Overweight but unseen: a review of the underestimation of weight status and a visual normalization theory

Pregnant women's dietary patterns and knowledge of gestational weight gain: A cross-sectional study

OBJECTIVE

Excess gestational weight gain (GWG) is a risk factor for various unfavorable maternal and neonatal outcomes that may be preventable. Maintaining a healthy lifestyle while pregnant can help prevent uncontrollable weight gain. The aim of this study was to assess pregnant women's knowledge on weight, GWG, diet, and knowledge of obesity-related complications among women who seek care at our semi-urban, regional setting.

METHODS

A prospective observational study was conducted at the prenatal clinic at Kalafong Academic Hospital. Prospective participants completed a questionnaire on their perception of GWG, attitudes toward GWG, knowledge of GWG, associated complications of obesity, and food choices. Data analysis was performed using SAS version 9.4.

RESULTS

The majority of the 500 individuals were overweight or obese prior to pregnancy. By the end of the third trimester, this increased by 10.1% (n = 420; 86.1%). Nearly half (n = 240; 48.78%) of the overweight and obese women underestimated their weight. Only 26.53% (n = 26) of women who checked their body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) gained weight according to recommendations. However, less than half (n = 96; 30.5%) gained weight within the recommended range, despite the fact that the majority of them (n = 315; 64%) were aware of the harmful effects of obesity on the cardiovascular system and the effects of high calories on weight gain (n = 321; 65%).

CONCLUSION

Despite basic knowledge of the impact of high-caloric intake on weight gain and cardiovascular complications, less than half of the study population gained weight within the recommended range.

Modeling body size information within weight labels using probability distributions

What images of bodies do we associate with thinness and fatness? Can our representations of weight-related words be described by simple probability distributions? To answer these questions, the present study examined participants' perceptions of a set of weight-related words using a pictural scale. 259 French women indicated the thinnest, fattest, and best-fitting figures for 13 words. We then used their responses to construct PERT probability distributions, simple skewed distributions allowing to visualize what body sizes were associated with each word. In particular, the variability of the distributions showed how different weight labels can have more or less precise meanings. We found some evidence that the lowest body mass index associated with a label shifted towards thinner figures as body dissatisfaction increased. Using the same method, we investigated the boundaries of what participants consider the ideal body, and showed that the inclusion of their own body in these boundaries predicted their levels of body dissatisfaction. We argue that PERT distributions can be a useful, easy-to-use tool in body image research for modeling the representations of weight labels in different populations.

The role of social norms, intergroup contact, and ingroup favoritism in weight stigma

Although average body size in the U.S. has increased in recent decades, stigma directed at individuals with higher weight has not diminished. In this study, we explored this phenomenon by investigating the relationship between people's perceived social norms regarding higher weight and their reported levels of weight bias (i.e., anti-fat attitudes). Our predictions for perceived social norms drew on the concepts of intergroup contact and ingroup favoritism, which were also probed in this study. We hypothesized that both greater descriptive norms and more favorable injunctive norms regarding higher weight would be associated with lower reported weight bias. Individuals' quantity and quality of social contact with people with higher weight were also predicted to be associated with lower weight bias. Finally, we predicted that individuals who perceived themselves as heavier would display ingroup favoritism (i.e., report less weight bias). Participants (N = 272) from the United States completed a set of online questionnaires about their perceived social norms, social contact with people with higher weight, and explicit weight bias. We found support for each of these pre-registered predictions (ps < 0.03), and post hoc analyses revealed that quality, but not quantity, of social contact with individuals with higher weight was an important predictor of lower weight bias. Together, these findings provide insight into the social psychology of weight bias and help to lay a theoretical foundation for future efforts to reduce weight stigma.

ACTION-FRANCE: Insights into Perceptions, Attitudes, and Barriers to Obesity Management in France

Background/Objectives: ACTION-FRANCE (Awareness, Care, and Treatment In Obesity maNagement in France) aims to identify the perceptions, attitudes, behaviors, and potential barriers to effective obesity management in France and guide collaborative actions. Methods: ACTION-FRANCE is a cross-sectional survey of people with obesity (PwO) and healthcare professionals (HCPs) in France. The PwO and HCP survey questionnaire periods ran from 27 September 2022 to 1 February 2023 and from 19 December 2022 to 31 March 2023, respectively. Results: The study, encompassing 1226 PwO and 166 HCPs, reveals a shared recognition of obesity as a chronic condition. However, despite being requested by most PwO, weight-related discussions are surprisingly infrequent, leading to delayed diagnosis and care. PwO and HCPs held different views as to why: HCPs often attributed it to PwO's lack of motivation or disinterest, whereas PwO avoided them because they felt weight management was their own responsibility and were uncomfortable discussing it. When weight was discussed, primarily with general practitioners (GPs), discussions mostly focused on physical activity and diet. However, results identified the strong psychosocial impact of obesity: 42% of respondents reported anxiety/depressive symptoms, and many more hesitated to engage in certain social activities because of their weight. Psychotherapy was only discussed by 55% of HCPs. Pharmaceutical options were also rarely discussed (19.5% of HCPs), though 56.1% of PwO reported they would want to. Conclusions: HCPs' and PwO's perceptions differed significantly and need to converge through enhanced communication. A holistic approach, integrating comprehensive training for GPs and recognizing psychological comorbidities, would help to bridge perceptual gaps effectively and foster more empathetic and effective patient care.

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).

Association between weight, weight perception, weight teasing and mental health among adolescents

BACKGROUND

Adolescent mental health problems are becoming increasingly prevalent, and there are correlations between weight-related concerns and adolescent mental health. The aim of this study is to explore the association between three weight-related factors (actual weight, weight perception, and weight teasing) and mental health problems (depressive symptoms, anxiety symptoms, and loneliness) in Chinese adolescents.

METHODS

10,070 adolescents between the ages of 11-18 from schools in Shanghai, China were selected using a stratified random cluster sampling method. Self-reported questionnaires were collected to investigate weight-related factors and mental health problems. Logistic regression analysis was used to examine the relationship.

RESULTS

The prevalence of depressive symptoms, loneliness, mild anxiety symptoms, and moderate to severe anxiety symptoms among adolescents were 18.0%, 53.8%, 26.5%, and 12.3%, respectively, with a higher prevalence found in females. After adjusting for weight perception and weight teasing, actual weight had no harmful impact on adolescents' mental health. Adolescents' perception of being overweight increased the risk of depressive symptoms, loneliness, mild anxiety symptoms, and moderate to severe anxiety symptoms, while the perception of being underweight had a similar but more profound impact (depressive symptoms OR = 1.590, 95% CI: 1.342-1.883; loneliness OR = 1.537, 95% CI: 1.353-1.746; mild anxiety symptoms OR = 1.368, 95% CI: 1.178-1.589; moderate to severe anxiety symptoms OR = 1.780, 95% CI: 1.449-2.186). Experiencing weight teasing more than once a year had a greater effect on adolescents' mental health, especially among adolescents with overweight/obesity (depressive symptoms OR = 2.970, 95% CI: 2.325-3.793; loneliness OR = 3.839, 95% CI: 3.119-4.727; mild anxiety symptoms OR = 2.822, 95% CI: 2.236-3.562; moderate to severe anxiety symptoms OR = 5.212, 95% CI: 3.846-7.065).

CONCLUSIONS

The prevalence of mental health problems among adolescents was high, especially loneliness. Weight perception and weight teasing, but not the actual weight, independently influenced adolescent mental health.

Associations Between Weight-Loss Attempts, Weight-Related Stress, and Body Image During Childhood and Adolescence in Children With Parental Obesity

Background: Few longitudinal studies have investigated the role of weight-loss attempts or weight-related stress on body image during childhood. We examined whether weight-loss attempts and weight-related stress are associated with weight misperception and body dissatisfaction across childhood and adolescence. Methods: Data were drawn from the Quebec Adipose and Lifestyle InvesTigation in Youth (QUALITY) cohort of Canadian children with parental obesity (8-10 years: n = 630; 10-12 years: n = 564; 15-17 years: n = 377). We assessed weight-loss attempts and weight-related stress at baseline and first follow-up, and perceived and desired silhouettes at first and second follow-up with questionnaires. Weight misperception consisted of the difference in BMI z-score (zBMI) from the perceived silhouette and the measured zBMI. Body dissatisfaction consisted of the discordance between perceived and desired silhouettes. We estimated multivariable mixed-effects regression models adjusting for age, sex, pubertal stage, parental BMI and education, and sport-based teasing. Results: Weight loss attempts were associated with a higher weight misperception score (ever tried, beta [95% confidence intervals; CI]: 0.13 [0.01-0.24]) and with 2.13 times higher desire to be thinner (95% CI: 1.39-3.26) at the subsequent follow-up. Similarly, children stressed by their weight had a higher misperception score (beta [95% CI]: 0.15 [0.02-0.27]) and greater desire to be thinner at the next follow-up (odds ratio [95% CI]: 1.73 [0.999-3.00]). Conclusions: Weight-loss attempts and weight-related stress in children and adolescents are associated with weight misperception and body dissatisfaction, supporting empowerment and counseling focusing on healthy eating behaviors and a positive body image. Clinical Trial Registration Number: NCT03356262.

Gestational weight loss and fetal growth in uncomplicated pregnancies among women with obesity: a population-based retrospective cohort study

OBJECTIVE

The impact of gestational weight loss (GWL) on fetal growth among women with obesity remains unclear. This study aimed to examine the association between weight loss during pregnancy among women with body mass index (BMI) ≥ 30 kg/m2 and the risk of small-for-gestational-age (SGA) and large-for-gestational-age (LGA) neonates.

METHODS

We conducted a retrospective, population-based cohort study of women with pre-pregnancy obesity that resulted in a singleton live birth in 2012-2017, using birth registry data in Ontario, Canada. Women with pregnancy complications or health conditions which could cause weight loss were excluded. GWL is defined as negative gestational weight change (≤0 kg). The association between GWL and fetal growth was estimated using generalized estimating equation models and restricted cubic spline regression analysis. Stratified analysis was conducted by obesity class (I:30-34.9 kg/m2, II:35-39.9 kg/m2, and III + : ≥40 kg/m2).

RESULTS

Of the 52,153 eligible women who entered pregnancy with a BMI ≥ 30 kg/m2, 5.3% had GWL. Compared to adequate gestational weight gain, GWL was associated with an increased risk of SGA neonates (aRR:1.45, 95% CI: 1.30-1.60) and a decreased risk of LGA neonates (aRR: 0.81, 95% CI:0.73-0.93). Non-linear L-shaped associations were observed between gestational weight change and SGA neonates, with an increased risk of SGA observed with increased GWL. On the contrary, non-linear S-shaped associations were observed between gestational weight change and LGA neonates, with a decreased risk of LGA observed with increased GWL. Similar findings were observed from the stratified analysis by obesity class.

CONCLUSION

These findings highlight that GWL in women with obesity may increase the risk of SGA neonates but reduce the risk of LGA neonates. Recommendations of GWL for women with obesity should be interpreted with caution.

Investigating the effects of rurality on stress, subjective well-being, and weight-related outcomes

Purpose

Rates of obesity are significantly higher for those living in a rural versus urban setting. High levels of stress and low levels of subjective well-being (SWB) have been linked to poor weight-related behaviors and outcomes, but it is unclear if these relationships differ as a function of rurality. This study investigated the extent to which living in a rural versus urban county ("rurality") moderated associations between stress / subjective wellbeing (predictors) and diet quality, dietary intake of added sugars, physical activity, and BMI (outcomes).

Methods

Participants were recruited from urban (n = 355) and rural (n = 347) counties in Washington State and self-reported psychological, demographic, and food frequency questionnaires while physical activity behavior was measured objectively.

Findings

After controlling for relevant covariates, levels of stress were positively associated with added sugar intake for those living in the urban county while this relationship was non-significant for those residing in the rural county. Similarly, SWB was negatively associated with added sugar intake, but only for urban residents. County of residence was also found to moderate the relationship between SWB and BMI. Higher SWB was inversely associated with BMI for those living in the urban county while no relationship was observed for rural county residents.

Conclusions

These findings support the hypothesis that the relationships between stress / SWB and weight function differentially based on the rurality of the residing county. This work adds to the growing body of literature highlighting the role stress and SWB play in the rural obesity disparity.

Body Image Misperceptions Among Tunisian Adolescents

Background Obesity is a globally recognized health concern with profound consequences for individual health, especially among adolescents. Tunisia, like many countries, is experiencing alarming rates of adolescent obesity. Understanding adolescents' perceptions of their weight status and the factors influencing these perceptions is pivotal for developing targeted interventions and policies to counteract the rising obesity trends. Objective To determine the accuracy of weight status perceptions among Tunisian adolescents compared to objective metrics and to identify sociodemographic characteristics associated with the inaccurate estimation of weight status. Methods A cross-sectional, school-based study was conducted among adolescents attending secondary schools in Sousse, Tunisia, during the 2017-2018 academic year. A total of 1399 students participated, with anthropometric measurements taken, and a pre-tested Arabic questionnaire administered to gather sociodemographic data and perceived weight status, assessed using the Figure Rating Scale (FRS). The accuracy of perceived weight status was determined by comparing the measured weight status with participants' self-reported perceptions. Results The study achieved an 86.68% response rate, with over half of the participants being female (60.5%), and the average age being 17 years. The majority of adolescents (41%) perceived themselves as having normal body weight, while 34.5% perceived themselves as underweight, 16.6% as overweight, and 7.9% as obese. However, based on BMI categories, 72.6% had a normal measured weight, 20.4% were overweight, and 6.9% were obese. A substantial proportion of participants (45.6%) underestimated their weight status, with a significant proportion being objectively overweight or obese (26%). Furthermore, we found a significant association between the perception of weight accuracy and both gender (p = 0.010) and the mother's educational level (p = 0.035). Conclusions The findings revealed a disparity between perceived and actual weight status among Tunisian adolescents, with a significant underestimation of weight status, particularly among those who are overweight or obese. The results highlighted the crucial need for interventions that address weight perception inaccuracies and promote healthy weight awareness and management among adolescents in Tunisia.

The relationship between body mass index and perceived control over labor

BACKGROUND

Individuals with an increased body mass index (BMI) (≥ 30 kg/m2) experience higher rates of perinatal mental health disorders than individuals with BMI < 30. Personal experience of decreased control over labor has been associated with the development postpartum mood and anxiety disorders. However, no studies have investigated the association between BMI and experience of control over labor. This study aimed to assess perceived control over labor and compare patients with BMI ≥ 30 to those with BMI < 30.

METHODS

We performed a secondary analysis of a cross-sectional study of postpartum patients who delivered at term (37-41 weeks gestation). Postpartum, participants completed the Labour Agentry Scale (LAS), a validated tool to assess perceived control over labor/birth. Demographic, maternal health history and obstetric/neonatal outcomes were abstracted from the patient chart. Bivariate analyses were performed between those with BMI < 30 and those with BMI ≥ 30 using Fisher's exact test. Continuous LAS scores were compared between patients with BMI < 30 and BMI ≥ 30 using Wilcoxon rank-sum tests. Higher LAS scores indicate higher perceived control over labor. Multivariable linear regression was then performed to account for confounding factors identified a priori.

RESULTS

There was no difference in LAS between those with BMI ≥ 30 and BMI < 30. When stratified by World Health Organization (WHO) class of BMI, those with BMI ≥ 40 had a significantly lower LAS scores than those with BMI < 30 (147 vs. 163, p = 0.02), however, this finding was no longer significant after controlling for length of labor and cesarean birth.

CONCLUSION

Only participants with the highest BMI experienced decreased control over labor, and this finding was no longer significant after controlling for mode of delivery and length of labor. Further research into the experience of birthing people with BMI ≥ 30 is critical to understand the increased risk of perinatal mood disorders among this population.

Do selfies make women look slimmer? The effect of viewing angle on aesthetic and weight judgments of women's bodies

Taking and posting selfies is a popular activity, with some individuals taking and sharing multiple selfies each day. The influence of the selfie angle, as opposed to more traditional photo angles such as the allocentric images we see in print media, on our aesthetic judgements of images of bodies has not been explored. This study compared the attractiveness and weight judgements that participants made of images of the same bodies taken from different visual angles over a series of four experiments (total N = 272). We considered how these judgements may relate to disordered eating thoughts and behaviours. Selfies were judged to be slimmer than images from other perspectives, and egocentric images were judged to be the least attractive. The way participants rated bodies seen from different perspectives was related to their own disordered eating thoughts and behaviours. These results contribute to our understanding of how we perceive the images we see on social media and how these might be related to how we feel about our own and other people's bodies.

Associations between health issues and food consumption with overweight and obesity in three university students minorities

Objective: To determine the presence of overweight and obesity among minorities, and the factors contributing to this weight disparity. Participants: The study comprises 3405 students including nonwhite, international, and first-generation college students. Methods: An online cross-sectional survey collected data on demographics, height, weight, self-health perception, overall sleep quality, progress in school, and food consumption. Three logistic regressions tested abnormal weight associations with health issues and food consumption. Results: Being 31 years-old or older, perception of health and consumption of ultra-processed food was significant with abnormal weight (BMI > 25). Only nonwhite and international students were correlated with ultra-processed and fast-food consumption respectively. Conclusion: Each minority presented vulnerabilities to high percentages of weights exceeding the appropriate rates of BMI. The high consumption of fast and ultra-processed foods makes it important to consider factors related to health perception in each minority group.

Efficacy of body appreciation training on body image concerns in overweight adolescents

Body image concern is one of the important issues in the field of overweight and the factors of failure in losing weight which is necessary to undergo intervention to increase the efficiency of sports and nutrition programs. This study aimed to analyze the efficacy of body appreciation training on body image concerns in overweight adolescents. It was a semi-experimental method with a pre-test and post-test design with a control group). The research community consisted of overweight girl adolescents who were referred to weight control and weight loss centers in Isfahan City in 2021. From the mentioned society, 30 adolescents were selected by targeted sampling method and assigned to two groups of 15 people, experiment and control. The experimental group received 9 sessions of 90-min body appreciation training. The control group was on the waiting list during this time. The research tool was the body image concern questionnaire of Littleton et al. (2005). Data analysis was done using SPSS-24 software and the covariance analysis method. The results showed that there is a significant difference between the two groups in the variable of concerns related to body image (P < 0.001); Also, the results showed that there is a significant difference between the two groups in the variables of dissatisfaction with appearance and interference in social functioning (P < 0.001). In this way, based on the results of this research, body appreciation training can be used to reduce concerns related to body image in overweight adolescents.

A Randomised Control Trial Investigating the Efficacy of the MapMe Intervention on Parental Ability to Correctly Categorise Overweight in Their Child and the Impact on Child BMI Z-Score Change at 1 Year

Research suggests parental ability to recognise when their child has overweight is limited. It is hypothesised that recognition of child overweight/obesity is fundamental to its prevention, acting as a potential barrier to parental action to improve their child's health-related behaviours and/or help seeking. The purpose of this study was to investigate the efficacy of an intervention (MapMe) to improve parental ability to correctly categorise their child as having overweight one-month post-intervention, and reduce child body mass index (BMI) z-score 12 months post-intervention. MapMe consists of body image scales of known child BMI and information on the consequences of childhood overweight, associated health-related behaviours and sources of support. We conducted a three-arm (paper-based MapMe, web-based MapMe and control) randomised control trial in fifteen English local authority areas with parents/guardians of 4-5- and 10-11-year-old children. Parental categorisation of child weight status was assessed using the question 'How would you describe your child's weight at the moment?' Response options were: underweight, healthy weight, overweight, and very overweight. Child weight status and BMI z-scores were calculated using objectively measured height and weight data and UK90 clinical thresholds. There was no difference in the percentage of parents correctly categorising their child as having overweight/very overweight (n = 264: 41% control, 48% web-based, and 43% paper-based, p = 0.646). BMI z-scores were significantly reduced for the intervention group at 12 months post-intervention compared to controls (n = 338, mean difference in BMI z-score change -0.11 (95% CI -0.202 to -0.020, p = 0.017). MapMe was associated with a decrease in BMI z-score 12 months post-intervention, although there was no direct evidence of improved parental ability to correctly categorise child overweight status. Further work is needed to replicate these findings in a larger sample of children, investigate mechanisms of action, and determine the use of MapMe as a public health initiative.

Quality of life and psychosocial outcomes among children with metabolically healthy and unhealthy obesity

BACKGROUND

Obesity and obesity-related morbidities are associated with poor psychosocial adjustment and health-related quality of life (HRQoL). This study aims to examine HRQoL and psychosocial outcomes in children with metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO), and the effects of familial health on these outcomes.

METHODS

Four hundred and six children with BMI for age ≥ 97th percentile were classified as having MHO and MUO based on the absence or presence of metabolic abnormalities. HRQoL and psychosocial outcomes were assessed using validated questionnaires such as PedsQL and DASS-21.

RESULTS

There were no significant differences in HRQoL and psychosocial outcomes between children with MHO and children with MUO. Children with MUO and prior knowledge of existing metabolic conditions reported significantly lower total HRQoL (71.18 ± 17.42 vs. 75.34 ± 15.33), and higher depression (12.16 ± 11.80 vs. 8.95 ± 8.52) and stress (12.11 ± 8.21 vs. 10.04 ± 7.92) compared to children with MHO. Children with MUO who had fathers with metabolically unhealthy phenotype reported significantly lower total HRQoL (72.41 ± 15.67 vs. 76.82 ± 14.91) compared to children with MUO who had fathers with metabolically healthy phenotype.

CONCLUSION

Prior knowledge of existing metabolic abnormalities was associated with poorer HRQoL and mental health in children with obesity. Paternal metabolic health status influenced HRQoL in children with MUO.

IMPACT

First study that compared health-related quality of life (HRQoL) and psychosocial outcomes between children with metabolically healthy obesity (MHO) and children with metabolically unhealthy obesity (MUO). No significant differences in HRQoL and psychosocial outcomes between children with metabolically healthy obesity (MHO) and children with metabolically unhealthy obesity (MUO). Children with MUO who had prior knowledge of existing metabolic conditions reported lower HRQoL, higher depression and stress compared to children with MHO. Paternal metabolic health status was found to influence HRQoL in children with MUO. Mental health support intervention with paternal involvement should be provided for children with MUO.

Associations of self-perceived and objective BMI and adiposity status among adolescents from Kraków (Poland)

OBJECTIVES

The study aimed to determine the association of self-perceived and objective BMI and adiposity status among adolescents from Kraków (Poland).

METHODS

The study was carried out in 2022, in randomly selected schools in Kraków (Poland). The study group consisted of 93 individuals (47 girls and 46 boys) aged 11-15. Anthropometric characteristics included body height, body weight and body fat percentage (%BF), measured by bioimpedance method (BIA). Body Mass Index (BMI) was calculated. Self-perceived body weight/adiposity status was obtained using a question extracted from the Polish version of the Health Behavior in School-Aged Children (HBSC).

RESULTS

The results of the current study provide evidence that girls who were dissatisfied with their bodies thought they were too fat, while boys, on the contrary, thought they were too thin. Trends in this regard begin to appear in girls around the age of 11, while in boys at around 12/13.

CONCLUSION

It is worth noting that the dissatisfaction of the examined children with their physique coincided with the onset of puberty. As some children begin puberty earlier than others, making them stand out from their peers. They begin to give more attention to their bodies and compare them with the physiques of others. Additionally, comparing one's body to the "ideal figure" depicted on social media and ones inability to obtain it also can lead to body dissatisfaction.

Mirror exposure following visual body-size adaptation does not affect own body image

Prolonged visual exposure to large bodies produces a thinning aftereffect on subsequently seen bodies, and vice versa. This visual adaptation effect could contribute to the link between media exposure and body shape misperception. Indeed, people exposed to thin bodies in the media, who experience fattening aftereffects, may internalize the distorted image of their body they see in the mirror. This preregistered study tested this internalization hypothesis by exposing 196 young women to an obese adaptor before showing them their reflection in the mirror, or to a control condition. Then, we used a psychophysical task to measure the effects of this procedure on perceptual judgements about their own body size, relative to another body and to the control mirror exposure condition. We found moderate evidence against the hypothesized self-specific effects of mirror exposure on perceptual judgements. Our work strengthens the idea that body size adaptation affects the perception of test stimuli rather than the participants' own body image. We discuss recent studies which may provide an alternative framework to study media-related distortions of perceptual body image.

Body Image and Lifestyle Behaviors in High School Adolescents

This secondary data analysis study aimed to examine the associations between 1) body size perception (BSP) and body size dissatisfaction (BSD) and 2) lifestyle behaviors and BSP and BSD in adolescents. The study pooled cross-sectional data from two studies (n = 301) performed in adolescents. Weight and height were measured, while lifestyle behaviors and perceived actual and desired body size variables were self-reported. Linear regression analysis assessed the contribution of sex and zBMI to BSP and BSD scores. Pearson's correlation explored associations between BSP and BSD. Cohen's effect sizes compared satisfied and dissatisfied adolescents within the underestimators subgroup. A positive association between BSP and BSD scores was observed among girls living with normal-weight and overweight/obesity only (r = 0.26; p ≤ 0.001 and r = 0.38; p < 0.05, respectively). Underestimators who were satisfied with their body size showed a moderate effect size for a lower zBMI, a small effect size for lower screen time, and higher sleep duration compared to dissatisfied underestimators. Underestimation was associated with more body size satisfaction in adolescent girls with normal weight and overweight/obesity, suggesting a protective effect of underestimation. These findings support the hypothesis that body size satisfaction and underestimation in adolescents is associated with healthier lifestyle behaviors.

Body Mass Index and Perceived Labor Control: Could weight stigma explain differences in birth experience?

Background

Individuals with a body mass index (BMI) of ≥ 30 kg/m2 experience weight stigma when interacting with the healthcare system. There is limited data on how weight stigma impacts patient's experience of obstetric care. This study aims to assess perceived control over the birth process and compare patients with BMI ≥ 30 to those with BMI < 30.

Methods

We performed a secondary analysis of a cross-sectional study of term patients. Postpartum, participants completed the Labour Agentry Scale (LAS), a validated tool to assess perceived control over labor/birth. Continuous LAS scores were compared between patients with BMI < 30 and BMI ≥ 30.

Results

There was no difference in LAS between those with BMI ≥ 30 and BMI < 30. When stratified by World Health Organization (WHO) class of BMI, those with BMI ≥ 40 had a significantly lower LAS scores than those with BMI < 30 (147 vs. 163, p = 0.02), however, this finding was no longer significant after controlling for length of labor and cesarean birth.

Conclusion

Only participants with the highest BMI experienced decreased control over labor, and this finding was no longer significant after controlling for mode of delivery and length of labor. Further research is necessary into how weight stigma influences birthing people's experience.

Obese patients' dissatisfaction with weight, body image and clinicians' interaction at a district hospital; Gauteng

BACKGROUND

Obesity in South Africa has created a public health crisis that warrants a multilevel intervention. However, patients' perceptions and clinicians' challenges hinder the management of obesity in primary care.

AIM

The study aimed to assess obese patients' dissatisfaction with weight and body image and their perspectives on interaction with clinicians regarding obesity management in a primary care setting.

SETTING

Outpatient department of Dr Yusuf Dadoo District Hospital.

METHODS

Cross-sectional study of 213 adult obese patients. A semi-structured questionnaire, a body image assessment tool and patients' medical records were used for data collection.

RESULTS

The study found that, contrary to popular belief, obese patients were dissatisfied with their weight (78.9%) and body image (95.3%). Many felt comfortable while discussing weight reduction with clinicians, although 37.1% reported never engaging with a doctor and 62.9% never interacted with a nurse on the subject. Only 6% reported receiving adequate information on weight reduction measures and 19.7% were followed-up. Clinicians' advice was mainly associated with patients' high body mass index and waist circumference. Doctors were less likely to recommend weight reduction to employed obese women, while nurses were more likely to engage Zulu-speaking patients. Patients were more likely to be followed up if they were young and excessively obese.

CONCLUSION

The study found that most obese patients were dissatisfied with their weight and body image and perceived their interaction with clinicians regarding obesity management as inadequate.Contribution: The study provides an angle of view of challenges in obesity management from patients' perspectives.

Attitudes, Behaviors, and Barriers among Adolescents Living with Obesity, Caregivers, and Healthcare Professionals in Spain: ACTION Teens Survey Study

Although the prevalence of pediatric obesity is rising, understanding of the perceptions, attitudes, behaviors, and barriers to effective obesity care among Spanish adolescents living with obesity (ALwO), their caregivers, and healthcare professionals (HCPs) is lacking. In 2021, the cross-sectional ACTION Teens survey study was conducted in 10 countries; results from the Spanish cohort are presented herein. The survey was completed by 648 ALwO, 644 caregivers, and 251 HCPs in Spain. A total of 25% of ALwO and 43% of caregivers thought that their/their child's weight was normal, and more caregivers than ALwO perceived the ALwO's health to be at least good (95% vs. 59%, respectively). Only 53% of ALwO and 9% of caregivers reported receiving an obesity diagnosis, despite HCPs reporting they provide diagnoses to 87% of ALwO/caregivers. Although 65% of HCPs felt that ALwO may not be comfortable discussing weight, only 26% of ALwO who had discussed weight with an HCP (n = 488) reported not feeling comfortable. Inability to control hunger was a key barrier to ALwO losing weight identified by ALwO/caregivers, but not HCPs. Improved communication between the three groups, a better understanding of barriers to weight loss, and improved health education on obesity are needed in order to enhance obesity care in Spain.

Biological normalcy and body fat: Obesity prevalence, fat stigma, and allostatic load among late adolescents and young adults

OBJECTIVES

Biological normalcy provides a framework to assess tensions between clinical definitions of "normal," statistical norms, and normative beliefs. A prevailing cultural belief is obesity directly causes poor health, but research has demonstrated consequences of fat stigma. Previous research linked fat stigma and allostatic load (AL) in adults, but this has not been demonstrated in youth, and the role of obesity prevalence is unknown. This study assesses the relationship between fat stigma and AL among youth from counties varying by obesity prevalence.

MATERIALS AND METHODS

Undergraduates from 38 counties across the US state of Indiana (n = 175) were recruited. Fat stigma was measured using the brief stigmatizing situations inventory (SSI). AL was calculated using eight biomarkers representing cardiovascular, metabolic, and immune function. Poisson regression assessed relationships of interest and adjusted for potential confounding. An interaction term and stratified analyses were used to assess moderation.

RESULTS

SSI was not statistically associated with obesity prevalence (RR = 0.96, p = 0.173) but did statistically significantly predict AL (RR = 1.019, p = 0.045) when adjusting for confounders. Obesity prevalence moderated the relationship between SSI and AL (RR = 0.993, p = 0.001).

DISCUSSION

Results suggest that fat stigma, regardless of body fat percentage, is associated with physiologic wear and tear on the late adolescent body, and that exposure to obesity during earlier adolescence moderates this relationship. Those most at risk for high AL reported high fat stigma and lived in counties with relatively low obesity prevalence during earlier adolescence, suggesting vulnerability to fat stigma may be heightened where obesity is less common.

Adolescents' polycystic ovary syndrome health-related quality of life questionnaire (APQ-20): development and psychometric properties

Several health-related quality of life (HRQOL) questionnaires for adults with polycystic ovary syndrome (PCOS) have been developed so far. However, an adolescent-specific HRQOL questionnaire for PCOS patients is still lacking. Hence, this study aimed to develop and validate a questionnaire to assess HRQOL in adolescents with PCOS. This mixed-method study was conducted in Tehran, Iran, from 2018 to 2020. The qualitative phase was conducted on 18 target participants, and in the quantitative phase, exploratory factor analysis (EFA) was performed on 200 adolescents with PCOS and confirmatory factor analyses (CFA) on the other 200 ones. The item-developing process was finalized with 77 questions. Concerning the optimum cutoff of content validity ratio, content validity index, kappa statistic coefficient, and item impact score, a draft with 55 items was finalized. Then, piloting scale was performed on 40 participants and considering the interitem correlation < 0.3, fifteen items were excluded. Based on the EFA, 20 items in six components (emotion and mood, loss of attractiveness due to the hirsutism, loss of attractiveness due to the acne, self-care, support, and menstrual cycle problem) that explain 60.3% of the variance were extracted. The CFA with acceptable values of goodness-of-fit statistics supports this construct validity. Results of reliability, floor, and ceiling effect were acceptable.  Conclusion: Our study showed that the short questionnaire of APQ-20 is valid and reliable for assessment of the HRQOL of adolescents with PCOS. Further studies are needed to assess the feasibility and reliability of APQ-20 for assessing the HRQOL of adolescents with PCOS. It constitutes a significant step forward in the measurement of HRQOL of adolescents with PCOS. What is Known: • There is no disease-specific questionnaire for assessment of the health-related quality of life (HRQOL) of adolescents with polycystic ovary syndrome (PCOS). What is New: • The short questionnaire of APQ-20 is easy to use, valid, and reliable for the assessment of the HRQOL of adolescents with PCOS. • APQ-20 constitutes a significant step forward in the measurement of HRQOL of adolescents with PCOS.

Adolescents' Self-Perceived Weight and Metabolic Syndrome

Background and Objective: The aim of this study was to assess the relationships of self-perceived weight with having more metabolic syndrome (MetS) components and the MetS score regardless of body mass index (BMI)-based weight category. Methods: Utilizing data from the Korea National Health and Nutrition Examination Survey 2014 to 2019, weight categories according to BMI and self-perception (underweight, normal weight, or overweight), MetS components defined by the International Diabetes Federation for adolescents, the MetS score, and confounding factors were evaluated in 1441 female adolescents and 1646 male adolescents aged 10 to 18 years. A complex samples general linear model and ordinal regression were used to analyze those relationships. Results: The odds of having more MetS components were 1.67 (95% confidence interval, CI: 1.38-2.03) in adolescents who self-perceived as overweight than in those who self-perceived as normal weight after controlling for sociodemographic and health-related factors and BMI-based weight categories. Compared with adolescents who accurately self-perceived as normal weight (reference group), the odds were 1.48 (95% CI: 1.19-1.84) in those with normal weight, but self-perceived as overweight; 2.90 (95% CI: 1.69-4.98) in those who were overweight, but self-perceived as normal weight; and 9.38 (95% CI: 7.52-11.71) in those who accurately self-perceived as overweight. In relation to the MetS score, similar findings were observed. The combined weight categories had significant interactions with sex and age groups (10-12 years vs. 13-18 years) in those relationships. Conclusions: Regardless of actual weight status, adolescents' self-perceived weight may be a crucial consideration when determining whether or not MetS components may be present.

Comparison of body size perception of young women in Korea and the United States

Body size perception among young women in Asian and Western countries is believed to be quite different, however, there are no confirming studies. We analyzed the data from young women aged between 20 and 40 who participated in the National Health and Nutrition Examination Survey (2001-2018) of the United States (US) and Korea. US young women had higher rates of being overweight and obesity than Korean young women, and there was no significant change over 20 years. In both countries, the percentage of properly estimating one's own weight exceeded 70 percent and remained relatively steady. The percentage of overestimating one's own weight was only about 10 percent in Korea in 2001, but increased to 20 percent. In the case of the US, the percentage was about 15 percent in 2001-2002, but has since continued to decline. The percentage of underestimating one's own body weight was about 18 percent in Korea in 2001, but decreased to about 8 percent. In the case of the US, the percentage was very low at about 10 percent in 2001-2002, but gradually increased to about 18 percent in 2017-2018. In conclusion, young women in the US tend to underestimate their body size, and those in Korea tend to overestimate it.

The experiences of people with overweight in GP consultations - a qualitative study

BACKGROUND

Overweight and obesity are increasing in the Norwegian population. GPs can play an important role in preventing weight gain and increased health risks in patients with overweight. The aim of this study was to obtain greater insight and a deeper understanding of the experiences of patients with overweight in consultations with their GP.

MATERIAL AND METHOD

Eight individual interviews with patients with overweight in the age group 20 - 48 years were analysed using systematic text condensation.

RESULTS

A key finding in the study was that the informants reported that their GP did not raise the subject of overweight. The informants wanted their GP to take the initiative to talk to them about their weight and regarded their GP as an important agent in connection with challenges of overweight. The GP could function as a 'wake-up call' to make them aware of the health risk and of poor lifestyle choices. The GP was also highlighted as an important source of support in a change process.

INTERPRETATION

The informants wanted their GP to take a more active role in talking about the health challenges connected with overweight.

The relationships between caregivers' self-reported and visual perception of child weight and their non-responsive feeding practices: A systematic review and meta-analysis

BACKGROUND

The impacts of caregivers' perception of child weight on their non-responsive feeding practices are inconclusive. This systematic review aimed to examine their relationships.

METHODS

A systematic search of five databases was conducted from inception to March 2022, following PRISMA guidelines. Data synthesis was performed using semi-quantitative approach and meta-analysis.

RESULTS

Twenty-two studies with 12005 respondents were included for semi-quantitative analyses. Eighteen studies examined 26 associations between caregivers' perception of child weight and food restriction with 12 statistically significant associations being observed. A total of 22 relationships between caregivers' perception of child weight and pressure to eat were investigated, with 13 being statistically significant. The statistically significant associations consistently reported that caregivers' visual and self-reported perception of child weight was positively associated with their restrictive feeding and negatively associated with pressure to eat. The pooled odds ratios (ORs) indicated that caregivers who perceived their child as overweight were found to apply pressure to eat less frequently (OR = 0.61; 95%CI: 0.44, 0.84) compared with those who did not. However, caregivers' perception of child weight was not statistically significantly associated with restrictive feeding (OR = 1.37; 95%CI: 0.74, 2.55).

CONCLUSION

Caregivers' self-reported and visual perception of child weight may be important risk factors for non-responsive feeding practices, particularly food restriction and pressure to eat. Thus, interventions need to consider the role of caregivers' perception of child weight, which may optimize feeding practices. Furthermore, longitudinal and intervention-based studies using validated measurements while controlling for potential covariates are needed to provide more evidence on their causal relationships.

Public beliefs about the consequences of living with obesity in the Republic of Ireland and Northern Ireland

Background

This study aimed to capture public beliefs about living with obesity, examine how these beliefs have changed over time and to explore whether certain characteristics were associated with them in a nationally representative sample of adults from the Republic of Ireland (RoI) and Northern Ireland (NI).

Methods

A cross-sectional survey employed a random quota sampling approach to recruit a nationally representative sample of 1046 adults across NI and RoI. Telephone interviews captured information on demographics; health behaviours & attitudes; and beliefs about the consequences of obesity (measured using the Obesity Beliefs Scale). Univariable analyses compared beliefs about the consequences of living with obesity between participants with a self-reported healthy weight and those living with overweight or obesity, and non-responders (those for whom weight status could not be ascertained due to missing data). Multiple linear regression examined associations between obesity-related beliefs and socio-demographics, self-rated health and perceived ability to change health behaviours. Multiple linear regression also compared changes in obesity-related beliefs between 2013 and 2020 in the RoI.

Results

Higher endorsement of the negative outcomes of obesity was significantly associated with living with a healthy weight, higher self-rated health, dietary quality and perceived ability to improve diet and physical activity. Those who lived with overweight, with obesity and non-responders were less likely to endorse the negative consequences of obesity. Those living with obesity and non-responders were also more likely to support there is an increased cost and effort in maintaining a healthy weight. Comparison with survey data from 2013 showed that currently, there is a greater endorsement of the health benefits of maintaining a healthy weight (p < 0001), but also of the increased costs associated with it (p < 0001).

Conclusion

Beliefs about the consequences of maintaining a healthy body weight are associated with individuals’ weight, self-rated health, diet and perceived ease of adoption of dietary and exercise-related improvements. Beliefs about the health risks of obesity and perceived greater costs associated with maintaining a healthy weight appear to have strengthened over time. Present findings are pertinent to researchers and policy makers involved in the design and framing of interventions to address obesity.

Supplementary information

The online version contains supplementary material available at 10.1186/s12889-022-14280-9.

A poor perspective of self weight significantly increases adverse outcomes in non-alcoholic fatty liver disease (NAFLD)

Background

Non-alcoholic fatty liver disease (NAFLD) is prevalent amongst overweight and obese individuals, and weight loss remains the main mode of treatment for NAFLD patients. Weight perception plays a key role in the efficacy of such treatment. The current study aims to investigate the prevalence, associating factors and implications of poor weight perception amongst such individuals.

Methods

An analysis was done on data collected from NHANES between 1999 and 2018. Comparison was made between NAFLD individuals with and without poor weight perception in terms of prevalence, associated characteristics, and clinical outcomes. Multivariate analysis was used to compare effect size of adverse events associated with NAFLD individuals with poor weight perception.

Results

Of the 12,170 NAFLD patients, 19.2% (CI: 18.5 to 19.9%) had poor weight perception. Poor weight perception was significantly associated with lower education levels, reduced levels of exercise and unhealthier lipid profiles. There was an increased risk in all-cause mortality (HR: 1.18, CI: 1.00 to 1.38, p = 0.047), cardiovascular disease mortality (SHR: 1.33, CI: 1.03 to 1.71, p = 0.026), major adverse cardiovascular events (OR: 1.21 CI: 1.10 to 1.32, p < 0.001), and advanced fibrosis (OR: 1.30, CI: 1.03 to 1.64, p = 0.025) for individuals with poor weight perception.

Conclusion

This study highlights the positive association between appropriate weight perception and better outcomes in individuals with NAFLD. Poor weight perception increased the risk of adverse events and decreased inclination toward seeking weight loss treatment. Greater emphasis should be placed on dealing with weight perception in individuals with NAFLD for better treatment outcomes.

Body image and health-related behaviors among fitspirit participants

Background

Body image variables such as body size perception (BSP) and body size dissatisfaction (BSD) can influence health-related behaviors. However, few studies have investigated these body image variables in adolescent girls participating in a physical activity intervention. Therefore, the study objectives were to examine the 1) associations between health-related behaviors (physical activity, screen-time, eating habits and sleep duration) and BSP and BSD among girls participating in FitSpirit, a physical activity intervention for girls; and 2) influence of weight control practices on the association between health-related behaviors and BSP and BSD.

Methods

This cross-sectional study assessed a sample of 545 adolescent girls (mean age: 15.0±1.5 years) from 240 schools. Body mass index, health-related behaviors, perceived actual body size and desired body size variables were self-reported and collected via an online questionnaire at the end of the FitSpirit intervention. A negative BSP score [perceived actual body size – calculated BMI z-score] indicates an underestimation of body size. A positive BSD score [perceived actual body size – desired body size] indicates a desire to reduce body size. A multiple linear regression analysis examined the effects of age, zBMI and health behaviors on BSP and BSD. A second multiple linear regression analysis examined the independent associations between BSP and BSD by weight control practice. The linear relationships between BSP and BSD were evaluated with Pearson’s correlations.

Results

Underestimation and dissatisfaction of body size are more prevalent in participants living with overweight/obesity. Screen-time and sleep duration were independently associated with BSP score (Beta=0.02; P<0.05 and Beta=-0.07; P<0.05, respectively), whereas only screen-time was associated with the BSD score (Beta=0.07; P<0.001). Physical activity was independently associated with the BSP score only in participants trying to control (maintain) their weight (Beta=-0.18; P<0.05).

Conclusions

Body size overestimation and dissatisfaction are associated with health-related behaviors, specifically with more screen-time and less optimal sleeping habits. Physical activity level does not appear to be associated with body image in girls engaged in a physical activity intervention and who want to lose or gain weight. Health promotion interventions could include screen-time and sleep components as they may influence body image.

The interaction between depression diagnosis and BMI is related to altered activation pattern in the right inferior frontal gyrus and anterior cingulate cortex during food anticipation

BACKGROUND

Depression and overweight/obesity often cooccur but the underlying neural mechanisms for this bidirectional link are not well understood.

METHODS

In this functional magnetic resonance imaging study, we scanned 54 individuals diagnosed with depressive disorders (DD) and 48 healthy controls (HC) to examine how diagnostic status moderates the relationship between body mass index (BMI) and brain activation during anticipation and pleasantness rating of food versus nonfood stimuli.

RESULTS

We found a significant BMI-by-diagnosis interaction effect on activation in the right inferior frontal gyrus (RIFG) and anterior cingulate cortex (ACC) during food versus nonfood anticipation (p < .0125). Brain activation in these regions was greater in HC with higher BMI than in HC with lower BMI. Individuals with DD showed an opposite pattern of activation. Structural equation modeling revealed that the relationship between BMI, activation in the RIFG and ACC, and participants' desire to eat food items shown in the experiment depended on the diagnostic status.

CONCLUSIONS

Considering that food anticipation is an important component of appetitive behavior and that the RIFG and ACC are involved in emotion regulation, response inhibition and conflict monitoring necessary to control this behavior, we propose that future clinical trials targeting weight loss in DD should investigate whether adequate mental preparation positively affects subsequent food consumption behaviors in these individuals.

The Interaction Effects of Age and Body Size on Body Appreciation and Health- Related Behaviors

Whilst the associations among age, body size, body (dis)satisfaction, and weight management behavior have been well documented, there is little research on how the combination of age and body size is related to body appreciation and health-related behavioral intentions. The purpose of this study is to identify the associations of age, body size, and their interactions with body appreciation and health-related behavioral intentions among Korean women. A cross-sectional research design was adopted with a convenience sampling method. Using an online survey questionnaire, complete data on body appreciation, health-related behavioral intentions, body size, height, weight, and age were collected from 531 Korean adult women aged 20-77 years. Using average scores for each variable, a series of hierarchical regression analyses were performed to identify the relative contributions of predictor variables on each criterion variable. The significant interaction terms were further examined using the PROCESS macro in SPSS. Overall, older Korean women were found to be more likely to have a positive body image and lower levels of behavioral intentions towards striving for a healthy body than younger women. This study confirmed the relative contribution of subjective body size in explaining women's body-related perceptions and behaviors, as compared to their actual BMI.

Caregiver Perception of Weight Status in 5-Year-Old Children From a Community of High Socioeconomic Deprivation in New Zealand

Background

Early childhood obesity is highly prevalent in Aotearoa New Zealand (NZ). Little is known about caregiver perception of children's weight status among those living in areas of high socioeconomic deprivation, particularly Māori and Pacific children.

Aims

To explore caregiver perception of weight status among children starting school in areas of high socioeconomic deprivation and examine potential associations between the child's body mass index (BMI) z-score and their caregiver's perception of their child's body size or health.

Methods

Participants were 5-year-old children living in a community of high socioeconomic deprivation and their caregivers. Children had their weight and height measured. BMI z-scores were calculated according to World Health Organization standards. Caregivers were asked to assess their child's BMI and health status, and choose a silhouette that best represented their child's body size.

Results

One hundred and six children (>75% Māori or Pacific) were included. Over half (58%) had overweight or obesity, with only 16% correctly perceived by their caregiver as overweight. These children tended to have higher BMI z-scores than those not correctly perceived as overweight. Caregivers chose larger silhouettes to represent children's body sizes as children's BMI z-scores increased. There was no discernible association between children's BMI z-scores and caregiver perception of children's health.

Conclusions

Caregivers appeared to judge their child's body size in comparison to other children. The normalization of childhood obesity and infrequent caregiver recognition of this condition in children in communities with a high prevalence may impact the uptake and efficacy of intervention initiatives.

Bidirectional Associations between Parental Non-Responsive Feeding Practices and Child Eating Behaviors: A Systematic Review and Meta-Analysis of Longitudinal Prospective Studies

Background: Parental non-responsive feeding practices and child eating behaviors both play significant roles in childhood obesity. However, their longitudinal relationships are less clear. This systematic review aimed to examine their bidirectional associations. Methods: A systematic search of five databases was conducted from inception to February 2022. Data synthesis was performed using a semi-quantitative and quantitative approach. Results: A total of 14 studies with 15348 respondents were included. A total of 94 longitudinal effects from 14 studies of parental non-responsive feeding practices on child eating behaviors were investigated, and 19 statistically significant effects were discovered. Seventy-seven longitudinal effects from nine studies of child eating behaviors on parental feeding practices were examined, with fifteen being statistically significant. The pooled results of meta-analysis showed five statistically significant associations: parental restrictive feeding positively predicted child enjoyment of food (β = 0.044; 95% CI: 0.004, 0.085); use of food as a reward positively predicted child emotional eating (β = 0.09; 95% CI: 0.04, 0.15); child food responsiveness positively predicted restrictive feeding (β = 0.04; 95% CI: 0.02, 0.06); use food as a reward (β = 0.06; 95% CI: 0.03, 0.10). In addition, the pooled effects showed that child satiety responsiveness negatively predicted restrictive feeding (β = −0.05; 95% CI: −0.08, −0.01). Conclusions: The bidirectional relationships between parental non-responsive feeding practices and child eating behaviors are inconsistent and a few showed statistical significance. Theory-driven longitudinal studies using validated instruments and controlling for potential confounders are needed to unveil their relationships and provide evidence for obesity prevention interventions.

Obesity in Polish Children and Parents' Perception of Their Children's Weight Status: The Results of the SOPKARD-Junior Study

One way to counteract the spread of obesity in children is its early recognition by parents. Therefore, the aim of this study was to investigate whether parents’ perception of their children’s BMI category was consistent with their actual BMI assessment and to determine potential influential factors. The study was conducted as part of the “A program for the early detection of risk factors for lifestyle diseases SOPKARD-Junior” (SOPKARD-Junior), a preventive health program implemented in public elementary schools from 2017 to 2019. The results from 381 children with a mean age of 11.67 (SD = 1.52) were analyzed. Height and weight were measured and BMI was calculated. Surveys were conducted to assess parents’ perceptions of their child’s weight, along with their sociodemographic status. Nearly one in three parents were unable to correctly identify their children’s weight; 25.0% underestimated it, and 6.0% overestimated it. Underestimation was observed along with an increase in the children’s BMI weight category, with as many as 57.1% of parents of obese children misclassifying their weight. The child’s BMI was the only significant predictor of incorrect assessment. Polish parents cannot properly assess their children’s BMI, especially when their child is overweight or obese. In children, weight and height measurements should be taken regularly, rather than allowing weight category to be dependent upon parental weight assessments.

Sex differences in the association of postural control with indirect measures of body representations

Besides anthropometric variables, high-order body representations have been hypothesised to influence postural control. However, this has not been directly tested before. Moreover, some studies indicate that sex moderates the relationship of anthropometry and postural control. Therefore, as a proof of concept we investigated the association of body representations with postural control as well as the influence of participants’ sex/gender. Body image measures were assessed with a figural drawing task. Body schema was tested by a covert and an overt task. Body sway was measured during normal bipedal quiet standing with eyes closed (with/without neck extended). Statistical analysis consisted of hierarchical multiple linear regressions with the following regression steps: (1) sensory condition, (2) sex/gender, (3) age, (4) anthropometry, (5) body schema, (6) body image, (7) sex/gender-interactions. Across 36 subjects (19 females), body schema was significantly associated with body sway variability and open-loop control, in addition to commonly known influencing factors, such as sensory condition, gender, age and anthropometry. While in females, also body image dissatisfaction substantially was associated with postural control, this was not the case in males. Sex differences and possible causes why high-order body representations may influence concurrent sensorimotor control of body sway are discussed.

Exploring barriers, motivators and solutions to achieve a healthy lifestyle among undergraduate student nurses

BACKGROUND

Many preregistration student nurses tend to be overweight or obese and have unhealthy lifestyles.

AIMS

This study aimed to quantify the prevalence of these issues, to identify barriers to adopting a healthy lifestyle as well as potential solutions, and to explore the use of smartphone health apps.

METHODS

An online questionnaire examined diet and physical activity habits, general health and attitudes to eHealth. An in-class questionnaire with a new sample assessed current lifestyle, barriers to healthier living, support needed to achieve goals and the use of health apps.

FINDINGS

Half of student nurses were overweight or obese and only 41% met the recommended levels of physical activity. An in-class questionnaire revealed that more than half of them wanted to have a better diet and to exercise more.

CONCLUSION

Generally, student nurses were not satisfied with their current lifestyles. A lack of motivation and time were the most frequently reported barriers; an intervention focusing on motivational support could be an acceptable and effective means of achieving and sustaining positive behaviour change.

Psychosocial Predictors of Body Weight Congruence in Adolescents Aged 15 and 17 Years in Poland: Findings from the Health Behaviour in School-Aged Children (HBSC) Study

Background: Body weight congruence (BWC) has implications for adolescent health. The main goal of this study was to examine the distribution of BWC and its relationship with six psychosocial factors. Methods: A representative sample of N = 3508 adolescents aged 15 and 17 years (52.4% girls) derived from the Health Behaviour in School-aged Children study, conducted in 2017/2018 in Poland, was used. BWC groups were defined based on self-reported BMI and subjective assessment of weight: (1) correct perception; (2) overestimation, and (3). underestimation. Principal component analysis (PCA) extracted the following two factors: a socio-relational factor (SR) related to perceived social support and social self-efficacy, and a body attitudes and social media exposure factor (BAME). Using the total sample, multinomial logistic regression was applied to estimate their impact on the BWC, and gender-specific models were compared. Results: Half (48.6%) of the adolescents correctly estimated their body weight, 31.0% overestimated it (girls 43.9%, boys 17.1%), and 20.0% underestimated it (boys 37.2%, girls 9.0%). Overestimation of body weight concerns 48.0% of normal weight girls, 50.0% of underweight girls, and 21.3% and 32.1% of normal weight and underweight boys, respectively. The percentage of normal weight (34.4%), and overweight and obese (30.8%) boys who underestimated their body weight was three times higher than the respective percentages of girls that underestimated their weight (9.0% and 11.9%). The SR factor protected adolescents from both underestimation (only in girls) and overestimation in the total sample (OR 0.74, 95%CI 0.68–0.81) and both genders. BAME increased this risk of overestimation in both genders (OR = 1.83, 95%CI 1.67–2.0), and the risk of underestimation among boys. Conclusions: Prevention programmes should include a wide range of psychosocial factors to improve BWC among adolescents.

Thriving or surviving: staff health metrics and lifestyle behaviours within an Irish higher education setting

Purpose

Due to the international paucity of empirical evidence, this study aimed to investigate the health metrics and lifestyle behaviours of a staff cohort in a higher education institution (HEI) in Ireland.

Design/methodology/approach

Data were collected from 279 (16.4% response rate) HEI staff (academic, management, clerical/support), via a web-based health questionnaire that incorporated validated measures such as the Mental Health Index-5, Energy and Vitality Index, Cohen's Perceived Stress Scale (short form) and the AUDIT-C drinking subscale. A cluster analytical procedure was used to examine the presence of distinct clusters of individuals exhibiting either optimal or sub-optimal health behaviours.

Findings

A multitude of concerning patterns were identified including poor anthropometric profiles (64.4% of males overweight/obese), excessive occupational sitting time (67.8% of females sitting for = 4 h per day), hazardous drinking among younger staff (38.2% of 18–34 year olds), sub-optimal sleep duration on weeknights (82.2% less than 8 h), less favourable mean psychometric indices than the general Irish population, and insufficient fruit and vegetable intake (62.1% reporting <5 daily servings). Cluster analysis revealed “Healthy lifestyle” individuals exhibited significantly lower BMI values, lower stress levels and reported fewer days absent from work compared to those with a “Sub-optimal lifestyle”.

Originality/value

In contrast to the abundance of research pertaining to student cohorts, the current study is the first to examine the clustering of health-related variables in a cohort of HEI staff in Ireland. Findings will be used to inform policy at the host institution and will be of broader interest to higher education stakeholders elsewhere. Future longitudinal studies are required to monitor the health challenges experienced by this influential, yet under-researched cohort.

Perception of body size and body dissatisfaction in adults

Self-perception of body size seems to be not always in line with clinical definitions of normal weight, overweight and obesity according to Word Health Organization classification. The effect of self-perception of body size disturbances and body dissatisfaction may be the development of eating disorders, such as anorexia nervosa or binge eating disorder-a major risk factor of obesity development. Therefore, the study aimed to assess separately the perception of weight status and body size as well as body dissatisfaction in adults with normal weight, overweight and obesity. The study included 744 adults (452 women; 35.9 ± 12.4 years; 21 underweight, 326 normal weight, 221 overweight, 176 obese) referred to Metabolic Management Center and volunteers. Body size perception and body dissatisfaction were assessed based on Stunkards' Figure Rating Scale (FRS). Additionally, participants' were asked: 'Do you think you are: underweight/normal weight/overweight/obese?' to assess perception of weight status. Participants' weight and height were measured to calculate body mass index (BMI) after completing the FRS. Individuals within the overweight BMI range have rated themselves as underweight (1.4%), normal weight (30.8%) and obese (2.8%). Also individuals within the obesity BMI range have rated themselves as normal weight (2.6%), and overweight (41.6%). Compatibility of self-assessment of weight status with BMI category according to the measured values was moderate-Kappa coefficient was 0.59 (95% CI: 0.54-0.64). Underestimation of weight status was significantly more common among men than women. There were statistically significant differences in the distribution of body dissatisfaction according to the weight in both women and men. Normal-weight subjects less often than overweight and obese were dissatisfied with their own body size. The degree of body dissatisfaction was greater among women than among men. Adults subjects frequently underestimate their own weight status and body size. Women with overweight and obesity more often than men are dissatisfied with their own body size.

Parents’ perceptions of their child’s weight among children in their first year of primary school: a mixed-methods analysis of an Australian cross-sectional (complete enumeration) study

Background/Objectives

To describe trends in overweight/obesity in early childhood for all children and those whose parents are concerned about their weight. To describe parents’ perceptions of their child’s weight and differences by their child’s anthropometric and sociodemographic factors.

Subjects/Methods

Analysis of the Kindergarten Health Check, a survey of all children enrolled in their first year of primary education in the Australian Capital Territory. Analysis of detailed data for 2014–2017, including qualitative analysis of parents’ comments on weight, and trends for 2001–2017.

Results

71,963 children participated in the survey between 2001 and 2017 (20,427 between 2014 and 2017). The average age of children (2001–2017) was 5 years and 9.6 months at the time of their physical health check. 2377 children (3.5%) were classified as obese based on measured body mass index (BMI) between 2001 and 2017, and a further 7766 (11.6%) overweight. Similar proportions were seen for 2014–2017. Among children with overweight/obesity in 2014–2017, 86.4% of parents (2479/2868) described their children’s weight as healthy and 13.3% (382/2868) as overweight/obese. Just 11.5% (339/2946) of parents whose children were later measured with overweight/obesity identified having a concern about their child’s weight.

Parental comments varied widely and were often incongruent with the known health risks associated with their child’s measured BMI. Comments from parents whose children were measured as obese often were normalising e.g., “born big, always big. Definitely NOT overweight, just bigger all over”, whilst parents of children in the healthy range expressed concerns about underweight.

Conclusion

Parents do not accurately perceive their child’s weight and few document concerns, even among children measuring in the obese BMI category. This lack of concern makes early interventions challenging as parents are in the “pre-contemplative” stage of behaviour change and may see public health campaigns or clinicians’ attempts to address their child’s weight as irrelevant or unhelpful.

Association between community average body mass index and perception of overweight

Some evidence indicates under-perception of overweight is associated with lower levels of weight loss. This might be due to 'visual normalisation' of overweight through comparisons made in communities where average body mass index (BMI) is high, resulting in under-perception of overweight, which in turn, may protect against negative weight-related self-perceptions and/or reduce motivation to lose weight. Evidence in support of this hypothesis was found initially in a precision-weighted multilevel logistic regression analysis of 3729 overweight Australians aged >18 y, after adjusting for age, sex and area-level disadvantage. Participants whose BMI was -1 kg/m² or less than the community mean BMI had lower odds of weight-related dissatisfaction (OR = 0.64, 95%CI = 0.51-0.80) and perceived overweight (OR = 0.56, 95%CI = 0.45-0.70), compared with peers whose BMI was within ± 1 kg/m² of the community mean. Moreover, participants whose BMI was 1 kg/m² or greater than the community mean BMI had higher odds of weight-related dissatisfaction (OR = 1.97, 95%CI = 1.69-2.30) and perceived overweight (OR = 2.81, 95%CI = 2.41-3.28) when compared to the same reference group. These findings were consistent for men and women; however, they were attenuated towards the null and rendered statistically insignificant after adjustment for personal BMI. Overall, these results indicate that among adults who are overweight, personal BMI, rather than the relative difference between personal and community BMI, is the stronger determinant of weight-related perception and satisfaction.

Gender Differences in Comorbidities and Attitudes Regarding Weight Control among Young Adults with Obesity in Korea

INTRODUCTION

Obesity in young adulthood increases the risk for premature death, and the prevalence of obesity rapidly increasing among young adults, particularly in young men. We evaluated the gender differences in accompanying comorbidities and attitudes regarding weight control among young Korean adults with obesity.

MATERIALS AND METHODS

We analyzed 2,050 young adults with obesity (1,325 men and 725 women) in the 7th KNHANES (2016-2018) aged 19-44 years, with body mass indexes (BMIs) ≥25.0 kg/m2. The odds ratios (ORs) and 95% confidence intervals (CIs) for poor lifestyle factors and accompanying illnesses as well as self-perceived weight status, weight control efforts, and weight control strategies in men compared to those in women were calculated by multivariate logistic regression analysis.

RESULTS

The mean BMIs and waist circumferences were 28.2 ± 0.1 kg/m2 and 93.6 ± 0.2 cm and 28.6 ± 0.1 kg/m2 and 88.7 ± 0.4 cm, in men and women, respectively. The ORs and 95% CIs for abdominal obesity (1.52, 1.11-2.07), hypertension (3.11, 2.20-4.40), hypercholesterolemia (1.45, 1.09-1.93), hypertriglyceridemia (3.37, 2.38-4.78), and elevated alanine transaminase concentration (6.53, 4.56-9.36) were higher in young men compared to those in young women. Despite the higher prevalences of comorbid conditions, the odds of inappropriate weight perception (8.13, 4.17-15.86), lack of weight control efforts (2.20, 1.71-2.84), lack of diet therapy (1.56, 1.13-2.16), lack of pharmacotherapy (13.27, 6.82-25.79), heavy drinking (1.32, 1.02-1.72), current smoking (6.92, 5.00-9.59), and frequent eating out (4.38, 3.35-5.71) were higher among men. However, the odds of not engaging in exercise (0.48, 0.35-0.64) were lower among men compared to that in women.

DISCUSSION

Despite their higher prevalences of comorbidities, appropriate weight perception and weight control efforts are insufficient in young men with obesity. These gender differences should be considered to provide tailored programs for weight reduction in young adults with obesity.

Normal Weight Obesity and Cardiometabolic Risk Factors: A Systematic Review and Meta-Analysis

BACKGROUND

Obesity is one of the most significant causes of morbidity and mortality worldwide. Current studies suggest a new type of obesity, normal weight obesity (NWO), which is defined as having a normal body mass index (BMI), but a high-fat percentage increases the risk of cardiometabolic risk factors (CMRFs). This systematic review and meta-analysis aimed to pool the association between NWO with CMRFs.

METHODS

A systematic search of the literature in all available electronic databases, including Scopus, Web of Science, EMBASE, and PubMed, was performed until October 2021. All English studies that assessed the association of NWOs [compared to normal weight non-obese (NWNO)] and the CMRFs were included. Two investigators extracted data and performed a quality assessment. The heterogeneity between studies was assessed with I-squared and Cochran's Q tests. Odds ratio (OR) was used as an effect size to pool the association of NWO with CMRFs.

RESULTS

Twenty-five articles that met the inclusion criteria entered the study. The total number of participants was 177,792, with an age range of 13 to 75 years. Most studies were conducted on the general population (adults) and were from China. The result of fixed-effect model meta-analysis indicated an increased odds of hyperglycemia (OR:1.50, 95%:1.23, 1.76), high TG (OR:1.90, 95% CH:1.44, 2.35), low HDL (OR: 1.28, 95% CI:1.06, 1.49) and diabetes (OR:1.39, 95% CI:1.30, 1.49). Moreover, the random effect meta-analysis showed that NWO increased the odds of dyslipidemia (OR:1.83, 95% CI:1.61, 20.4), HTN (OR:1.40, 95% CI:1.28, 1.51) and metabolic syndrome (OR:1.92, 95% CI:1.58, 2.26). Moreover, the mean of all CMRFs except plasma glucose in NWO subjects was statistically higher than NWNO subjects (p-value<0.05).

CONCLUSION

The present study showed that NWO increased the odds of CMRFs. These findings indicate the inadequacy of the BMI measurement and the need for body fat assessment for a better obesity risk assessment.

The association between living environmental factors and adolescents' body weight: a cross-sectional study

BACKGROUND

The effect of the living environment on public health has received increasingly scholarly attention. This study aims to explore the relationship between adolescents' body weight and their living environmental factors.

METHODS

This cross-sectional study comprised 1362 middle-school students from Nanjing and 826 from Changzhou in China. We further collected information on living environmental factors based on their home address and ran multivariate logistic regressions to explore potential correlations after considering a range of potential confounding factors.

RESULTS

Approximately 25% (n = 303) of students from Nanjing and 26% (n = 205) of students from Changzhou were excessive body weight. In Nanjing, students' BMI (Body Mass Index) showed a strong negative correlation with the number of sports venues in their neighborhood (Adjusted Odds Ratio (AOR): 0.64, 95%CI: 0.40-0.94) after controlling for other covariates. In Changzhou, we observed a positive correlation between adolescents' body weight and the number of bus stops in their neighbourhood (AOR:1.63, 95%CI:1.11-2.38).

CONCLUSIONS

The living environment factors were independently associated with teenagers' excessive body weight. We hypothesis that the environmental risk factors might be associated with political management, which will consequently affect personal health outcomes. Further research and proactive measures are required to manage those potential risks and attenuate the problem.

Underestimation of overweight weight status in children and adolescents aged 0-19 years: A systematic review and meta-analysis

BACKGROUND

Perceptions of children's weight status may be important in obesity prevention and treatment.

AIMS

This review identifies the prevalence of the underestimation of overweight status in children by parents/main carers, children, and healthcare professionals (HCP). The review critically synthesized both quantitative and qualitative evidence to explore the factors associated with this underestimation. The diverse methods used to assess this phenomenon are reported.

METHODS

Pooled effect sizes were calculated using random-effects model. Published studies, up to 2020, were accessed using the following search engines: CINAHL, EMBASE, PUBMED, and Psych-Info and including the "Cited by" and "Related Articles" functions. Hand-searching was used to retrieve further articles. Publication language and location had no bearing on the nature of the included studies.

RESULTS

A total of 91 articles were included. In the quantitative studies, 55% (95% CI 49%-61%) of caregivers underestimated their child's level of overweight and obesity using a verbal scale and 47% (95% CI 36%-55%) using visual scales. Of the children studied, 34% (95% CI 25%-43%) underestimated their own level of overweight and obesity using both scales. In (n = 3) articles, HCPs reflected this misperception, but limited studies prevented meta-analysis. Underestimation was associated with the child's age, gender, BMI and parental weight status, ethnicity and education. In the qualitative studies, parents/main carers of children with overweight and obesity described their child's weight in terms other than overweight, for example, "big boned," "thick," and "solid."

CONCLUSION

The results confirm the prevalence of underestimation of child overweight status across international studies. Understanding the factors which lead to this inaccuracy may help to improve communication within the therapeutic triad and facilitate the recognition and management of children's overweight status.

Views of Own Body Weight and the Perceived Risks of Developing Obesity and NCDs in South African Adults

Obesity has become a serious public health problem worldwide and is linked to an increased risk of non-communicable diseases (NCDs). Poor self-perception of body weight is postulated to play a negative role in curbing increased rates of obesity. This study investigated the views of own body weight and perceived risk of developing NCDs in South African adults. This was a community-based quantitative study. Descriptive statistics were used, and logistic regression analysis was conducted on the data. A total of 1050 respondents took part in the study. Of the 161 respondents who perceived themselves to be normal weight, 98.8% (n = 159) misperceived their body weight. The majority of respondents (>90%) who were overweight according to the calculated BMI perceived no risk of developing obesity-related diseases. Most of the respondents, 46% (n = 253), believed that body weight was influenced by heredity. The method used for weight loss by 57% (n = 173) of the respondents was exercising at home. There was a statistically significant association between Body Mass Index (BMI), employment status, risk of developing diabetes, and body weight misperception (p < 0.05). Misperception of body weight was common among the study respondents and may influence weight control intervention strategies. Health promotion targeting personal behaviour, such as body weight self-perception, is crucial in supporting targeted strategies to address obesity in South Africa.