All ETDs from UAB

Advisory Committee Chair

Olivia Affuso

Advisory Committee Members

Monica L Baskin

Tiffany L Carson

Russell Griffin

Emily B Levitan

Document Type


Date of Award


Degree Name by School

Doctor of Philosophy (PhD) School of Public Health


African American (AA) women are disproportionately burdened by obesity, an epidemic with implications that reach beyond physiological consequences. Given that perceptions of body image may impact health-promoting behaviors and weight management efforts, we sought to evaluate the presence and magnitude of body image dissatisfaction (BID) and explore its relationship with waist circumference (WC), independent of weight among overweight and obese treatment-seeking rural AA women. Participants referred to images from the Pulvers Figure Rating Scale that included nine body silhouettes to answer: “How I think I look now” (i.e., current body image) and “How I would like to look” (i.e., desired body image). Silhouettes were scored from 1 (thinnest) to 9 (heaviest). BID was calculated as the difference between current and desired body image. Participants presented with a median age and body mass index (BMI) of 47.0 years and 37.2 kg/m2, respectively. We implemented a cross-sectional design to describe current body image, desired body image, and magnitude of BID. We further explored the relationship between BID and BMI. Our analysis revealed that scores for current body image [Median=6.0 IQR: (5.0-7.0)] were larger than scores for desired body image [Median=4.0 IQR: (3.0-4.0)], indicating a desire among participants to be thinner. Additionally, average values for BID were greater at higher categories of BMI. Furthermore, receiver operating curves (ROCs) demonstrated the ability of the Pulvers scale to correctly identify participants classified according to BMI. We further implemented logistic regression generalized estimating equations (GEEs) to evaluate whether a change in WC is associated with improved BID, independent of change in weight. Findings showed that participants with the largest decline in WC were more likely to become more satisfied with their body image over time (six months: OR=2.2; 95% CI: 1.2, 4.1; one year OR=1.9; 95% CI: 1.2, 3,0); however, this association was no longer statistically significant after controlling for change in weight. Despite null findings, participants demonstrated significant declines in BID, WC and weight at each measurement period. Given the presence and persistence of BID in this sample, additional research is needed to identify factors that influence BID, which will guide the development and implementation of more comprehensive interventions among this sub-population.

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