Review of Literature Introduction Despite the well-publicized health and emotional consequences of obesity, a successful weight-loss industry, and a high rate of voluntary dieting, the prevalence of obesity in African American women continued to increase. For the most part, African American women are aware of the serious health risks related to obesity. Honest attempts to diet and exercise properly usually resulted in gaining of the weight loss and additional pounds in the process. A limited number of studies suggest that African American women maybe less motivated to control their weight because of culturally determined, permissive attitudes toward obesity (Kumanyika & Guilford-Davis, 1993). In fact a select few of obese African American women may feel more attractive about their bodies than women of other races may. The African American culture appears to be more accepting of obesity than other cultures in society.

On the other hand, African American women experience great social pressure in respect to body size and receive painful accounts of ridicule (Averett & Sanders, 1996). Obese African American women have also been linked to the lower socioeconomic status in regards having the means to purchase nutritional foods for a proper diet. The stigma attached to obesity causes African American women to feel shame and guilt of self-blame (Crocker, Cornwell, & Major, 1993). Emotionally, African American women tend to blame themselves for their obesity and will become withdrawn. Therefore, African American women may begin to experience insecurities and low self-esteem. There are several serious health risks that are associated with obesity.

Obese African American women experience a high rate of diabetes, hypertension, heart disease, and an array of other long-term critical health problems. Over years of time obesity can be fatal. Gradual weight loss can help to reverse risk factors and add years to live a healthier life. Social Context Obesity is more prevalent among African American women in the lower socioeconomic status. Characteristics of being subject to lower economic status included poorer education, income levels, less likely to have private insurance with no real source of regular medical care (Rajaram, 1998). Therefore low-income African American women are less educated on proper diet and exercise.

The U. S. Department of Agriculture's Food Guide Pyramid was created as a guide to follow everyday for proper food servings and choices. The fundamental principles of the food guide were moderation, variety, and balance.

A diet was balanced if it contained appropriate amount of each nutrient, and chose foods from each of the food groups helped ensure that balance. African they can purchase. The U. S. Department of Agriculture's Food Guide Pyramid is based on a recommended number of servings from six food groups. Food groups were the bread, cereal, rice, and pasta group (6-11 servings), vegetable group (3-5 servings), fruit group (2-4 servings), milk, yogurt, and cheese group (2-3 servings), meat, poultry, fish, dry beans, eggs, and nuts group (2-3 servings), and fats, oils, and sweets (use sparingly) (2001).

Inexpensive fat-filled, low-nutrient-density foods predominate in African American communities (Rajaram 1998). Proper education would have informed the proper foods, servings, and amount of servings to ensure proper eating habits that abstractly monitors weight control. According to statistics, 27. 4% of African American women who had less than high school education was obese as opposed to only 15.

7% of African American women with college or above was obese (U. S. Surgeon General, 2001). In combination with proper diet there must be physical activity. The U. S.

Surgeon General stated that regular physical activity was very important maintaining weight loss, but was extremely helpful for the prevention of obesity (2001). African American women tend to be less active physically. The amount of physical activity will be determined by the amount of food intake. The U. S. Surgeon General informs that adding moderate amount of physical activity five or more times a week uses 150 calories of energy on each day of activity, which can be equivalent to approximately five pounds in six months or ten pounds in one year (2001).

Samples of physical activities included but are not limited to common chores around the house or in the garden and sporting activities such as walking, dancing, and bicycling. An example of balanced food intake and physical activity included one small cookie (50 calories) was equivalent to walking briskly for ten minutes (U. S. Surgeon General, 2001). The all too common fast food "meal" containing a double patty cheeseburger, extra-large fries and a twenty-four ounce soft drink is equal to running two and half-hours at ten-minute mile pace (1500 calories) (2001).

Again proper education would inform African American women what to eat, how much, how often and the amount of physical activity to help prevent obesity and maintain weight control. Along with proper nutrition habits and moderate exercise it is essential that obese African American women obtain regular medical care. A disproportionate number of African American women live in or near poverty which puts them at higher risk of obesity (Rajaram, 1998). African American women that live in or near poverty should have top priority to the means of getting adequate medical care on a regular basis. Regular medical care from a professional was an opportunity for African American women to have basic fitness assessments and testing. Benefits of a fitness assessment: helps establish the client's current health status and provide you with baseline information, provides extremely useful information for comparison later as the client progresses and improves, and serves as a powerful and educational motivating tool, thus increasing the likelihood of adherence.

Components of a fitness assessment would include a medical history form, of risk factors, informed consent form, and suggestions to some form of an actual fitness activity test. This is very useful information as to the existing health status and appropriate procedures to gradually improve present health status. This type of medical care must be made available to obese African American women of the lower socioeconomic level especially since that is a effect obesity. Obese African American women were discriminated by society in the workplace. Being obese in society is seen as a form of laziness, self-disrespect, and poor self-control.

Rothblum, Miller, and Gar butt (1988) found that overweight job applicants were evaluated more negatively than average weight applicants on issues such as their supervisory potential, self-discipline, and personal hygiene (Morrison & O'Connor, 1999). Qualifications for employment should never be based on an individual's weight. For example, Larkin and Pines (1979) briefly displayed and overweight or a normal weight job candidate, followed by an identical videotape depicting hands filling out a job application. Furthermore, viewers who associated the application with the overweight person were less likely to perceive the candidate as having desirable qualities that warranted employment.

This could a double edge sword facing obese African American women. In an attempt to sum it all up society places barriers on obese African American women from the lower socioeconomic status and they continue to strive for adequate education, better income, and regular medical care. Regular medical care is of the most importance that way obesity can be prevented. Obesity is defined as an abnormal accumulation of body fat, usually twenty percent or more over an individual's ideal body weight (Gale Encyclopedia of Medicine, 1999).

For adults body mass index (BMI) is used to measure obesity. BMI is a measure of weight in relation to height: BMI = weight (kg) / height (m) 2 Or BMI = (weight (pounds) /height (inches) 2) 703 A BMI of 25. 0 - 29. 9 is classified as overweight.

BMI classifies obesity in three different levels: class I 30. 0 - 34. 9, class II 35. 0 - 39. 9, and class III >40. 0.

Of the adults in the United States sixty nine percent of African American women are obese a BMI >25 (U. S. Surgeon General, 2001). The primary concern of obese African American woman was one of physical heath.

Obesity is associated to critical health conditions such as diabetes, hypertension, and an array of other long term health conditions up and including death. Rajaram found that among people with diagnosed diabetes, eighty three percent of adult black women are obese (1998). Diabetes was a condition in which the pancreas no longer produced enough insulin or when cells stop responding to the insulin that is produced, so that glucose in the blood cannot be absorbed into the cells of the body (Gale Encyclopedia, 1999). Hypertension is basically high blood pressure. Blood pressure was the force of blood pushing against the walls of arteries as it flowed through them. Arteries were the blood vessels that carry oxygenated blood from the heart to the body's tissues (Gale Encyclopedia, 1999).

Hypertension makes the heart work harder to pump blood through the body. The extra workload can make the heart muscle thicken and stretch. When the heart becomes too enlarged it cannot pump enough blood. If hypertension is not treated, the heart may fail. Kumanyika advised that modest weight loss could not only prevent or reverse blood pressure elevations but also have a favorable impact on obesity-related cardiovascular risk factors such as diabetes and hypertension (1997). Other major symptoms obese African American women are susceptible to included but are not limited to heart disease, cancer, breathing problems, arthritis, amenorrhea, skin disorders, and reproductive complications.

The percentage of incidences of heart disease (heart attack, congestive heart failure, sudden cardiac death, angina or chest pain, and abnormal heart rhythm) increased in obese African American women (Surgeon, 2001). Obesity is associated with an increased risk for some types of cancer including endometrial (cancer of the lining of the uterus), colon, gall bladder, prostate, kidney, and postmenopausal breast cancer (Surgeon, 2001). Breathing problems such as sleep apnea, asthma, and shortness of breath, which would be incapacitating was more common today in obesity (Gale, 1999). For every 2-pound increase in weight, the risk of developing arthritis is increased by nine to thirteen percent (Gale, 1999).

The occurrence amenorrhea or menstrual irregularities or cessation of menstruation increased in obese African American women. Embarrassing skin disorders surface on the bodies of obese African American women from the bacterial breakdown of sweat and cellular material in thick folds of skin or from increased friction between fold (Surgeon, 2001). Obesity caused complications in pregnancies. Obesity during pregnancy is associated with increased risk of death in both the baby and the mother times ten. Pregnant obese African American women risked neural tube birth defects such as spina bifida (Surgeon, 2001). Additional health consequences of obesity emotionally affect the quality of life through limited mobility and decreased physical endurance social discrimination.

The fact that one is obese is physically noticeable to the eye and prejudgment al responses are soon followed either voiced or in mind. Everyday obese African American women coped with society in the workplace, grocery stores, restaurants, shopping malls, and everyday society stigmatizes them. Society viewed obesity as deviant and therefore reacted negatively. Crocker, Cornwell, & Major (1993) feel that the obese are frequently stereotyped as aesthetically displeasing, morally and emotionally impaired, and socially handicapped (Allow, 1982; Cahn man, 1968; Crandall & Biernat, 1990). Society assumed that obese African American women are not displeased with their physical looks and blame themselves for it. Hebl & Heatherton found that obe se African American women recognized that the criticism or rejection is due to their obesity and lay the blame on themselves for being obese rather than on the critic or rejecter for being prejudiced (1998).

They go on to say such attitudes explained in part why obese African American women tend to have lower self-esteem than their non obese counterparts (Hebl & Heatherton, 1998). The stigmatization of obesity caused negative attitudes to their personal inadequacy or lack of deserving ness, vulnerability to low self-esteem, depression, and felt justified suffrage (Crocker, Cornwell, & Major, 1993). In the media "fat jokes" are common on television (Quinn & Crocker, 1999). In comedy fat people made jokes about themselves just as much as there are jokes made about fat people. Crocker, Cornwell, & Major stated that although many stigmatized individuals might try protecting their self-esteem by attributing criticism and rejection to others' prejudices but fail to make such attributions (1993). In the world of academic obese African American women had experienced discrimination for acceptance for admittance.

Rothblum, Brand, Miler, and Oetjen (1990) found that obese individuals were more likely than their average weight counterparts to report having been victimized at school and were less likely to be accepted at elite colleges. Goldfield and Chrysler (1995) found that fat people were less likely to be selected as friends were by their peers. Researchers have suggested that anti fat attitudes may stem from the view that obesity is aesthetically displeasing in the eyes of society and a symptom of poor self-control (Crandall & Biernat, 1990). It was hard enough for African American women to cope with obesity and it was even harder to cope with obesity when society looked so down upon it. There have been several medical solutions proposed to help cure obesity such as medical observation liquid diet, stomach stapling, and liposuction. An individual must have the funds to afford these services because they are not covered under traditional medical insurance.

Another solution to help obese African American women cope with low self-esteem and other negative emotions could be counseling. Laue Metcalfe, MS manufactured " The 10 Skills for Developing a Healthy Body Image & Self-Esteem" to help obese individuals to cherish their differences and accept their bodies. The ten skills included: (a) honor your personal story, (b) accept yourself the way you are, (c) create a positive mental outlook, (d) develop positive self-talk, (e) guide away from comparisons, (f) build you self-reliance, (g) live in the now, (h) reward yourself, (i) give yourself praise, and (j) be connected. Self- acceptance has been difficult to achieve because African American women struggled with the societal message one was acceptable only if they are thin. Physical and emotional well beings go hand in hand, but do not blossom in highly critical environments. Creating a safe, nurturing environment frees people to take risks and learn to trust themselves and their bodies regardless of size, age, limited mobility or lack of experience.

When obese African American women should focus on finding their own strengths, rather than comparing themselves to others, they are free to feel good about their progress without holding out for perfection to feel success. Furthermore obese African American women that obtained high-level wellness gave good personal physical care to oneself, used mind constructively, expressed emotions effectively, creatively involved those around, and showed concern for their physical, psychological, and spiritual environments. The Iceberg Model written in the fourth edition Fit & Well book listed three levels to ensure quality wellness in life. The first level was the Lifestyle/Behavioral level-what to eat, how to use and exercise the body, how to relax and let go of stress, and how to safeguard oneself from surrounding hazards (1997). The second level was the Psychological/Motivational/Cultural level-here one learned why the lifestyle chosen and learn what payoffs gained from being obese, eating well, and getting regular exercise.

Finally the third level was Spiritual/Being/Meaning level which included the mystical and mysterious, and everything else in the unconscious mind, and concerned with such issues as the reason for being, the real meaning of life, or finding a place in the universe. The U. S. Surgeon General suggested that obese individuals check their wellness energy system-the input and output (2001). Energy input was when the body receives energy from three different sources: breathing (oxygen), sensing (stimuli in the environment) and eating (food, which is oxidized by cells and is used to build and repair body tissue) (General, 2001). Energy output was the thought of the body as a pipeline or means of energy.

Energy output was when energy was channeled throughout the body, mind and being, converted into forms of energy before it was returned back to the environment (General, 2001). Out of the nine different outflows of energy, self-responsibility and love was the most important. Self-responsibility and love was a form of energy that reveals as the attitude you choose toward. Living life with self-responsibility and love would enhance wellness. There is clearly no single cause of obesity. In the research shared obesity is prevalent among African American women from the lower socioeconomic status.

Without adequate education, low income, and no insurance for regular medical care African American women are left to become obese. Obesity is linked to serious health risks-diabetes being the most critical. Society looked down upon obesity and they begin to blame themselves and their self-esteem suffers. An expensive solution to obesity would be surgery if an individual had the funds. On the other hand, one may invest time to learn about proper diet and fitness, and learn to love them just the way they are.

Proposal With all the studies combined my research question is what are the social, physical, and emotional effects of obesity on African American women? African American women experience obesity at an alarming rate when compared to women of other races. According to statistics from the U. S. Surgeon General, sixty-nine percent of African American women can be in one of three classifications of obesity (2001). Experts identify obesity as being twenty percent above the ideal weight based upon medically approved weight charts. There are several explanations proposed for the high level of obesity in African American communities.

Contributing factors of obesity included but are not limited to socioeconomic circumstances of inadequate education, low income, and no insurance for regular medical cares. In the workplace obese African American women face discrimination just for their physical appearance and looked upon as being lazy with no self-control. In a physical health context obesity is associated with critical health problems such as diabetes, hypertension, and an array of long-term conditions not excluding death. In an emotional context obese African American women tend to blame themselves for the discrimination expressed in society. The self-fulfilling prophecy plays out. African American women emotionally depressed, lose self-esteem, and become full of shame and guilt because of their obesity.

Procedures A sample of two hundred and thirty-seven African American women living in Clovis Apartments was surveyed. These participants were selected based upon body weight, income statues, and race. A survey was mailed to each participant. Four follow-up mailings were conducted, sending reminders at two weeks intervals.

This was done to increase the return rate of the survey. An incentive was also included, a one month free pass to work with a personal trainer to the first twenty participants who returned their survey. As a result of these efforts one hundred and sixty survey were returned for a return rate of sixty-eight percent. The age of our participants ranged from twenty-four to eighty-fives years with the average age of forty-four.

Their education ranged from less than high school to a high school diploma, with some college. Instruments The primary instrument utilized in this project was a questionnaire created specifically for the study. The study constructed questionnaire consisted of twenty items attempting to gather information regarding factors that contributed to them becoming over weight. Qualitative questions addressed their race, educational background, medical insurance, and proper nutrition. Quantitative questions addressed their age and income level. Results After tallying up the responses from all one hundred and sixty surveys there were three theme categories.

The first theme was the majority of the sample had less than a high school education. The second theme was the majority of the sample earned little or no income. Finally, the third theme was the majority of the sample had not been educated on proper nutrition. In conclusion, there need to be more research specifically targeted towards obesity in African American women and how to control the contributing factors to overcome obesity. References Allan, J. D.

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