Ethnic differences in body image perception in patients with type 2 diabetes

Women's perceptions of body mass graphics and their preferences for weight counselling

Health care providers may lack data-driven guidance about best practises for discussing weight. We assessed women's self-perception of body mass index (BMI) and preferences for weight counselling by provider characteristics and the initiating question. A voluntary, anonymous survey was completed by 756 women (age ≥ 19 year) at our tertiary care obstetrics and gynaecology clinics in autumn 2021. The respondents' height and weight were collected before respondents selected graphics from a validated Body Image Scale that they felt best represented their current body size and which graphs should prompt weight loss or gain recommendations. Respondents were asked their preferences about provider characteristics for discussion about weight and to identify which of six initiating questions from a provider was most and least preferred. Blank responses were allowed. In 708 responses, 366 women (52%) selected the most accurate graphic that corresponded to their BMI; the selected graphic represented a lower than actual BMI in 268 women (38%) and higher in 74 women (10%). In 648 responses, 374 women (58%) preferred a female provider, but provider body shape, ethnicity/race and age were not important to most women. The most preferred question to initiate a discussion about weight was "A lot of women have trouble achieving or maintaining a healthy weight; is that something we can discuss?" in 181 of 555 women (33%), and the least preferred question was "Do you feel like you are at an appropriate weight?" in 172 of 554 women (31%). Provider knowledge about patient preferences regarding questions may facilitate the discussion about weight.

Investigation of body awareness and body image perception in patients with type 2 diabetes mellitus

OBJECTIVES

The purpose of the study is to investigate body awareness and body image perception of patients with type 2 diabetes mellitus (T2DM) and to explore the association between clinical parameters and body awareness.

METHODS

A total of 92 participants with T2DM (38 women and 54 men) aged 36-76 years were recruited. Biochemical measurements, including fasting blood glucose, postprandial blood glucose and hemoglobin A1c (HbA1c), were obtained from the patients' blood sample records. The Body Awareness Questionnaire (BAQ), Body Cathexis Scale (BCS) and Awareness Body Chart (ABC) were filled in by all subjects.

RESULTS

Most participants had an above-average BAQ (81.5%) and BCS (87%) score. There was a significant correlation between body mass index and ABC pain subscale. HbA1c was significantly associated with the duration of diabetes and sleep-wake cycle, process domains and total BAQ score. The body awareness score for the lower leg and foot regions (ABC parts) was negatively correlated with fasting blood glucose and HbA1c levels, while body awareness in the foot region was negatively correlated with the duration of diabetes. There was no association between BCS and any clinical parameters.

CONCLUSION

This study showed that body awareness is associated with diabetes-related clinical parameters, such as fasting blood glucose and HbA1c levels, and duration of diabetes in patients with T2DM. Following diabetes progression and an increase in blood glucose levels, body awareness tended to decrease, particularly in the lower leg and foot regions. These findings highlighted the importance of evaluating body awareness in patients with T2DM.

Examining health experiences and body dissatisfaction in two unique samples of patients with type 2 diabetes

Using cross-sectional data from two samples of adult patients with type 2 diabetes (n = 123 and n = 111), we used an embodiment perspective to examine whether health experiences were related to the extent of individuals' dissatisfaction with their bodies. The nature and strength of associations differed across the two unique samples examined, but weight status had the strongest and most robust association with body dissatisfaction in both samples. None of the associations differed as a function of gender or age. These findings contribute to an understanding of the complex relationship between physical and mental health in the context of diabetes.

The Role of the Person Focused IARA Model in Reducing Anxiety and Improving Body Awareness and Illness Management in Diabetics with Acquired Lipodystrophy: A Mixed-Method Study

Background: Lipodystrophy is one of the most frequent complications in people with diabetes following subcutaneous insulin therapy, and poor management can lead to several problems, such as impaired glycemic control and adherence to therapy, anxiety, and depression. Poor injection technique represents the main risk factor for lipodystrophies. In order to enhance the patient’s insulin injection technique to heal lipodystrophy, improve psychological indices, and promote involvement in their health and care, the efficacy of emerging person-centered care called the IARA model was tested. Methods: A total of 49 patients were randomly allocated to the IARA group (Experimental; n = 25) or standard education (Control; n = 24). The following questionnaires were used in a mixed-method design: (i) State Anxiety Scale; (ii) Beck Depression Inventory; (iii) Italian Summary of Diabetes Self-Care Activities. An ad hoc open-ended questionnaire was structured for the qualitative analysis. Finally, photos were taken in order to verify if injection sites were changed until the follow-up at 12 months. The number of patients who participated until the completion of the study was 17 in the IARA and 11 in the Control group. Results: State anxiety was significantly reduced in people who followed IARA to follow-up at 3 and 6 months (p < 0.05). The IARA group also demonstrated better compliance in blood glucose monitoring and foot-care compared to Control at follow-up at 12 months. The management of insulin injections dramatically improved in participants who received IARA intervention. Conclusions: IARA could be considered an effective strategy to improve well-being and compliance in people affected with diabetes mellitus and lipodystrophy complications.

Sex Differences in Body Image Perception and Ideals: Analysis of Possible Determinants

The study analyzed the differences between sexes in body image perception and body ideals to assess possible dissatisfaction and misinterpretation in the body image considered attractive for the other sex. Moreover, the influence of anthropometric traits and sports practice on body dissatisfaction and misjudgment was evaluated. Using a cross-sectional design, 960 Italian university students were investigated. Anthropometric characteristics were measured directly. Assessment of body image perception was performed using Thompson and Gray’s silhouettes. We developed two new indexes to assess the possible discrepancy between (1) the perceived silhouette of one’s body and that of the same sex deemed attractive to the other sex (FAD); (2) the silhouette is deemed attractive to the opposite sex and the average attractive silhouette selected by the opposite sex (AMOAD). As expected, females showed greater dissatisfaction with their bodies than males concerning both their own ideal and the silhouette they considered attractive to the opposite sex. Although both sexes misjudged the attractive silhouette for the opposite sex, women were found to be more wrong. According to the outcomes of multivariate regression models, stature, body composition parameters, amount of sport, sex, and FAD were significant predictors of dissatisfaction and misjudgment. In addition to action aimed at correcting misperceptions, the study revealed the importance of sports participation in improving the perception and acceptance of one’s body image.

Body self-esteem is related to subjective well-being, severity of depressive symptoms, BMI, glycated hemoglobin levels, and diabetes-related distress in type 2 diabetes

BACKGROUND

There are limited data on the role of body image in patients with type 2 diabetes. The purpose of this study was to compare body self-esteem in this group with norms for the general Polish population and to investigate the relationship between body self-esteem and the psychological and clinical characteristics of the course of diabetes.

METHODS

A group of 100 consecutive adult patients with type 2 diabetes (49 women and 51 men) aged 35 to 66 years were assessed using the Body Esteem Scale (BES), World Health Organization-Five Well-Being Index (WHO-5), Problem Areas in Diabetes Scale (PAID), and Hamilton Rating Scale for Depression (HAM-D).

RESULTS

In comparison to norms for the general population, women with type 2 diabetes had lower body self-esteem only in the dimension of Physical Condition (M = 30.71; SD = 7.11 versus M = 32.96; SD = 5.69; P = 0.003), whereas men in the dimensions of Physical Condition (M = 42.43; SD = 9.43 versus M = 48.30; SD = 8.42; P <0.001) and Upper Body Strength (M = 32.16; SD = 6.60 versus M = 33.97; SD = 5.86; P = 0.015). There were moderate or weak positive correlations between the overall BES score and/or its dimensions and subjective well-being, and negative correlations between the overall BES score and/or its dimension and the severity of depression symptoms, level of glycated hemoglobin (HbA1c), body mass index (BMI), and diabetes-related distress among women. Among men, BES scores were positively correlated with well-being, and negatively, with BMI and diabetes-related distress. A correlation of r = 0.39 between BES scores and HbA1c levels was relatively high compared with values for other psychosocial factors. Both in women and men, a high Physical Condition score was a significant predictor of better well-being, less severe depression, and milder diabetes-related distress. Among men, it was also a significant predictor of lower BMI, whereas among women, BMI was predicted by Weight Concern.

CONCLUSIONS

Persons with diabetes seem to have lower body self-esteem than the general population, which is significantly associated with clinical and psychological characteristics of the diabetes course. The observed differences and relationships are gender-specific.

Perception of body mass index and health issues related to overweight/obesity in an outpatient women's clinic

A body mass index (BMI) ≥25 kg/m² is linked to worse health outcomes. Little is known about women's awareness of their BMI and their awareness of associations between high BMI and cardiovascular and gynecologic diseases. We investigated perceived versus actual BMI of women in an outpatient women's health clinic and determined awareness of health risks linked to high BMI. We administered an anonymous survey to women presenting for health care in gynecological services at an urban OB/GYN women's health clinic. We used a Kappa test to determine agreement between perceived versus actual BMI category (defined using CDC guidelines) and Fisher's exact tests to determine rates of awareness of health risks linked to high BMI. One-hundred seventeen women (84% African-American) participated in ≥1 portion of the survey. Mean age = 31.03 ± 9.54 years; mean BMI = 33.8 ± 10 kg/m². Of 76 respondents, 50 underestimated their BMI category (p < .01). Women were unaware that high BMI was linked to gynecologic outcomes and earlier death (<58% of women reported awareness for each outcome; p > .09 for all). Women seeking outpatient gynecologic care did not accurately perceive BMI and were unlikely to associate high BMI with gynecologic conditions. Improved awareness of BMI and health risks of obesity are educational opportunities for women.

"What's a normal weight?" - Origin and receiving country influences on weight-status assessment among 1.5 and 2nd generation immigrant adolescents in Europe

Many adolescents struggle with adequately assessing their weight-status, often leading to unnecessary weight-related interventions or preventing necessary ones. The prevalence of weight-status over- and underestimation differs considerably cross-nationally, suggesting that individual weight-status assessment is informed by cross-nationally differing standards of evaluation. For adolescents with a migration background, this brings up the possibility of a simultaneous influence of origin- and receiving country standards. The current study examines the magnitude of both influences using data from the 2014 Health Behaviour in School-Aged Children study. The cross-national design of the study enabled us to aggregate weight-evaluation standards for 41, primarily European, countries. Subsequently, we identified a sample of 8 124 adolescents with a migration background whose origin as well as receiving country participated in the study. Among those adolescents, we assessed the effects of origin and receiving country weight-evaluation standards using cross-classified multilevel regression analyses. Descriptive analyses revealed considerable differences in weight-evaluation standards between the countries. Regression analyses showed that both origin- and receiving country weight-evaluation standards were significantly associated cross-sectionally with weight-status assessment among the immigrant adolescents, with a stronger impact of receiving country standards. Results illustrate the context-sensitivity of adolescent weight-status assessment and reinforce the theoretical notion that immigrant adolescent development is not only informed by factors pertaining to their receiving country but also, albeit to a lesser extent, by those pertaining to their origin country.

Intuitive eating and body appreciation in type 2 diabetes

Our objective was to explore the socio-demographic, clinical, and nutritional factors of body appreciation in type 2 diabetics. This is a cross-sectional observational study with 179 adults and older adults (60 ± 10 years old). Most of the sample was female (n = 133; 74.3%). Through logistic regression analysis, it was observed that being perceived as overweight was associated with a 91.6% lower chance of being satisfied with one's body. Trusting hunger and satiety cues doubled the chances of body satisfaction. Thus, eating more intuitively, attending to the signs of hunger and satiety, is associated with greater body satisfaction in type 2 diabetics.

Effects of Different Resistance Training Frequencies on Body Composition, Cardiometabolic Risk Factors, and Handgrip Strength in Overweight and Obese Women: A Randomized Controlled Trial

BACKGROUND

Resistance training improves health in obese and overweight people. However, it is not clear what is the optimal weekly resistance training frequency and the most efficacious training protocol on body composition, cardiometabolic risk factors, and handgrip strength (HS). The aim of this study was to determine the effects of a supervised structured 24 week resistance training program on obese and overweight women.

METHODS

Forty-five women (BMI 37.1 ± 6.3 kg/m²; age 56.5 ± 0.7 years) were randomly assigned to one of two groups: A group with a high weekly training frequency of three times a week (HIGH) and a group that performed it only once a week (LOW). Cardiometabolic risk factors, anthropometric and HS measures were taken before and after the intervention period.

RESULTS

A significant (p < 0.05) group by time interaction was observed for body weight, body mass index, waist circumference, fat mass, plasma glucose, plasma insulin, homeostatic model assessment, and for dominant and absolute HS. Additionally, only the HIGH group saw increased HS and decreased total cholesterol and LDL-cholesterol after the intervention period (p < 0.05). The observed increase in HS was associated with an improved insulin resistance sensitivity (absolute handgrip strength: r = -0.40, p = 0.007; relative handgrip strength: r = -0.47, p = 0.001) after training, which constitutes an essential element for cardiovascular health.

CONCLUSIONS

The results suggest that high weekly frequency training give greater benefits for weight loss and cardiometabolic risk factors improvement than a training program with a training session of once a week. Furthermore, the improvement of HS can be achieved with a high weekly frequency training.

The association between body composition and quality of life among elderly Italians

OBJECTIVE

This study aimed to assess the body composition and quality of life in elderly Italian people and to value the association between these variables.

METHODS

Height, weight, humerus breadth, circumferences, skinfolds, and hand grip strength were measured in 256 older adults (age: M: 81.1 ± 7.3, F: 84.9 ± 8.1 years). Body mass index, waist-hip ratio, waist-height ratio, upper-arm areas, and body composition parameters were calculated. Quality of life (QoL) was measured by WHO Quality of Life-BREF questionnaire (WHOQOL-BREF). Differences between sexes were valued. A multiple regression analysis was carried out to assess the influence of nutritional status and of socio-demographic characteristics on QoL.

RESULTS

The participants were in average overweight. Even if the percentage of overweight/obese subjects was high in both sexes, males presented a more centripetal fat distribution. These characteristics, joined to data regarding lower values of arm-muscle area and hand grip strength, put males at greater risk of cardiometabolic diseases. Regarding quality of life assessments, psychological domain showed the worst scores, and, marital status resulted the main explanatory variable for this domain.

CONCLUSIONS

Social care facilities for the elderly people require planning strategies based on health promotion criteria in order to accentuate active ageing interventions to ameliorate the quality of life of residents.