Health professionals need to use more than tape measures and scales to define and tackle obesity, according to a paper in the latest Journal of Advanced Nursing.
A research review carried out by Maryanne Davidson from Yale University, USA, has discovered that many women don't make the link between high weight and poor health and that culture plays a big role in how positively they see themselves.
She reviewed key papers published over a 10-year period to see how health professionals and Black and White American women define obesity and to identify differences in attitudes.
This revealed that while health professionals used quantitative methods, such as Body Mass Index measurements based on the height to weight ratio, women are more likely to base their ideal weight on cultural criteria.
"My review revealed that Black American participants defined obesity in positive terms, relating it to attractiveness, sexual desirability, body image, strength or goodness, self esteem and social acceptability" says Davidson. "In addition they didn't view obesity as cause for concern when it came to their health."
White Americans, on the other hand, expressed completely the opposite view.
"They defined obesity in negative terms, describing it as unattractive, not socially desirable, associated with negative body image and decreased self-esteem and being socially unacceptable.
"But when it came to the links between body weight and health, this group was much more likely to voice mixed views, with some expressing concern and others feeling that weight wasn't a health issue.
Davidson also discovered variations in how health professionals define obesity.
"Although most of them use the Body Mass Index to actually measure obesity, we found different views about what level of BMI constitutes normal weight and what level indicates obesity" she says.
"I'm glad to say that that situation is changing and there is a move towards standardised measurement of what is obese and what is overweight. For example the International Obesity Task Force is helping to address the need for a global objective measurement based on BMI."
The findings provide a real challenge for healthcare professions.
"These differences could pose substantial threats to communication and understanding between healthcare providers and their patients. That's why it is so important that obesity is approached in a culturally sensitive way, rather than just using quantitative measures like the Body Mass Index."
People have been obsessed with their weight since records began, says Davidson, who points out that the Spartans reportedly ostracised a man for being too fat and Socrates danced every day to keep his weight within reason!