This study used hermeneutic phenomenology to explore the lived experience of obesity in adolescent African American males, paying particular attention to the concepts of self-perception and meaning. Self-perception and meaning have been explored as individual concepts on many levels within the adolescent population; however, few studies have explored the concepts together and none have directly explored the combined relationship of the two in obese African American adolescent males.
Self-perception is a major determinant in the quality of decisions that adolescents make (Loughnan et al., 2010). Adolescents are greatly influenced by their own perception of self and their perception of the world around them. Factors such as life experiences, social relationships, societal influences, and structural forces (Sorensen et al., 2007) contribute to the formation of self-perception and reflect how peers use and interpret information about each other.
Findings from this study are consistent with findings from previous studies that point to self-perception as a determinant in how adolescents interact with peers and the influence that self-perception has on life experiences, both past and future (Mond, van den Berg, Boutelle, Hannan, & Neumark-Sztainer, 2011; Neumark-Sztainer, Paxton, & Hannan, 2006; Paxton, Neumark-Sztainer, Hannan, & Eisenberg, 2006). Adolescents from this study who expressed a negative self-perception conveyed qualities consistent with previous reports of impaired social relationships, increased risk taking behaviors, depression, and inaccurate perception of weight status (Araujo, Dumith, Menezes, & Hallal, 2010; Dave & Rashad, 2009; Edwards, Pettingell, & Borowsky, 2010). Their messages of struggles related to social interactions with others and their efforts to ignore the hurt are important factors that cannot be overlooked.
Adolescents from this study who viewed their weight as a positive factor were also consistent with previous studies that showed a positive correlation between positive self-perception and better mental health and emotional well-being (Giletta et al., 2010; Harter, 2006). Personality, along with feeling a sense of personal and social acceptance among friends was an important part of self-perception for these adolescents. Focusing solely on social acceptance ultimately contributed to the positive values they assigned to their obesity.
A study by Stockton et al. (2009) highlights the importance of self-perception in adolescents particularly as it applies to vital health promoting behaviors and the ability to overcome barriers that may lead to poor health behaviors. Furthermore, they contend that self-perception has a greater impact on BMI than diet or physical activity (Stockton et al., 2009). Self-perception is not static and continues to develop as adolescents learn to make social comparisons and reflect on their own personal behaviors. It is through this process of self-evaluation and social comparisons that adolescents become able to incorporate personal successes and failures into their own self-perception.
This relationship between obesity and the understanding of obesity in this population is an important factor to consider in treatment. When conflict occurs, serious barriers leading to noncompliance and dissatisfaction are more likely. Low health literacy leads to poorer health outcomes in all persons regardless of age, race or socioeconomic status (Berkman, Sheridan, Donaheu, Halpern, & Crotty, 2011). As such, adolescents who lack an understanding of their obesity are perhaps of greatest concern, as this may imply a disconnect from the reality of the situation and may put them at an increased risk for exacerbation of their obesity, thereby making them less likely to have successful outcomes. On the other hand, it has been shown that adverse health and social consequences can be effective motivators to behavior change (Hollands, Prestwich, & Marteau, 2011); therefore, those with a negative understanding of their obesity, particularly in regard to health-related and social implications, are more likely to adhere to treatment and have successful outcomes.
Individual life events and unique situations faced by obese adolescents contribute to their organization of personal realities, ultimately allowing them to make meaning of their lives, thereby contributing to their personal self-perception. As Fife (2005) reported in a study on constructing meaning following the onset of a life-threatening illness, meaning making along with self-perception have significant implications on an individual's perception of the future.
In the most basic form, meanings allow individuals to describe, define, justify, and to interpret behavior (Kerksiek, 2011). As an individual interprets meaning from, or gives meaning to, a particular experience, the experience begins to make sense and thereby allows the person to give worth or value to that experience (Kerksiek, 2011). Meaning is fluid and changes as individuals encounter, manage, and adapt to changes surrounding their own illness experience (Fife, 2005). Meanings that adolescents assign to their experiences, in this case weight-related experiences, are important for health care practitioners to understand because these meanings form the underlying motivation behind the adolescents' thoughts and actions (Kerksiek, 2011). Ultimately, these meanings impact how adolescents interpret and apply the information they receive or are exposed to through social interaction (Krauss, 2005).
Although literature related to the importance and implications of “meaning making” dates back to 1971 (Parkes, 1971), findings from this study support the opinion of Fife (2005) that the concept continues to be unclear. With regard to the meanings they assigned to their obesity, adolescents in this study who conveyed a simple understanding that they were obese did so without indicating that they understood obesity as an illness. And, while some adolescents responded with comments that support a limited understanding of their obesity, these adolescents still did not express complete understanding of their obesity. When their comments conveyed a more positive psychological effect, participants based the meaning of their obesity more upon their positive attributes than their obese physical characteristics.
It is important to note that fear of medical problems, in general, was of concern to these adolescents. Although some participants spoke specifically about obesity and the potential effects on their health, which indicated some basic knowledge, or association, between obesity and elevated health risks. When specific health concerns were discussed the most common fears were attributed to diabetes and heart problems. This provides evidence to support the claim that adolescents with a limited understanding of their obesity are perhaps of greater concern, thereby making intervention from a health care standpoint significantly more complicated.
Overall, responses by adolescents who participated in this study support the need for educational perspectives that present critical information about obesity and the effects of obesity in a manner that is cognitively relevant to adolescents.
Qualitative research is designed to enhance understanding of a phenomenon and, as a result, contribute valuable knowledge to the community. This is accomplished by using small, purposive samples, thus limiting generalizability of the findings. Because all participants for this study were recruited from one geographical location, it is important to recognize that similar studies done with different populations are likely to yield different results. Furthermore, African American adolescent males living in other geographical locations are likely to report different experiences based on the uniqueness of their environments and personal beliefs.
Findings from this study have given rise to many opportunities for future research. This study explored the lived experience of obesity among adolescent African American males receiving treatment within a clinical setting. It would be beneficial to apply these research objectives to obese adolescents who are not receiving medical treatment for their obesity so that data can be gathered and compared with those adolescents who are receiving treatment. It would be interesting to explore the influence culture has on both self-perception and meaning, as well as the role cultural patterns may have on the causes and sequelae of obesity in adolescents. Stressors associated with culture and gender, or perhaps both, would be of benefit to this body of research. The effect that biomarkers, such as physiologic characteristics and genetics, may have on the development of obesity in minority population would also be of considerable benefit and has not received enough emphasis in clinical research. Lastly, treatment protocols need to be developed that take into account interventions that are tailored to individual cultures, genders, and environments. To provide more appropriate and effective management of obesity in adolescents, more studies need to be done on minority adolescents that focus on developmental and cultural considerations unique to that population.
To date, health care practitioners have been unable to effectively assist adolescents toward successful long-term weight management, because understanding the experience uniquely from the adolescent's perspective has not been adequately explored, especially among minority populations. Ultimately, the information gained from this study will add to the body of knowledge regarding the lived experience of obese adolescents in general, lead to further exploration of self-perception and meaning among adolescent males from minority populations, and aid in the development of interventions designed to promote and support physical and psychological adaptive processes of obese adolescents from minority populations.