Body image assessment: Comparison of figure rating scales among urban Black women

Purpose: To determine a psychometrically stable and socially acceptable scale for assessing perceptual body image in Black women. Methods: The study sample (N = 50) was selected sequentially from Black women (mean age 52.3 ± 10 years) who were being screened for a larger randomized trial (Project Joy). Three standard published figure rating scales (FRS) were compared with a new scale (Reese FRS). Distributions of respondents' selections on all scales were examined relative to anthropometric measures, including body mass index (BMI) and categories of obesity and overweight (National Expert Panel on Overweight and Obesity Guidelines). Cultural identity, developed from an adaptation from the African-American Acculturation Scale II (cross-validation and short form), and its relationship to FRS preference was also assessed. Results: Body weight distribution of women in this study matched that of US Black women over 40 years of age in the NHA-NES III data. All four FRS performed similarly and correlated significantly with BMI, r was -0.70 to -0.75, P<.0001. Twenty-two percent of the women identified themselves with one of the three largest images (determined by consensus of an expert panel to represent obesity) on three FRS and 38% identified with the three largest images on one scale. For all scales, this was below 56% of women identified as obese based on national guidelines. Among women with the highest cultural identity scores, indicating the strongest identification with elements of Black culture, 72% preferred the new Reese FRS. Conclusion: Overall, there is considerable overlap among images selected for any weight category based on national BMI classifications. A strong preference exists for the Reese scale, especially among women with a strong Black cultural identity. This new scale performs similarly to existing scales in successively assessing the self-assignment of an image for self, but is more socially acceptable. Reasons for the small percentage of obese women who identified themselves as obese need further investigation.