurately Winkler et al. Mother-daughter correlations of obesity and cardiovascular disease risk factors in Black and White households: The NHLBI growth and health study. (99)70484-X. Neumark-Sztainer D, Story M, French SA, Hannan PJ, Resnick MD, Blum RW. Psychosocial concerns and health-compromising behaviors among overweight and nonoverweight adolescents. Obesity
doi:10.1080/03630242.2016.1159267 pmid:26933972 pmcid:PMC5050158 fatcat:hfi72cmdq5hg5atkekyzckyy7e