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Background  Excess weight contributes to the development and progression of Type 2 diabetes mellitus (T2DM). Distorted body image amongst urban Black women and the perception that thinness is linked with HIV, may however be compounding the problem, particularly in areas with a high HIV burden.    Objectives  This study aimed to compare the perception of body image in urban Black women with and without T2DM.    Methods  A cross-sectional comparative study was conducted on 328 Black women systematically sampled into two groups (with and without T2DM). Body mass index (BMI) (weight [kg]/height [m 2 ]) was determined and the adapted Stunkard Body Image Silhouettes for Black women was used to determine perceived body image (PBI).    Results  Seventy-two per cent had T2DM and in this group 89% were obese, with a mean BMI of 39.5 kg/m 2  (s.d. ± 8.5). In the non-diabetes group (NDG) 44% were obese, with a mean BMI of 31.3 kg/m 2  (s.d. ± 9.0) Black women underestimated their body image across all weight categories ( p  < 0.05). Both groups (99% of the study group) also perceived thinness as being associated with HIV.    Conclusions  This study identified an incongruence between PBI and actual BMI amongst urban Black women. This, combined with their belief that thinness is associated with HIV, places those with T2DM at risk of secondary complications arising from diabetes mellitus, and those without diabetes mellitus at a higher risk of developing T2DM. A discrepancy between PBI and BMI may therefore serve as a risk marker to alert clinicians to use a more ethno-cultural specific approach in engaging with urban Black women regarding weight loss strategies in the future.

Incongruence in body image and body mass index: A surrogate risk marker in Black women for type 2 diabetes mellitus