1. Body Image and Weight Status among African American and Caucasian Overweight Postpartum Women Participating in a Weight Loss Intervention Lori Carter-Edwards, PhD Department of Community and Family Medicine Duke University Medical Center Durham, NC 12th Annual CDC Maternal and Child Health Epidemiology Conference Atlanta, GA 07 December 2006 Sponsor: National Institute of Diabetes, Digestive, and Kidney Diseases (NIDDK) [R01DK64986]

2. LCE_97877_CDCConfPres_0612072 Collaborating Team Duke University Medical Center (Durham, NC) Truls Ostbye, MD, PhD Lori Bastian, MD Jessica Revels, BA University of North Carolina (Greensboro, NC) Holiday Durham, MS Shaw University (Raleigh, NC) DaJuanicia Holmes, MS M. Ahinee Amamoo, MS

3. LCE_97877_CDCConfPres_0612073 Presentation Overview  Purpose  Methods  Results  Conclusions  Strengths and Limitations  Background  Implications

4. LCE_97877_CDCConfPres_0612074 Background  Racial differences exist in postpartum weight and weight retention.  Postpartum body image may influence adoption and maintenance of healthy lifestyle behaviors.  Body image may differ by race.

5. LCE_97877_CDCConfPres_0612075  Similar postpartum body area dissatisfaction exists by race.  The magnitude of dissatisfaction is greater among Caucasians than African Americans.  Body image unclear among overweight or obese postpartum women  Body image unclear among those engaged in behavior modification Background (cont.)

6. LCE_97877_CDCConfPres_0612076 Purpose  To examine whether body image and weight status differ by race among a sample of African American and Caucasian overweight postpartum women participating in a weight loss intervention.

7. LCE_97877_CDCConfPres_0612077  Study Sample  Derived from the Active Mothers Postpartum (AMP) Study  Effectiveness of a diet and physical activity intervention on reducing weight among 450 overweight postpartum women (BMI > 25)  Two-arm, unblinded, randomized trial Methods

8. LCE_97877_CDCConfPres_0612078  Active Mothers Postpartum (AMP) Study  Intervention (n=225) – 8-10 months  Health magazine subscription  Education manual  Group diet and physical activity sessions  Phone counseling sessions  Jogging stroller (6 months postpartum)  Control (n=225)  Health magazine subscription Methods (cont.)

9. LCE_97877_CDCConfPres_0612079  Active Mothers Postpartum (AMP) Study  Measurements  Baseline  12 months  18 months  24 months  6 months, intervention group only Methods (cont.)

10. LCE_97877_CDCConfPres_06120710  Study Sample  Intervention Group - Exclusions  Loss to follow-up (n=31)  Strollers only (n=5)  Race other than African American or Caucasian (n=9) Methods (cont.) Study Sample Size = 180

11. LCE_97877_CDCConfPres_06120711 Methods (cont.)  Variables  Predictor Variables  Race  BMI group  Outcome Variable  Body Image  Figure Rating Scale (Stunkard et al., 1980)  Range: 1-9  8 characteristics about shape

12. LCE_97877_CDCConfPres_06120712 Methods (cont.)  Figure Rating Scale  Most attractive  Would like to look like  Women find most attractive  Men find most attractive  An ideal mother  Once baby was born  Look like now  Pre-pregnancy “Desired” Shapes“Actual” Shapes

13. LCE_97877_CDCConfPres_06120713 Results Table 1. Demographics (n=180) * Statistically significant difference by race (using t-test and chi-square tests). ** n=172 respondents CharacteristicAfrican American CaucasianP-value* N75105-- Mean Age at Baseline (yrs)29.8 (+6.2)32.4 (+4.8)0.016 % Married49.393.3<0.001 % College or College Grad44.076.0<0.001 % Annual Household Income >= $30,000**57.688.9<0.001 % Primiparous37.344.80.320

14. LCE_97877_CDCConfPres_06120714 Results Table 2. Weight Characteristics (n=179) * Statistically significant difference by race (using t-tests and chi-square tests). ** Chi-square test of trend of BMI group by race. CharacteristicAfrican American CaucasianP-value* N75104-- Mean BMI at 6 Months Postpartum35.0 (+8.2)30.1 (+6.4)0.021 Mean Weight at 6 Months Postpartum (lbs)210.4 (+49.9)181.9 (+36.9)0.005 % Normal Weight (BMI<25)016.2<0.001** % Overweight (25<BMI<30)33.337.1-- % Obese (BMI>30)66.746.7-- Mean BMI Overweight27.727.80.918 Mean BMI Obese38.735.50.038

15. LCE_97877_CDCConfPres_06120715 Results (cont.) Mean Distribution of Body Image Factors at 6-Months Postpartum by Race and Weight Status Shape that is Most Attractive African American Caucasian P=0.012 3.33.6 By Race - Total (n=153) By Race - BMI>30 (n=89) P=0.225 3.63.8

16. LCE_97877_CDCConfPres_06120716 Results (cont.) Mean Distribution of Body Image Factors at 6-Months Postpartum by Race and Weight Status African American Caucasian P=0.011 3.43.8 By Race - Total (n=153) By Race - BMI>30 (n=89) P=0.048 3.84.2 Shape You Would Like to Look Like

17. LCE_97877_CDCConfPres_06120717 Results (cont.) Mean Distribution of Body Image Factors at 6-Months Postpartum by Race and Weight Status African American Caucasian P=0.044 2.83.1 By Race - Total (n=153) By Race - BMI>30 (n=89) P=0.496 3.13.2 Shape Women Find Most Attractive

18. LCE_97877_CDCConfPres_06120718 Results (cont.) Mean Distribution of Body Image Factors at 6-Months Postpartum by Race and Weight Status African American Caucasian P=0.006 2.93.3 By Race - Total (n=153) By Race - BMI>30 (n=89) P=0.039 2.73.1 Shape Men Find Most Attractive

19. LCE_97877_CDCConfPres_06120719 Results (cont.) Mean Distribution of Body Image Factors at 6-Months Postpartum by Race and Weight Status African American Caucasian P<0.001 3.84.5 By Race - Total (n=153) By Race - BMI>30 (n=89) P=0.017 4.14.6 Shape of an Ideal Mother

20. LCE_97877_CDCConfPres_06120720 Results (cont.) Mean Distribution of Body Image Factors at 6-Months Postpartum by Race and Weight Status African American Caucasian P=0.189 6.15.8 By Race - Total (n=153) By Race - BMI>30 (n=89) P=0.212 6.56.2 Your Shape Once Baby Was Born

21. LCE_97877_CDCConfPres_06120721 Results (cont.) Mean Distribution of Body Image Factors at 6-Months Postpartum by Race and Weight Status African American Caucasian P=0.841 5.5 By Race - Total (n=153) By Race - BMI>30 (n=89) P=0.699 6.16.0 Shape You Look Like Now

22. LCE_97877_CDCConfPres_06120722 Results (cont.) Mean Distribution of Body Image Factors at 6-Months Postpartum by Race and Weight Status African American Caucasian P=0.936 4.7 By Race - Total (n=153) By Race - BMI>30 (n=89) P=0.459 5.45.2 Pre-Pregnancy Shape

23. LCE_97877_CDCConfPres_06120723 Strengths and Limitations  Nested within a weight-loss intervention  Examined postpartum body image by race and weight status  Modest sample size  Body image figure rating scale may not be culturally representative  No information on weight change (beyond study scope)

24. LCE_97877_CDCConfPres_06120724 Conclusions  A greater proportion of African-American compared to Caucasian women:  Were larger at 6 months.  Had larger “desired” shapes.  Obese postpartum women differed by race in:  Desired shape for themselves.  Desired shape perceived by men.  Desired shape of an ideal mother.  There were no significant racial differences in perceptions of “actual” shape.

25. LCE_97877_CDCConfPres_06120725 Implications  There are cultural differences in perceptions of attractiveness based on shape.  Future behavior modification programs may need to account for potential racial differences in body image when designing postpartum weight loss interventions.