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Chapter 2: Factors Affecting Weight

Many factors affect an individual’s weight. Environmental conditions, poverty, traumatic life experiences, and unmanaged stress are deeply connected to reasons why women gain and retain weight. Cultural norms also influence women’s satisfaction level with their size and their motivation to change eating and fitness habits. 

Food Deserts

Baltimore City has many areas that are considered food deserts [1] – areas where grocery stores are more than a quarter-mile walk, fresh or healthy foods are scarce, the median household income is no more than 185 percent above the poverty level, and at least 40 percent of households lack access to cars. 
  • 1 in 5 Baltimore City residents live in food deserts. (Approximately 125,000 -or- 20%)
  • Nearly 1 in 4 of Baltimore’s school aged children (0-17) live in a food desert. (approximately 31,000 -or- 23% of Baltimore’s population)
  • 1 in 4 of Baltimore’s African American population lives in a food desert. (approximately 105,000 -or- 26% of Baltimore’s population)
  • In a food desert, 1 in 4 households receive Supplemental Nutrition Assistance Program (SNAP) benefits, twice the percentage of non-food desert households. (13,000 households or 24.5%)
  • 1 in 3 of Baltimore’s neighborhoods (36%) are located within a food desert. (100 out of 278)


Poverty is directly linked with obesity. Women from homes with high risk for food insecurity are more likely to be obese because of their consumption of poor quality diets.

In Baltimore City, 77 percent of families living with an income below the poverty level are headed by single women. Nearly 200,000 families in Baltimore City receive SNAP benefits. 

Unsafe Communities

Many neighborhoods in Baltimore lack safe spaces for physical activity. Young women in Baltimore consistently rated crime, violence, drug dealers and sexual offenders as the most important barriers to physical activity. [2] 


Studies highlight the association between trauma, depression and obesity. The Adverse Childhood Experiences (ACE) Study has shown a clear association between obesity and past abuse or trauma. This study examines the relationships of health risk behavior and disease in adulthood to the number of traumatic events experienced in childhood. Such childhood events include psychological, physical or sexual abuse; violence against their mothers; and/or living with household members who were substance abusers, mentally ill, suicidal, or ever imprisoned. [3]

An estimated 65% of women living in Baltimore City have experienced childhood trauma. Depression and other mental health issues are widely under-diagnosed – about two-thirds of pregnant women with depression are not diagnosed.

For more information about identifying trauma and making your organization more trauma informed, visit the National Center for Trauma-Informed Care.

Cultural Norms and/or Perceptions About Weight

Cultural influences on perceptions of weight may interfere with African American and Latina women’s attainment of the medical standard for a healthy weight. Studies indicate that African American women may view larger body types as more desirable. According to these studies, Latina women feel similarly, but to a lesser degree.

In the HIP study, for example, over 400 female participants who identified themselves as being part of these minority groups, were asked to choose a model on an evidence-based body image scale that represented themselves. Based on their choice, and their BMI, less than half of the group selected an image that was consistent with their BMI. Further, nearly three fourths of the African American women desired to be obese, and less than 40% desired to be what was considered a healthy weight on the Pulver’s Body Image Scale. Similarly, 42.9% of the Latina participants chose an obese image as the ideal type. [4]

Evaluators of our own B’more Fit for Healthy Babies program found similar results among participants who completed a body image assessment and focus group discussions. Thirty eight B’more Fit participants (30 African American and eight Latina) were asked to rate the healthiest image vs. the ideal image on a newly revised Pulver’s Body Image Scale. For African American women, the mean ideal body image was larger than the mean “healthiest” body image. In contrast, the Latina group did not indicate that the ideal image was larger than the healthiest one. Across both racial groups, 86.8% of participants reported that their current image was larger than their ideal image, which reveals that this group has a desire to lose weight.

Dr. Janice Bowie and Dr. Amber Summers, of the Johns Hopkins Bloomberg School of Public Health, will be presenting these findings in more detail at the 2014 APHA Conference. B’more Fit participants have also verbalized that many of their male partners desire women with more curvaceous figures. 


[1] Center for Livable Future. Baltimore City Food Environment Map [map]Johns Hopkins Bloomberg School of Public Health: Baltimore, MD.

[2] Ries AV, Gittelsohn J, Voorhees CC, Roche KM, Clifton KJ, Astone NM. The environment and urban adolescents' use of recreational facilities for physical activity: a qualitative studyAmerican Journal of Health Promotion. 2008; 23: 43-50. 

[3] The Adverse Childhood Experiences (ACE) Study. Retrieved from

[4] Mama SK, Quill BE, Fernandez-Esquer ME, Reese-Smith JY, Banda JA, Lee RE. Body image and physical activity among Latina and African American womenEthnicity & Disease. 2011, 21, p.281-287.

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