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Factors associated with inappropriate weight loss attempts by early adolescent girls in Japan
Abstract
Attempting to lose weight by normal or underweight adolescent girls is a serious issue in many countries. It has been reported that the mode of attempted weight loss does not differ between normal weight and overweight girls. These inappropriate weight loss attempts (IWLA) by normal or underweight adolescent girls is associated with various health issues, but factors associated with IWLA have only been marginally elucidated. In this study, we applied a single multivariate regression analysis to clarify independent factors for IWLA. Study subjects were 134 pairs of early adolescent girls (aged 12-15) and their mothers. In addition to IWLA, many factors including height, weight, body image, perceived weight status, depressive symptoms, media influence and self-esteem were surveyed in both mothers and daughters and subjected to multivariate analysis. Approximately half of girls surveyed had IWLA, even though all were of normal weight and 62.9% knew that they were of normal weight. IWLA were independently associated with depressive symptoms (OR (95% CI); 2.80 (1.21-6.50), p=0.016) independent of actual or perceived weight status. Factors significantly associated with IWLA by the girls were percentage deviation of weight from standard weight (%DW) and media influence on the girls themselves, and media influence on and self-esteem of their mothers. IWLA, which were frequently observed among early adolescent girls even among those of normal weight, were closely related to depressive status. IWLA were significantly associated with not only factors related to the girls (1.09 (1.04-1.14), p=0.001), but also with maternal psychological factors (1.06 (1.00-1.13), p=0.035) conveyed by the media. Future prospective or interventional studies are required to clarify whether these factors could be targeted in an effort to prevent IWLA.
... The literature has shown the association between nutritional states and longevity, as well as health status, among middle-aged Japanese individuals [5][6][7][8][9][10]. Moreover, the nutritional concerns have been recently raised in younger generations, including children [11][12][13][14][15][16]. The present study aimed to provide evidence of malnutrition, especially in younger generations in Japan and to identify feasible causes. ...
... Eat Weight Disord (2016) 21:679-685 683 however, investigated non-overweight Japanese female adolescents and their mothers, regarding weight-loss attempts in daughters and self-esteem and media influence on mothers [17]. A higher prevalence of weight overestimation and weight-loss efforts in females as compared with males is internationally consistent across diverse regions of the world [18]. ...
Purpose
Although weight-loss efforts in non-overweight adolescents and young adults are quite common, the relation between parental and offspring factors related to this behavior remains unclear. This study assessed the parental and offspring factors related to offspring’s weight-loss efforts according to offspring’s weight status.
Methods
Data pertaining to weight-loss efforts and weight status for 1026 families, including 1449 offspring (703 male and 749 female offspring, aged 10–25 years) and 1026 pairs of parents, were derived from the Korea National Health and Nutrition Examination Survey from 2010 to 2013. A generalized estimating equation was used to examine factors associated with offspring’s weight-loss efforts after adjusting for intra-familial correlations.
Results
Weight-loss efforts in adolescents and young adults increased with offspring factors, such as female sex [OR (95 % CI), 2.64 (2.02–3.46)], overweight status [9.54 (6.66–13.67)], weight overestimation [2.96 (2.08–4.20)], and maternal weight-loss efforts [1.37 (1.05–1.79)], while weight-loss efforts decreased with offspring’s weight underestimation [0.27 (0.19–0.37)], after adjusting for similar parental factors and intra-familial correlations. In non-overweight adolescents and young adults, weight-loss efforts were associated with maternal weight-loss efforts [1.52 (1.11–2.08)] and offspring sex [female vs. male; 2.93 (2.14–4.01)], as well as offspring’s weight underestimation [vs. accurate estimation; 0.15 (0.08–0.28)] or overestimation [vs. accurate estimation; 3.05 (2.13–4.38)]. In overweight adolescents and young adults, weight-loss efforts were associated with offspring’s weight underestimation [0.45 (0.28–0.71)].
Conclusions
Weight-loss efforts in adolescents and young adult offspring are associated with maternal weight-loss efforts, offspring’s weight perception, and sex in non-overweight offspring, and offspring’s weight perception in overweight offspring.
... In recent years, the occurrence of obesity has increased worldwide [29],while women, especially young adults, attempt to lose weight despite being of normal weight or underweight [30,31]. In this respect, our study showed that both women with high or low pre-pregnancy BMI have a high risk of pregnancy-related discomforts that not only affect their quality of life and limit their daily activities, but might also have a negative impact on their children's health [4,5]. ...
Objective: To determine the association between pregnancy-related discomforts and pre-pregnancy body mass index in a longitudinal study.
Methods: The study included 355 pregnant women (age, 31.1 ± 4.1 years). Participants were divided into three groups according to their pre-pregnancy body mass index: the low body mass index group, normal body mass index group, and high body mass index group. The occurrence of pregnancy-related discomforts during the second and third trimesters was investigated. Binomial logistic regression analysis was used to examine the association between pre-pregnancy body mass index and pregnancy-related discomforts experienced during the last two trimesters.
Results: The occurrence of most pregnancy-related discomforts increased in the third trimester, while that of constipation and shoulder stiffness or headache decreased. Based on logistic regression analysis, pre-pregnancy body mass index was significantly associated with various discomforts. The occurrence of hip joint or pubis pain (odds ratio/95% confidence interval = 2.38/1.14–4.95) during the second trimester, and sleeping difficulty (2.00/1.09–3.67), hand or finger stiffness (3.00/1.36–6.45), leg cramps (2.29/1.32–3.98), low back pain (2.20/1.29– 3.75), hip joint or pubis pain (2.14/1.23–3.73), and shoulder stiffness or headache (2.01/1.06–3.82) during the third trimester was significantly higher in the high body mass index group than in the normal body mass index group. The low body mass index group exhibited a significantly a higher occurrence of shoulder stiffness or headache (2.84/1.35–5.96) during the second trimester and constipation (2.28/1.08–4.82) during the third trimester than the normal body mass index group.
Conclusion: The occurrence of discomforts decreased or increased during pregnancy. Furthermore, both prepregnancy high and low body mass index represent important risk factors for many pregnancy-related discomforts, compared with a pre-pregnancy normal body mass index.
... 10) Negative attitude towards obesity and discrimination against obese persons can induce even those who are not overweight to attempt weight control to keep their body slim and attractive. 11) A recent study in Korea reported that 43.1% of adults (men, 22.3%; women, 58.5%) who tried to control weight during the past one year were not overweight. 12) Since socio-cultural pressure to be thin is particularly intense for women, 13) women tend to consider a thinner body shape as ideal, overestimate their own body weight, and be more concerned with weight control compared to men. ...
Underweight refers to the weight range in which health risk can increase, since the weight is lower than a healthy weight. Negative attitudes towards obesity and socio-cultural preference for thinness could induce even underweight persons to attempt weight control. This study was conducted to investigate factors related to weight control attempts in underweight Korean adults.
This was a cross-sectional study on 690 underweight adults aged 25 to 69 years using data from the Korea National Health and Nutrition Examination Survey, 2007-2010. Body image perception, weight control attempts during the past one year, various health behaviors, history of chronic diseases, and socioeconomic status were surveyed.
Underweight women had a higher rate of weight control attempts than underweight men (25.4% vs. 8.1%, P < 0.001). Among underweight men, subjects with the highest physical activity level (odds ratio [OR], 7.75), subjects with physician-diagnosed history of chronic diseases (OR, 7.70), and subjects with non-manual jobs or other jobs (OR, 6.22; 12.39 with reference to manual workers) had a higher likelihood of weight control attempts. Among underweight women, subjects who did not perceive themselves as thin (OR, 4.71), subjects with the highest household income level (OR, 2.61), and unmarried subjects (OR, 2.08) had a higher likelihood of weight control attempts.
This study shows that numbers of underweight Korean adults have tried to control weight, especially women. Seeing that there are gender differences in factors related to weight control attempts in underweight adults, gender should be considered in helping underweight adults to maintain a healthy weight.
To assess the validity and utility of PRIME-MD (Primary Care Evaluation of Mental Disorders), a new rapid procedure for diagnosing mental disorders by primary care physicians.
Survey; criterion standard.
Four primary care clinics.
A total of 1000 adult patients (369 selected by convenience and 631 selected by site-specific methods to avoid sampling bias) assessed by 31 primary care physicians.
PRIME-MD diagnoses, independent diagnoses made by mental health professionals, functional status measures (Short-Form General Health Survey), disability days, health care utilization, and treatment/referral decisions.
Twenty-six percent of the patients had a PRIME-MD diagnosis that met full criteria for a specific disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition. The average time required of the primary care physician to complete the PRIME-MD evaluation was 8.4 minutes. There was good agreement between PRIME-MD diagnoses and those of independent mental health professionals (for the diagnosis of any PRIME-MD disorder, kappa = 0.71; overall accuracy rate = 88%). Patients with PRIME-MD diagnoses had lower functioning, more disability days, and higher rates of health care utilization than did patients without PRIME-MD diagnoses (for all measures, P < .005). Nearly half (48%) of 287 patients with a PRIME-MD diagnosis who were somewhat or fairly well-known to their physicians had not been recognized to have that diagnosis before the PRIME-MD evaluation. A new treatment or referral was initiated for 62% of the 125 patients with a PRIME-MD diagnosis who were not already being treated.
PRIME-MD appears to be a useful tool for identifying mental disorders in primary care practice and research.
To assess the influence of the media on girls' weight concerns, weight control/loss behaviors, and perceptions of body weight and shape.
Cross-sectional survey completed in school. The questionnaire assessed body weight, dissatisfaction with body weight and shape, exposure to fashion magazines, the impact of media on feelings about weight and shape, attributes of and preferences for body types, and whether subjects had gone on a diet to lose weight or initiated exercise because of an article in a magazine.
Mandatory physical education class in public elementary, junior high, and high schools.
Subjects included 548 5th- through 12th-grade girls in a working-class suburb in the northeastern United States.
Perceived influence of fashion magazines on body dissatisfaction, idea of the perfect body shape, dieting to lose weight, and initiating an exercise program.
Pictures in magazines had a strong impact on girls' perceptions of their weight and shape. Of the girls, 69% reported that magazine pictures influence their idea of the perfect body shape, and 47% reported wanting to lose weight because of magazine pictures. There was a positive linear association between the frequency of reading women's magazines and the prevalence of having dieted to lose weight because of a magazine article, initiating an exercise program because of a magazine article, wanting to lose weight because of pictures in magazines, and feeling that pictures in magazines influence their idea of the perfect body shape. In multivariate logistic regression models controlling for weight status (overweight vs not overweight), school level (elementary vs junior high school, elementary vs high school), and race/ethnic group, girls who were frequent readers of fashion magazines were two to three times more likely than infrequent readers to diet to lose weight because of a magazine article (odds ratio [OR] = 2.11, 95% confidence interval [CI]: 1.19-3.75); to exercise to lose weight because of a magazine article (OR = 3.02, 95% CI: 1.77-5.17); and to feel that magazines influence what they believe is the ideal body shape (OR = 2.81; 95% CI: 1.72-4.58). In addition, moderate-frequency readers were more likely than infrequent readers of fashion magazines to report exercising because of a magazine article (OR = 1.94; 95% CI: 1.14-3.30) and feeling that magazines influence what they believe is the ideal body shape (OR = 2.03; 95% CI: 1.30-3.15).
The majority of the preadolescent and adolescent girls in this school-based study were unhappy with their body weight and shape. This discontentment was strongly related to the frequency of reading fashion magazines. Although previous studies have concluded that the print media promotes an unrealistically thin body ideal, which in turn is at least partially responsible for promoting eating disorders, the present study is the first that we are aware of to assess directly the impact of the print media on the weight and body shape beliefs of young girls. We observed that the frequency of reading fashion magazines was positively associated with the prevalence of having dieted to lose weight, having gone on a diet because of a magazine article, exercising to lose weight or improve body shape, and deciding to exercise because of a magazine article. Given the substantial health risk associated with overweight and the fact that during the past 2 decades the prevalence of overweight has increased sharply among children and adolescents, it is not prudent to suggest that overweight girls should accept their body shape and not be encouraged to lose weight. However, aspiring to look like underweight models may have deleterious psychological consequences. The results suggest that the print media aimed at young girls could serve a public health role by refraining from relying on models who are severely underweight and printing more articles on the benefits of physical
To study the predictors of new eating disorders in an adolescent cohort.
Cohort study over 3 years with six waves.
Students, initially aged 14-15 years, from 44 secondary schools in the state of Victoria, Australia.
Weight (kg), height (cm), dieting (adolescent dieting scale), psychiatric morbidity (revised clinical interview schedule), and eating disorder (branched eating disorders test). Eating disorder (partial syndrome) was defined when a subject met two criteria for either anorexia nervosa or bulimia nervosa according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV).
At the start of the study, 3.3% (29/888) of female subjects and 0.3% (2/811) of male subjects had partial syndromes of eating disorders. The rate of development of new eating disorder per 1000 person years of observation was 21.8 in female subjects and 6.0 in male subjects. Female subjects who dieted at a severe level were 18 times more likely to develop an eating disorder than those who did not diet, and female subjects who dieted at a moderate level were five times more likely to develop an eating disorder than those who did not diet. Psychiatric morbidity predicted the onset of eating disorder independently of dieting status so that those subjects in the highest morbidity category had an almost sevenfold increased risk of developing an eating disorder. After adjustment for earlier dieting and psychiatric morbidity, body mass index, extent of exercise, and sex were not predictive of new eating disorders.
Dieting is the most important predictor of new eating disorders. Differences in the incidence of eating disorders between sexes were largely accounted for by the high rates of earlier dieting and psychiatric morbidity in the female subjects. In adolescents, controlling weight by exercise rather than diet restriction seems to carry less risk of development of eating disorders.
Depressive disorders are highly prevalent in the general population, but recognition and accurate diagnosis are made difficult by the lack of a simple confirmatory test.
To review the accuracy and precision of depression questionnaires and the clinical examination for diagnosing clinical depression.
We searched the English-language literature from 1970 through July 2000 using MEDLINE, a specialized registry of depression trials, and bibliographies of selected articles.
Case-finding studies were included if they used depression questionnaires with easy to average literacy requirements, evaluated at least 100 primary care patients, and compared questionnaire results with accepted diagnostic criteria for major depression. Eleven questionnaires, ranging in length from 1 to 30 questions, were assessed in 28 published studies. Reliability studies for the clinical examination required criterion-based diagnoses made by at least 2 clinicians who interviewed the patient or reviewed a taped examination. Fourteen studies evaluated interrater reliability.
Pairs of authors independently reviewed articles. For case-finding studies, quality assessment addressed sample size and whether patients were selected consecutively or randomly, the criterion standard was administered and interpreted independently of and blind to the results of the case-finding instrument, and the proportion of persons receiving the criterion standard assessment was less than or more than 50% of those approached for criterion standard assessment. For reliability studies, quality assessment addressed whether key patient characteristics were described, the interviewers collected clinical history independently, and diagnoses were made blinded to other clinicians' evaluations.
In case-finding studies, average questionnaire administration times ranged from less than 1 minute to 5 minutes. The median likelihood ratio positive for major depression was 3.3 (range, 2.3-12.2) and the median likelihood ratio negative was 0.19 (range, 0.14-0.35). No significant differences between questionnaires were found. For mental health care professionals using a semistructured interview, agreement was substantial to almost perfect for major depression (kappa = 0.64-0.93). Nonstandardized interviews yielded somewhat lower agreement (kappa = 0.55-0.74). A single study showed that primary care clinicians using a semistructured interview have high agreement with mental health care professionals (kappa = 0.71).
Multiple, practical questionnaires with reasonable performance characteristics are available to help clinicians identify and diagnose patients with major depression. Diagnostic confirmation by mental health care professionals using a clinical interview or by primary care physicians using a semistructured interview can be made with high reliability.
Although weight loss improves risk factors for cardiovascular and metabolic disease, it is unclear whether intentional weight loss reduces mortality rates.
To examine the relationships among intention to lose weight, weight loss, and all-cause mortality.
Prospective cohort study using a probability sample of the U.S. population.
Interviewer-administered survey.
6391 overweight and obese persons (body mass index > or = 25 kg/m2) who were at least 35 years of age.
Intention to lose weight and weight change during the past year were assessed by self-report in 1989. Vital status was followed for 9 years. Hazard rate ratios (HRRs) were adjusted for age, sex, ethnicity, education, smoking, health status, health care utilization, and initial body mass index.
Compared with persons not trying to lose weight and reporting no weight change, those reporting intentional weight loss had a 24% lower mortality rate (HRR, 0.76 [95% CI, 0.60 to 0.97]) and those with unintentional weight loss had a 31% higher mortality rate (HRR, 1.31 [CI, 1.01 to 1.70]). However, mortality rates were lower in persons who reported trying to lose weight than those in not trying to lose weight, independent of actual weight change. Compared with persons not trying to lose weight and reporting no weight change, persons trying to lose weight had the following HRRs: no weight change, 0.80 (CI, 0.65 to 0.99); gained weight, 0.94 (CI, 0.65 to 1.37); and lost weight, 0.76 (CI, 0.60 to 0.97).
Attempted weight loss is associated with lower all-cause mortality, independent of weight change. Self-reported intentional weight loss is associated with lower mortality rates, and weight loss is associated with higher mortality rates only if it is unintentional.
To assess whether dieting to control weight was associated with weight change among children and adolescents.
A prospective study was conducted of 8203 girls and 6769 boys who were 9 to 14 years of age in 1996, were in an ongoing cohort study, and completed at least 2 annual questionnaires between 1996 and 1999. Dieting to control weight, binge eating, and dietary intake were assessed annually from 1996 through 1998 with instruments designed specifically for children and adolescents. The outcome measure was age- and sex-specific z score of body mass index (BMI).
In 1996, 25.0% of the girls and 13.8% of the boys were infrequent dieters and 4.5% of the girls and 2.2% of the boys were frequent dieters. Among the girls, the percentage of dieters increased over the following 2 years. Binge eating was more common among the girls, but in both sexes, it was associated with dieting to control weight (girls: infrequent dieters, odds ratio [OR]: 5.10; frequent dieters, OR: 12.4; boys: infrequent dieters, OR: 3.49; frequent dieters, OR: 7.30). During 3 years of follow-up, dieters gained more weight than nondieters. Among the girls, frequency of dieting was positively associated with increases in age- and sex-specific z scores of BMI (beta = 0.05 and beta = 0.04 for frequent and infrequent dieters vs nondieters). Among the boys, both frequent and infrequent dieters gained 0.07 z scores of BMI more than nondieters. In addition, boys who engaged in binge eating gained significantly more weight than nondieters.
Although medically supervised weight control may be beneficial for overweight youths, our data suggest that for many adolescents, dieting to control weight is not only ineffective, it may actually promote weight gain.
In this study, the authors examined body image perception and body mass index (weight (kg)/height (m)(2)) among race-gender groups in a biracial (Black-White) population of young adults in Bogalusa, Louisiana. A mail-out survey was completed in 1994 by 3,698 (65%) participants aged 18.5-35 years in the Bogalusa Heart Study (mean age = 27.6 years). As part of the survey, body image perception was determined in terms of body shape representations from a figure rating scale. A body image discrepancy score was calculated from the difference between z-standardized values of body image perception and body mass index. A stepwise proportional odds model including the covariates income, employment, education, and physical activity was used to identify factors influencing lower perception of body shape. Mean body mass index was highest among Black females (p < 0.001). The odds of having a lower perception of body shape (vs. body mass index) were 1.72 times higher in Blacks (p < 0.001), 0.80 times lower in persons who were currently employed (p < 0.001), and 0.86 times lower in persons with a higher education (p = 0.032). Gender, income, and physical activity were not found to be significant predictors of body image perception (p > 0.05). The authors conclude that significant differences exist within racial groups concerning body image perception in relation to overweight status among young adults. This has implications for prevention and education programs.
Young women in the United States and Western Europe are notoriously concerned about weight but less is known about attitudes to weight in other regions of the world. This study explores the associations between body mass index (BMI), weight perceptions, and attempts to lose weight in male and female university students from 22 countries.
Data were collected from 18,512 university students, using standardised methods, as part of the International Health Behaviour Survey. Measures included weight, height, perception of overweight, and weight loss status. BMI was calculated from weight and height, but was categorised into gender and country-standardised deciles rather than the conventional weight categories in response to the inaccuracy of self-reports. Perceived overweight and weight loss status were plotted against country-standardised BMI deciles. The 22 countries were grouped into five geopolitical/economic areas for regional analyses: North-Western Europe and the USA, Central and Eastern Europe, the Mediterranean, Pacific Asia, South America. Perceived overweight compared across the five regions.
Perceived overweight increased systematically across BMI deciles in all countries. More women than men felt overweight at any decile. Women had low levels of perceived overweight in the lowest decile but rates rapidly increased to 50% by the 5th decile. Men, even in the highest deciles, were less aware that they are overweight and few of them were trying to lose weight. Women had a faster rise of weight loss attempts over the BMI deciles but nevertheless the proportion trying to lose in the highest decile did not exceed 75%. Perceived overweight profiles across BMI deciles were similar across all regions, suggesting that perceptions of overweight derive from local comparisons. The patterning for trying to lose weight was more diverse, with men and women from Asian countries showing higher levels of trying to lose weight at all deciles.
This study shows the international consistency in perceptions of overweight in educated young men and women across diverse regions of the world. It confirms the patterning of women's overestimation of weight at lower BMI deciles and men's underestimation of weight at the higher deciles. Perceptions of overweight and attempts to lose weight were highest in the group of Asian countries where body weights are generally low, suggesting that local culture and norms could moderate attitudes to weight.
This study examined whether mothers' preoccupation with their own weight and eating was linked to daughters' restrained eating behavior. Participants included 173 non-Hispanic, White mother-daughter dyads, measured longitudinally when daughters were ages 5, 7, 9, and 11. Mothers who were preoccupied with their own weight and eating reported higher levels of restricting daughters' intake and encouraging daughters to lose weight over time. Mothers' encouragement of daughters' weight loss was linked to daughters' restrained eating behavior; this relationship was partially mediated by daughters' perception of maternal pressure to lose weight. These findings suggest that mothers' preoccupation with weight and eating, via attempts to influence daughters' weight and eating, may place daughters at risk for developing problematic eating behaviors.
Of concern to health educators is the suggestion that college females practice diet and health behaviors that contradict the 2005 dietary guidelines for Americans. In this regard, there remain gaps in the research related to dieting among college females. Namely, do normal weight individuals diet differently from those who are overweight or obese, and are there dieting practices used by females that can be adapted to promote a healthy body weight? Since it is well recognized that females diet, this study seeks to determine the dieting practices used among normal, overweight, and obese college females (do they diet differently) and identify dieting practices that could be pursued to help these females more appropriately achieve and maintain a healthy body weight.
A total of 185 female college students aged 18 to 24 years participated in this study. Height, weight, waist and hip circumferences, and skinfold thickness were measured to assess body composition. Surveys included a dieting practices questionnaire and a 30-day physical activity recall. Participants were classified according to body mass index (BMI) as normal weight (n = 113), overweight (n = 35), or obese (n = 21). Data were analyzed using JMP IN(R) software. Descriptive statistics included means, standard deviations, and frequency. Subsequent data analysis involved Pearson X2 and one-way analysis of variance with comparison for all pairs that were significantly different using Tukey-Kramer honestly significant difference test.
Outcomes of this study indicate the majority of participants (83%) used dieting for weight loss and believed they would be 2% to 6% greater than current weight if they did not diet; normal weight, overweight, and obese groups perceived attractive weight to be 94%, 85%, and 74%, respectively, of current weight; 80% of participants reported using physical activity to control weight, although only 19% exercised at a level that would promote weight loss; only two of 15 dieting behaviors assessed differed in terms of prevalence of use among groups, which were consciously eating less than you want (44% normal weight, 57% overweight, 81% obese) and using artificial sweeteners (31% normal weight and overweight, 5% obese); and the most prevalent explicit maladaptive weight loss behavior was smoking cigarettes (used by 9% of participants) and most unhealthy was skipping breakfast (32%).
Collectively, results indicate female college students, regardless of weight status, would benefit from open discussions with health educators regarding healthy and effective dieting practices to achieve/maintain a healthy body weight. The results are subject to replication among high school, middle-aged, and older females.
To investigate weight perception, dieting and emotional well being across the range of body mass index (BMI) in a population-based multiethnic sample of early adolescents.
Cross-sectional population-based survey.
In total, 2789 adolescents 11-14 years of age from three highly deprived regional authorities in East London, in 2001.
Data were collected by student-completed questionnaire on weight perception, dieting history, mental and physical health, health behaviours, social capital and sociodemographic factors. Height and weight were measured by trained researchers. Overweight was defined as BMI > or =85th centile and obesity as BMI > or =98th centile. Underweight was defined as BMI< or =15th centile.
In all, 73% were from ethnic groups other than white British. Valid BMI were available for 2522 subjects (90.4%) of whom 14% were obese. Only 20% of overweight boys and 51% of overweight girls assessed their weight accurately. Accuracy of weight perception did not vary between ethnic groups. In all, 42% of girls and 26% of boys reported current dieting to lose weight. Compared with white British teenagers, a history of dieting was more common among Bangladeshi, Indian and mixed ethnicity boys and less likely among Pakistani girls. Self-esteem was not associated with BMI in girls but was significantly lower in obese boys than those of normal weight (P=0.02). Within ethnic subgroups, self-esteem was significantly lower in overweight white British boys (P=0.03) and obese Bangladeshi boys (P=0.01) and Bangladeshi girls (P=0.04), but significantly higher in obese black African girls (P=0.01) than those of normal weight. Obese young people had a higher prevalence of psychological distress (P=0.04), except among Bangladeshi teenagers, where overweight and obese young people had less psychological distress than those of normal weight (P=0.02). Birth outside the UK was associated with reduced risk of obesity in girls (P=0.02) but not with history of dieting, weight perception or psychological factors in either gender.
High levels of current dieting for weight control and inaccurate perception of body mass are common across all ethnic groups. However, dieting history and the associations of obesity with self-esteem and psychological distress vary between ethnic groups. Interventions to prevent or treat obesity in black or minority ethnicity groups must consider cultural differences in the relationship between body mass, self-esteem and psychological distress.
Dieting has been found to predict weight gain in adolescents, but reasons for this association remain unclear. This study aimed to explore potential mechanisms by which dieting predicts weight gain over time in adolescents.
Population-based, 5-year longitudinal study.
Adolescents (n=2,516) from diverse ethnic and socioeconomic backgrounds who completed Project EAT (Eating Among Teens) surveys in 1999 (Time 1) and 2004 (Time 2).
Body mass index (BMI) change over 5 years.
Multiple regressions were used to examine associations between Time 1 dieting and Time 2 binge eating, breakfast consumption, fruit and vegetable intake, and physical activity. Associations were then examined between these behaviors and BMI change. Finally, to test for mediating effects, associations between dieting and BMI change were examined with and without the inclusion of these behaviors, and regression coefficients were compared.
In female adolescents, dieting predicted increased binge eating (P<0.001) and decreased breakfast consumption (P=0.030). In male adolescents, dieting predicted increased binge eating (P<0.001), decreased physical activity (P=0.006), and a trend toward decreased breakfast consumption (P=0.064). These behaviors were also associated with increases in BMI. The association between dieting and BMI increase was weakened, but still remained significant, after binge eating, breakfast consumption, fruit/vegetable intake, and physical activity were included in the model being tested. Thus, the longitudinal association between dieting and BMI increase was partially mediated by these behaviors.
In part, dieting may lead to weight gain via the long-term adoption of behavioral patterns that are counterproductive to weight management.
The purpose of this study was to determine the prevalence of overweight and obesity and to examine the effects of actual weight status, perceived weight status and body satisfaction on self-esteem and depression in a high school population in Turkey.
A cross-sectional survey of 2101 tenth-grade Turkish adolescents aged 15-18 was conducted. Body mass index (BMI) was calculated using weight and height measures. The overweight and obesity were based on the age- and gender-specific BMI cut-off points of the International Obesity Task Force values. Self-esteem was measured using the Rosenberg Self-Esteem Scale, and depression was measured using Children's Depression Inventory. Logistic regression analysis was used to examine relationships among the variables.
Based on BMI cut-off points, 9.0% of the students were overweight and 1.1% were obese. Logistic regression analysis indicated that (1) being male and being from a higher socio-economical level were important in the prediction of overweight based on BMI; (2) being female and being from a higher socio-economical level were important in the prediction of perceived overweight; (3) being female was important in the prediction of body dissatisfaction; (4) body dissatisfaction was related to low self-esteem and depression, perceived overweight was related only to low self-esteem but actual overweight was not related to low self-esteem and depression in adolescents.
The results of this study suggest that school-based adolescents in urban Turkey have a lower risk of overweight and obesity than adolescents in developed countries. The findings of this study suggest that psychological well-being of adolescents is more related to body satisfaction than actual and perceived weight status is.
Objective.
—To assess the validity and utility of PRIME-MD (Primary Care Evaluation of Mental Disorders), a new rapid procedure for diagnosing mental disorders by primary care physicians.Design.
—Survey; criterion standard.Setting.
—Four primary care clinics.Subjects.
—A total of 1000 adult patients (369 selected by convenience and 631 selected by site-specific methods to avoid sampling bias) assessed by 31 primary care physicians.Main Outcome Measures.
—PRIME-MD diagnoses, independent diagnoses made by mental health professionals, functional status measures (Short-Form General Health Survey), disability days, health care utilization, and treatment/ referral decisions.Results.
—Twenty-six percent of the patients had a PRIME-MD diagnosis that met full criteria for a specific disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition. The average time required of the primary care physician to complete the PRIME-MD evaluation was 8.4 minutes. There was good agreement between PRIME-MD diagnoses and those of independent mental health professionals (for the diagnosis of any PRIME-MD disorder, κ=0.71; overall accuracy rate=88%). Patients with PRIME-MD diagnoses had lower functioning, more disability days, and higher rates of health care utilization than did patients without PRIME-MD diagnoses (for all measures, P<.005). Nearly half (48%) of 287 patients with a PRIME-MD diagnosis who were somewhat or fairly well-known to their physicians had not been recognized to have that diagnosis before the PRIME-MD evaluation. A new treatment or referral was initiated for 62% of the 125 patients with a PRIME-MD diagnosis who were not already being treated.Conclusion.
—PRIME-MD appears to be a useful tool for identifying mental disorders in primary care practice and research.(JAMA. 1994;272:1749-1756)
Objective
To explore the relationship of self-reported weight status and dieting to actual weight and height in a cross-sectional nationally representative sample of young adolescents.
Methods
Weights and heights were obtained on 1932 adolescents aged 12 to 16 years enrolled in the National Health and Nutrition Examination Survey III. Information on adolescents' perception of weight status, desired weight, and weight loss attempts was obtained by questionnaire.
Results
Adolescents' reports of whether they considered themselves overweight or normal weight correlated poorly with medical definitions of overweight: 52% of girls who considered themselves overweight were, in fact, normal weight (body mass index ≤85th percentile), while only 25% of boys who considered themselves overweight were normal weight (P<.001). Adolescent white girls were significantly more likely to consider themselves overweight, even when their weight status was normal, than black girls (P<.001), black boys (P<.001), and white boys (P<.001). Adolescent white girls were also more likely to diet than black girls (P<.001), black boys (P<.001), and white boys (P<.001). Dieting behavior was associated with whether adolescents viewed themselves as overweight independent of whether they actually were overweight. Racial differences between dieting and self-perceived weight status were limited to girls. There were no significant differences in self-perceived weight status (P=.28), dieting behaviors (P=.99), and desire to weigh less (P=.95) among black and white boys.
Conclusions
Significant sex and racial differences existed in weight perception, desired weight, and dieting. A high proportion of normal-weight white girls consider themselves overweight and have attempted to lose weight.
OBJECTIVE: To examine dieting, eating and exercise behaviors, use of diet pills, and vomiting or use of laxatives to lose weight among younger adolescents. DESIGN: Analysis of data from a modified version of the Youth Risk Behavior Survey administered to middle school students in North Carolina in 1995. SETTING: Fifty-three randomly selected middle schools in North Carolina. SUBJECTS: Two thousand three hundred thirty-one students in the sixth, seventh, and eighth grades. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Responses to questions regarding weight control practices, including vomiting or laxative use, dieting, exercise, or diet pill use. RESULTS: Of the students surveyed, 110 (9.7%) of the girls and 46 (4.0%) of the boys reported vomiting or using laxatives to lose weight. Among the girls, vomiting or laxative use was associated with feeling overweight, other weight loss practices, older age, being a poor student, smoking, eating more salads or vegetables, and eating more candy or other sweets (P Language: en
Objective:
To determine the validity of a two-question case-finding instrument for depression as compared with six previously validated instruments.
Design:
The test characteristics of a two-question case-finding instrument that asks about depressed mood and anhedonia were compared with six common case-finding instruments, using the Quick Diagnostic Interview Schedule as a criterion standard for the diagnosis of major depression.
Setting:
Urgent care clinic at the San Francisco Department of Veterans Affairs Medical Center.
Participants:
Five hundred thirty-six consecutive adult patients without mania or schizophrenia.
Measurements and main results:
Measurements were two questions from the Primary Care Evaluation of Mental Disorders patient questionnaire, both the long and short forms of the Center for Epidemiologic Studies Depression Scale, both the long and short forms of the Book Depression Inventory, the Symptom-Driven Diagnostic System for Primary Care, the Medical Outcomes Study depression measure, and the Quick Diagnostic Interview Schedule. The prevalence of depression, as determined by the standardized interview, was 18% (97 of 536). Overall, the case-finding instruments had sensitivities of 89% to 96% and specificities of 51% to 72% for diagnosing major depression. A positive response to the two-item instrument had a sensitivity of 96% (95% confidence interval [CI], 90-99%) and a specificity of 57% (95% CI 53-62%). Areas under the receiver operating characteristic curves were similar for all of the instruments, with a range of 0.82 to 0.89.
Conclusions:
The two-question case-finding instrument is a useful measure for detecting depression in primary care. It has similar test characteristics to other case-finding instruments and is less time-consuming.
To assess prospectively the influence of peers, parents, and the media on the development of weight concerns and frequent dieting.
Prospective cohort study.
Questionnaires mailed annually to participants throughout the United States.
One-year follow-up of 6770 girls and 5287 boys who completed questionnaires in 1996 and 1997 and were between 9 and 14 years of age in 1996.
Onset of high levels of concern with weight and dieting frequently to control weight.
During 1 year of follow-up, 6% of girls and 2% of boys became highly concerned with weight and 2% of girls and 1% of boys became constant dieters. Peer influence was negligible. Independent of age and body mass index, both girls (odds ratio [OR]): 1.9; 95% confidence interval [CI]: 1.1-3.1) and boys (OR: 2.7; 95% CI: 1.1-6. 4) who were making a lot of effort to look like same-sex figures in the media were more likely than their peers to become very concerned with their weight. Moreover, both girls (OR: 2.3; 95% CI: 1.1-5.0) and boys (OR: 2.6; 95% CI: 1.1-6.0) who reported that their thinness/lack of fat was important to their father were more likely than their peers to become constant dieters.
Our results suggest that parents and the media influence the development of weight concerns and weight control practices among preadolescents and adolescents. However, there are gender differences in the relative importance of these influences.
Daily and major life stress, psychological symptoms, and dieting were measured in 143 adolescent girls ages 14–18 at the beginning and end of a 4-month prospective study. Two hypothetical relations among the variables were examined; (1) that weight reducing in adolescents is predicted by stress and psychological symptoms prospectively, versus (2) that stress and psychological symptoms are a consequence of increased weight-reducing efforts. Stress and symptoms were related to weight reducing in cross-sectional correlations. Multiple regressions and LISREL analyses showed that future levels of psychological stress, but not symptoms, were predicted by weight-reducing behavior when baseline scores were controlled. The hypothesis that negative psychological functioning predicts more dieting in the future was not supported. Besides potential physical health hazards of weight reducing during adolescence and its apparent status as a risk factor for eating disorders, this indicates that weight reducing also may have some negative psychological impact on the young dieter.
There are few topics so fascinating both to the research investigator and the research subject as the self-image. It is distinctively characteristic of the human animal that he is able to stand outside himself and to describe, judge, and evaluate the person he is. He is at once the observer and the observed, the judge and the judged, the evaluator and the evaluated. Since the self is probably the most important thing in the world to him, the question of what he is like and how he feels about himself engrosses him deeply. This is especially true during the adolescent stage of development.
Gender differences in college students' perceptions and satisfaction with body weight were examined. Females tended to perceive themselves as overweight when they were not, failed to see themselves as underweight when they were, and many of those who did not see themselves as even slightly overweight wanted to lose weight. Although males reported some dissatisfaction with their bodies, they tended to want to gain rather than lose weight. Females dieted more frequently than did males, and nearly one-third of the females reported either self-induced vomiting or laxative use as a weight-loss strategy. The relationship between social pressure for female slenderness, dieting, and eating disorders are discussed.
Edlund B, Hallqvist G, Sjödén P-O. Attitudes to food, eating and dieting behaviour in 11 and 14-year-old Swedish children. Acta Pædiatr 1994;83:572–7. Stockholm. ISSN 0803–5253
All students in grades 5 and 8 of three randomly chosen schools in Uppsala (n= 236) were eligible, and 197 participated. The survey included a Swedish version of the Children's Eating Attitudes Test (ChEAT) and a demographic and dieting questionnaire. In total, 47% of the children (girls 70%, boys 25%) wanted to be thinner and 25% had tried to lose weight. In the 5th grade, 49% of the girls reported that they wanted to be thinner and in the 8th grade 83%. Fifty-three percent of the girls in the 8th grade reported that they had tried to lose weight; 36% admitted that they felt too fat but only 5% reported that other people found them too fat. The methods used were caloric restriction and exercise. Compared with US data, the Swedish students dieted less often and showed lower ChEAT scores. Compared with earlier data, our results show that weight concerns begin at an earlier age among Swedish children today.
To examine dieting, eating and exercise behaviors, use of diet pills, and vomiting or use of laxatives to lose weight among younger adolescents.
Analysis of data from a modified version of the Youth Risk Behavior Survey administered to middle school students in North Carolina in 1995.
Fifty-three randomly selected middle schools in North Carolina.
Two thousand three hundred thirty-one students in the sixth, seventh, and eighth grades.
None.
Responses to questions regarding weight control practices, including vomiting or laxative use, dieting, exercise, or diet pill use.
Of the students surveyed, 110 (9.7%) of the girls and 46 (4.0%) of the boys reported vomiting or using laxatives to lose weight. Among the girls, vomiting or laxative use was associated with feeling overweight, other weight loss practices, older age, being a poor student, smoking, eating more salads or vegetables, and eating more candy or other sweets (P< or =.01). A logistic regression model consisting of diet pill use, dieting to lose weight, lower academic achievement, and currently trying to lose weight correctly classified 92% of female students who had or had not vomited or used laxatives. Among boys, vomiting or laxative use was associated with feeling overweight, other weight loss practices, minority racial status, smoking, frequency of eating hamburgers or other high-fat meats, and frequency of eating french fries or potato chips (P< or =.01). A model consisting of diet pill use, minority race, dieting to lose weight, smoking, feeling overweight, and number of servings of hamburgers, hot dogs, or barbecue correctly classified 97% of the boys who had or had not vomited or used laxatives.
Younger adolescents trying to lose weight engage in a variety of problem dieting and weight loss behaviors that can compromise health and may be associated with eating disorders.
To explore the relationship of self-reported weight status and dieting to actual weight and height in a cross-sectional nationally representative sample of young adolescents.
Weights and heights were obtained on 1932 adolescents aged 12 to 16 years enrolled in the National Health and Nutrition Examination Survey III. Information on adolescents' perception of weight status, desired weight, and weight loss attempts was obtained by questionnaire.
Adolescents' reports of whether they considered themselves overweight or normal weight correlated poorly with medical definitions of overweight: 52% of girls who considered themselves overweight were, in fact, normal weight (body mass index < or = 85th percentile), while only 25% of boys who considered themselves overweight were normal weight (P<.001). Adolescent white girls were significantly more likely to consider themselves overweight, even when their weight status was normal, than black girls (P<.001), black boys (P<.001), and white boys (P<.001). Adolescent white girls were also more likely to diet than black girls (P<.001), black boys (P<.001), and white boys (P<.001). Dieting behavior was associated with whether adolescents viewed themselves as overweight independent of whether they actually were overweight. Racial differences between dieting and self-perceived weight status were limited to girls. There were no significant differences in self-perceived weight status (P = .28), dieting behaviors (P = .99), and desire to weigh less (P = .95) among black and white boys.
Significant sex and racial differences existed in weight perception, desired weight, and dieting. A high proportion of normal-weight white girls consider themselves overweight and have attempted to lose weight.
The attitudes towards body weight and shape, desire for thinness and dieting behaviours were investigated in pre-adolescent and adolescent girls and boys (547 elementary school students, 615 junior high school students, and 470 senior high school students) aged 10–17 years in Osaka Prefecture, Japan, by a self-report questionnaire.
Forty-eight per cent of 10-year-old females and 84% of 17-year-old females categorized themselves as ‘fat’ or ‘too fat’. The fear of weight gain and desire for thinness was reported in 35% and 51% of 10-year-old girls, respectively, and increased progressively with ageing to 79% and 87% of 17-year-old girls. In contrast, these were reported by 20–30% of boys in the corresponding age groups. Some practices to be slim were found in 22% of the 10-year-old girls, and increased to 37% among the 17-year-old girls, whereas they were found in around 20% of the boys at each age. The practices to be slim were found in 32% of the girls who were 85–90% of the standard body weight (SBW) and in 14% of the girls less than 85% of the SBW. These results suggest that significant concerns about weight and shape and dieting behaviours are present in young Japanese girls and increase progressively with age. These results are compatible with those in Western society.
The purpose of this brief report is to document the emergence of dieting in adolescent girls across a 2-year period, and to establish whether the changes in dieting status were related to the girls' age, body mass index, or to seasonal effects.
As part of a large-scale longitudinal study concerned with adolescent health and well-being, 478 girls, initially aged 12 to 16 years old, completed Strong and Huon's (Eating Disorders 5:97-104, 1997) dieting status measure on four separate occasions across a 2-year period.
A total of 273 girls (57.1%) identified themselves as nondieters when we first visited their school. Of those, approximately 20% indicated that they had begun to diet on one of the subsequent testing occasions. The emergence of dieting was observed to occur more in the 13- and 14-year-olds than in any other age group. Higher body mass index was not associated with the initiation of dieting as some underweight, and even very underweight girls, began to diet.
The emergence of dieting occurs in early adolescence and might be triggered by concerns about changes in body shape.
This study examines the emergence of body image concerns and dieting behaviors in early adolescence as a function of girls' perceptions of family relationships, maternal modeling of dieting behaviors and body image concerns, and familial and peer pressures to diet.
Self-report measures were obtained from 77 White girls and their mothers in early adolescence (mean age = 12.3 years) and 1 year later.
Girls' perceptions of family relations and mothers' perceptions of daughters' weight at Time 1 significantly predicted girls' dieting behavior 1 year later over and above Time 1 dieting and body image. Only girls' previous body image and dieting behaviors significantly predicted more body dissatisfaction 1 year later. Girls' body image was found to mediate the relationship between family relations and dieting at Time 1 assessment, but not over time.
The importance of implementing early prevention and interventions programs is discussed.
The role of maternal identification in the development of girls' body image, eating attitudes, and self-esteem was examined.
Hispanic and Anglo girls (n = 410) ages 8-13 were surveyed using the Body Esteem Scale (BES), the Children's Eating Attitudes Test, the Piers-Harris Children's Self-Concept Scale, and the Child Figure Drawing task. From this sample, normal-weight girls with high or low scores on the BES were selected for the main study. Ninety-two mother-daughter pairs participated in this second phase in which mothers completed similar questionnaires and girls performed a Q-sort task measuring maternal identification.
Maternal identification was positively correlated with girls' self-esteem and negatively correlated with eating problems and body dissatisfaction. Also, mothers with high self-esteem tended to have daughters with high self-esteem. The mothers of girls with low BES scores found a significantly greater discrepancy than the mothers of girls with high BES scores when contrasting their daughters' current shape with either the ideal figure for their daughter or the figure they believed boys would find attractive.
Girls who aspired to be like their mothers in terms of personality traits felt better about themselves and their bodies compared with girls with low maternal identification.
To assess the psychometric validity of versions of the Sociocultural Attitudes Towards Appearance Questionnaire (SATAQ) designed for use with middle school girls and boys.
As part of a larger study, the SATAQ was administered to 505 middle school children. To assess concurrent validity, scales concerning the use of Weight Control and Muscle Building Techniques as well as the Body Esteem Scale (BES) were also administered. Body mass index (BMI) was also calculated.
Both the girls and boys versions of the SATAQ showed adequate validity. Two SATAQ subscales, Internalization and Awareness of societal ideals of thinness, were identified for girls. For boys, three SATAQ subscales were identified: Internalization and Awareness of a muscular, non-fat ideal and a scale tapping the the importance of a Muscular Look. The subscales and total score showed acceptable concurrent validity. Even after controlling for BMI, they contributed significant explained variance for the use of Weight Control Techniques in both boys and girls and use of Muscle Building Techniques in boys. Patterns of relationships among variables differed by gender.
The results suggest that sociocultural influences play a role in the use of Weight Control and Muscle Building Techniques for middle school boys although their influence is not as strong as it is for the use of Weight Control Techniques by middle school girls. The SATAQ seems to be an adequate measure of the nature of some of these influences.
To clarify whether screening adults for depression in primary care settings improves recognition, treatment, and clinical outcomes.
The MEDLINE database was searched from 1994 through August 2001. Other relevant articles were located through other systematic reviews; focused searches of MEDLINE from 1966 to 1994; the Cochrane depression, anxiety, and neurosis database; hand searches of bibliographies; and extensive peer review.
The researchers reviewed randomized trials conducted in primary care settings that examined the effect of screening for depression on identification, treatment, or health outcomes, including trials that tested integrated, systematic support for treatment after identification of depression.
A single reviewer abstracted the relevant data from the included articles. A second reviewer checked the accuracy of the tables against the original articles.
Compared with usual care, feedback of depression screening results to providers generally increased recognition of depressive illness in adults. Studies examining the effect of screening and feedback on treatment rates and clinical outcomes had mixed results. Many trials lacked power to detect clinically important differences in outcomes. Meta-analysis suggests that overall, screening and feedback reduced the risk for persistent depression (summary relative risk, 0.87 [95% CI, 0.79 to 0.95]). Programs that integrated interventions aimed at improving recognition and treatment of patients with depression and that incorporated quality improvements in clinic systems had stronger effects than programs of feedback alone.
Compared with usual care, screening for depression can improve outcomes, particularly when screening is coupled with system changes that help ensure adequate treatment and follow-up.
To investigate the pattern of weight perception and its relationship with psychological distress among Chinese adolescents.
A sub-cohort of 2179 healthy Chinese adolescents randomly selected from schools in Wuhan, China, including 1156 boys and 1023 girls 11 to 15 years of age was included in the current study. Weight, height, self-perceptions of weight status, depressive psychological symptoms including anxiety, depression, perceived peer isolation, and other constructs were measured by a structured questionnaire. A General Linear Model was used to compare psychological differences between actual and perceived weight groups.
Perceived underweight was more likely to occur in boys, whereas perceived overweight was more likely to occur in girls. Compared with objective body weight status defined by the International Obesity Task Force (IOTF) and the World Health Organization (WHO) age- and gender-specific body mass index (BMI) cutoffs, girls were more likely to misperceive themselves as overweight, whereas relatively more boys misclassified their weight status as underweight. After adjusting for age, parents' educational attainment, and urban residence, perceived overweight boys and girls were more likely to experience anxiety and depression than perceived normal and underweight subjects (p <.05). Perceived overweight girls and perceived underweight boys experienced higher peer isolation than other groups (p <.05). Significant differences were not found in social support, school connectedness, trouble with teachers, and family disharmony among different weight-perception groups.
Our results suggested distortion of weight perception was prevalent, and may have detrimental psychological influences in Chinese adolescents.
The current study was designed to evaluate the role of sociocultural influences over a 16 month period on strategies to lose weight, extreme weight loss strategies, and strategies to increase muscles among adolescent boys (n=344) and girls (n=246). All participants completed measures of body dissatisfaction, body image importance, strategies to lose weight, extreme weight loss strategies, and strategies to increase muscles. Measures of perceived pressure to lose weight or increase muscles from mother, father, best male friend, best female friend and the media were also evaluated. Data were gathered on three occasions, 8 months apart. The results demonstrated that boys showed a decrease in strategies to lose weight and increase muscles over time, whereas girls showed an increase. Both boys and girls showed an increase in extreme weight loss strategies with girls demonstrating a greater increase than boys. The sociocultural influences generally were perceived by girls to relate to messages to lose weight, whereas for boys they were perceived to relate to increasing muscles. Messages from parents, particularly fathers, were strong predictors of both strategies to lose weight and increase muscles among boys, with the media and best male friend playing a limited role. For girls, the strongest influences were mothers and best female friends, with few influences from fathers or the media. The results of this study are discussed in terms of the importance of the various sociocultural influences in shaping body change strategies among young adolescent boys and girls, and the implications of these findings for intervention programs for adolescents.
To assess the validity of self-reported height and weight in a Japanese workplace population, and to examine factors associated with the validity of self-reported weight.
Comparison of self-reported height and weight with independent measurement.
In total, 4253 men and 1148 women aged 35-64 y (mean measured body mass index (BMI): 23.3 kg/m(2) in men, 21.9 kg/m(2) in women) were included in the study.
Self-reported height and weight were obtained by a self-administered questionnaire. Measured height and weight were based on annual health checkups. Sex, age, measured BMI, and the presence of hypertension, diabetes, and hyperlipidemia were examined as potential factors associated with the accuracy of self-reported weight.
Self-reported height and weight were highly correlated with measured height and weight for men and women (Pearson's r for men and women: 0.979 and 0.988 in height, 0.961 and 0.959 in weight, 0.943 and 0.950 in BMI, respectively). For men, mean differences+/-2 s.d. of height and weight were 0.078+/-2.324 cm and -0.034+/-5.012 kg, respectively, and for women 0.029+/-1.652 cm and 0.024+/-4.192 kg, respectively. The prevalence of obesity with BMI > or =25 kg/m(2) based on self-reported data (23.6 and 11.5% for men and women, respectively) was slightly smaller than that based on measured data (24.9 and 12.4%, respectively). Specificity and sensitivity, however, were quite high for both men and women (sensitivity was 85.8 and 85.2%, and specificity was 97.0 and 98.9%, respectively). The subjects with higher measured BMI significantly underestimated their weight compared with those with smaller BMI after adjustments for age in men and women. Furthermore, the presence of diabetes in men and age in women affected self-reported weight. Neither the presence of hypertension nor hyperlipidemia was associated with reporting bias.
The self-reported height and weight were generally reliable in the middle-aged employed Japanese men and women. However, it should be remembered that self-reported weight was biased by actual BMI and affected by age and the presence of diabetes.
To assess the association between weight concerns and weight control practices of adolescents and their mothers.
Cross-sectional study of 5331 adolescent girls and 3881 adolescent boys (age range, 11.8-18.4 years) in an ongoing cohort study and their mothers. Participants were included in the analysis if both the adolescent and his or her mother returned a questionnaire mailed in 1999 and provided information on weight, height, and weight concerns.
More adolescent girls (33.0%) than boys (8.1%) thought frequently about wanting to be thinner. Compared with adolescent girls who accurately perceived that their thinness was not important to their mother, girls who misperceived (odds ratio [OR] = 1.9; 95% confidence interval [CI], 1.3-2.8) or accurately perceived (OR = 2.85; 95% CI, 1.0-8.4) that it was important to their mother that they be thin were significantly more likely to think frequently about wanting to be thinner. Among the adolescent boys, only those who accurately perceived that it was important to their mother that they not be fat were more likely than their peers to think frequently about wanting to be thinner (OR = 3.8; 95% CI, 2.3-6.2). Adolescents who accurately perceived that it was important to their mother to be thin or not fat were significantly more likely to be frequent dieters than their peers who accurately perceived that their weight was not important to their mother.
Among adolescents, an accurate perception that weight status is important to their mother is associated with thinking frequently about wanting to be thinner and about frequent dieting.
To examine correlates of dieting behavior in overweight and non-overweight youth.
Data came from Project EAT (Eating Among Teens), a study of eating and weight-related attitudes, behaviors, and psychosocial variables among 4746 adolescents in public schools. Logistic regression was used to compare dieters and non-dieters, and to examine interactions of dieting and overweight status.
Approximately one third (31.8%) of the sample was overweight. Dieting in the previous year was reported by 55.2% of girls and 25.9% of boys. Dieting was associated with similarly elevated rates of extreme weight control behaviors, body dissatisfaction, and depression in both the non-overweight and overweight groups for both boys and girls. Girls reporting dieting behavior in both the non-overweight and overweight groups had similarly elevated risk for cigarette use, alcohol use, and marijuana use.
The negative correlates of dieting are similarly common among teens of varying weight status. These data suggest that dieting may not be a preferred method of weight management, even for overweight adolescents. Regardless of weight status, dieting may be a marker for other unhealthy behaviors and depressed mood in adolescents.
To examine the relationship between body mass index (BMI), body weight perception (BWP), and indicators of internalizing and externalizing distress and social, attention and thought problems in a large representative sample of Dutch youth.
A total of 1826 pupils in the eighth grade of primary education and 5730 students in the first four years of secondary education gave their height and weight to obtain an estimate of their BMI. They reported their evaluation of their body weight and completed Achenbach's Youth Self-Report (YSR) (1991), which assesses eight types of problem behavior. Data were analyzed in a multivariate framework with BMI and BWP as predictors and the YSR scores on different kinds of problem behavior as dependent variables, controlling for background characteristics.
Both BMI and BWP are associated with internalizing and externalizing problem behavior, and social, attention and thought problems. Multivariate tests show that BWP is more closely linked to problem behavior than BMI. Adolescents who were either underweight or overweight but considered themselves in good shape had no more problems than the group with normal BMI and BWP 'good'. The perception of being 'too thin' and particularly the perception of being 'too heavy' best predict problem behavior in both male and female adolescents. Overweight youngsters with an adequate perception of their weight have less somatic complaints than their normal-weight peers who perceive themselves as too heavy, but they show higher withdrawnness, social problems, and anxiety/depression.
Adolescent girls are more dissatisfied with their weight than boys; however, the relationship between weight perception and problem behavior is the same for both genders.
The purpose of this study was to explore the relationship between maternal and adolescent weight-related behaviors and concerns in a population-based sample.
Participants were 810 adolescents (n=429 girls and n=381 boys) and their mothers/guardians. Adolescents were part of the Project EAT (Eating Among Teens) study, which was a comprehensive study of eating patterns and weight concerns among adolescents in Minnesota. Outcome variables included child's body dissatisfaction, weight concerns, dieting, and use of healthy and unhealthy weight control behaviors.
Adolescents reported lower rates of maternal dieting than mothers. Maternal self-report of dieting was not significantly associated with children's weight-related concerns. Children's perceptions of their mothers' behaviors were significantly related to their level of weight concerns and use of weight control behaviors.
Adolescents' perceptions of maternal behavior affect their weight-related concerns and behaviors. This suggests that mothers who choose to diet should model healthy choices in the areas of nutrition and physical activity.
A Japanese version of the Rosenberg Self-Esteem Scale (RSES) was developed through the forward-backward translation procedure.
Married couples consisting of a native English speaker and a native Japanese speaker acted as translators to enhance the representativeness of language in the target population. Multiple translations were produced, and a panel of reviewers identified problems in conceptual and semantic equivalence between the original scale and the translated version. The Japanese version was altered accordingly with reference to alternate Japanese forms from the original English to Japanese translations. The altered translation was again retranslated into English, and problematic differences were checked. This forward-backward process was repeated until satisfactory agreement had been attained. The RSES was administered to 222 native English speakers, and the developed Japanese version (RSES-J) was administered to 1320 native Japanese speakers.
Factor analysis revealed nearly identical factor structure and structural coefficients of the items between two sets of data. Target rotation confirmed the factorial agreement of the two scales in different cultural groups. High Cronbach's alpha coefficients supported the reliability of test scores on both versions.
The equivalence between the RSES and the RSES-J was supported in this study. It is suggested that the RSES and the RSES-J are potential tools for comparative cross-cultural studies.
Effects of maternal eating behaviors and attitudes, maternal feedback to daughter about weight issues, mother-daughter relationship closeness, media influences, and mothers' perceptions of daughters shape on daughters' body image and eating pathology were examined using 91 pairs of mothers and college-aged daughters. Hierarchical multiple regressions using daughters' BMI as the first step were separately performed for daughters' body image and eating pathology. Variables predictive of daughters' body image included negative feedback from mother, mother's disapproval of daughter's figure, and mothers' eating behaviors and attitudes as perceived by daughters. A similar pattern was found for daughters' eating pathology scores with the addition of mothers' tendency to internalize media messages regarding thinness and beauty significantly adding to the prediction. Maternal influence through modeling may be best assessed by using the daughters' perceptions of their mothers because this corresponds to what the daughter was aware of in their mothers' eating attitudes and behaviors. Negative feedback from mothers about daughters' figures and eating patterns significantly increased daughters' difficulties in these areas. Mothers who showed a greater internalization of media messages about thinness were most likely to have daughters with eating pathologies.
The authors assessed associations between body weight perception and weight loss strategies.
They randomly selected male and female college students (N = 38,204).
The authors conducted a secondary data analysis of the rates of weight loss strategies and body weight perception among students who completed the National College Health Assessment survey.
Half of respondents (50%) were trying to lose weight, although only 28% of students were overweight or obese. Also, 12% of respondents had inaccurate body weight perception. Women and men with inaccurate body weight perception were significantly more likely to engage in inappropriate weight loss strategies than were those with accurate body weight perception. Of all students attempting to lose weight, 38% used both diet and exercise.
These data show that college students are interested in weight loss and that body weight perception plays an important role in the desire to lose weight.
The use of the sociocultural attitudes towards appearance
- L Smolak
- Mp Levine
- Thompson
Smolak L, Levine MP, Thompson JK. The use of the sociocultural attitudes towards appearance
Weight concerns and weight control behaviors of adolescents and their mothers
- A E Field
- S B Austin
- R Striegel-Moore
- AE Field
Onset of adolescent eating disorders: population based cohort study over 3 years
- G C Patton
- R Selzer
- C Coffey
- GC Patton