Being Realistic About Body Image May Help Women Lose Weight

    • May 3, 2013

A healthy body image has long been considered protection against the risk of developing eating disorders, especially for women. Research has also shown that America’s intense focus on very narrowly defined ideas of beauty can wreak havoc on women’s self-esteem. Yet psychologist Rebecca Thurston, PhD, reports that having an accurate and balanced body image may be the best way to maintain a healthy weight.

“Self-perception really matters when it comes to managing obesity and losing weight,” said Thurston, a Robert Wood Johnson Foundation (RWJF) Health & Society Scholar (2003-2005).

In a study that sheds light on the links between culture, ethnicity, and how women think about their bodies, Thurston confirmed what many previous studies have found: African American women have a more positive body image when it comes to weight.

In the Eyes of the Beholder

Working with a team led by Semara Thomas, MD, a physician at the University of Virginia, Thurston explained that “we studied 689 women, ages 40 to 65, from the Pittsburgh area to gain a better understanding of how they perceived their body weight and how that affected their ability to manage weight. Five-hundred forty-four of the women were White and 145 were African American.”

Self perception really matters when it comes to managing obesity.” - Rebecca Thurston, PhD

Thurston and her colleagues published their results in the article “Racial Differences in Perception of Healthy Body Weight in Midlife Women: Results from the Do Stage Transitions Result in Detectable Effects study,” in the March 2013 issue of the journal Menopause.

The purpose of the study was to determine more effective tools for helping women avoid being overweight or obese. The team reported that “the African American women studied were more likely to be accepting of their weight at a higher BMI (body mass Index), relative to the White women.” The results have implications for health because in previous research, Thurston found that obese women who correctly perceived themselves as such lost more weight than obese women who perceived themselves as normal weight. These women actually tend to continue to gain weight over a period of 10 years.

“The fact that African American women have a better body image has both a good side and a bad side,” Thurston said. “The African American women in this study were heavier than the White women by approximately 25 pounds, yet they were more likely than the White women to see themselves as not weighing enough. These perceptions can have an impact on whether the women can manage their weight.”

Cultural Considerations

While the researchers made every effort to control for socioeconomic variations in the study population, there were significant differences between the African American women and the White women. The White women were more likely to be married, have a graduate-level education, be in perimenopause and free of health problems.

Most of the African American women were high school graduates or had some college education. They were also primarily postmenopausal or had undergone a hysterectomy, and had three or more chronic illnesses.

Though Thurston explained that her study did “not specifically focus on how perception of body weight differed according to socioeconomic position, we did see significant gradients in body weight perceptions with educational attainment.”

Finding Balance

Thurston, who is director of the Women's Biobehavioral Health Laboratory at the
University of Pittsburgh, explained that having a balanced view of one’s body is key to being able to avoid being overweight or obese. For women and providers, she offered this advice:

  • Be realistic. “Even though perceptions of body weight differ and that can have some positive impact, accurately assessing body image is an important part of maintaining a healthy weight,” Thurston said.
  • Providers must get involved. “Many providers are burned out when it comes to talking to patients about their weight,” she said. “But the only way to address obesity is to give people workable tools. You have to talk to your patients about it.”
  • Lead with compassion. “The conversation cannot stigmatize the patient. It must be held with great empathy and respect. Don’t just say, ‘you need to lose this amount of weight,’” said Thurston. “I run weekly groups and we give people lots of feedback and support and we share tools to help them measure food intake and track eating patterns.”

Mastering these skills is needed to truly address the national obesity epidemic, said Thurston, who credits her RWJF Health & Society Scholars program experience with “teaching me about racial disparities, epidemiology, and how to successfully work across disciplines.  I understand that physicians are not trained to bring about behavior change, but the field needs to evolve to learn to address obesity more effectively.”


Related Websites

Learn more about the RWJF Health & Society Scholars program.
For an overview of RWJF scholar and fellow opportunities visit