Body Weight Misperception and Weight Disorders among Chinese Children and Adolescents: A Latent Class Analysis

Self-perceived body weight and weight status: analysis of concordance by age group and sex

OBJECTIVES

Previous studies suggest that there is discordance between actual weight status and body-weight perception. This fact has implications when it comes to designing public health interventions. The aim of this study was to estimate the prevalence of the different categories of weight status and body-weight perception and to analyse their concordance in a representative Spanish population sample.

STUDY DESIGN

Cross-sectional study.

METHODS

Data were sourced from the 2018 Galician Risk Behaviour Data System, with the target population being all persons aged 16 years and above. We collected data on self-perceived body weight and assessed weight status on the basis of body mass index (BMI). BMI was estimated using self-reported measures of weight and height. To estimate concordance, Cohen's kappa coefficient, both unweighted and weighted with Cicchetti weights, was calculated.

RESULTS

Data were obtained for 7853 individuals aged 16 years and above, whereas the overall unweighted concordance was 0.393 (95%CI: 0.377-0.409), with an agreement percentage of 61.6%, weighted concordance was 0.503 (0.490-0.517), with an agreement percentage of 86.6%. The highest concordance between self-perceived body weight and weight status was observed in women. By age group, the highest concordance was observed in the youngest group (16-24 years) for the BMI categories of underweight and overweight, and in the 45-64 age group for the category of obesity.

CONCLUSIONS

The results highlight the existence of differences between self-perceived body weight and weight status, according to sex and age.

Body image and dietary habits in adolescents: a systematic review

CONTEXT

Adolescence is a critical developmental stage in which increasing concerns about body image (BI) coincide with the consolidation of dietary habits (DHs). Multiple studies have sought robust associations between BI and DHs to prevent unhealthy behaviors.

OBJECTIVE

The aim of this systematic review was to examine the available literature on the association between BI perception (BIP) and/or satisfaction (BIS) and DHs in adolescents.

DATA SOURCES

A search was carried out of 5 electronic databases (PubMed, SciELO, Cochrane, Embase, and PsycInfo) using a combination of keywords (and synonyms) related to adolescence, BI, and diet.

DATA EXTRACTION

Data screening, extraction, and quality assessment were performed independently by 2 investigators using the PRISMA and AXIS guidelines.

DATA ANALYSIS

Of 2496 articles screened, 30 articles, published in English or Spanish, that evaluated the relationship between BI and DHs in adolescents aged between 10 years and 18 years, were included. A relationship between accurate BI perception in adolescents and healthy DHs was reported in 5 articles (16.2%). A relationship between overestimation of body weight in adolescents and healthy DHs was reported in 4 articles (13.3%). A relationship between underestimation of body weight and unhealthy DHs was reported in 8 articles (26.7%). In addition, 4 articles (13.3%) reported a relationship between BIS and healthy DHs. The desire to gain weight was associated with unhealthy DHs in 3 (10%) of the articles, while the desire to lose weight was related to healthy DHs in 3 (10%) of the articles and to unhealthy DHs in 3 (10%) other articles. There were also gender differences in the relationship between BIP or BIS and DHs.

CONCLUSION

Adolescents who underestimate their body weight tend to report less healthy DHs than body weight overestimators. Adolescents unsatisfied with their BI and with a drive for thinness frequently engage in DHs linked to losing weight.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42020184625.

Trends of obesity and overweight among children and adolescents in China

BACKGROUND

Recent decades have shown a rapid increase in the prevalence of overweight and obesity among Chinese children based on several national surveys. Restrictions due to the coronavirus disease 2019 outbreak have worsened its epidemiology. This review updates the trends in the prevalence of overweight and obesity among Chinese children and adolescents and analyzes the underlying reasons to provide evidence for better policy making.

METHODS

Studies published in English and Chinese were retrieved from PubMed, Google Scholar, China National Knowledge Infrastructure and Wanfang.

RESULTS

The prevalence of overweight and obesity has been increasing for decades and varies with age, sex and geography but is more pronounced in primary school students. The increase in obesity in boys appeared to be slower, whereas that in girls showed a declining trend. The northern areas of China have persistently maintained the highest levels of obesity with a stable trend in recent years. Meanwhile, the prevalence in eastern regions has dramatically increased. Notably, the overall prevalence of obesity in children has shown a stabilizing trend in recent years. However, the occurrence of obesity-related metabolic diseases increased. The effect of migrants floating into east-coast cities should not be neglected.

CONCLUSIONS

The high prevalence of overweight and obesity among Chinese children and adolescents persists but with varying patterns. Obesity-related metabolic diseases occur more frequently despite a stable trend of obesity. Multiple factors are responsible for the changing prevalence. Thus, comprehensive and flexible policies are needed to effectively manage and prevent the burden of obesity and its related complications.

Body image and behavioural and emotional difficulties in German children and adolescents

BACKGROUND

Behavioural and emotional difficulties might play an important role in the development of body image disturbances, which represent serious risk factors for eating disorders or depression. The present study provides a detailed overview on body image disturbances and several behavioural and emotional difficulties (differences between gender, age, and weight status) and their inter-relations in German children and adolescents.

METHODS

Data on body image disturbances, assessed through a Figure Rating Scale, and on behavioural and emotional difficulties, assessed through Goodman's Strengths and Difficulties Questionnaire (SDQ), were available for 5255 observations of 1982 German children and adolescents aged 8 to 18 years from the LIFE Child study, based in Leipzig, Germany. Associations were investigated using multiple logistic regression. Each association was checked for interaction with gender, age, and weight status.

RESULTS

Boys reported more behavioural difficulties than girls, while girls reported more emotional difficulties. Gender, age and weight status were related to behavioural and emotional difficulties as well as body image disturbances. Individuals with fewer difficulties were more satisfied with their own body. Children and adolescents who desired to be larger showed more prosocial behaviour problems, conduct and emotional problems and more signs of hyperactivity. Those, who desired to be thinner showed more problems in all SDQ-subscales. A more accurate body size perception was associated with fewer behavioural and emotional difficulties. Children and adolescents who overestimated their body size showed more prosocial behaviour and emotional problems. Underestimation one's body size was associated with more signs of hyperactivity.

CONCLUSION

The current findings highlight the importance of raising the awareness about the association between behavioural and emotional difficulties and body image disturbances in children and adolescents to prevent negative outcomes.

Weight self-misperception and obesity-related knowledge, attitudes, lifestyle behaviours and cardio-metabolic markers among Chinese school-aged children and adolescents

OBJECTIVE

The relationships between childhood weight self-misperception and obesity-related factors particularly health markers have not been extensively discussed. This study aims to examine the associations between weight self-misperception and obesity-related knowledge, attitudes, lifestyles and cardio-metabolic markers among Chinese paediatric population.

DESIGN

Cross-sectional study.

SETTING

Data sourced from a national survey in Chinese seven provinces in 2013.

PARTICIPANTS

Children and adolescents aged 5-19 years.

RESULTS

Of the total 14 079 participants, there were 14·5 % and 2·2 % participants over-estimated and under-perceived their weight, respectively. Multi-variable logistic regression was applied to calculate OR and 95 % CI (95 % Cl) of obesity-related behaviours and cardio-metabolic markers by actual and perceived weight status. Individuals who perceived themselves as overweight/obese were more likely to have prolonged screen time, insufficient dairy intake and over sugar-sweetened beverages consumption (all P < 0·05), regardless of their weight. Furthermore, actual overweight/obese individuals had higher odds of abnormal cardio-metabolic markers, but a smaller magnitude of association was found among weight under-estimators. Among non-overweight/obese individuals, weight over-estimation was positively associated with abdominal obesity (OR: 10·49, 95 % CI: 7·45, 14·76), elevated blood pressure (OR: 1·30, 95 % CI: 1·12, 1·51) and dyslipidemia (OR: 1·43, 95 % CI: 1·29, 1·58).

CONCLUSIONS

Weight over-perception was more prevalent than under-estimation, particularly in girls. Weight over-estimators tended to master better knowledge but behave more unhealthily; both weight over-perception and actual overweight/obesity status were associated with poorer cardio-metabolic markers. Future obesity intervention programmes should additionally pay attention to the population with inaccurate estimation of weight who were easily overlooked.

Body Image Perception and Satisfaction of Junior High School Students: Analysis of Possible Determinants

Body image (BI) is a multidimensional construct that refers to one's perceptions of and attitudes toward one's own physical characteristics. Adolescence is a critical developmental stage in which concerns about BI increase. Therefore, the present cross-sectional study aimed to evaluate body image and aesthetic body shape standards in a sample of middle school students living in China. The researchers gathered demographic information, as well as height and weight data, for their study. They used a body silhouette to assess body image perception and body shape aesthetics and calculated two indexes: BIP, which measures the accuracy of self-perception and the estimation of bodily dimensions, and BIS, which indicates the difference between an individual's perceived and ideal body images. A total of 1585 students in three grades at two middle schools were included in the study (759 = female, mean age = 13.67 ± 0.90; 839 = male, mean age = 13.70 ± 0.90). The results showed that the BIP bias rate of middle school students was 55.7%, and the BI dissatisfaction rate was 81.0%. Females tended to overestimate their body shape and desire to be thinner compared to males. Students with a higher BMI grading were more prone to underestimating their body shape and aspiring to be thinner. Furthermore, 8.6% of students chose underweight as the ideal body type for boys, while 22.6% chose underweight as the ideal body type for girls. In conclusion, there are significant gender differences in the aesthetic standards of body shape, and adolescents believe that for women, a thin body shape is beautiful.

Sociodemographic factors associated with weight perception of adolescents: A systematic review and meta-analysis

PURPOSE

To systematically assess the main sociodemographic factors associated with weight perception of adolescents.

METHODOLOGY

All studies related to adolescents' weight perception were retrieved from seven databases from January 2001 to July 2022. A total of 13 Medical Subject Headings (MeSH) and keywords were used to identify qualified studies, and reference lists included in the retrieved studies were manually searched to identify potentially relevant publications. Two evaluators independently assessed the eligibility and extracted data of each study. Agency for Healthcare Research and Quality (AHRQ) risk of bias evaluation tool was used to evaluate the quality and bias risk of included studies. RevMan (version: 5.3) software was used to conduct heterogeneity test and meta-analysis.

RESULTS

A total of 12 studies, published between 2003 and 2020, were selected and included in the systematic review and meta-analysis, consisting of 325,367 adolescents from five countries. The risk of bias evaluation indicated that risk of bias was low in five studies and moderate in seven studies. The results of meta-analysis showed that there were no differences in the weight perception accuracy among adolescents under different gender (odds ratio [OR] = 1.00, 95% confidence interval [CI]: 0.88-1.15, p = 0.940), place of residence (OR = 0.98, 95% CI: 0.83-1.16, p = 0.800), grade (OR = 1.73, 95% CI: 0.68-4.42, p = 0.250), and family economic level (OR = 0.94, 95% CI: 0.86-1.02, p = 0.140). Egger's linear regression showed that there was no significant publication bias in the primary analysis.

CONCLUSIONS

The current analysis indicates that gender, place of residence, grade, and family economic level were not identified as influencing factors for adolescents' weight perception accuracy. Due to the limitations of the review and included studies, more robust trials are warranted in different social and economic environments to confirm our findings.

Relationships of weight perceptions with weight control related behaviors among Chinese children and adolescents: A school-based study in Zhejiang Province

OBJECTIVES

Weight perceptions have been implicated in weight control related behaviors among children and adolescents, yet studies in mainland China are scarce. We examined the associations of self-perceived weight status and weight misperception with weight control related behaviors in Chinese middle and high school students.

METHODS

We used cross-sectional data from the 2017 Zhejiang Youth Risk Behavior Survey which that included 17,359 Chinese students, with 8,616 boys and 8,743 girls. Perceived weight status, as well as height, weight and weight control related behaviors information was collected via a self-reported questionnaire. Odds ratios (ORs) with 95% confidence intervals (CIs) calculated by multinomial logistic regression were used to assess the relationships between weight perceptions and weight control related behaviors.

RESULTS

Among the 17,359 students aged 9 to 18 years, the mean (SD) age was 15.72 (1.64) years. Overall, 34.19% of children and adolescents perceived themselves as overweight and the prevalence of weight misperception was 45.44%, with 35.54% overestimation and 9.90% underestimation. Children and adolescents perceiving themselves as overweight were more likely to have weight control behaviors, with OR was 2.60 (95% CI: 2.39-2.83) for weight control attempt, 2.48 (2.28-2.70) for exercising, 2.85 (2.60-3.11) for dieting, 2.01 (1.51-2.68) for taking laxatives, 2.09 (1.67-2.02) for taking diet pills, and 2.39 (1.94-2.94) for fasting, respectively, compared to those with right weight status. Among children and adolescents with overestimating weight status, the OR was 2.40 (2.22-2.59), 2.50 (2.31-2.70), 2.85 (2.61-3.11), 1.81 (1.39-2.37), 2.20 (1.77-2.74), and 2.16 (1.77-2.63) for weight control attempt, exercising, dieting, taking laxatives, taking diet pills, and fasting, relative to those with accurate weight perception.

CONCLUSIONS

Self-perceived overweight and weight misperception are prevalent in Chinese children and adolescents, and positively associated with weight control related behaviors.

Effects of school-based "We Fit" weight control programme in adolescents

Aim

This study examined the effects of a 12‐week school‐based “We Fit” weight control programme.

Design

A nonequivalent control group was used, with a non‐synchronized pretest–posttest design.

Methods

In total, 109 Korean high school adolescents participated. The programme comprised exergaming, diet diary and counselling, health education, and social networking service‐based group discussions. Anthropometric factors, physiological factors and physical activity (daily steps and sitting time) were measured in the intervention and the control groups before and after the intervention. Programme satisfaction was assessed post‐intervention. Data were analysed using descriptive statistics; the chi‐square, Mann–Whitney U and t tests; and generalized estimating equations.

Results

The intervention group showed a significantly decreased waist circumference, increased skeletal muscle mass, increased high‐density lipoprotein cholesterol, decreased low‐density lipoprotein cholesterol and reduced weekend sitting time.

Conclusion

This study adds to the evidence for the applicability and effectiveness of healthy weight control programmes using exergames for adolescents in school settings.

Lifestyle Clusters and Cardiometabolic Risks in Adolescents: A Chinese School-Based Study Using a Latent Class Analysis Approach

Background: Unhealthy dietary and lifestyle behaviors are associated with a higher prevalence of non-communicable chronic diseases and higher mortality in adults. However, there remains some uncertainty about the magnitude of the associations between lifestyle behaviors and cardiovascular factors in adolescents. Methods: We conducted a school-based cross-sectional study of 895 Chinese adolescents aged 15-19 years. They participated in a questionnaire survey, physical examination, and blood sample collection. Latent class analysis (LCA) was used to identify heterogeneous subgroups of lifestyle behaviors. A set of 12 latent class indicators, which reflected lifestyle behaviors including dietary habits, physical activity, sleep duration, screen time, and pressure perception, were included in the analysis. Logistic regression analysis was performed to determine whether the derived classes were related to a cardiometabolic risk. Results: In total, 13.7 and 5.6% of the participants were overweight and obese, respectively, and 8.4 and 14.1% reported having pre-hypertension and hypertension, respectively. A two-class model provided the best fit with a healthy lifestyle pattern (65.8%) and a sub-healthy lifestyle pattern (34.2%). There were more female participants with a healthy lifestyle (56.2 vs. 43.8%), whereas there were more males with a sub-healthy lifestyle (45.4 vs. 54.6%), (all P = 0.002). Increased risk of cardiometabolic abnormality (BMI categories, blood pressure and lipids) was not significant across lifestyle patterns, except for waist circumference (70.5 vs 69.1 cm, P = 0.044). There was no significant difference in physical activity and intake of fruit and vegetable between the two patterns. Conclusion: Primary prevention based on lifestyle modification should target patterns of behaviors at high risk in adolescents. Due to the complex effect of lifestyle clusters on cardiometabolic risks, well-designed and prospective studies in adolescents are needed in the future.

Systems Nutrology of Adolescents with Divergence between Measured and Perceived Weight Uncovers a Distinctive Profile Defined by Inverse Relationships of Food Consumption

Changes in food consumption, physical inactivity, and other lifestyle habits are potential causes of the obesity epidemic. Paradoxically, the media promotes idealization of a leaner body appearance. Under these circumstances, self-perception of weight by adolescents may be affected. Here, we performed a cross-sectional study, between June and December 2009, to evaluate the interaction between anthropometric status, perceived body weight, and food consumption profiles in 1496 adolescents from public schools in Salvador, Brazil. Data on socio-epidemiological information, anthropometric status, and dietary patterns were analyzed using multidimensional statistical approaches adapted from systems biology. There were dissimilarities between anthropometric status and perception of body weight related to sex. Four dietary patterns were identified based on the food intake profile in the study participants. The distinct dietary patterns were not influenced by divergence between measured and perceived weight. Moreover, network analysis revealed that overestimation of body weight was characterized by a selectivity in ingestion of food groups that resulted in appearance of inverse correlations of consumption. Thus, misperception of body weight is associated with inverse correlations of consumption of certain food groups. These findings may aid individualized nutritional interventions in adolescents who overestimate body weight.