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Agreement between Weight Status and Perceived Body Size and the Association with Body Size Satisfaction in Children: Children's Body Size Perception and Satisfaction

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Agreement between Weight Status and Perceived Body Size and the Association with Body Size Satisfaction in Children: Children's Body Size Perception and Satisfaction

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Abstract

Objective: Extensive evidence suggests that children and adolescents often inaccurately perceive their body size. However, the extent of this misperception is unclear. This paper describes the agreement between children's actual weight and the perception of body size (self-reported and maternally reported) and the association of actual weight with self-reported body satisfaction. Methods: In a population-based cohort study of 3,408 children aged 9 to 10 years, we assessed the children's self-perception and ideal perception of their body size with the Children's Body Image Scale. Maternal perception of offspring body size was assessed with the question "How would you describe your child at the moment?" Children's height and weight were measured. Results: Children tended to rate themselves toward average proportions; e.g., 83.0% of 499 children with overweight/obesity perceived themselves as less heavy then they were. Of those who underestimated their body size, most (79.2%) had a desire to be thinner; all of the children who correctly recognized their overweight/obesity had such a desire. Conclusions: Despite the misperception of body size, the majority of children with overweight/obesity indicated dissatisfaction with their body size, suggesting more self-awareness than would be assumed based on the self-perception assessment of body size alone.

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... About 71.5% of the overweight and obese participants were dissatisfied with their body as compared with 52.5% of participants who had normal weight and were thin. This finding was consistent with other studies [21,27]. In this study, about 33.8% of the participants from the overweight and obese group underestimated their body weight status, while about 18.2% of the participants from the non-overweight group overestimated their body weight status. ...
... As compared with other studies, among overweight and obese children, more than one-third was not aware that he or she was overweight [28]. In addition, it was reported that among underweight children, 72.0% of them perceived themselves at a higher body size, while 83.0% of overweight and obese children perceived themselves at a lower body size [27]. ...
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Introduction: Obesity is recognized as a serious public health threat. Recent evidence has warned of the alarming rise in the prevalence of childhood overweight and obesity throughout the world. This study aimed to determine the prevalence of overweight and obesity, and its associations with socio-demographic, behavioral, and psychosocial factors among school-going adolescents in Seremban, Negeri Sembilan. Methods: Cross-sectional study was conducted. A total of 2,221 adolescents were randomly selected from eight secondary schools. A questionnaire was administered to assess socio-demographic profiles, meal patterns, physical activity level, self-efficacy, self-esteem, body size satisfaction, perception of body weight status, depression, anxiety, stress, and nutrition knowledge. Bodyweight and height were measured and BMI-for-age z scores were computed to determine the body weight status. Bivariate analysis and multivariate logistic regression were used for the data analysis. Results: The prevalence of overweight among the participants in this study was 17.0%, while the prevalence of obesity was 14.9%. The significant predictors of overweight and obesity in this study were breakfast skipping, low physical activity level, low self-efficacy scores in terms of healthy eating, weight and physical activity, body dissatisfaction, and perception of large body size. Conclusion: The results emphasize the need to broaden the scope of nutrition guidelines, public health policies, and programs to address overweight and obesity among adolescents in Malaysia. The findings also suggest that health education programs should cover practical advice for modifying healthy eating behaviors, increasing physical activity, as well as matters on body image and body satisfaction.
... In the present study maternal perception of children's body weight using silhouette scales showed a high magnitude of perceived children in normal weight category and fewer percentages in categories of underweight, overweight and obesity. Leppers et al. [20] reported similar results to those performed in this work studying Dutch children aged 9 to 10 years using the CBIS template with the exception of maternal perception of BMI in obesity category with a low magnitude of 0.64 percent as well as higher percentage in normal weight category (75.9 percent). ...
... However, concordance index among women was lower of 0.36. For the contrary, Leppers et al. [20] found an inverse magnitude of concordance indexes evaluating actual BMI categories and mother's perception of children's BMI categories of 0.44 for girls and 0.36 for boys. These results suggest, in our study, that mothers better perceive the actual BMI categories among boys than among girls in the context of Piedras Negras City, probably as cultural issue in the Northern frontier of Mexico. ...
... Se ha reportado, sobre todo, que la magnitud de la insatisfacción con la imagen corporal se ha incremen- tado en niños prepuberales 14,15 , y que frecuentemente se acompaña de estrategias para bajar de peso y de trastornos de la conducta alimentaria 16 . Se ha obser- vado que los niños con sobrepeso y obesidad tienden a representarse en figuras más delgadas que las que les corresponden, mostrando una insatisfacción con su imagen corporal real 17 . Para evaluar la percepción y la insatisfacción con la imagen corporal se han uti- lizado diferentes formatos de siluetas corporales que proporcionan una medida de la imagen percibida, la ideal y la real, esta última medida por el índice de masa corporal (IMC) [18][19][20] . ...
... Al evaluar la percep- ción corporal con las siluetas de Stunkard, se observó una subestimación pequeña del peso bajo, del 2.8%, mientras que el 83% se percibió más robusto de lo que en realidad era 23 . Estos resultados discrepan de lo reportado por la literatura internacional, en la que se señala que los niños tienden a subestimar sus di- mensiones corporales cuando son extremas 17,[24][25][26] . Aunque en la frontera norte del Estado de Coahuila se presenta una frecuencia alta de sobrepeso y obe- sidad en niños de edad escolar, no se ha evaluado el comportamiento de la autopercepción de la imagen corporal en esa población. ...
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Background: The prevalence of overweight and obesity has increased worldwide. In this context, the lack of awareness of excess weight among overweight and obese children is a public health concern that needs to be explored in the Northern border of Mexico. Methods: Body mass index (BMI) was calculated from children from third to sixth grades of basic education. The Children's Body Image Scale was applied to evaluate perceived and ideal BMI comparing against calculated BMI. We also analyzed the frequency of accurate perceivers of actual weight and discrepancy of ideal weight against calculated BMI. Results: We studied 155 children (43.8% were female) with a mean age of 10.2 years. Accuracy prevalence of BMI perceived respect to calculated BMI was 59.4%. Discrepancy prevalence of ideal BMI respect to calculated BMI was 44.4%. Comparison of perceived BMI respect to calculated BMI showed an overestimation on low weight category (33%) and subestimations in categories of normal weight (12.4%), overweight (85%) and obesity (81.6%). Comparison of ideal BMI respect to calculated BMI showed an absolute overestimation of low weight and underestimations in categories of normal weight, overweight and obesity of 5.6%, 100%, and 97.4%, respectively. Conclusions: The results of this work showed a consistent underestimation of children's body weight, particularly among those classified in categories of overweight and obesity in a demographic context in which the prevalence of both categories was of 38% in this study.
... We calculated a body shape satisfaction score by subtracting the score on the question regarding "ideal body shape" from the score on the question measuring "self-perception" (range À6 to 6). A negative score indicated that the child has a desire to be heavier, a score of zero that the child is happy with his/her body shape and a score above zero means that the child has a desire to be thinner (Leppers et al., 2017). Child IQ was assessed at age 6 years with two subtests of a validated, Dutch, nonverbal intelligence test (i.e., SON-R 2½-7 [Tellegen, Winkel, Wijnberg-Williams, & Laros, 2005]). ...
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Background Individuals with anorexia nervosa (AN) tend to have rigid thoughts and behaviors regarding their body weight, body image, and eating habits. While a diagnosis of AN implies severe levels of impairment, AN traits can vary on a continuum within the population. However, little is known about how early markers of AN relate to rigid thought patterns and to what extent cognitive rigidity is already present in early childhood. We examined the association of set-shifting abilities as a measure of cognitive flexibility in preadolescents with AN-related features. Methods Participants included 3,987 children participating in the Generation R Study, a Dutch population-based birth cohort. Set-shifting abilities (mother report) were assessed at 4 years of age, body mass index (BMI) was determined at 4 and 9 years and restrictive eating patterns (mother report) and body image (child report) were assessed at 9 years. Results Lower set-shifting abilities at 4 years were associated with a lower BMI (β = −.44, p = 2.2 × 10⁻⁴) in girls, and more restrictive eating (β = 0.15, p = 2.7 × 10⁻⁶) in both boys and girls at 9 years of age. Moreover, set-shifting at age 4 was not associated with body image at age 9. Conclusion These findings contribute to the idea that the association between set-shifting problems and AN-related features are present early in childhood, prior to the typical range of the onset of eating disorders (EDs). Longitudinal studies that capture the peak age for the development of EDs will be important to assess whether early cognitive inflexibility is an early marker of AN.
... Almost three quarters of parents of children with overweight showed satisfaction with child's silhouette. Usually, parents are more likely to misclassify their child towards the healthy weight category [34,35], and this is based on predefined concepts, perceptions and beliefs [6]. As prevalence of childhood obesity increases, so does the number of parents who incorrectly identify their child's weight status as normal weight and are not concerned about their child's excessive weight. ...
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Purpose: We compared parent’s perceived child’s silhouette, and investigated predictors of their dissatisfaction. Methods: Participants were 4930 mother–child dyads enrolled at a Portuguese birth cohort. Parents’ perceptions of child’s current and desired silhouette was assessed and dissatisfaction with child’s silhouette was defined as the discrepancy between these ratings (current–desired body). Multinomial logistic regressions, adjusted for potential confounders, were performed. Results: Mothers were more dissatisfied with child’s silhouette, compared to fathers, in all weight categories. Mothers and fathers of girls were more dissatisfied, preferring thinner silhouettes (OR = 2.77, 95% CI 2.19; 3.51 and OR = 2.08, 95% CI 1.18; 3.66, respectively), compared to parents of boys. Lower birth weight increased maternal desire for a heavier child silhouette. Younger (< 20 years) and less educated (≤ 9 years of schooling) mothers were more dissatisfied with their child’s silhouette, preferring heavier children (OR = 1.65, 95% CI 1.10; 2.48 and OR = 1.73, 95% CI 1.42; 2.09, respectively). Parents’ own dissatisfaction was also associated with child’s silhouette dissatisfaction. Conclusion: Sociodemographic characteristics and parents’ dissatisfaction with their own silhouette influenced their dissatisfaction with child’s silhouette and should be considered when developing obesity interventions.Level of evidenceLevel III, case–control analytic study.
... Resultados similares à presente investigação também revelaram o sobrepeso/obesidade como características de insatisfação corporal, mostrando que à medida que aumenta o IMC aumenta a insatisfação corporal (7)(8)24) . Esse achado foi, inclusive, sintetizado em revisão sistemática da literatura mundial sobre o tema (22) . ...
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Objetivou-se avaliar a autopercepção corporal em escolares da rede pública de ensino de Campina Grande e examinar a associação com o sexo, a idade e o estado nutricional. Estudo transversal com 1081 crianças de cinco a dez anos. As crianças foram pesadas e medidas segundo procedimentos padronizados. O estado nutricional foi obtido por meio do IMC/I. Para a avaliação da percepção corporal utilizou-se a escala Children’s Body Image Scale. A prevalência de sobrepeso foi de 75,9%. Crianças com sobrepeso e obesas apresentaram maiores percentuais de insatisfação corporal. Das crianças obesas, 73,7% perceberam-se mais magras. Constatou-se que 94,7% dos escolares com sobrepeso, 98% dos obesos e 41,8% dos eutróficos gostariam de ser mais magros, enquanto 83,3% dos desnutridos desejariam ser mais gordos. A visão mais distorcida do corpo verificou-se nas crianças mais velhas e nos meninos. Aponta-se que o sexo, a idade e o estado nutricional podem influenciar a percepção corporal.
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O status social subjetivo é a percepção de um indivíduo acerca da sua posição social nos mais diversos contextos de vida. O objetivo deste estudo foi comparar o status social subjetivo entre atletas de modalidade esportivas coletivas. Participaram deste estudo 115 atletas do sexo masculino das seguintes modalidades: futebol, voleibol, handebol e basquetebol. A avaliação da percepção do status social subjetivo foi realizada por meio da escala MacArthur. Para analise dos dados foram utilizados os testes Qui-quadrado, Anova one way e Kolmogorov Smirnov. De acordo com os dados, pode-se observar que os atletas de futebol foram os que apresentaram os menores escores de status social subjetivo atual no clube (X: 4.9; ±2.0) e no contexto familiar (X: 7.0; ±2.0). Além disso, os atletas de futebol apresentam maiores prevalências de insatisfação (87.2%; n=42). Concluí-se que os atletas de futebol têm uma maior percepção de insatisfação com o status social subjetivo.
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Background: To examine the association between body size perception (BSP) and body size dissatisfaction (BSD) in elementary school children and to document the potential contribution of individual factors [age, sex, and actual body size (BMI Z-scores: BMIZ)] that may influence their relationship. Methods: This study included 269 children (124 boys and 145 girls) between 6 and 13 years of age (9.2 ± 1.6 years). The BSP score was calculated as the difference between the perceived actual body size and BMIZ (actual body size). A negative BSP score indicated an underestimation of their body size. To assess the BSD score, the difference between perceived actual body size and desired body size was calculated. A positive BSD score indicated a desire to be thinner. Results: Perceived actual body size was smaller than BMIZ, independent of age group and weight status. Overall, 64% of children underestimated their body size. The young children living with obesity demonstrated the highest misperception. Results also showed that the proportion of children who desired to be thinner was higher in overweight and obese subgroups. No significant relationship was found between BSP and BSD scores in the entire sample, while a positive association was observed among younger children in the normal-weight and obese subgroups (r = 0.40; p < 0.001 and r = 0.78; p < 0.05, respectively). Conclusions: Underestimation and dissatisfaction of body size are more prevalent in children living with overweight/obesity. Moreover, there is an association between BSP and dissatisfaction, yet this association is dependent on age and weight status.
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Antecedentes: As taxas de obesidade continuam aumentando, principalmente entre as crianças. Estudos apontam a subestimação do peso corporal como principal fator para a não adesão aos comportamentos de perda de peso e, em crianças, bem como a subestimação do tamanho do corpo, a percepção percebida pelos pais sobre o peso de seus próprios filhos. é crucial para a manutenção principal do sobrepeso e obesidade. Assim, enfatiza-se que a percepção acurada da imagem corporal de crianças e pais é essencial para combater a alta prevalência de sobrepeso e obesidade na população infantil. Objetivo: Avaliar a concordância entre a autopercepção e a percepção materna do peso corporal das crianças e seu status de peso corporal. Métodos: Foram avaliadas 935 crianças de 6 a 10 anos e 922 mães. O status do peso corporal foi avaliado por meio de medidas de peso e altura e a percepção da imagem corporal por meio de software para Avaliação da Percepção Corporal Infantil. Resultados: Crianças classificadas como "baixo peso" ou "peso normal" demonstraram maior acurácia em suas percepções e tendência à superestimação em meninas cujo status de peso é "normal", enquanto crianças obesas ou com excesso de peso tendem a superestimar seu status de peso. As mães, por outro lado, subestimaram o status de peso dos filhos, independentemente do sexo do filho. Conclusão: As crianças apresentaram percepções mais precisas do que as mães em relação ao peso / tamanho corporal.
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To determine cut offs to define thinness in children and adolescents, based on body mass index at age 18 years. International survey of six large nationally representative cross sectional studies on growth. Brazil, Great Britain, Hong Kong, the Netherlands, Singapore, and the United States. 97 876 males and 94 851 females from birth to 25 years. Body mass index (BMI, weight/height(2)). The World Health Organization defines grade 2 thinness in adults as BMI <17. This same cut off, applied to the six datasets at age 18 years, gave mean BMI close to a z score of -2 and 80% of the median. Thus it matches existing criteria for wasting in children based on weight for height. For each dataset, centile curves were drawn to pass through the cut off of BMI 17 at 18 years. The resulting curves were averaged to provide age and sex specific cut-off points from 2-18 years. Similar cut offs were derived based on BMI 16 and 18.5 at 18 years, together providing definitions of thinness grades 1, 2, and 3 in children and adolescents consistent with the WHO adult definitions. The proposed cut-off points should help to provide internationally comparable prevalence rates of thinness in children and adolescents.
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The Generation R Study is a population-based prospective cohort study from fetal life until young adulthood. The study is designed to identify early environmental and genetic causes of normal and abnormal growth, development and health from fetal life until young adulthood. In total, 9,778 mothers were enrolled in the study. Prenatal and postnatal data collection is conducted by physical examinations, questionnaires, interviews, ultrasound examinations and biological samples. Major efforts have been conducted for collecting biological specimens including DNA, blood for phenotypes and urine samples. In this paper, the collection, processing and storage of these biological specimens are described. Together with detailed phenotype measurements, these biological specimens form a unique resource for epidemiological studies focused on environmental exposures, genetic determinants and their interactions in relation to growth, health and development from fetal life onwards.
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This investigation examines self-perception and parental perception of child body size and factors associated with accurate parental perception of child body size. Latino at-risk for overweight (AROW) and/or overweight preadolescent children (ages 8-11 years) along with their parents were recruited (N=123 dyads). Children's body mass index (BMI) was measured but not discussed before participants were shown pictures of body sizes and asked to select the image that represented the child's body. The correlation between the child's body size selection and the child's actual BMI was 0.117 (p=0.20) whereas the correlation between the parent's assessment of the child's body size and the child's actual BMI was 0.470 (p<0.001). Logistic regression revealed that only parental education level (> or =college) was associated with a more accurate parental perception of their child's body size (OR: 0.11/95% CI: 0.01, 0.89) while child's sex, parental BMI, and parental health status were not associated with a perception that corresponded to the child's BMI. The sample was drawn from a single community clinic in Forsyth County which serves a large population of newer Latino immigrants in the county. The results indicate that (1) Latino AROW/overweight preadolescent children do not have an accurate perception of their own body size; (2) Latino parents have a more accurate perception of their child's body size with a moderately sized correlation suggesting that their perception of their child's body size is frequently inaccurate; and (3) Latino parents with higher education perceive their child's body size more accurately than less educated parents.
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To compare children's, parents' and physicians' perceptions of children's body size. We administered a structured questionnaire of body size perception using a descriptive Likert scale keyed to body image figures to children ages 12 to 18 years. The same scale was given to parents of children ages 5 to 18 years. The sample consisted of 91 children and their parents being seen in the Pediatric Gastroenterology Clinic for concerns unrelated to overweight. Weight and height of the children were measured, and body mass index (BMI) was calculated. The children's BMI percentiles were categorized as underweight (<15th), normal (15th-85th), overweight (85th-95th), and obese (95th and above). The attending physician independently completed the body image and description scale and indicated the figure that most accurately represented the patient without reference to BMI standards. Accuracy of the patients', parents', and doctors' estimates were statistically compared. The sample population consisted of 6.4% underweight, 70.5% normal weight, 7.7% overweight, and 15.4% obese. Forty-four percent of parents underestimated children's body size using word descriptions and 47% underestimated using figures. Forty percent of the children underestimated their own body size using descriptions and 43% underestimated using figures. The physicians in this study had a higher percentage of correct estimates; however, they underestimated 33% of the patients using both word descriptions and figures. Some obese children were not recognized, and several average children were perceived as underweight. Many children underestimated their degree of overweight. Their parents and even their attending physicians shared this misperception. This study demonstrates the need to further educate physicians to recognize obesity and overweight so that they can counsel children and their families.
Article
Importance Previous analyses of obesity trends among children and adolescents showed an increase between 1988-1994 and 1999-2000, but no change between 2003-2004 and 2011-2012, except for a significant decline among children aged 2 to 5 years. Objectives To provide estimates of obesity and extreme obesity prevalence for children and adolescents for 2011-2014 and investigate trends by age between 1988-1994 and 2013-2014. Design, Setting, and Participants Children and adolescents aged 2 to 19 years with measured weight and height in the 1988-1994 through 2013-2014 National Health and Nutrition Examination Surveys. Exposures Survey period. Main Outcomes and Measures Obesity was defined as a body mass index (BMI) at or above the sex-specific 95th percentile on the US Centers for Disease Control and Prevention (CDC) BMI-for-age growth charts. Extreme obesity was defined as a BMI at or above 120% of the sex-specific 95th percentile on the CDC BMI-for-age growth charts. Detailed estimates are presented for 2011-2014. The analyses of linear and quadratic trends in prevalence were conducted using 9 survey periods. Trend analyses between 2005-2006 and 2013-2014 also were conducted. Results Measurements from 40 780 children and adolescents (mean age, 11.0 years; 48.8% female) between 1988-1994 and 2013-2014 were analyzed. Among children and adolescents aged 2 to 19 years, the prevalence of obesity in 2011-2014 was 17.0% (95% CI, 15.5%-18.6%) and extreme obesity was 5.8% (95% CI, 4.9%-6.8%). Among children aged 2 to 5 years, obesity increased from 7.2% (95% CI, 5.8%-8.8%) in 1988-1994 to 13.9% (95% CI, 10.7%-17.7%) (P < .001) in 2003-2004 and then decreased to 9.4% (95% CI, 6.8%-12.6%) (P = .03) in 2013-2014. Among children aged 6 to 11 years, obesity increased from 11.3% (95% CI, 9.4%-13.4%) in 1988-1994 to 19.6% (95% CI, 17.1%-22.4%) (P < .001) in 2007-2008, and then did not change (2013-2014: 17.4% [95% CI, 13.8%-21.4%]; P = .44). Obesity increased among adolescents aged 12 to 19 years between 1988-1994 (10.5% [95% CI, 8.8%-12.5%]) and 2013-2014 (20.6% [95% CI, 16.2%-25.6%]; P < .001) as did extreme obesity among children aged 6 to 11 years (3.6% [95% CI, 2.5%-5.0%] in 1988-1994 to 4.3% [95% CI, 3.0%-6.1%] in 2013-2014; P = .02) and adolescents aged 12 to 19 years (2.6% [95% CI, 1.7%-3.9%] in 1988-1994 to 9.1% [95% CI, 7.0%-11.5%] in 2013-2014; P < .001). No significant trends were observed between 2005-2006 and 2013-2014 (P value range, .09-.87). Conclusions and Relevance In this nationally representative study of US children and adolescents aged 2 to 19 years, the prevalence of obesity in 2011-2014 was 17.0% and extreme obesity was 5.8%. Between 1988-1994 and 2013-2014, the prevalence of obesity increased until 2003-2004 and then decreased in children aged 2 to 5 years, increased until 2007-2008 and then leveled off in children aged 6 to 11 years, and increased among adolescents aged 12 to 19 years.
Article
Objective: This study addressed gaps in the existing literature about correlates of parental perception of child weight using a community sample. This study evaluated how weight-status and its perception related to parents' personal and parenting attitudes/behaviors. Design and methods: Participants were parents (N = 1,007; 65.3% mothers, 34.4% fathers) of children 5 to 15 years old. Parents completed online measures of personal eating attitudes/behaviors, attitudes/behaviors about their children's eating and weight, and parental practices related to weight-related attitudes. Results: Parents frequently underestimated children's overweight/obesity, even more frequently than their own overweight/obesity (P < 0.001). Parents' personal eating attitudes/behaviors were related to their own weight-status (P < 0.001) and perceived child weight-status (P < 0.001) but not actual child weight-status. Parents' child-focused eating attitudes/behaviors were related to actual (P < 0.001) and perceived child weight-status (P < 0.001), but not parent weight-status. Conclusions: In general, parents' personal attitudes/behaviors did not extend into their perceptions of their children's weight or their response to it. Results suggest a dual need to improve parent accuracy perceiving children's overweight/obesity and to guide parent responses to perceived overweight/obesity. Given the high prevalence of childhood obesity, and the serious consequences during childhood and into adulthood, further research is needed to enhance understanding of parents' specific needs to engage in prevention and treatment programs.
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Body image development begins during the preschool years and perhaps even during infancy. Preschool girls (4- to 6-year-old) already demonstrate anti-fat bias, social comparison, and, perhaps, body dissatisfaction. Body dissatisfaction and dieting are clearly evident among elementary school-age girls (6- to 12-year-old). Sociocultural, psychological, and biological variables have all been implicated as risk factors for body dissatisfaction. Girls who exhibit body dissatisfaction may also have lower self-esteem and engage in more dieting. Research needs are discussed as is the importance of universal prevention of body dissatisfaction.
Article
BACKGROUND This study examined the relationship between actual body weight and self-perceived weight, and how perception of one's weight affects weight management behaviors among US adolescents.METHODS Adolescents ages 16-19 years with objectively-measured weight and height and self-reported perception of weight, weight-loss efforts, and health-related behaviors (N = 642) from the 2009-2010 National Health and Nutritional Examination Survey (NHANES) were included. Sociodemographic variables, body mass index percentile, weight perception, weight-loss efforts, and health-related behaviors were examined using Wald chi-square, Student's t test, analysis of variance, and logistic regression.RESULTSApproximately 15% were overweight, and 20% were obese; 26% inaccurately perceived their weight. Ethnic minority groups displayed higher rates of overweight and obesity. Overweight adolescents had a higher rate of inaccurate weight perception than obese adolescents. More girls correctly perceived their weight status than boys. Nearly 25% had tried to lose weight during the past year. Among overweight and obese adolescents, accurate weight perception was significantly and positively related to weight-loss efforts after controlling for sociodemographic variables and actual weight.CONCLUSIONS Accurate body weight perception is a significant factor in adolescents' weight-loss efforts. Targeting counseling for body weight perception and weight management toward boys and overweight adolescents may impact obesity in this age group.
Article
Parental perceptions of their children's weight play an important role in obesity prevention and treatment. The objective of this study was to determine the proportion of parents worldwide who underestimate their children's weight and moderators of such misperceptions. Original studies published to January 2013 were chosen through literature searches in PUBMED, PSYCHINFO, and CINAHL databases. References of retrieved articles were also searched for relevant studies. Studies were published in English and assessed parental perceptions of children's weight and then compared perceptions to recognized standards for defining overweight based on anthropometric measures. Data were extracted on study-level constructs, child- and parent-characteristics, procedural characteristics, and parental underestimates separately for normal-weight and overweight/obese samples. Pooled effect sizes were calculated using random-effects models and adjusted for publication bias. Moderators were explored using mixed-effect models. A total of 69 articles (representing 78 samples; n = 15 791) were included in the overweight/obese meta-analysis. Adjusted effect sizes revealed that 50.7% (95% confidence interval 31.1%-70.2%) of parents underestimate their overweight/obese children's weight. Significant moderators of this effect included child's age and BMI. A total of 52 articles (representing 59 samples; n = 64 895) were included in the normal-weight meta-analysis. Pooled effect sizes indicated that 14.3% (95% confidence interval 11.7%-17.4%) of parents underestimate their children's normal-weight status. Significant moderators of this effect included child gender, parent weight, and the method (visual versus nonvisual) in which perception was assessed. Half of parents underestimated their children's overweight/obese status and a significant minority underestimated children's normal weight. Pediatricians are well positioned to make efforts to remedy parental underestimates and promote adoption of healthy habits.
Article
AimThis article is a report of an analysis of the concept of parental perception of child weight. Background Perception is commonly studied, but lacks a strong conceptual definition. Concept analysis is important in providing a conceptual definition of parental perception of child weight. DesignRodgers's evolutionary view of concept analysis guided this enquiry. Data sourcesA search of multiple nursing and social sciences databases was undertaken, including CINAHL, Academic Search Complete, Science Direct, ProQuest, PsychINFO, Medline and SocINDEX. Review methodsData from 2000-2012 related to the concept of interest were reviewed. Fifty-eight articles meeting the inclusion criteria were included. Key attributes, antecedent occurrences and consequences of the concept's use were identified. Thematic analysis revealed common themes related to the concept attributes, antecedents and consequences. ResultsFive attributes were identified including: parental recognition of body size, physical appearance, functional abilities, psychosocial effects and health effects related to body weight. Antecedents of this concept are parental beliefs and values about body weight, fatalism, societal normalization of overweight, parental weight status and parental mental health status. The consequences of this concept are parental concern, increased knowledge about obesity-related health risks, motivation to make changes and family lifestyle changes. The ultimate goal is a healthy weight for the child. ConclusionsA middle-range explanatory theory of parental perception of child weight was proposed. Parents who recognize child weight issues may be motivated to initiate lifestyle changes, resulting in a healthy weight for the child.
Article
First, we give an overview of child psychiatric research in the Generation R Study, a population-based cohort from fetal life forward. Second, we examine within Generation R whether the functional polymorphism (5-HTTLPR) in the promoter of the serotonin transporter gene interacts with prenatal maternal chronic difficulties, prenatal maternal anxiety or postnatal maternal anxiety to influence child emotional development. A total of 2,136 northern European children were genotyped for 5-HTTLPR and rs25531. Mothers reported chronic difficulties and anxiety symptoms at 20 weeks' pregnancy and when the child was 3 years old. Child emotion recognition was observed at 3 years, and child emotional problems were assessed with the CBCL/1½-5 at 5 years. There were consistent main effects of maternal difficulties and anxiety on child emotional problems, but no main effect of 5-HTTLPR. Moreover, children with the s allele were at increased risk for emotional problems if their mothers reported prenatal anxiety symptoms (β = 2.02, p < .001) or postnatal anxiety symptoms (β = 1.64, p < 0.001). Also, in children of mothers with prenatal anxiety symptoms, the s allele was associated with less accurate emotion-matching (β = -0.11, p = .004). This population-based study shows that vulnerability due to 5-HTTLPR is not specific for certain adverse exposures or severe events, but suggests that the small effects of gene-environment interaction on emotional development become manifest early in life.
Article
To examine how the associations among body mass index (BMI) and body dissatisfaction and weight and shape concern evolve from late childhood through late adolescence in boys and girls. We analyze data from subjects aged 9-18 years from the Growing Up Today Study, a national prospective cohort of U.S. youth (n = 16,882, yielding 59,750 repeated-measures observations during five waves of data collection). Generalized additive models produced curves of association for body dissatisfaction and weight concern across BMI percentiles. Generalized estimating equations (adjusting for correlated within-subject repeated measures, sibling clusters, pubertal maturation, and region of residence) tested main and interactive effects of BMI, age, and gender. Girls above the 50th BMI percentile reported greater body dissatisfaction than girls below the 50th percentile. By contrast, boys who reported the most body dissatisfaction were either above the 75th BMI percentile (approaching overweight) or below the 10th percentile (approaching underweight). Body dissatisfaction increased with age for both girls and boys, but the gender-specific patterns of BMI effects remained constant. Male and female participants in the overweight/obese BMI range reported the greatest weight concern, but among older adolescents (particularly girls), healthy weight became increasingly associated with greater weight and shape concern. Body dissatisfaction and weight and shape concern intensify across adolescence, but associations between the constructs and BMI remain gender specific. Findings have important implications for eating disorder risk assessment and prevention.
Article
Two studies examined the accuracy of parents' assessment of their children's mathematics performance and how this relates to the time parents spend on children's homework. Fourth, 5th, and 6th graders completed a mathematics test. Their parents then predicted their child's test performance. Parents overestimated their children's mathematics scores (Study 1: 17.13%; Study 2: 14.40%). The time parents spent helping their children with mathematics homework was unrelated to children's mathematics performance, parents' predictions of their children's mathematics performance, and the accuracy of parents' predictions of their children's mathematics performance. Although increasing parents' knowledge of their children's mathematics competency should remediate poor mathematics performance of U.S. children, neither homework nor traditional report cards effectively inform parents regarding their children's mathematics performance. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
An increasing number of children worldwide are overweight, and the first step in treating obesity is to identify overweight. However, do parents recognise overweight in their child and which factors influence parental perception? The aim of the present review is to systematically study differences between parental perception and the actual weight status of children. Medline, EMbase, CINAHL and PsychINFO were searched. After screening 2497 abstracts and 106 full texts, two reviewers independently scored the methodological quality of 51 articles (covering 35 103 children), which fulfilled the inclusion criteria. The primary outcome parameters were sensitivity and specificity of parental perception for actual weight status of their child. The methodological quality of the studies ranged from poor to excellent. Pooled results showed that according to objective criteria 11 530 children were overweight; of these, 7191 (62.4%) were incorrectly perceived as having normal weight by their parents. The misperception of overweight children is higher in parents with children aged 2-6 years compared with parents of older children. Sensitivity (correct perception of overweight) of the studies ranged from 0.04 to 0.89, while specificity (correct perception of normal weight) ranged from 0.86 to 1.00. There were no significant differences in sensitivity or specificity for different cut-off points for overweight, or between newer and older studies. Therefore we can conclude that parents are likely to misperceive the weight status of their overweight child, especially in children aged 2-6 years. Because appropriate treatment starts with the correct perception of overweight, health care professionals should be aware of the frequent parental misperception of the overweight status of their children.
Article
The primary objective of our research was to investigate the nutritional status in Belgrade schoolchildren (aged 12–15). The second objective was to compare the children and parents view about the children nutritional status. The study was carried out in two phases: (a) questionnaires for children and parents (questionnaire-c and questionnaire-p) were administrated; (b) anthropometrical measurement was conducted among children. There were 2263 participants, randomly chosen from seven Belgrade (Serbia and Montenegro) primary schools. At the end of the study, 1555 children completed the questionnaires and had been measured. According to our results, there were 18.1% boys and 11.3% girls who were overweight/obese. Children were more objective in estimating their nutritional status than their parents. Although the participants were offered free counselling, low response rate of only 4.71% was achieved, suggesting that parents should take an active and unbiased role in children's nutritional education. Copyright © 2006 John Wiley & Sons, Ltd and Eating Disorders Association.
Article
Objective To develop an internationally acceptable definition of child overweight and obesity, specifying the measurement, the reference population, and the age and sex specific cut off points. Design International survey of six large nationally representative cross sectional growth studies. Setting Brazil, Great Britain, Hong Kong, the Netherlands, Singapore, and the United States. Subjects 97 876 males and 94 851 females from birth to 25 years of age. Main outcome measure Body mass index (weight/height 2 ). Results For each of the surveys, centile curves were drawn that at age 18 years passed through the widely used cut off points of 25 and 30 kg/m 2 for adult overweight and obesity. The resulting curves were averaged to provide age and sex specific cut off points from 2›18 years. Conclusions The proposed cut off points, which are less arbitrary and more internationally based than current alternatives, should help to provide internationally comparable prevalence rates of overweight and obesity in children.
Article
Questionnaires using Likert-type rating scales are an important source of data in marketing research. Researchers use different rating scale formats with varying numbers of response categories and varying label formats (e.g., 7-point rating scales labeled at the endpoints, fully labeled 5-point scales, etc.) but have few guidelines when selecting a specific format. Drawing from the literature on response styles, we formulate hypotheses on the effect of the labeling of response categories and the number of response categories on the net acquiescence response style, extreme response style and misresponse to reversed items. We test the hypotheses in an online survey (N = 1207) with eight experimental conditions and a follow-up study with two experimental conditions (N = 226). We find evidence of strong effects of scale format on response distributions and misresponse to reversed items, and we formulate recommendations on the choice of a scale format.
Article
Obesity is one of the most common chronic diseases in childhood. Many studies offer a variety of explanations for the alarming increase in childhood obesity; however, none discuss why an apparent disconnect exists in parental perceptions of their child's weight status. The purpose of this article was to review the current research literature on parental perceptions about their children's weight. The articles included in this review were retrieved through a literature search using PubMed. Key words used to obtain relevant articles include childhood obesity, childhood overweight, and parental perception. Several studies looked at parental perceptions of childhood obesity generated from the United Kingdom, Australia, Italy, and the United States. Universally, parents were more likely to misperceive their child's weight. This was especially true for parents who were themselves overweight. If parents do not recognize their child as at risk for overweight or overweight, they cannot intervene to diminish the risk factors for pediatric obesity and its related complications. More research is needed to identify why this phenomenon occurs. Only then can effective interventions be initiated.
Article
This paper presents a general statistical methodology for the analysis of multivariate categorical data arising from observer reliability studies. The procedure essentially involves the construction of functions of the observed proportions which are directed at the extent to which the observers agree among themselves and the construction of test statistics for hypotheses involving these functions. Tests for interobserver bias are presented in terms of first-order marginal homogeneity and measures of interobserver agreement are developed as generalized kappa-type statistics. These procedures are illustrated with a clinical diagnosis example from the epidemiological literature.
Article
Childhood obesity increases the risk of obesity in adulthood, but how parental obesity affects the chances of a child's becoming an obese adult is unknown. We investigated the risk of obesity in young adulthood associated with both obesity in childhood and obesity in one or both parents. Height and weight measurements were abstracted from the records of 854 subjects born at a health maintenance organization in Washington State between 1965 and 1971. Their parents' medical records were also reviewed. Childhood obesity was defined as a body-mass index at or above the 85th percentile for age and sex, and obesity in adulthood as a mean body-mass index at or above 27.8 for men and 27.3 for women. In young adulthood (defined as 21 to 29 years of age), 135 subjects (16 percent) were obese. Among those who were obese during childhood, the chance of obesity in adulthood ranged from 8 percent for 1- or 2-year-olds without obese parents to 79 percent for 10-to-14-year-olds with at least one obese parent. After adjustment for parental obesity, the odds ratios for obesity in adulthood associated with childhood obesity ranged from 1.3 (95 percent confidence interval, 0.6 to 3.0) for obesity at 1 or 2 years of age to 17.5 (7.7 to 39.5) for obesity at 15 to 17 years of age. After adjustment for the child's obesity status, the odds ratios for obesity in adulthood associated with having one obese parent ranged from 2.2 (95 percent confidence interval, 1.1 to 4.3) at 15 to 17 years of age to 3.2 (1.8 to 5.7) at 1 or 2 years of age. Obese children under three years of age without obese parents are at low risk for obesity in adulthood, but among older children, obesity is an increasingly important predictor of adult obesity, regardless of whether the parents are obese. Parental obesity more than doubles the risk of adult obesity among both obese and nonobese children under 10 years of age.
Article
This study explored friendship variables in relation to body image, dietary restraint, extreme weight-loss behaviors (EWEBs), and binge eating in adolescent girls. From 523 girls, 79 friendship cliques were identified using social network analysis. Participants completed questionnaires that assessed body image concerns, eating, friendship relations, and psychological family, and media variables. Similarity was greater for within than for between friendship cliques for body image concerns, dietary restraint, and EWLBs, but not for binge eating. Cliques high in body image concerns and dieting manifested these concerns in ways consistent with a high weight/shape-preoccupied subculture. Friendship attitudes contributed significantly to the prediction of individual body image concern and eating behaviors. Use of EWLBs by friends predicted an individual's own level of use.
Article
Adolescent obesity is becoming an increasing public health problem. This study determines: 1) differences in teen and parental report of obesity, 2) amount of misclassification using body mass index (BMI) from self-reported versus measured height and weight as an indicator of obesity, and 3) whether misclassification varies by gender and socioeconomic status. Weighted data from 15 483 baseline (T1) youth and parental interviews from the National Longitudinal Study of Adolescent Health were used. Seventy-four percent of teens were reinterviewed 1 year later (T2). Parents reported socioeconomic status indicators and whether their teen was obese. Teens reported height, weight, and weight perception. BMI was calculated from both self-reported height and weight at T1 and T2 and from measured height and weight at T2. Those with a BMI > or =95% corrected for age and gender were considered obese. At T1, nearly one half of teens (47%) reporting they were very overweight were not obese by BMI. For teens obese by BMI, 19.6% were reported to be obese by both parent and teen, 6.4% by teen only, 29. 9% by parent only, and 44.2% by neither teen nor parent. For those with persistent obesity, teen and/or parental report failed to identify more than one third (34%) as obese; 23.4% were identified by both teen and parent report, 5.4% by teen report only, and 37.2% by parent only. At T2, the correlation between BMI calculated from self-reported versus measured height and weight for the overall population was very strong (r = .92). Specificity of obesity status based on self-reported BMI, compared with obesity status based on measured BMI was .996; sensitivity, .722; positive predictive value, .860; and negative predictive value, .978. Overall, 3.8% of teens were misclassified using self-report measures. Girls were no more likely than boys to be misclassified as obese using BMI from self-reported height and weight. Parental report is a better indicator of obesity than teen report of weight status, but parental and teen reports are both poor predictors of adolescent obesity. Using BMI based on self-reported height and weight correctly classified 96% as to obesity status. Thus, studies can use self-reported height and weight to understand teen obesity and its correlates/sequelae.
Article
The Development and Well-Being Assessment (DAWBA) is a novel package of questionnaires, interviews, and rating techniques designed to generate ICD-10 and DSM-IV psychiatric diagnoses on 5-16-year-olds. Nonclinical interviewers administer a structured interview to parents about psychiatric symptoms and resultant impact. When definite symptoms are identified by the structured questions, interviewers use open-ended questions and supplementary prompts to get parents to describe the problems in their own words. These descriptions are transcribed verbatim by the interviewers but are not rated by them. A similar interview is administered to 11-16-year-olds. Teachers complete a brief questionnaire covering the main conduct, emotional, and hyperactivity symptoms and any resultant impairment. The different sorts of information are brought together by a computer program that also predicts likely diagnoses. These computer-generated summary sheets and diagnoses form a convenient starting point for experienced clinical raters, who decide whether to accept or overturn the computer diagnosis (or lack of diagnosis) in the light of their review of all the data, including transcripts. In the present study, the DAWBA was administered to community (N = 491) and clinic (N = 39) samples. There was excellent discrimination between community and clinic samples in rates of diagnosed disorder. Within the community sample, subjects with and without diagnosed disorders differed markedly in external characteristics and prognosis. In the clinic sample, there was substantial agreement between DAWBA and case note diagnoses, though the DAWBA diagnosed more comorbid disorders. The use of screening questions and skip rules greatly reduced interview length by allowing many sections to be omitted with very little loss of positive information. Overall, the DAWBA successfully combined the cheapness and simplicity of respondent-based measures with the clinical persuasiveness of investigator-based diagnoses. The DAWBA has considerable potential as an epidemiological measure, and may prove to be of clinical value too.
Article
The aim of this study was to develop a gender-appropriate pictorial scale to measure body image in young children based on a measurable index of adiposity. Pictorial scales for boys and girls containing seven body pictures representing standard percentile curves for body mass index (BMI) for healthy children were developed. The Children's Body Image Scale (CBIS) was administered to 312 children aged between 7 and 12 years. Accuracy of body size perception, indicated by the correlation between actual and perceived BMI category figure, developed with age, girls acquiring accuracy earlier than boys. Whereas girls developed a good accuracy (r =.60, p <.001, 10-12 years), in boys, the correlation, though significant, was not strong (r =.35, p <.01, 10-12 years). There was a consistent bias towards underestimation of body size using this technique. There was a high frequency of body size dissatisfaction across all the age ranges, 48% girls and 36% boys wished to have a smaller body figure than their own, and only 10% of girls and 20% boys wished to have a larger body figure. Construct validity was assessed in a subset of 153 children in which additional measures of restrained eating (DEBQ-R) and body esteem were available. From the age of 8 years, the CBIS provides a good measure of body dissatisfaction. The CBIS provides a good measure of body size perception in girls and an adequate measure in boys aged 8 years and older. It also provides a good measure of body size dissatisfaction in children. Internalization of a thin body ideal takes place at a young age, many children desiring a BMI below the average norm.
Article
Body image disturbance is characteristic of eating disorders, and current treatments use body exposure to reduce bad body feelings. There is however little known about the cognitive effects of body exposure. In the present study, eye movement registration (electroculography) as a direct index of selective visual attention was used while eating symptomatic and normal control participants were exposed to digitalized pictures of their own body and control bodies. The data showed a decreased focus on their own 'beautiful' body parts in the high symptomatic participants, whereas inspection of their own 'ugly' body parts was given priority. In the normal control group a self-serving cognitive bias was found: they focused more on their own 'beautiful' body parts and less on their own 'ugly' body parts. When viewing other bodies the pattern was reversed: high symptom participants allocated their attention to the beautiful parts of other bodies, whereas normal controls concentrated on the ugly parts of the other bodies. From the present findings the hypothesis follows that a change in the processing of information might be needed for body exposure to be successful.
Article
While the majority of adults are attempting weight loss at any given time, few engage in optimal diet and exercise. We examined factors associated with being in advanced stages of behavior change for weight loss, diet, and exercise. We surveyed primary care patients about their health, health habits, and perception and advice about weight as health risk, and about stage of readiness to lose weight, improve diet (control food portions, limit fat intake, increase fruits and vegetables), and increase planned exercise using the Prochaska Stage of Behavior Change model. We conducted bivariable analyses to describe the association between being at the preparation (change in 1 month), action (changing now), and maintenance (maintaining change) stages of change for weight loss and being at 1 of these 3 advanced stages for improving diet and exercise. We also conducted multivariable analyses to examine factors associated with being at these advanced stages of readiness to concurrently lose weight, improve diet, and increase exercise. Of 365 patients (response rate of 60%), 33% were overweight (body mass index [BMI], 25.0-29.9 kg/m(2)) and 27% were obese (BMI, 30.0+kg/m(2)). Of 199 respondents at the preparation, action, or maintenance stage of losing weight, 61% were also at an advanced stage for improving diet and exercise. Those perceiving weight as a health risk were more likely to be at advanced stages of readiness to concurrently lose weight, improve diet, and increase exercise (adjusted odds ratio [AOR], 5.6; 95% CI, 2.5 to 12.5) after adjustment for confounders; this perception was associated with BMI ([AOR, 1.2; 95% CI, 1.1 to 1.3 for each unit increment in BMI]) and being advised by a physician about weight as a health risk (AOR, 6.7; 95% CI, 3.0 to 15.1). Demographic factors, having obesity-related comorbidities, and mental and physical functioning did not appear important. A large proportion of primary care patients are at advanced stages of readiness to lose weight, improve diet, and increase exercise. Future studies should examine the effectiveness of primary care interventions to help patients optimize weight-related behavior.
Article
To test the reliability of the Children's Body Image Scale (CBIS) and assess its usefulness in the context of new body size charts for children. Participants were 281 primary schoolchildren with 50% being retested after 3 weeks. The CBIS figure scale was compared with a range of international body mass index (BMI) reference standards. Children had a high degree of body image dissatisfaction. The test-retest reliability of the CBIS was supported. The CBIS is a useful tool for assessing body image in children with sound scale properties. It can also be used to identify the body size of children, which lies outside the healthy weight range of BMI.
Article
The aim of this study was to investigate (i) the associations between mental disorders (in particular the anxiety disorders) and obesity in the general population and (ii) potential moderators of those associations (ethnicity, age, sex, and education). A nationally representative face-to-face household survey was conducted in New Zealand with 12,992 participants 16 years and older, achieving a response rate of 73.3%. Ethnic subgroups (Maori and Pacific peoples) were oversampled. Mental disorders were measured with the Composite International Diagnostic Interview (CIDI 3.0). Height and weight were self-reported. Obesity was defined as a body mass index (BMI) of 30 kg/m(2) or greater. Obesity was significantly associated with any mood disorder (OR 1.23), major depressive disorder (OR 1.27), any anxiety disorder (OR 1.46), and most strongly with some individual anxiety disorders such as post-traumatic stress disorder (PTSD) (OR 2.64). Sociodemographic correlates moderated the association between obesity and mood disorders but were less influential in obesity-anxiety disorder associations. Adjustment for the comorbidity between anxiety and mood disorders made little difference to the relationship between obesity and anxiety disorders (OR 1.36) but rendered the association between obesity and mood disorders insignificant (OR 1.05). Stronger associations were observed between anxiety disorders and obesity than between mood disorders and obesity; the association between PTSD and obesity is a novel finding. These findings are interpreted in light of research on the role of anxiety in eating pathology, and deserve the further attention of researchers and clinicians.
Personal and parental weight misperception and self-reported attempted weight loss in US children and adolescents, National Health and Nutrition Examination Survey
  • H Y Chen
  • S C Lemon
  • S L Pagoto
  • B A Barton
  • K L Lapane
  • R J Goldberg
Chen HY, Lemon SC, Pagoto SL, Barton BA, Lapane KL, Goldberg RJ. Personal and parental weight misperception and self-reported attempted weight loss in US children and adolescents, National Health and Nutrition Examination Survey, 2007-2008 and 2009-2010. Prev Chronic Dis 2014;11:E132. doi:10.5888/pcd11.140123
Encyclopedia of Body Image and Human Appearance
  • L Smolak
Smolak L. Body image development -girl children. In: Cash T, ed. Encyclopedia of Body Image and Human Appearance. Amsterdam, Netherlands: Academic Press; 2012:212-218.