Underestimation of weight and its associated factors in overweight and obese university students from 21 low, middle and emerging economy countries

Knowledge, perceptions and practices towards diabetes risk in sub-Saharan Africa: a mixed-methods scoping review

OBJECTIVE

To synthesise current evidence on knowledge, perceptions and practices towards type 2 diabetes risk in sub-Saharan Africa.

DESIGN

Mixed-methods scoping review, which included 101 studies (seventy-three quantitative, twenty qualitative and eight mixed methods) from seven electronic databases.

SETTING

Sub-Saharan Africa, 2000-2023.

PARTICIPANTS

Men and women without diabetes with mean ages ranging from 20 to 63 years.

RESULTS

The majority of participants in most studies knew the three main diabetes modifiable risk factors - excess weight, unhealthy diet and physical inactivity. However, most people with excess weight in almost all studies underestimated their weight. Further, the self-described ideal body weight was between midpoint of normal weight and the upper limits of overweight in most quantitative studies and was described as not too skinny but not too fat in qualitative studies. In the majority of studies, participants reported low engagement in weight control, high regular sugar intake, and low regular fruit and vegetable intake but moderate to high engagement in physical activity. Barriers to reducing diabetes risk were social (e.g. societal perceptions promoting weight gain) and environmental (e.g. limited affordability of healthy foods, high accessibility of Western diets and lack of physical activity facilities).

CONCLUSION

There is a need for multicomponent type 2 diabetes prevention interventions that increase knowledge of identifying diabetes risk (e.g. what constitutes excess weight) and create social and physical environments that support healthy lifestyles (e.g. societal perceptions that promote healthy living, increased availability and affordability of healthy foods and physical activity facilities).

Income or educational attainment: which is more effective in the fight against overweight? Evidence from Spain and Andalusia

Considered the epidemic of the 21st century by the WHO, obesity is a global problem that is on the rise and will continue to increase in the coming years. Spain and Andalusia, in particular, are no exception to this pathology, which has tripled since the 1970s, representing a public health challenge. The aim of this study is to analyse the socioeconomic determinants of this pathology, with special emphasis on answering the question of what has a greater influence on overweight, education level, or income. For this purpose, we have used the European Survey of Health in Spain (ESHS-2020), a microdata base, with a total of 22,072 valid individual observations (of which 2,820 belong to the Andalusian population). Results we obtain in our estimations of qualitative response models reveal that, although both income and educational attainment could be effective in the fight against overweight, the social gradient of this health problem is greater with respect to educational attainment. Additionally, there are many other variables and other factors related to the individual's overweight (mental health, subjective state of health, oral health, among others) which are much less explored and which must be considered in health policies to combat this disease.

The effectiveness of an online video-based group schema therapy in improvement of the cognitive emotion regulation strategies in women who have undergone bariatric surgery

BACKGROUND

Adaptive cognitive emotion regulation (CER) strategies toward eating play a very important role in obesity and according to schema therapy, patients with obesity learn that don't respond to their emotional stimuli by eating. Thus, this study aimed to evaluate the effectiveness of an online video-based group schema therapy in improvement of the CER strategies and body mass index (BMI) in women who had undergone bariatric surgery.

METHODS

Forty women who had undergone sleeve gastrectomy were selected and randomly divided into two groups of control and experimental. The experimental group received 10 weekly 90-min sessions of group schema therapy, the control group did not receive any intervention at all. Both groups completed the CER strategies questionnaire during pre-test, post-test and follow-up stages, and the data were analyzed using a multivariate analysis of covariance (MANCOVA) through SPSS software (version 20).

RESULTS

Our results indicated that the experimental group demonstrated significantly higher adaptive CER strategies (P = 0.0001, F = 31.15) and significantly lower maladaptive CER strategies (P = 0.001, F = 9.42), significantly lower BMI (P = 0.001, F = 23.48), as compared to the control condition, following the group schema therapy after the follow-up stage.

CONCLUSION

The findings demonstrated that group schema therapy could lead to an increases in adaptive CER strategies and a decrease in maladaptive CER strategies and BMI in women who had undergone bariatric surgery.

TRIAL REGISTRATION

IRCT, IRCT20180523039802N2. Registered 5 August 2020, http://www.irct.com/IRCT20180523039802N2 .

Mediterranean Diet, a Posteriori Dietary Patterns, Time-Related Meal Patterns and Adiposity: Results from a Cross-Sectional Study in University Students

The transition to university is connected to potentially obesogenic dietary changes. Our aim was to assess the relation of Mediterranean diet adherence, and a posteriori dietary and meal patterns with adiposity in Greek students at the University of the Peloponnese. A total of 346 students (269 women) participated. Anthropometry was performed, and a food frequency questionnaire was administered. The MedDietScore was higher in women and was not linearly related to adiposity. Principal component analysis revealed six patterns: (1) legumes/vegetables/fruits/tea/dairy/whole grains, (2) juice/sodas/liquid calories, (3) olive oil/fats, (4) meat/poultry/fish, (5) alcohol/eggs/dairy and (6) fast foods/sweets. Patterns 4 and 6 were related to overweight/obesity probability (OR = 1.5, 95% CI: 0.995-2.538 and OR = 2.5, 95% CI: 1.07-6.06, respectively) and higher waist circumference (men). Men "early eaters" (breakfast/morning/afternoon snack) had a higher MedDietScore and lower overweight probability (OR = 0.47, 95% CI: 0.220-1.020). Poor meal and dietary patterns relate to overweight and central obesity, which is important for targeted health promotion programs.

Perceptions of body weight that vary by body mass index: Clear associations with perceptions based on personal control and responsibility

This project aimed to identify the perceptions of body weight that vary by body mass index. First, a qualitative study explored body weight perceptions in 17 individuals with overweight. Second, a questionnaire was developed and completed by a UK sample with body mass index from 16.6 to 59.7 kg/m2 (N = 328). A higher body mass index was associated with perceptions of less personal control and responsibility. Body mass index in females was also associated with three other questionnaire factors and body mass index in males with illness/medication. Thus, body mass index was associated with different perceptions of body weight. Focussing on personal control and responsibility may be useful for treatment and prevention.

Underestimation of Overweight and Health Beneficial Outcomes in Two Adolescent Cohorts in Norway - The HUNT Study

PURPOSE

Underestimating overweight may prevent efforts toward reducing weight, but simultaneously benefit mental health and well-being. The magnitude of underestimation of overweight and obesity in adolescents is largely unknown, and so is to what extent this underestimation is associated with dieting behaviors, mental distress, and life satisfaction. As overweight has become more common during the past decades, associations between body size underestimation and mental health may have changed.

METHODS

Overweight (iso-body mass index, iso-BMI ≥25) adolescents (aged 13-19 years) who participated in The Young-HUNT1 (1995-97, n = 1,338) or The Young-HUNT3 (2006-08, n = 1,833) surveys were included. Being overweight, but perceiving oneself as average-weighted or underweighted was defined as underestimation. Results were based on clinical examinations and self-report questionnaires. Multivariable logistic regression models were used to examine associations between body size underestimation, dieting behaviors, and symptoms of anxiety, depression, and life satisfaction.

RESULTS

Among adolescents with overweight and obesity (iso-BMI ≥25), the prevalence of obesity (iso-BMI ≥30), body size underestimation, and having symptoms of anxiety and depression had increased from the first survey to the next. At both time points, body size underestimation was more common among boys than girls. In 2006-08, body size underestimation was negatively associated with symptoms of anxiety and depression in both sexes, and overall associated with higher life satisfaction equally over time. Dieting behavior was negatively associated with underestimation of body size.

CONCLUSIONS

Body size underestimation in adolescents with overweight/obesity has become more prevalent and a phenomenon associated with less dieting, better life satisfaction and mental health in both boys and girls.

Comparison of Perceived and Measured Body Composition in a Military Population: An Exploratory Study

INTRODUCTION

Weight status perception (WSP) is the subjective assessment of one's own body weight. It is not correlated with the body mass index (BMI). People practicing sports, including overweight people, tend to perceive themselves as normal weight. The military is in a paradoxical position between the need to gain muscle mass for professional purposes while respecting BMI standards. Using body composition might be more advantageous than using BMI as part of an individual approach in making a decision about fitness to serve. However, measuring body composition is not easy in current practice, and a bridge between WSP and body composition would make it possible to develop a simple assessment tool.

MATERIALS AND METHODS

This was a prospective, descriptive, cross-sectional study. We collected sociodemographic data, anthropometric data, and WSP.

RESULTS

Thirty-eight subjects were included. Among them, 71.1% were male. Mean age was 31.2 years (SD 8.9). The BMI was greater than 25 for 15 (39.5%) subjects. Twenty-four (63.2%) defined themselves as being overweight. Thirteen were overweight according to fat percentage (Fat%). A significant association (P = .008) was found between WSP and Fat%.

CONCLUSION

We were able to show a statistically significant association between WSP and Fat%. Such an association may be of great interest because the measurement of the Fat%, whatever the method used, is not easy in current practice. A replication of the study in the general population would be of great interest, especially since Fat% is closely associated with the incidence of cardiovascular diseases and many cancers.

Self-estimated BMI, but not self-perceived body size, accurately identifies unhealthy weight in US adults

BACKGROUND

Self-perceptions of health and disease can be a major driver of health behaviors. Improving accuracy of self-ascertainment of obesity may prompt uptake of weight-control behaviors in those with obesity.

METHODS

We assess performance of self-perceived body size ('too small', 'about right' or 'too large'), self-estimated BMI in kg/m², and sociodemographics in detecting measured BMI category (under-, normal-, overweight and obese; BMI cutpoints 18.5, 25 and 30) in first bivariate and then multivariable models.

RESULTS

Of 37,281 adults in the US from NHANES, 2, 34, 33 and 32% were under-, normal-, overweight and obese. Respectively 56, 73, 60 and 91% self-perceived as 'too small', 'about right', 'too large' and 'too large.' Of those who self-perceived as 'too small', 22% were underweight and 10% were overweight or obese. 99.7% of obese participants self-estimated a BMI in the overweight/obese range, including many who did not self-perceive as 'too large'. Among obese participants, self-perception as either 'about right' or 'too small' was more likely for those who were younger (OR for perception as 'too large' 1.01 per year, 95% confidence interval 1.00-1.01) male (OR 0.33, (0.28-0.39)) nonwhite (ORs 0.36-0.79 for different ethnicities), low-income (ORs 0.61 and 1.8 for the lowest and highest of six categories, vs. the third) or measured recently (OR 0.98 (0.96-1.0) per year since 1999). Misperception was less common, but still existed, for participants with moderate or severe obesity (ORs 2.9 (2.3-3.5) and 7.9 (5.4-12), vs. 'mild.') (all p < 0.01.) CONCLUSIONS: A tenth of adults in the US with obesity, especially those from overweight peer groups, self-perceive as normal or underweight and thus may not be motivated to control their weight. However, virtually all self-estimate an overweight or obese BMI. If measured BMI is not available, self-estimates are sufficiently accurate that interventions may rely on it to identify obesity.

Correlates of over- or under-estimation of body size among resource-poor urban dwellers in a sub-Saharan African city

BACKGROUND

Individual perception of body size has implications for lifestyle behaviours including dietary habits and weight management practices.

AIM

To examine factors related to respondents' estimation of their body sizes compared to their body mass index (BMI).

SUBJECTS AND METHODS

This cross-sectional survey comprised a sample of 917 adults in urban poor Accra, Ghana. Silhouette figure ratings were used to assess perceived body size and ideal body size at a community level. Logistic regression analysis was used to determine correlates of respondents overestimating or underestimating their body sizes.

RESULTS

Approximately, 69% of respondents either underestimated or overestimated their body sizes. About a quarter of respondents perceived being overweight as the preferred ideal body size in their communities. The mean BMI of females and males who underestimated their body sizes were within the overweight category and normal weight category, respectively. Gender, educational level, employment status, the community of residence, and ethnicity were associated with how respondents correctly estimated, over- or under-estimated their body sizes. There was evidence of ethnicity mediating the association between the community of residence and body size estimation.

CONCLUSION

Weight management interventions must be mindful of the socio-demographic and cultural proclivities of the targeted populace for optimum impact.

Lifestyle and risk behaviors for chronic noncommunicable diseases among healthcare undergraduates in Midwest, Brazil

This study aimed to assess the lifestyle of undergraduate university students, and to investigate the prevalence of risk behaviors for chronic noncommunicable diseases. This cross-sectional study took place in Brasilia, with 2.163 healthcare undergraduates. We used a self-administered questionnaire for demographic variables, social class, behavioral data, self-perception of health and self-reported diseases. Given a total of 2.163 students, 69.3% were female, 65.4% were 20-29 years, men smoked more cigarettes (p < 0.01) and used more alcohol than women. We found significant differences in the consumption of beans (p < 0.04) and full-fat milk (p < 0.01) between females and males. Women also had more sedentary lifestyles (p < 0.01) and showed higher prevalences of overweight (33.8%) and obesity (5.0%). Students who did not engage in physical activity were more morbidities, overweight (p = 0.03), consumed more soft drinks (p < 0.01) and meat with excess fat (p = 0.01). University students were found to have unhealthy lifestyles. There is an urgent need for both a formulation and implementation of public health policies to promote health and improve student quality of life (QoL).

Relationship between body weight perception and weight-related behaviours

Objectives

This study aimed to examine the prevalence of weight misperception and to explore the association of weight perception with physical activity and dietary intake.

Methods

A population-based, nationally representative cross-sectional survey was conducted of 920 Thai adolescents aged 13 to 24 years. Respondents were selected using stratified multistage sampling. Respondents who agreed to participate were asked to complete the Youth Risk Behavior Questionnaire.

Results

Females were more likely than males to misperceive themselves as overweight (21.8% vs. 11.7%), whereas males were more likely than females to misperceive themselves as underweight (12.3% vs. 3.4%). Males were more likely than females to report a high intake of vegetables (45.7% vs. 38.0%), milk (39.1% vs. 38.0%), 100% fruit juice (20.9% vs. 17.7%) and soda or pop (38.5% vs. 20.6%). Males were also more likely than females to report vigorous physical activity of more than 60 minutes per day (38.1% vs. 21.3%) and vigorous exercise to strengthen or tone muscles (37.3% vs. 13.2%).

Conclusions

Gender differences in dietary intake and physical activity were identified. However, there were no significant differences in dietary intake and physical activity between adolescents who correctly perceived themselves as overweight and those who misperceived themselves as overweight.

Body weight misperception and health-related factors among Iranian children and adolescents: the CASPIAN-V study

BACKGROUND

Along with increased prevalence of obesity, body weight misperception has also increased among adolescents. This study aims to evaluate the proportion of weight misperception among Iranian children and adolescents and its association with some health-related factors.

METHODS

Data were collected from 14,440 Iranian students, aged 7-18 years, who participated in the national school-based surveillance program (CASPIAN-V). The students' anthropometric indices and blood pressure were measured using standardized methods, and valid questionnaires were used to assess their weight perception, eating patterns, physical activity and sedentary behaviors. According to agreements between the real weight and self-perceived weight status, participants were classified as underestimated, accurate and overestimated weight.

RESULTS

The rates of underestimated, accurate and overestimated weight were 30.8%, 40.8% and 28.4%, respectively. In comparison with the accurate-weight group, both the underestimated- and overestimated-weight groups were less likely to have daily consumption of sugar-sweetened beverages (OR: 0.83, 95% CI: 0.74-0.93 and OR: 0.39, 95% CI: 0.34-0.44, respectively), sweets (OR: 0.81, 95% CI: 0.73-0.90 and OR: 0.68, 95% CI: 0.61-0.76, respectively) and salty snacks (OR: 0.78, 95% CI: 0.66-0.92 and OR: 0.30, 95% CI: 0.24-0.38, respectively). In the overestimated-weight group, the odds of daily intake of fast food decreased by 67% and the odds of low physical activity declined by 38% in comparison with the accurate-weight group.

CONCLUSIONS

Weight misperception had a high prevalence among Iranian children and adolescents and is associated with their dietary patterns and physical activity behaviors. Suitable education programs need to be developed to correct the children and adolescents' insight about their weight status.

"Safe Foods" or "Fear Foods": the implications of food avoidance in college students from low- and middle-income countries

PURPOSE

The primary objective of this study was to explore if self-reported food avoidance (fats, carbohydrates and protein) exists among college students in low- and middle-income countries (LMICs) and its relationship with body mass index (BMI), dieting, mood/anxiety symptoms, physical activities and general health knowledge.

METHODS

This study is a subset (N = 6096) of a larger 26 LMICs cross-sectional survey, which consisted of 21,007 college students. We ascertained socio-demographic information, food avoidance, physical activities, dieting behaviours, depressive and PTSD symptoms, and recorded anthropometric measurements. Chi-square analyses assessed the relationship between predictor variables and food categories eliminated from participants' diet. Multiple logistic regression assessed if food avoidance predicts outcome variables such as binge drinking, high physical activity, being underweight, exhibiting significant depressive and PTSD symptoms.

RESULTS

Food avoidance exists in as many as one-third of college students in low- and middle-income countries, with this being more likely in persons who are trying to lose weight whether by dieting or otherwise. Food avoidance was associated with higher BMI, depressive symptoms, and high intensity exercises, as well as the level of health knowledge influencing the types of food avoided. A significant difference was noted between lower middle-income and upper middle-income countries with respect to the foods they avoided.

CONCLUSION

Despite being knowledgeable about health-related behaviours, we found that college students in our sample were not that different from those in developed countries and may be influenced by a similar advice given by non-experts about macronutrients. These results hold implications for intervention programmes and policy makers.

LEVEL OF EVIDENCE

Level V, descriptive cross-sectional survey.

Weight-loss strategies of South African female university students and comparison of weight management-related characteristics between dieters and non-dieters

Background

Female university students are at risk for weight gain and use of inappropriate weight-loss strategies. By gaining a greater understanding of the weight-loss strategies used by and weight management related characteristics of these students, effective weight management interventions for this vulnerable group can be developed.

Methods

Two hundred and fifty female students from South Africa universities, aged 18–25 years, participated in this cross-sectional study; 162 attempted weight loss during the year preceding the study (dieters) and 88 were non-dieters. Weight and height were measured and BMI (kg/m²) computed. A self-administered questionnaire was used to record all other variables. Weight loss strategies were described for dieters and compared between BMI groups within the dieters group. Weight management related characteristics were compared between dieters and non-dieters. Statistical tests included Pearson Chi-square test, independent samples t-test or Mann-Whitney U test (depending on distribution of the data). Predictors for a higher BMI and being overweight/obese (BMI ≥25 kg/m²) were identified using regression models.

Results

Healthy weight-loss strategies included increased exercise and fruit/vegetable intake and decreased intake of sugar and fat containing items; unhealthy methods included eating little food and skipping meals; and extreme weight loss strategies included laxatives and vomiting. The most commonly used weight-loss product was Herbex. Dieters were characterized by a higher BMI, overestimation of their weight (especially normal weight students), dissatisfaction with weight and select body parts, higher intake of breakfast and healthy foods, lower intake of unhealthy foods, higher levels of vigorous physical activity, higher use of select informal weight-loss information sources and experiencing more pressure to lose weight from mothers, siblings and friends. Predictors of higher BMI and/or increased risk for BMI ≥25 included weight-loss attempt during the past year, race, dissatisfaction with waist, perception of currently being “chubby,” and higher frequencies of intake of a snack and fatty foods.

Conclusion

Attempting weight-loss is common among female students and predicts BMI. Healthy (mainly), unhealthy and extreme weight loss methods are used. Dieters are characterized by a less realistic body image, lower body satisfaction, higher pressure to lose weight, use of informal weight-management information and a healthier life-style.