Rural urban differences in weight, body image, and dieting behavior among adolescent Egyptian schoolgirls

Body image as a global mental health concern

Body image concerns related to weight or other dimensions of appearance are now prevalent on a global scale. This paper reviews the theoretical frameworks that account for the global similarities and regional differences in rates and presentation of body image concerns, as well as reviewing the extant data. Given the harmful consequences of body image concerns in terms of mental and physical health, their global burden is high. Interventions to mitigate these concerns at the individual and systemic level are warranted.

Sex and Rural/Urban Centre Location as Determinants of Body Image Self-Perception in Preschoolers

Body image and self-perception are highly related to psychological health and social well-being throughout the lifespan. Body image problems can lead to pathologies affecting the quality of life. Thus, it is essential to analyse perceived self-image from an early stage. This study aimed to assess body image and dissatisfaction in preschoolers, analyzing possible differences depending on sex (boy/girl) and school location (rural/urban). The sample consisted of 304 preschoolers from Extremadura (Spain) between three and six years of age. The Mann-Whitney U test was used to evaluate the differences in scores according to sex and centre location. The results showed significant differences in the body shape perception depending on the student's sex, with females showing higher scores in their Body Mass Index (BMI). However, females showed greater body dissatisfaction than their male counterparts, with greater disagreement between their perceived and desired figures. Actions and programmes to promote children's healthy body image need to be implemented with consideration for differences between the sexes.

Global Trends in the Availability of Dietary Data in Low and Middle-Income Countries

Individual-level quantitative dietary data can provide suitably disaggregated information to identify the needs of all population sub-groups, which can in turn inform agricultural, nutrition, food safety, and environmental policies and programs. The purpose of this discussion paper is to provide an overview of dietary surveys conducted in low- and middle-income countries (LMICs) from 1980 to 2019, analyzing their key characteristics to understand the trends in dietary data collection across time. The present study analyzes the information gathered by the Food and Agriculture Organization of the United Nations/World Health Organization Global Individual Food consumption data Tool (FAO/WHO GIFT). FAO/WHO GIFT is a growing repository of individual-level dietary data and contains information about dietary surveys from around the world, collected through published survey results, literature reviews, and direct contact with data owners. The analysis indicates an important increase in the number of dietary surveys conducted in LMICs in the past four decades and a notable increase in the number of national dietary surveys. It is hoped that this trend continues, together with associated efforts to validate and standardize the dietary methods used. The regular implementation of dietary surveys in LMICs is key to support evidence-based policies for improved nutrition.

Body size preferences for women and adolescent girls living in Africa: a mixed-methods systematic review

OBJECTIVE

To synthesise evidence on body size preferences for females living in Africa and the factors influencing these.

DESIGN

Mixed-methods systematic review including searches on Medline, CINHAL, ASSIA, Web of Science and PsycINFO (PROSPERO CRD42015020509). A sequential-explanatory approach was used to integrate quantitative and qualitative findings.

SETTING

Urban and rural Africa.

PARTICIPANTS

Studies of both sexes providing data on body size preferences for adolescent girls and women aged ≥10 years.

RESULTS

Seventy-three articles from twenty-one countries were included: fifty quantitative, fifteen qualitative and eight mixed methods. Most studies reported a preference for normal or overweight body sizes. Some studies of adolescent girls/young women indicated a preference for underweight. Factors influencing preferences for large(r) body sizes included: socio-demographic (e.g. education, rural residency), health-related (e.g. current BMI, pubertal status), psycho-social (e.g. avoiding HIV stigma) and socio-cultural factors (e.g. spouse's preference, social standing, cultural norms). Factors influencing preferences for slim(mer) body sizes included: socio-demographic (e.g. higher socioeconomic status, urban residency, younger age), health-related (e.g. health knowledge, being nulliparous), psycho-social (e.g. appearance, body size perception as overweight/obese) and socio-cultural factors (e.g. peer pressure, media).

CONCLUSIONS

Preference for overweight (not obese) body sizes among some African females means that interventions need to account for the array of factors that maintain these preferences. The widespread preference for normal weight is positive in public health terms, but the valorisation of underweight in adolescent girls/young women may lead to an increase in body dissatisfaction. Emphasis needs to be placed on education to prevent all forms of malnutrition.

Overweight and obesity in Eastern Morocco: Prevalence and associated risk factors among high school students

BACKGROUND

Overweight and obesity in children and adolescents have become a major public health problem affecting most countries worldwide. The purpose of the study was to assess the prevalence and risk factors of overweight and obesity among public high school students in Eastern Morocco.

METHODS

A cross-sectional survey was conducted between February and May 2014 among a sample of 2271 students (1086 girls and 1185 boys). References from the International Obesity Task Force (IOTF) were used to determine the prevalence of overweight and obesity.

RESULTS

The prevalence of overweight and obesity reached 12.2% (14.2% in girls vs 10.4% in boys, P<0.01) and 3.0% (3.1% in girls vs 2.8% in boys), respectively. Risk factors associated with overweight and obesity were urban residence (OR=1.76; [1.18-2.63]; P<0.01), father's income≥5000MAD (OR=1.32; [1.02-1.70]; P<0.05), father's overweight (including obesity) (OR=1.87; [1.38-2.54]; P<0.001) and female sex (OR=1.31; [1.02-1.68]; P<0.05).

CONCLUSION

The prevalence of overweight/obesity has reached an alarming rate among high school students in the Eastern region of Morocco. The findings of the present study suggest an urgent need to set up a strategy to prevent and combat this epidemic.

Body Image Satisfaction, Eating Attitudes and Perceptions of Female Body Silhouettes in Rural South African Adolescents

This study aims to examine the associations between BMI, disordered eating attitude, body dissatisfaction in female adolescents, and descriptive attributes assigned to silhouettes of varying sizes in male and female adolescents, aged 11 to 15, in rural South Africa. Height and weight were measured to determine BMI. Age and sex-specific cut-offs for underweight and overweight/obesity were determined using the International Obesity Task Force cut-offs. Body image satisfaction using Feel-Ideal Discrepancy (FID) scores, Eating Attitudes Test-26 (EAT-26), and perceptual female silhouettes were collected through self-administered questionnaires in 385 adolescents from the Agincourt Health and Socio-Demographic Surveillance System (HSDSS). Participants self-reported their Tanner pubertal stage and were classified as early pubertal (< = Tanner stage 2), and mid to post pubertal (Tanner stage > 2). Mid to post pubertal boys and girls were significantly heavier, taller, and had higher BMI values than their early pubertal counterparts (all p<0.001). The prevalence of overweight and obesity was higher in the girls than the boys in both pubertal stages. The majority (83.5%) of the girls demonstrated body dissatisfaction (a desire to be thinner or fatter). The girls who wanted to be fatter had a significantly higher BMI than the girls who wanted to be thinner (p<0.001). There were no differences in EAT-26 scores between pubertal groups, within the same sex, and between boys and girls within the two pubertal groups. The majority of the boys and the girls in both pubertal groups perceived the underweight silhouettes to be “unhappy” and “weak” and the majority of girls in both pubertal groups perceived the normal silhouettes to be the “best”. These findings suggest a need for policy intervention that will address a healthy body size among South African adolescents.

Obesity and physical activity in children of immigrants

Childhood overweight and obesity have increased in recent decades, reaching alarming proportions. Children with a migrant background seem to be particularly at risk of developing overweight and obesity. This article provides an overview of the prevalence of overweight or obesity among North African (NA) children living in their own countries or as immigrants in Europe. The aim is to show the effect of the migration process on this trend and to discuss its possible contributing factors. Publications were identified by a systematic search of PubMed and the existing literature. Original longitudinal or cross-sectional studies on the prevalence of childhood and adolescent overweight and obesity and of physical activity among ethnic groups from North Africa compared with the native population were reviewed. The results confirmed that children of NA origin in Europe have higher levels of overweight and obesity than the native ones, especially girls. However, this trend can also be detected in urban areas of NA countries. Important factors contributing to the increase of overweight and obesity among children and adolescents are discussed, in particular the westernization of eating habits, the level of physical activity and body image perception. The review shows that factors linked to acculturation in the host society and others maintained from the country of origin come into play in determining childhood overweight and obesity among NA immigrants in Europe. The importance of health promotion targeting the groups most at risk of childhood overweight and obesity, i.e. aspects of a healthy diet and the benefits of physical activity, is underlined.

Changes in eating attitudes, body esteem and weight control behaviours during adolescence in a South African cohort

Failure to consume an adequate diet or over consumption during adolescence can disrupt normal growth and development, resulting in undesirable weight change. This leads to an increase in unhealthy weight control practices related to eating and exercise among both adolescent girls and boys to meet the societal 'ideal' body shape. This study therefore aims to examine the longitudinal changes in eating attitudes, body-esteem and weight control behaviours among adolescents between 13 and 17 years; and, to describe perceptions around body shape at age 17 years. A total of 1435 urban South African black and mixed ancestry boys and girls, who had data at both age 13 and 17 years from the Birth to Twenty cohort were included. Data were collected through self-administered questionnaires on eating attitudes (EAT-26), body esteem and weight control behaviours for either weight loss or muscle gain attempts. Height and weight were measured at both time points and BMI was calculated. Black females had a higher BMI (p<0.001) and an increased risk of developing eating disorders as well as significant increase in the prevalence of weight loss practices between the ages 13 and 17 years. At age 17 years both Mixed ancestry adolescents had lower body-esteem compared to black adolescents. The prevalence of possible eating disorders was 11% and 13.1% in early and late adolescents respectively. Males and females shared similar opinions on normal silhouettes being the 'best', 'getting respect' and being the 'happiest', while the obese silhouette was associated with the 'worst' and the 'unhappiest', and the underweight silhouette with the "weakest". Black females had a higher BMI and an increased risk of developing eating disorders. Adolescent females engaged more in weight loss practices whereas, males in muscle gain practices indicating that Western norms of thinness as the ideal are becoming more common in South Africa.

The prevalence of underweight, overweight, obesity and associated risk factors among school-going adolescents in seven African countries

Background

The burden caused by the coexistence of obesity and underweight in Low and Middle Income Countries is a challenge to public health. While prevalence of underweight among youth has been well documented in these countries, overweight, obesity and their associated risk factors are not well understood unlike in high income countries.

Methods

Cross-sectional data from the Global School-based Student Health Survey (GSHS) conducted in seven African countries were used for this study. The survey used a clustered design to obtain a representative sample (n = 23496) from randomly selected schools. 53.6% of the sample was male, and participants ranged in age from 11-17 years old. Body Mass Index (BMI) was calculated using age and sex adjusted self-reported heights and weights. Classification of weight status was based on the 2007 World Health Organization growth charts (BMI-for-age and sex). Multivariable Logistic Regression reporting Odds Ratios was used to assess potential risk factors on BMI, adjusting for age, sex, and country. Statistical analyses were performed with Stata with an alpha of 0.05 and reporting 95% confidence intervals.

Results

Unadjusted rates of being underweight varied from 12.6% (Egypt) to 31.9% (Djibouti), while being overweight ranged from 8.7% (Ghana) to 31.4% (Egypt). Obesity rates ranged from 0.6% (Benin) to 9.3% (Egypt). Females had a higher overweight prevalence for every age group in five of the countries, exceptions being Egypt and Malawi. Overall, being overweight was more prevalent among younger (≤12) adolescents and decreased with age. Males had a higher prevalence of being underweight than females for every country. There was a tendency for the prevalence of being underweight to increase starting in the early teens and decrease between ages 15 and 16. Most of the potential risk factors captured by the GSHS were not significantly associated with weight status.

Conclusions

The prevalence of both overweight and underweight was relatively high, demonstrating the existence of the double burden of malnutrition among adolescents in developing countries. Several factors were not associated with weight status suggesting the need to explore other potential risk factors for overweight and underweight, including genetic factors and socioeconomic status.

Obesity and body size preferences of Jordanian women

The nutrition transition is associated with increased obesity rates and increased desire to be thin. This study evaluates the relationship between actual body size and desired body size among a representative sample of 800 Jordanian women. Using Stunkard's body silhouettes, women were asked to identify their current and ideal body sizes, healthy body size, and their perception of the body size preferred by men. Body mass index (BMI) calculations indicate that 53.8% of the women were overweight or obese. Their mean current body size was 5, which is consistent with the mean BMI of 26 in the sample. Although 66% of the women were dissatisfied with their body size, the desired weight loss was not extreme. Pearson correlation was positive (.858, p <.0001) between measured BMI and body silhouettes chosen as an indicator of current body size. Jordanian women seemed pulled between the traditional and Westernized body preferences. Possible cultural explanations are explored.

Incidence of perioperative adverse events in obese children undergoing elective general surgery

BACKGROUND

A worldwide increase in the prevalence of obesity has been observed in both developed and developing countries. Few studies have addressed the anaesthetic or perioperative implications of childhood obesity.

METHODS

Children aged 2-16 yr undergoing general surgery were classified using age- and sex-adjusted BMI. Patient characteristic, co-morbidity, and perioperative data were collected to ascertain the risks associated with overweight and obese children.

RESULTS

We enrolled 1465 subjects in our study, of which 154 (10.5%) were classified as obese and a further 223 (15.2%) as overweight. After adjusting for age, we identified increased rates of arterial haemoglobin desaturation, difficult mask ventilation, airway obstruction, and bronchospasm in obese children. The relative risk (RR) of adverse respiratory events was higher among obese subjects than non-obese subjects and higher in younger age groups. Controlling for age, adjusted-RR (confidence interval) was 1.49 (1.2-1.86). There was a significant association between obesity and asthma with a higher odds ratio (OR) in younger age groups controlling for age: adjusted-OR=1.8 (1.15-2.82). A significant association was detected between obesity and sleep apnoea controlling for age: adjusted-OR=4.03 (2.37-6.8).

CONCLUSIONS

These results suggest an increased incidence of perioperative adverse respiratory events in obese children, especially at younger ages.

Percepção da imagem corporal de crianças e adolescentes com diferentes níveis socio-econômicos na cidade de Florianópolis, Santa Catarina, Brasil

OBJETIVOS: identificar a percepção da imagem corporal em diferentes níveis socioeconômicos de crianças e adolescentes. MÉTODOS: estudo transversal realizado no município de Florianópolis, Santa Catarina, no ano de 2006. Quatrocentos e dois escolares, com média de idade de 11,35 ± 1,98 anos, matriculados nas séries finais do ensino fundamental, foram investigados. A percepção da imagem corporal foi identificada por meio do protocolo de silhuetas de Stunkard e o nível socioeconômico pelos critérios propostos pela Associação Nacional de Empresas e Pesquisa (ANEP). Foram calculadas razões de prevalências para insatisfação pelo excesso de peso e pela magreza. RESULTADOS: no sexo masculino, a silhueta 3 foi a mais citada nas classes alta e média e a 4 na baixa; no feminino a silhueta 2 foi a mais citada nas classes alta e baixa e a 3 na média considerando a percepção real de sua silhueta. A silhueta 3 para o sexo masculino e a 2 para o feminino foram consideradas ideais pelo maior percentual de escolares. Os jovens da classe baixa apresentaram maiores prevalências de insatisfação pelo excesso de peso em relação os da classe alta. CONCLUSÕES: houve uma tendência dos escolares das classes mais altas apresentarem insatisfação pela magreza e das mais baixas pelo excesso de peso.

Prejudice against obesity among 10-year-olds: a nationwide population-based study

AIMS

Population-based research on children's possible prejudice against thin, obese and average body sizes is scarce. This study examined children's prejudice against various body sizes of both sexes. The effects of sex, body size, place of residence and socio-economic status (SES) on children's prejudice were also investigated.

METHODS

In 2005, a nationally representative sample of 10-year-old children (N = 1409) responded to a questionnaire measuring stereotypes and prejudice against thin, average-weight and obese silhouettes.

RESULTS

As estimated by odds ratios (ORs), children were more likely to report prejudice against obesity (OR = 53, 95% confidence interval [CI]: 42-67) and thinness (OR = 20, 95% CI: 16-26) than against average body weight. The risk of being prejudiced varied with child's sex and with sex and body size of the silhouette figure. No association was found between own body weight and prejudice against various body sizes. Children with high SES were more likely to be prejudiced against obesity compared with children with low SES (OR = 1.2, 95% CI: 1.1-1.4).

CONCLUSION

This large, population-based study showed that Swedish 10-year-old children hold stereotypical attitudes and are prejudiced against not only peers with obesity but also those with thin body sizes. Interestingly, no association was found between own body weight and prejudice against various body sizes.

Body size preference and body weight perception among two migrant groups of non-Western origin

Objectives

To evaluate body size preference, body weight perception and their relationship with actual weight in two migrant groups of non-Western origin, Turks and Moroccans; additionally, to study the association between body size preference and acculturation.

Design

Cross-sectional study.

Setting

Amsterdam, The Netherlands.

Subjects and methods

Males and females (18–30 years) were randomly selected from the population registry (n 451); participants, or at least one of their parents, were born in Turkey or Morocco. Body size preference was assessed using seven silhouette drawings and body weight perception was assessed by asking participants’ opinion of own weight. Acculturation variables were generation status and two scale measures, cultural orientation and social contacts.

Results

Participants showed preference for a thin body size. The discrepancy between ideal and current size was significant in women but not men (P < 0·001). Perceived current body size was correlated with BMI (Spearman’s correlation coefficient 0·60, P < 0·001 (men) and 0·73, P < 0·001 (women)). Among overweight participants (BMI = 25·0–29·9 kg/m2), 63–82 % of men and 35 % of women perceived themselves as ‘average’. Paying attention to own body weight was associated with a discrepancy between ideal and current size among women and with perceiving oneself as ‘overweight’ among men. Body size preference was not significantly associated with the three acculturation variables.

Conclusion

We did not observe a preference for large body sizes in these two non-Western migrant groups. Similar to Western populations, most women wished to be thinner than they were. This was not the case among men, the majority of whom were also unaware of being overweight.

Embodied drawings as expressions of distress among impoverished single Bedouin mothers

This paper demonstrates how marginalized, Bedouin, single mothers define pain through different depictions of their bodies and their embodied experience. Using visual data generated through an empowerment group with single Bedouin women living in the Negev, illustrative pictures were selected. The potential of drawing as an indirect, but deeply communicative symbolic vehicle with which to express the women's pain and struggle as marginalized and impoverished women is demonstrated through themes that emerged from a content analysis of the women's art and their verbal comments about what they had drawn. A central theme identified pain due to painful life circumstances, rather than due to inherent sickness or weakness. Other themes identified included the body as a site for cultural transition, power negations with men, intellectual development, and the struggles of motherhood. This shows how the visual depiction of pain on the page offers a socially critical, yet potentially mental health promoting medium that locates women's distress, not as the result of personal and physical weakness, but as the result of social oppression. The implications for the use of art with socially marginalized women are discussed.

Prevalence of overweight and cardiovascular risk factors in rural and urban children from Central Asia: the Kazakhstan health and nutrition examination survey

Kazakhstan is undergoing a rapid modernization process, which carries the risk of an epidemic of obesity and cardiovascular disease. We enrolled a sample of about 50 children for every combination of gender, environment (urban vs. rural), ethnic group (Kazakh vs. Russian), and age group from 7 to 18 years, for a total of 4,808 children. Anthropometry and blood pressure were measured on all children while fasting blood cholesterol and glucose were measured only in 2,616 children aged > or =12 years. The prevalence of overweight and risk of overweight ranged from 2.8 (rural male Kazakhs) to 9.1% (urban male Russians). The prevalence of prehypertension and hypertension ranged from 8.3 (urban females) to 15.9% (rural females); that of hypercholesterolemia from 11.5 (male rural Russians) to 26.5% (female rural Kazakhs); and the overall prevalence of impaired fasting glucose was 0.1%. We conclude that overweight and cardiovascular risk factors are less prevalent in children living in Kazakhstan than in those living in Western countries. However, these figures are not negligible and suggest that preventive measures are needed to contain the epidemic of overweight and cardiovascular disease that will most likely accompany the modernization of Kazakhstan in the next years.

Rural/urban differences in the distribution of eating disorder symptoms among adolescents from community samples

OBJECTIVE

Rural/urban differences in the prevalence of mental disorders have often been reported in the last 30 years, among others in the distribution of eating disorder symptoms and suicide rates. The role of sex, age and socioeconomic status in the differences by place of residence has often been neglected in past studies.

METHOD

Two independent community samples of students (mean age=17.4 years, SD=1.4), taken from among those attending high school in an urban district (Cagliari; n=817) and in a rural one (Carbonia; n=507) of south Sardinia, Italy, were invited to fill in the Eating Attitudes Test (EAT), the Bulimic Investigatory Test of Edinburgh (BITE), the Body Attitudes Test (BAT) and the revised Hopkins Symptom checklist (SCL-90-R).

RESULTS

Female students scored higher than male students on all inventories. In male participants, the scores on the EAT were higher in the urban than in the rural sample. Conversely, in both male and female students the rural sample reported higher scores on the BITE symptoms subscale. When the comparison was confined to the fraction of those who scored higher than the suggested cut-off on the EAT and the BITE, students in the urban sample outnumbered those in the rural sample. No other differences were found. Socioeconomic status and age did not influence the differences in the reporting of eating disorder symptoms by place of residence.

CONCLUSIONS

Although caution is required when reading the findings drawn from self-report instruments, it is evident that the factors influencing the distribution of eating disorder symptoms and their psychological correlates by place of residence are far more complex than currently thought.

Association between measured BMI and self-perceived body size in Mexican adults

AIM

The study examined the association between perceived body size (through self-selection of Stunkard's body shape silhouettes) and measured body mass index (BMI) in Mexican Mestiso adult men and women, and determined the BMI values that corresponded to each silhouette.

SUBJECTS

A sample of 1092 men and 1247 women, apparently healthy, aged 20-69, was studied.

METHODS

Participants were asked to identify the silhouette that most accurately represented his/her body size. Weight and height were measured in duplicate to calculate BMI. A simple linear regression analysis was used to adjust BMI values to silhouette categories by gender. Areas under the receiver operating characteristic curves (AUC) were calculated to assess accuracy.

RESULTS

Gender-specific BMI values for each silhouette were obtained. Correlation coefficients between silhouette ratings and BMI were 0.702 in males and 0.766 in females. Overweight ranged from silhouette 4 to 6 and obesity from silhouette 6 to 9, in both men and women. In the regression models, 49.3% of BMI variance in males and 58.7% in females were explained statistically by silhouette self-selection. AUC were higher than 0.8 for overweight and obesity in males and females.

CONCLUSIONS

Both male and female models had a good fit, indicating that BMI can be associated with body shape silhouettes. Silhouettes can be useful for defining overweight and obesity in settings such as schools or worksites, or where scales and stadiometers might not be available. They can also be used to provide health advice to the public.

The impact of body mass index and Western advertising and media on eating style, body image and nutrition transition among Jordanian women

OBJECTIVES

To identify the impact of body mass index (BMI) and Western advertising and media on the stage of the nutrition transition among Jordanian women, and to evaluate their impact on eating styles and body image.

DESIGN

A randomised cross-sectional survey that included a variety of culturally measured Likert-type scales and body size images. In addition, BMI was calculated based on measured height and weight.

SETTING

In the homes of the participants. The data were collected by female interviewers who worked for the Jordan Department of Statistics.

SUBJECTS

The sample was based on a random and representative selection of 800 mostly urban Jordanian women. A pre-test sample of 100 women was also used to validate the instruments.

RESULTS

Women tended to agree that they ate based on emotional cues. They had high levels of disordered eating attitudes and behaviours and 42.1% were considered restrained eaters. However, these women also had higher than expected body esteem levels and desired a healthy body size. As expected, being obese was associated with a desire to lose weight, being a restrained and emotional eater, and having more disordered eating attitudes and behaviours. Similarly, Western advertising and media were associated with restrained and emotional eating, desired weight loss, and disordered eating attitudes and behaviours.

CONCLUSIONS

There is a need to develop health education materials that explain the influence of obesity on health and the negative psychological and physical consequences of restrained and emotional eating, building on the current cultural preferences of healthy body size. Further implications and suggestions for future research are discussed.