Body-Image and Obesity in Adolescence: A Comparative Study of Social-Demographic, Psychological, and Behavioral Aspects

Neural mechanisms of perceptual and affective body-image disturbance during own-body and ideal-body estimation

Body-image disturbance is a core feature of eating disorders and can predict their development in healthy individuals. There are two components of body-image disturbance: perceptual disturbance (associated with overestimation of body size) and affective disturbance (associated with body dissatisfaction). Previous behavioral studies have hypothesized that attention to particular body parts and negative body-related emotions resulting from social pressure are associated with the respective degrees of perceptual and affective disturbance; however, the neural representations that underlie this hypothesis have not been elucidated. Thus, this study investigated the brain regions and connectivity associated with the degree of body-image disturbance. Specifically, we examined the brain activations associated with participants' estimation of the width of their actual and ideal bodies; we sought to determine which brain regions and functional connectivity from body-related visual processing regions were correlated with the degree of each component of body-image disturbance. The degree of perceptual disturbance was positively correlated with excessive width-dependent brain activations in the left anterior cingulate cortex when estimating one's body size; it was positively correlated with the functional connectivity between the left extrastriate body area and left anterior insula. The degree of affective disturbance was positively correlated with excessive width-dependent brain activation in the right temporoparietal junction and negatively correlated with functional connectivity between the left extrastriate body area and right precuneus when estimating one's ideal body size. These results support the hypothesis that perceptual disturbance is associated with attentional processing, whereas affective disturbance is associated with social processing.

The Interactive Role of Family Functioning among BMI Status, Physical Activity, and High-Fat Food in Adolescents: Evidence from Shanghai, China

Objectives: Family functioning (FF), physical activity (PA), and high-fat food consumption (HF) are associated with adolescents being overweight and obese; however, little is known about their interactions. Therefore, this study aimed to examine how they work jointly on adolescent obesity with BMI as the outcome variable. Methods: A cross-sectional survey utilizing a cluster sampling design was conducted. Multinomial logistic regressions, multiplication interaction (MI), and marginal effects (MEs) were tested. Results: Active PA (non-overweight vs. obesity: OR = 2.260, 95% CI [1.318, 3.874]; overweight vs. obesity: OR = 2.096, 95% CI [1.167, 3.766]), healthy HF (non-overweight vs. obesity: OR = 2.048, 95% CI [1.105, 3.796]) and healthy FF (overweight vs. obesity: OR = 2.084, 95% CI [1.099, 3.952]) reduced obesity risk. Overweight students with healthy FF were less likely to become obese regardless of PA (inactive: OR = 2.181, 95% CI [1.114, 4.272]; active: OR = 3.870, 95% CI [1.719, 8.713]) or HF (unhealthy: OR = 4.615, 95% CI [1.049, 20.306]; healthy: OR = 5.116, 95% CI [1.352, 19.362]). The MEs of inactive PA and unhealthy FF were −0.071, 0.035, and 0.036 for non-overweight, overweight, and obese individuals, respectively (p < 0.05); the MEs of HF and healthy FF individuals were −0.267 and 0.198 for non-overweight and obese individuals, respectively (p < 0.05). Conclusions: Unhealthy FF regulated the influence of inactive PA or unhealthy HF on adolescent obesity, altogether leading to a higher risk of obesity.

Associations between family functioning during early to mid-childhood and weight status in childhood and adolescence: findings from a Quebec birth cohort

BACKGROUND

Impaired family functioning has been associated with obesity in children and adolescents, but few longitudinal studies exist. We examined whether family functioning from early to mid-childhood is associated with overweight and obesity in later childhood and adolescence.

METHODS

We examined data from the Quebec Longitudinal Study of Child Development (QLSCD), a birth cohort (N = 2120), collected between 1998 and 2011. Parent-reported family functioning was assessed at 4 time points between ages 0.5 and 8 years using the McMaster Family Assessment Device with established cut-offs for impaired family functioning. Participants were classified as having experienced: 1) early-childhood impaired functioning, 2) mid-childhood impaired functioning, 3) both early and mid-childhood impaired functioning, or 4) always healthy family functioning. Overweight and obesity were determined at 10- and 13-years using WHO criteria. Covariate adjusted multinomial logistic regressions were fitted to the data to examine associations between longitudinal family functioning groups (using the always healthy functioning as reference category) and the likelihood of having overweight and obesity (vs normal weight) at ages 10 (n = 1251) and 13 years (n = 1226).

RESULTS

In the 10- and 13-year sub-samples, respectively 10.2% and 12.5% of participants had experienced both early and mid-childhood impaired family functioning. Participants in this group had an increased likelihood of having obesity (vs normal weight) at age 10 years [OR = 2.63 (95% CI: 1.36; 5.08)] and at age 13 years [OR = 1.94 (95% CI: 0.99; 3.80] compared to those in the always healthy functioning group. No associations were found for other family functioning categories or for overweight status.

CONCLUSION

Approximately one in ten children experienced impaired family functioning throughout early and mid-childhood. Findings suggest a link between impaired functioning across childhood and the development of obesity at 10 years of age and possibly at 13 years of age.

Family Dynamics and Pediatric Weight Management: Putting the Family into Family-Based Treatment

PURPOSE OF REVIEW

The treatment of pediatric obesity entails working with entire families. However, aside from parenting and family health behaviors, family dynamics and relationships are not often incorporated in clinical treatment of obesity.

RECENT FINDINGS

Evidence across several studies suggest a relationship between family dynamics and child weight, with impaired family dynamics associated with higher weight status in children. Evidence is mixed if child age and family function are associated. Unfortunately, there is little evidence that addressing family dynamics (i.e., relationships and overall family system) will improve weight in children with obesity. Notably, few studies target family dynamics specifically. There are several validated measures of family dynamics available for researchers to explore the family system as it relates to child health and behaviors. A deeper understanding of family dynamics and relationships may provide new avenues to address issues of weight in children; accounting for the family, and their underlying functioning, may benefit the clinician and child engaged in weight management.

A Comparative Analysis of Patients' Quality of Life, Body Image and Self-confidence Before and After Aesthetic Rhinoplasty Surgery

OBJECTIVE

Having desired facial features creates a better mental image, results in increased self-confidence and boosts social activities to a more acceptable level. The goal of the current study is to investigate how rhinoplasty surgery affects patients admitted to Shahrekord surgical clinic.

METHODS

The study was conducted on 100 patients randomly selected and referring for rhinoplasty surgery. The required information was collected through demographic questionnaires of rhinoplasty outcomes F 36 and Rosenberg's self-esteem scale. The questionnaires were filled out by patients before surgery and 3 months after surgery. The data were analyzed using SPSS and data mining software.

FINDINGS

Out of the hundred participants, 63% were female and 37% were male. The number of individuals in the studied groups decreased in older age groups so that most of the participants were in the 20-24-year group followed by 25-30 y/o group. Patients from other age groups were less frequent. In terms of educational attainment, the highest frequency was associated with a BSc and the lowest with a diploma. In terms of employment status, the highest frequency was among students and the unemployed and employees and the self-employed followed. Body image and self-esteem were significantly improved after surgery (p < 0.005). Although not statistically significant, quality of life was improved too after surgery.

CONCLUSION

According to the results of this study, physicians and patients should measure the pros and cons of the surgery before making a treatment decision. It also showed that rhinoplasty leads to an increase in quality of life and self-esteem. Prior to surgery, specialist consultation should be performed, and rhinoplasty should be performed if a specialist physician allows it.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the Online Instructions to Authors www.springer.com/00266.

Is Underweight Associated with more Positive Body Image? Results of a Cross-Sectional Study in Adolescent Girls and Boys

The aim of the study was to investigate the relationship between body image and prevalence of underweight, normal weight, and overweight in adolescents. The study included 1702 girls and 1547 boys, aged 14–16 years, who completed questionnaire assessing body satisfaction. The participants’ BMI status: underweight, normal weight or overweight was determined on the basis of BMI cut-off values. Results revealed that more girls (p < .001) showed low body satisfaction (44.8%) and fewer girls (p < .001) had high body satisfaction (17.6%) compared to boys (28.5% and 29.0%, respectively). A two-way ANOVA revealed a significant interaction between BMI status and gender on body satisfaction F(2, 3243) = 4.10, p = .017, η2 = .003. In boys, body satisfaction was higher in normal weight and underweight in comparison to overweight individuals (p < .001). Underweight girls presented higher body satisfaction than those who were normal weight and overweight (p < .001). Our findings indicated that, in relation to gender, BMI status can be associated with different body satisfaction in adolescents. This should be taken into consideration when designing programs aimed at obesity and disordered eating prevention and body image improvement. Due to the fact that underweight girls and boys have high body satisfaction, this can lead to behaviors that maintain low body weight in adolescents and in turn this may have negative health consequences.

[Self-esteem, body image and depression in adolescents with different nutritional conditions]

OBJECTIVE

To investigate self-esteem, body image and depression in adolescents under different nutritional conditions. The study included 418 adolescents (14-18 years old).

METHODOLOGY

Four questionnaires were administered: Characterization; Child Depression Inventory; Self-esteem Scale, and Body Image Questionnaire. The nutritional conditions were classified using the Body Mass Index (BMI).

RESULTS

Boys had a higher prevalence of overweight or obesity, a lower depression and body dissatisfaction rate, and higher self-esteem than girls (p<0.001). Depression was negatively related to self-esteem (p<0.01), which also had a negative association with body dissatisfaction (p<0.01). Even though adolescents with superior nutritional conditions were more dissatisfied (p<0.001), the BMI was related to body dissatisfaction only in girls (p<0.01). Regarding the relation between depression and body dissatisfaction, it was negative for boys (p<0.01), but positive for girls (p<0.01).

CONCLUSION

Overweight or obese adolescents have higher body dissatisfaction. Depression and self-esteem are related to body image, and not to BMI, demonstrating that the subjectivity of adolescents must be assessed. The differences identified between boys and girls for these relations must be further investigated.

Family functioning and quality of parent-adolescent relationship: cross-sectional associations with adolescent weight-related behaviors and weight status

BACKGROUND

Little is known about how factors within the general family environment are associated with weight and related behaviors among adolescents/young adults.

METHODS

We studied 3768 females and 2614 males, 14-24 years old in 2011, participating in the Growing Up Today Study 2. We used generalized mixed models to examine cross-sectional associations of family functioning and quality of mother- and father-adolescent relationship with adolescent/young adult weight status, disordered eating, intake of fast food and sugar-sweetened beverages, screen time, physical activity, and sleep duration. In all models, we included participant's age and family structure.

RESULTS

Eighty percent of participants reported high family functioning and 60% and 50% of participants reported high-quality mother and father relationship, respectively. Among both males and females, high family functioning was associated with lower odds of disordered eating (adjusted odds ratio [AOR] females = 0.53; 95% Confidence Interval [CI] = 0.45-0.63; AOR males = 0.48; CI = 0.39-0.60), insufficient physical activity, i.e., less than 1 h/day, (AOR females = 0.74; CI = 0.61-0.89; AOR males = 0.73; CI = 0.58-0.92), and insufficient sleep, i.e., less than 7 h/day, (AOR females = 0.56; CI = 0.45-0.68; AOR males = 0.65; CI 0.5-0.85). High family functioning was also associated with lower odds of being overweight/obese (AOR = 0.73; CI = 0.60-0.88) and eating fast food one or more times/week (AOR = 0.74; CI = 0.61-0.89) among females only. Among females, high-quality mother and father relationship were both associated with lower odds of being overweight/obese and disordered eating, eating fast food, and insufficient sleep and the magnitude of associations were similar for mother and father relationship quality (AOR range 0.61-0.84). Among males, high-quality mother and father relationship were both associated with lower odds of disordered eating, insufficient physical activity and insufficient sleep, but only father relationship quality was associated with lower odds of overweight/obesity.

CONCLUSIONS

Adolescents/young adults reporting high family functioning and more positive relationships with their parents reported better weight-related behaviors. For weight status, females appear to be affected equally by the quality of their relationship with both parents, whereas males may be more affected by their relationship with fathers.

Fitness Intention and Its Relationship With Eating Attitudes: A Cross-Sectional Study of Iranian Female Medical College Students

Background

Fitness is a very important goal among young adults that may lead to eating disorders.

Objectives

The aim of this study was to identify the factors influencing fitness intention based on the theory of planned behavior (TPB) and its relationship to eating attitudes.

Materials and Methods

A cross-sectional study was conducted among 231 female college students during the winter of 2012. Participants were randomly selected in proportion to their distribution among the different faculties at Hamadan University of Medical Sciences. A structured questionnaire was applied for collecting data and data was analyzed by SPSS version 21 using a T-test, ANOVA, bivariate correlations, and linear regression at a 95% significant level.

Results

Nearly 21.6% of the participants had abnormal eating attitudes. The TPB variables accounted for 40% of the variation in fitness intention. Bivariate correlations indicated a positive correlation between fitness intention and eating attitude (r = 0.417, P < 0.05).

Conclusions

Based on our results, it seems that designing and implementing educational programs to reduce positive attitudes and encourage subjective norms toward fitness may be useful for preventing abnormal eating attitudes.

The relationship between family functioning and child and adolescent overweight and obesity: a systematic review

There is mounting evidence that family functioning is linked to childhood overweight and obesity, and that both of these are associated with health-related behaviours and adverse health outcomes in children and adolescents. This paper systematically examines the peer-reviewed evidence regarding the relationship between child and adolescent overweight and obesity and family functioning. Peer-reviewed literature published between 1990 and 2011 hosted in Scopus, Pub Med or Psyc INFO were searched, in addition to the reference lists of included papers. Twenty-one studies met the selection criteria. Of the 17 identified cross-sectional and longitudinal studies, 12 reported significant associations between family functioning and childhood overweight and obesity. The instruments used to measure family functioning in the identified studies were heterogeneous. Poor family functioning was associated with increased risk of obesity and overweight in children and adolescents, and obese children and adolescents were more likely to come from families with poor family functioning. Aspects of family functioning which were associated with increased risk of child and adolescent obesity included poor communication, poor behaviour control, high levels of family conflict and low family hierarchy values. Half (2/4) of the identified intervention studies showed a significant relationship between family functioning and changes in child weight. The results demonstrate that family functioning is linked to obesity; however, higher level evidence and greater understanding of the mechanisms behind this relationship are required. The results indicate a need for a standardised family functioning measure applicable across populations. The results provide evidence of the value of considering family functioning in childhood obesity research and intervention.

Effectiveness of rhythmic movement therapy for disordered eating behaviors and obesity

The aims of the present study were: a) to examine associations between pre-treatment BMI, body dissatisfaction, perfectionism, alexithymia, and restraint, emotional and external eating behaviour in obese patients; b) to analyze the impact of the pre-treatment measures in psychological variables on the outcome of cognitive-behavioral therapy (CBT) program; c) to test the effectiveness of rhythmic movement therapy (RMT) in the treatment of disordered eating behaviors and obesity with the CBT non-responders. At the first stage of treatment a total of 104 patients (32 males and 72 females, mean age was 37.6 +/- 6.7 years) self-referred or referred by professionals to CBT weight management program were selected at random. At the second stage 58 obese CBT-non-responders were randomly divided among the continuing CBT individual treatment group and RMT group. Control group was included. Results revealed that: a) significant associations existed between pre-treatment BMI, external eating and two dimensions of perfectionism, as well as between emotional and external eating and all dimensions of perfectionism, alexithymia and body image dissatisfaction; b) pre-treatment means of psychological variables significantly impacted the CBT program outcome; c). the efficacy of RMT approach for weight reduction as well as for the improvement of psychological status for CBT-non-responders was confirmed.

Body change techniques in Iranian adolescents. Relationship to sex and body weight status

OBJECTIVE

Several studies indicated that techniques to change body weight and appearance were prevalent and different among adolescents. The aim of the study, therefore, was to assess differences in frequency and type of body change techniques used among adolescents by sex and body weight status.

METHODS

A sample of 758 adolescents aged 12-18 years were recruited from private and public schools in Tehran. Information about socio-demographic background and body change techniques were collected via a self-administered questionnaire.

RESULTS

A high percentage of adolescents used body change techniques frequently to alter their body appearance. Girls changed normal eating pattern significantly (p=0.007) to lose weight more frequently than boys while boys used this method significantly (p=0.01) to gain weight more frequently than girls. Overweight/obese adolescents exercised significantly to change muscle size (p=0.03) and changed normal diet to lose weight (p<0.001) more frequently than normal weight adolescents. The relation between sex and body weight status with body change techniques (p<0.0) implied that male and female adolescents especially overweight/obese adolescents were frequently trying to change their body appearance.

CONCLUSION

Significant differences existed in using body change techniques according to sex and body weight status and these should be considered in obesity prevention programs for adolescents.