title: Visual Representation of Body Shape in African-American and European American Women: Clinical Considerations.
abstract: BACKGROUND
  Body mass index (BMI) has been used widely among clinicians to assess obesity in their patients due to its ease and availability. However, BMI has some diagnostic limitations and other measures related to health risks; in particular, body shape may be of greater relevance to health outcomes.
  
  
  OBJECTIVE
  The objective of this study was to illustrate the importance of body shape assessments above and beyond BMI and its relationship to health risk among a sample of African-American and European American women.
  
  
  METHODS
  African-American and European American women aged 19-78 years (n = 552) in Birmingham, Alabama, were recruited and stratified by menopausal status (ie, pre- or postmenopausal). Pictorial body shapes were derived from digital photographs, while body fat distribution defined by android-gynoid ratio (AGR) and body composition were obtained from dual-energy X-ray absorptiometry.
  
  
  RESULTS
  Images of BMI and age-matched women illustrate variability in fat distribution. Among both menopausal status groups, more than 50% of women had a pear body shape (AGR < 1). An apple body shape was associated with higher odds of having diabetes (unadjusted odds ratio [OR]: 4.1, 95% confidence interval [CI]: 1.9-9.3), hypertension (unadjusted OR: 3.1, 95% CI: 2.0-4.7), and high cholesterol (unadjusted OR: 3.0, 95% CI: 1.8-5.1).
  
  
  CONCLUSIONS
  Use of visual cues alongside traditional methods of weight status assessment may help to facilitate weight management conversations between physicians and female patients. However, next steps should include the validation of visual assessments of body shape in women for use by physicians.
authors.affiliation: Office of Energetics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA.; Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Patrice L
authors.initials: PL
authors.lastname: Capers
authors.affiliation: Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, AL, USA.; Department of Nutrition Sciences, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Amber W
authors.initials: AW
authors.lastname: Kinsey
authors.affiliation: Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Edrika L
authors.initials: EL
authors.lastname: Miskell
authors.affiliation: Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, AL, USA.; Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA.; Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Olivia
authors.initials: O
authors.lastname: Affuso
keywords: BMI; body shape; fat distribution; visual representation; women