A Positive Body Image, but a Greater Risk of Health Problems

At 5 feet 4 and 130 pounds, Roniece Weaver is a happy, healthy, size 8. Yet when her husband first introduced her to his family, they told him: “She’s a nice girl, but you gotta fatten her up.”

In the black community “we don’t view excess pounds as negatively as white folks do,” says Weaver, who is African American and runs a nonprofit nutritional consulting firm in Orlando, Fla. “We don’t want to be a size 2, 4 or 6 . . . we enjoy being full-figured.”

While this attitude reflects a positive body image and high self-esteem, “it is also a drawback that can compromise our future health,” says the 39-year-old registered dietitian. “The fact is that black women are getting heavier and are at a much greater risk of obesity-related diseases.” In her new book, “Slim Down Sister” (Dutton), Weaver and co-authors Fabiola Gaines and Angela Ebron cite these alarming statistics about African American women’s health:

* More than half are obese (compared with about one-third of white women).

* Nearly one in three has high blood pressure.

* Among those 55 and older, one in four has Type II diabetes, and these women are far more likely than their white counterparts to die or develop complications from the disease.

* Between the ages of 34 and 74, they have a 38% higher chance of suffering a fatal heart attack than white women.

* They are three times more likely to die of a stroke than white women.

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Physical activity can help reduce the risk of all of these diseases, yet minority women--especially those over age 40--are the least likely group of Americans to exercise.

“African American women are 35% less likely to engage in leisure time physical activity than white women are,” says Ross Brownson, director of prevention research at St. Louis University School of Public Health. Whether these women are active enough in their work to gain some health benefits remains controversial. “But no matter how you look at it,” he says, “minority women have the lowest rates of physical activity.”

Brownson’s recent study of nearly 3,000 women concluded that the greatest barrier to becoming physically active for African American women is “lack of a safe place to exercise.” White women cited “lack of time.” Latinas cited “care-giving duties,” and American Indian/Alaskan Native women cited “lack of energy.”

These findings reflect just one part of a complex picture, says Shiriki K. Kumanyika, associate dean for health promotion and disease prevention at the University of Pennsylvania School of Medicine.

“There are multiple factors in the neighborhoods, in the society and in the culture that prevent these women from being able to get physical activity,” says Kumanyika, who has done extensive research in this area.

Minority women are more likely to live in unsafe neighborhoods with few, if any, public recreational areas.

“There are fewer opportunities for physical activity in the black community, which gives individuals a more limited range of choices,” she says.

Economics also plays a role, because research indicates that the lower the income, the higher the prevalence of a sedentary lifestyle. Minority women are more apt to have lower incomes and jobs with limited flexibility and control over their time. Many are single mothers, and some work more than one job. They are not only less able to afford health club memberships, but also don’t want to spend what little leisure time they do have working out.

“In our society,” Kumanyika says, “being healthy has become an elite behavior.”

At the individual level, “there are some cultural attitudes that compete with healthy behavior,” she says. “The idea of exercise for its own sake is not well developed, particularly in the older segment of the black community. Exercise is often viewed as an added stress, and being skinny is seen as unhealthy.”

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Many minority women still view exercise as something that requires uncomfortable, tight clothes and sweating through unenjoyable activity.

“That’s why it’s important to get the message across that you can improve your health by putting more activity into your daily life in simple ways, like walking more,” says Kumanyika, who tries to walk as much as possible throughout her busy days.

An increasingly popular strategy for encouraging physical activity among minority women are church- and neighborhood-based health promotion programs that involve enjoyable group exercise such as Gospel Aerobics or walking or dancing to spiritual music.

To help communities begin their own such program, the National Institutes of Health recently released a guidebook called “Sisters Together: Move More, Eat Better.” Based on a pilot program that took place in Boston from 1994 to 1998, Sisters Together offers a variety of materials ranging from advice on starting a walking program to hair-care tips.

“Our program helped break a silence that exists for women in general and for black women in particular, which is that hair concerns often keep them from exercising,” says Rima Rudd of the Harvard University School of Public Health, who served as principal investigator on the Sisters Together project. “Our hair brochure shows women that it’s possible to be fit and keep a beautiful hairstyle, too.”

The key to helping minority women become physically active is “to foster sisterhood and create a program that treats the whole person--spiritual, physical and mental,” says Orlando’s Weaver, who cites a program at her own church. About 30 women, ages 25 to 71, meet regularly for Bible discussion related to health, lectures on good nutrition (including Weaver’s original Soul Food Pyramid) plus 30 minutes of walking around the fellowship hall to the beat of inspirational music.

“Just getting down from a size 18 to a size 14 would make these women’s day,” Weaver says. “But it’s not about appearance. It’s about getting their blood pressure down and their blood sugar down. Also, we need to teach women about living a healthy lifestyle because there’s way too many 10-year-old kids in our community with Type II diabetes. Women are the ones who will pass these healthy behaviors on to their families.”

For more information about the free materials offered by the Sisters Together Program, call (800) WIN-8098 or visit https://www.hsph.harvard.edu/sisterstogether.