Cultural perceptions of healthy weight in rural Appalachian youth.

INTRODUCTION: Rates of overweight among US children have been rising over the past three decades. Changes in lifestyle behaviors, including dietary and physical activity habits, have been examined thoroughly to identify correlates of weight status in children. Youth in rural US Appalachia are at a disproportionately greater risk for obesity and related health complications. Inadequate physical activity and poor dietary habits are two primary causes of obesity that have been noted in West Virginia adolescents. Few existing data describes the decisional balance in performing lifestyle behaviors, nor the perceptions of these youth regarding their beliefs about weight. The purpose of this study was to identify the perceptions of a healthy weight in rural Appalachian adolescents.

METHODS: Ninth grade students were recruited from classroom presentations in four high schools throughout West Virginia. Interested parent-caregiver pairs returned forms to indicate interest in participation. Separate focus group interviews were conducted concurrently with adolescent and parents or caregivers to identify the cultural perceptions of a healthy weight. Questions were developed using grounded theory to explore how a healthy weight was defined, what factors dictate body weight, the perceived severity of the obesity issue, and the social or health ramifications of the condition. Verbatim transcripts were analyzed to identify dominant themes, and content analysis provided text segments to describe the themes. This article describes the data obtained from the adolescent focus groups.

RESULTS: When asked what defined a healthy weight, the adolescents who participated in the focus groups placed great value on physical appearance and social acceptability. Students believed there was a particular number, either an absolute weight or body mass index value that determined a healthy weight. These numbers were usually conveyed by a physician; however, there was also a general acceptance of being 'thick' or a reliance on 'feeling healthy' as a determinant of maintaining a healthy weight. Despite these beliefs, many teens had unrealistic and unhealthy perceptions of weight. Female participants were more concerned with weight than males, some to the point of obsession. Both males and females expressed a social stigma associated with overweight. Issues of guilt and diminished self-esteem were prevalent. When asked about the extensiveness of the problem of childhood overweight, the students indicated that a degree of familiarity with being overweight has developed and 'you just get used to [seeing] it.' Because of the rising rates of chronic disease in this region, a fear was evident in these youth about the increased risk of developing these conditions in those who are overweight. Experiences with family members with diabetes and cardiovascular disease fueled these concerns, which instilled a fear of becoming overweight in many of the students. Many perceptions of healthy weight and appropriate body size were shaped by the media and entertainment industry. Additionally, some participants admitted to performing unsafe practices to reduce body mass, such as very low calorie diets or fasting.

CONCLUSIONS: Youth in rural Appalachia present similar perceptions about weight as other children; however, differences in perceived healthy lifestyle habits and a general acceptance of a higher average body weight present additional challenges to addressing the increasing problem of child overweight. Despite the relative isolation of many of these communities, the media has a profound impact on weight valuation that has been intertwined with school-based health education and cultural values of health. These data will provide valuable information for the development of obesity prevention programs in rural Appalachia.