A cross-cultural perspective on obesity and health in three groups of women: the Mississippi Choctaw, American Samoans, and African Americans

This study compares obesity as assessed by Body Mass Index (BMI) and the relationship of BMI to hypertension and diabetes in adult females from three populations, the Mississippi Band of Choctaw (N=50), American Samoa (N=155), and an African American community in West Alabama (N=367). These groups were surveyed in the early to mid 1990s. All three groups of women have very high levels of overweight and obesity, with the Samoans being most extreme in this regard. While there are indications that all three groups of women consume a calorically dense diet, low activity appears to be the most likely causal factor in the high rates of obesity. Relaxed negative attitudes toward an overweight/obese body image may also play a role in the high rates. The prevalences of hypertension and diabetes are alarmingly high in all three groups. There are, however, very different associations between BMI, hypertension, and diabetes in the three groups of women. The Samoans are substantially more obese (and older), but they have lower rates of hypertension than the African American women and lower rates of diabetes than the Choctaw women. While the genetic background of the three groups no doubt plays a role, it is also likely that a BMI of 30+, the common cutoff for obesity, means different things in these different populations. These results provide further support for the idea of variation in the relationship of BMI to disease in different populations.