The continual increase in the prevalence of obesity in the past two decades alarms public health practitioners because of its associated health consequences, but more importantly, because of the disproportionate burden of this disease on minorities. Obesity at any stage is problematic, but childhood adiposity is of particular concern because of its significant impact on health and its associated longterm healthcare cost. Attributable consequences of adiposity in childhood include increased frequency of respiratory illnesses, persistence of obesity through adulthood, development of pediatric hypertension and juvenile onset drug diabetes, development of psychological problems (such as eating disorders), body image disturbance, and higher predisposition to the social problem of weight discrimination in later life.
A comprehensive review on the prevalence of childhood obesity conducted by Ogden and colleagues in 1997 revealed that overweight prevalence for infants—defined as weight for length above the 95th percentile of the NCHS growth chart—were 9.6% and 11% for U.S. infant boys and girls, respectively. Infant African-American boys had a rate of 10.2% and girls 15.0%, both of which were higher than the national prevalence. A follow-up study by the investigators showed that by 2000, 11.4% of all infants were overweight, and 18.5% of African-American infant boys and girls were overweight. This increasing prevalence highlights the concerns about obesity in minority populations in view of the fact that it persists into adulthood, and a large proportion of African-American adults currently suffer from obesity and its related diseases.
In the course of human growth and development infancy is unique because it is the period of most rapid extra-utero growth. This rapid growth is manifested as an increase in both cell size and number and is directly a function of dietary intake. As such, overnutrition or undernutrition during this period adversely affects the growing individual and sets the stage for weight issues for a lifetime. Parental misconceptions and health beliefs concerning what constitutes a normal body weight and normal diet for infants have been reported as the cause of inorganic failure to thrive in Caucasians and infant adiposity in minority populations in the United States. Parental perceptions are important because they determine parental health actions.
The literature is replete with studies on infant feeding in almost all conceivable human social groups. However, not many studies have focused on the relationship between infant feeding and body image. Whereas body weight is the measure of the mass of an entity, body image is the perception of the distribution of that mass on the skeletal structure. It is measured normatively as positive or negative body image. Many studies have explored body image perceptions in adult populations, but fewer have focused on infants and children. In the literature, two of the few studies which have intentionally examined parental perception of their children’s body image were conducted by Alexander et al. in 1991 and Kramer et al. in 1983. Kramer’s study focused on a Canadian population and discovered that women who preferred obese children later on ended up with chubbier children. Alexander’s study, which focused on a Mexican-American population, observed that obese mothers consistently preferred obese children. Collectively, these two studies suggested that in early childhood, adiposity outcome may have more to do with parental weight preference for their children and less with other factors. No other study has yet been located that has intentionally targeted perceptions of adiposity during infancy in African-American mothers. Therefore, the objective of this prospective study was to contribute to this knowledge base by exploring, in a low-income African-American inner-city population, the relationship between maternal perceptions of infant body size (weight) and its relationship to infant feeding beliefs and practices and infant adiposity in the first six- to seven months of life. Additionally, this study endeavored to document whether Alexander’s and Kramer’s findings, that parental weight preference significantly influences the development of childhood adiposity, are applicable to an inner-city African-American population.