Being Normal Weight but Feeling Overweight in Adolescence May Affect Weight Development into Young Adulthood-An 11-Year Followup: The HUNT Study, Norway

Weight misperception and weight-related behaviors in non-Hispanic Black youth

Current literature is conflicting regarding whether accurate weight perception encourages healthy weight-related behaviors. This study examined the prevalence of weight misperception and explored associations between weight misperception and weight-related behaviors among 353 Black adolescents in Broward County, Florida. Overall, 44.8% of participants misperceived their weight, with boys more often misperceiving their weight than girls (52.2% vs 40.2%). Students who misperceived their weight were more likely to try to lose weight but less likely to be adequately physically active. Adolescents who underestimated their weight were less likely to be physically active and excessively play video or computer games or use a computer. There was no association between weight misperception and daily physical education attendance or excessive television watching. Weight misperception appears to be a risk factor for obesity in adolescents, as weight misperception was associated with lower engagement in physical activity.

Effect of a Multifaceted Intervention on Children's Body Image and the Mediating Role of Body Image in Changes in Adiposity Indicators

Besides genetic factors and energy-related behaviors, psycho-cultural factors are also important in obesity etiology. Previous studies have suggested that improving body image might be an effective method for managing body weight. Thus, this study aimed to evaluate the effects of a multifaceted intervention on the body image of children and explore whether body image played a mediating role in changes in adiposity indicators. This study was embedded in a cluster randomized controlled trial, involving 1287 children from 24 primary schools in three cities in China (Beijing, Changzhi and Urumqi). The 9-month multifaceted intervention on childhood obesity included five components (three targeted children and two targeted environments), and randomization was performed by an independent person who was blinded to the schools. Two indicators (body size perception and body size expectation) were chosen to characterize body image and were measured by Ma figural stimuli at baseline and the end of the trial. Changes in body image indicators were classified as conducive to weight loss or not. Other anthropometric measures and self-reported behaviors were also collected at both time points. Generalized linear mixed models were used in the analyses. Compared to the controls (n = 648), the proportion of body size perception conducive to weight loss increased in the intervention group (n = 639), with an odds ratio of 2.42 (95%CI: 1.70~3.45, p < 0.001). The proportion of body size expectation conducive to weight loss also increased more in the intervention group than in the controls (OR = 1.74, 95%CI: 1.14~2.66, p = 0.010). In children whose baseline nutritional status was "normal weight with higher BMI" or "overweight/obese", the improvements in body size perception and body size expectation partly mediated the association between the intervention and changes in BMI, BMI Z score, waist circumference and body fat percentage (p < 0.05). This multifaceted study effectively improved the body image of children, which, in turn, led to beneficial changes in adiposity indicators. For the first time, body size perception and body size expectation have been confirmed to be important factors associated with the beneficial effect of a childhood obesity intervention, suggesting that body image components should be generalized in the future.

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.

Association between lifestyle-related, psychosocial factors and obesity among female adolescents in Taiwan

PURPOSE

To examine a wide range of potential contributors to the risk of obesity in female adolescents.

DESIGN AND METHODS

Data for this study were collected using a cross-sectional design. A group of 175 female adolescents were recruited, and information on their demographic characteristics, lifestyle-related behaviors, and psychosocial factors was collected using a self-administered questionnaire during September 2018 to January 2019. Data were analyzed using SPSS 24.0.

RESULTS

An overestimation of body weight was negatively correlated with overweight in the female adolescents. Age at menarche was negatively correlated with the arisk of overweight. Adolescents who slept for >7 h on weekend nights were less likely to be overweight. Eating more cheese, fish, seafood, and organ meats was negatively correlated with obesity risk. The female adolescents were more likely to become overweight if they ate dinners prepared by family and experienced more disturbances from parents and other family members.

CONCLUSIONS

Female adolescents are a unique population affected by obesity. Although incorporating both lifestyle-related behavioral and psychosocial factors in future investigations and developing multicomponent interventions for obesity prevention are crucial, female adolescents should receive the utmost attention from researchers to alleviate the health burden of obesity.

PRACTICE IMPLICATIONS

The intertwined nature of obesity-related factors warrants future investigations to elaborate their roles interplaying with the risk of obesity. Multicomponent interventions should be developed, and nurses and health-care providers should target their efforts on obesity prevention for this specific population.

The Association between Body Weight Misclassification in Adolescence and Body Fat and Waist Circumference in Adulthood: A Longitudinal Study

This study examined the longitudinal association between adolescent body weight misclassifications and body fat and waist circumference during adulthood. A sample was derived from a large Australian birth cohort study. The data analyses were restricted to 1002 participants for whom data on both measured and perceived weight at a 14-year follow-up and the actual measure of adult body fat and waist circumference at a 30-year follow-up were available. To determine misclassifications, we compared the perceived weight with the measured weight. The results were presented as means and mean differences (with a 95% confidence interval) of the body fat percentages and waist circumference levels across the weight misclassification groups, adjusting for potential covariates. For both male and female adolescents, weight underestimation was significantly associated with an increase in body fat percentages and waist circumference in adulthood as compared to those who correctly estimated their weight. In the mean difference analyses, adolescent males and females who underestimated their weight were found to have significantly higher body fat, and waist circumference means than those who correctly estimated their weight in the unadjusted and adjusted comparisons. The adolescent males who overestimated their weight had higher body fat, and waist circumference means when they reached adulthood. Increased awareness of weight misclassification and actual weight among adolescents might contribute to better control of weight gain in adulthood.

Weight misperception and substance use: Brazilian Study of Cardiovascular Risks in Adolescents (ERICA)

BACKGROUND

Adolescence is a crucial period for body image formation. Weight misperception is the discrepancy between individuals' body weight perception and their actual nutritional status. Both weight concerns and substance use are common among adolescents, and there is evidence of an associations between these two variables. Thus, the aim of this study was to assess the association between weight misperception and substance use (smoking and alcohol) in a national sample of normal weight Brazilian adolescents.

METHODS

Data were obtained from the Brazilian Study of Cardiovascular Risks in Adolescents (ERICA), a cross-sectional, multicenter, national, school-based survey, carried out in 124 municipalities with more than 100,000 inhabitants from Brazil. The sample included adolescents aged 12-17 years, classified as normal weight by nutritional status evaluation. The following measures were collected: weight underestimation and overestimation (exposure); having tried cigarette smoking, current smoking, current alcohol consumption, binge drinking and current smoking and alcohol consumption(outcomes); macro-region, sex, type of school, and excessive screen time (confounders). The frequency of variables was calculated with 95% confidence intervals (CI). Poisson regression models were used to estimate prevalence ratios (PR).

RESULTS

In total, data from 53,447 adolescents were analyzed. Weight misperception was present in a third of the adolescents, with similar prevalence of weight underestimation and overestimation. In adolescents aged 12-14 years, weight underestimation and overestimation were associated with having tried cigarette smoking (PR: 1.18 and 1.43, respectively), current alcohol consumption (PR: 1.33 for both weight misperception categories), and binge drinking (PR: 1.96 and 2.01, respectively). Weight underestimation was associated with both having tried cigarette smoking and current alcohol consumption in boys (PR: 1.14 and 1.16, respectively) and girls (PR: 1.32 and 1.15, respectively). In girls, weight overestimation was associated with all substance use variables (PR between 1.19 and 1.41).

CONCLUSIONS

Our results showed an association between weight misperception and having tried cigarette smoking, alcohol consumption, and binge drinking in younger adolescents. In addition, weight overestimation was associated with all substance use indicators in girls. Based on our findings, interventions aimed to improve weight perception in normal weight adolescents may contribute to the reduction of substance use in this population.

Lean Body Mass and Self-Perceived Body Image among Youth in the United Arab Emirates

BACKGROUND AND AIM

Lean body mass may be a promising tool to screen body image disorders. This study aim was to explore the relationships between fat free mass index (FFM-I) on self-perceived body image and shape among university students in the United Arab Emirates.

METHODS

Cross-sectional study, using questionnaires to evaluate demographics, body figure, shape and image dissatisfaction; in addition to anthropometrics like BMI and FFM-I. Accordingly, participants were categorized into adequate muscle mass (AMM) and low muscle mass (LMM) individuals.

RESULTS

A total of 402 participants (50.4% females) aged between 18 and 25 years, were recruited. Almost third (33.8%) of the participants were overweight/obese, 81% had AMM; 48.5% and 76.3% of them were concerned about their body shape and image, respectively; 55.2% desired to be thinner. Males (M) had significantly higher BMI and body fat compared to females (F). Subjects with LMM, irrespective of sex, were underweight (49% F; 40.7% M), desired to be heavier (44.9% F; 74.1% M) and they had a lower agreement in their perceived BMI versus actual (k=0.024; poor) compared with those with AMM (k=0.408; fair); and in general males had a better agreement between their perceived and actual BMI compared to females (0.432, moderate vs. 0.308, fair).

CONCLUSIONS

Our results conclude that female sex and LMM were associated with higher body image and shape dissatisfaction; thus, highlighting the importance of increasing awareness among youth to assess body composition and engage in muscle mass building activities as an effective step towards improving body image perception. (www.actabiomedica.it).

Association between body weight misperception and dietary patterns in Brazilian adolescents: Cross-sectional study using ERICA data

The association between body image and eating behaviors or weight control strategies has been demonstrated in the scientific literature, but there is a lack of evidence on the association between weight misperception and food consumption indicators in adolescents. This study aimed to evaluate the association between weight misperception and dietary patterns (DPs) in the Brazilian Study of Cardiovascular Risks in Adolescents (ERICA). It was a national school-based cross-sectional study conducted among students aged 12-17 years. Data were collected in the form of anthropometric measurements, responses in self-answered questionnaires, and 24-h dietary recall. The following variables were assessed: weight underestimation and overestimation (independent variables), which were defined as the presence of a disagreement between nutritional status and self-perceived weight; dietary patterns (dependent variables), defined by a posteriori method using principal component factor analysis; and individual and demographic variables (covariates). Data analysis was performed using the Poisson regression models method, stratified by sex. A total of 52,038 adolescents with normal weights were evaluated. The weight misperception prevalence was 34.0% (95% confidence interval [CI]: 33.0, 35.0). Three DPs were identified: "Traditional Brazilian," "Processed meat sandwiches and coffee," and "Ultra-processed and sweet foods." In girls, weight underestimation was directly associated with the "Traditional Brazilian" (1.24; 95% CI: 1.08, 1.43) and "Ultra-processed and sweet foods" DPs (1.29; 95% CI: 1.09, 1.54), and overestimation was inversely associated with all the DPs. In boys, a direct association between underestimation and the "Ultra-processed and sweet foods" DP (1.29; 95% CI: 1.10, 1.51) was found. Overestimation was inversely associated with the "Traditional Brazilian" DP (0.79; 95% CI: 0.63, 0.99). The inverse association between overestimation and the "Traditional Brazilian" DP, and the direct association between underestimation and the "Ultra-processed and sweet foods" DP indicated that weight misperception was related to unhealthy eating habits in Brazilian adolescents.

Systems Nutrology of Adolescents with Divergence between Measured and Perceived Weight Uncovers a Distinctive Profile Defined by Inverse Relationships of Food Consumption

Changes in food consumption, physical inactivity, and other lifestyle habits are potential causes of the obesity epidemic. Paradoxically, the media promotes idealization of a leaner body appearance. Under these circumstances, self-perception of weight by adolescents may be affected. Here, we performed a cross-sectional study, between June and December 2009, to evaluate the interaction between anthropometric status, perceived body weight, and food consumption profiles in 1496 adolescents from public schools in Salvador, Brazil. Data on socio-epidemiological information, anthropometric status, and dietary patterns were analyzed using multidimensional statistical approaches adapted from systems biology. There were dissimilarities between anthropometric status and perception of body weight related to sex. Four dietary patterns were identified based on the food intake profile in the study participants. The distinct dietary patterns were not influenced by divergence between measured and perceived weight. Moreover, network analysis revealed that overestimation of body weight was characterized by a selectivity in ingestion of food groups that resulted in appearance of inverse correlations of consumption. Thus, misperception of body weight is associated with inverse correlations of consumption of certain food groups. These findings may aid individualized nutritional interventions in adolescents who overestimate body weight.

Longitudinal Relationship Study of Depression and Self-Esteem in Postnatal Korean Women Using Autoregressive Cross-Lagged Modeling

Individuals with low self-esteem are vulnerable to depression. Depressed individuals process information related to themselves in a distorted way, thereby negatively affecting their self-esteem. The purpose of this study was to examine the relationship between depression and self-esteem in postnatal Korean women using longitudinal data and an autoregressive cross-lagged analysis. This study was conducted in postpartum women who had consistently participated in the Panel Study on Korean Children (PSKC) from Wave 1 through to Wave 8. The study results showed that depression and self-esteem in postnatal women had a significant positive correlation over time. Moreover, the longitudinal relationship between depression and self-esteem in postnatal women was affected by weight gain during pregnancy. This study overcomes the limitations of cross-sectional studies by using longitudinal data on the correlations between depression and self-esteem in postnatal women; the study findings may be used in developing weight control programs for pregnant and postnatal women.

Predictors of Persistent Body Weight Misclassification from Adolescence Period to Adulthood: A Longitudinal Study

This study examined whether body weight misclassification continues from adolescence to adulthood and the associated predictors behind that misclassification. Data are from a sample of a longitudinal Australian birth-cohort study. Data analyses were restricted to 2938 participants whose measured and perceived body weights were recorded during their adolescence and adulthood follow-ups. To identify misclassification, we objectively compared their measured and perceived body weights at each follow-up. Potential predictors during early life or adolescence periods were included in data analyses. At each follow-up, underestimation was recorded more often among overweight and obese participants, whereas overestimation was mostly recorded among underweight ones. Over 40% males and females were able to correctly estimate their body weight at one follow-up, whereas almost 30% males and 40% females were able to do so in more than one follow-ups. One-third females and 45% males underestimated their body weight at one follow-up, whereas 13% females and a quarter of males were able to do so in more than one follow-ups. Being female, dieting, being overweight, having an overweight mother, and having poor mental health were the most significant predictors for more than one follow-up misclassifications. Further studies are needed to evaluate the impact of persistent misclassification on population health benefits.

Analyzing the distinguishing factors that affect childhood obesity in South Korea

Understanding obesity in children is crucial because it can lead to adulthood obesity and result in fatal chronic diseases. Distinctive factors associated with obesity in adults have been described, but distinctive factors related to children remain unclear. We analyzed the correlation between the percentage of body mass index and lifestyle habits by conducting surveys on physical, nutritional, and psychological factors, and we used annual physical examination data to compare different traits among elementary school students (n = 197) and middle school students (n = 461). Our study revealed that the computing hours in elementary school students with overweight and obesity were significantly correlated with the percentage of body mass index (r = 0.29 on school days and r = 0.35 on days off, all P < 0.05). No statistically significant difference was found (all P > 0.05) in the computing hours of middle school students with overweight and obesity. Childhood obesity can cause depression and reduce children's quality of life because of their distorted body perception. In conclusion, physical factors directly affecting childhood obesity and psychological and environmental factors surrounding a child should be considered.

Incidence of childhood overweight and obesity and its association with weight-related attitudes and behaviors in China: a national longitudinal study

BACKGROUND

Childhood obesity is a major public health challenge. We aimed to investigate the incidence of overweight/obesity among Chinese children; and prospectively examine the associations of weight-change intention with risk of overweight/obesity and behavioral changes in initially normal-weight children.

METHODS

A national sample of 21,796 children aged 6-17 years were investigated in September 2013 and followed up nine months later, of which 19,887 (91%) were normal weight and 1909 (9%) were underweight at baseline. Weight and height were objectively measured. Weight perception, weight-change intention, weight control practices, weight-related behaviors, and demographic information were obtained by questionnaires.

RESULTS

Among children with underweight or normal-weight, the cumulative incidence of overweight/obesity was 2.77% (95% CI 2.55-2.99). Among normal-weight children, those who overestimated their weight had higher baseline BMI z-scores and an increased relative risk (RR) of overweight/obesity (RR 1.51, 95% CI 1.15-1.99). Children who misperceived themselves as underweight or overweight had stronger weight-change intention than their counterparts. However, children with weight-change intention did not develop greater changes in dietary intakes, physical activities, or sedentary behaviors than those without intention. There was no significant association between weight-change intention and incidence after adjusting for BMI z-scores at baseline. Self-reported improving diet, increasing physical activity, and dieting were associated with certain actual behavioral improvements and smaller increase in BMI z-score, but not associated with decreased risk of overweight/obesity.

CONCLUSION

The 9-months cumulative incidence of overweight/obesity was 2.77% among Chinese children. Weight-change intention was not associated with incidence of overweight/obesity in normal-weight children, regardless of their weight perception. More importantly, children's weight-change intention was insufficient in achieving desirable behavioral changes. Future overweight and obesity prevention programs should directly target on promoting children's actual behavioral changes.

Mismatch in Children's Weight Assessment, Ideal Body Image, and Rapidly Increased Obesity Prevalence in China: A 10-Year, Nationwide, Longitudinal Study

OBJECTIVE

This study examined secular trends in children's weight-status assessment, measured weight status, and ideal body image and their associations with subsequent changes in BMI, and it explored the differences between sociodemographic groups in China.

METHODS

Longitudinal data from the China Health and Nutrition Survey of 4,605 children aged 6 to 17 collected between 2000 and 2011 were used and fitted to mixed models.

RESULTS

From 2000 to 2011, overweight/obesity prevalence increased from 6.5% to 16.8%, but the percentage of children with self-perceived weight status as "fat" remained around 2.0%; 49.0% of children underestimated their weight status at baseline. Self-perceived body image of most participants was tracked during follow-up. Children who perceived themselves as being fat at baseline had a higher BMI increase over time during follow-up than those with an average body image (β [SE] = 0.99 [0.14] kg/m² per year, P < 0.001). Boys, young children, recent cohorts, and rural children had higher BMI increases than their counterparts. Over time, the thin-body silhouette became more desirable (8.4 percentage points higher, P < 0.001).

CONCLUSIONS

Chinese children experience a large incongruence between their weight-status assessment, ideal body image, and actual weight status. Health promotion programs should examine their role in assisting children in developing a healthy body image and gaining greater self-motivation toward promoting a healthy lifestyle.

Relationship between body weight perception and weight-related behaviours

Objectives

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

Methods

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

Results

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

Conclusions

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

A systematic review of the relationship between weight status perceptions and weight loss attempts, strategies, behaviours and outcomes

It is commonly assumed that a person identifying that they are 'overweight' is an important prerequisite to successful weight management. However, there has been no systematic evaluation of evidence supporting this proposition. The aim of the present research was to systematically review evidence on the relationship between perceived overweight and (i) weight loss attempts, (ii) weight control strategies (healthy and unhealthy), (iii) weight-related behaviours (physical activity and eating habits), (iv) disordered eating and (v) weight change. We synthesized evidence from 78 eligible studies and evaluated evidence linking perceived overweight with outcome variables separately according to the gender, age and objective weight status of study participants. Results indicated that perceived overweight was associated with an increased likelihood of attempting weight loss and with healthy and unhealthy weight control strategies in some participant groups. However, perceived overweight was not reliably associated with physical activity or healthy eating and was associated with greater disordered eating in some groups. Rather than being associated with improved weight management, there was consistent evidence that perceived overweight was predictive of increased weight gain over time. Individuals who perceive their weight status as overweight are more likely to report attempting weight loss but over time gain more weight.

Healthy Teens @ School: Evaluating and disseminating transdiagnostic preventive interventions for eating disorders and obesity for adolescents in school settings

BACKGROUND

The worldwide prevalence of overweight and obesity is at alarming levels. Nearly one in three children in Europe is overweight or obese. Disordered eating and body image concerns are equally widespread and increase risk for more chronic and severe weight-related problems. Research has shown that online interventions that address both healthy weight regulation and body image can reduce risk for eating disorders and obesity simultaneously and are feasible to implement in school settings. To date, evaluation and dissemination of such programs in Europe is scant.

METHODS

The Healthy Teens @ School study is a multi-country cluster-randomized controlled trial (RCT) comparing the effectiveness of an unguided, online, multi-level intervention for promoting a healthy lifestyle and reducing problematic eating behavior, eating disorder and obesity risk among students aged 14 to 19 years with control condition. As part of the Horizon 2020 funded project ICare (GA No. 634757) the trial is conducted in Austria and Spain. Cluster randomization by school is used. The intervention is an adapted version of an evidence-based program developed in the USA (StayingFit). Participants of the intervention group are assigned to one of two possible program tracks based on the results of the initial online-assessment: Overweight adolescents are assigned to the "Weight Management" track emphasizing balanced eating and exercise for weight maintenance, and all other individuals are assigned to the "Healthy Habits" track which aims at promoting healthy habits related to e.g., nutrition, physical activity, sleep. The participants of both tracks work on ten modules (one 20-30 min module per week) during school hours and/or at home. Assessments are conducted at pre- and post-intervention, and at 6- and 12-months after baseline assessment. The primary outcome is intuitive eating, secondary outcomes are eating disorder symptomatology, body image concerns, body mass index, food intake, physical activity, self-esteem, stress coping, depression, and anxiety. Following the initial assessment, individuals in the control group do not have access to the prevention program but continue as normal and are only prompted to the assessments at all time points. At the end of the 12-month study they will get access to the program.

DISCUSSION

The results from this study will add to the understanding of how to address eating and weight related problems in adolescents and will shed light on the feasibility of implementing online prevention programs in school routine in Austria and Spain. As part of the larger ICare project this RCT will determine how an adapted version of StayingFit is disseminated within Europe.

Does Knowing Hurt? Perceiving Oneself as Overweight Predicts Future Physical Health and Well-Being

Identifying oneself as being overweight may be associated with adverse health outcomes, yet prospective tests of this possibility are lacking. Over 7 years, we examined associations between perceptions of being overweight and subsequent health in a sample of 3,582 U.S. adults. Perceiving oneself as being overweight predicted longitudinal declines in subjective health ( d = -0.22, p < .001), increases in depressive symptoms ( d = 0.09, p < .05), and raised levels of physiological dysregulation ( d = 0.24, p < .001), as gauged by clinical indicators of cardiovascular, inflammatory, and metabolic functioning. These associations remained after controlling for a range of potential confounders and were observed irrespective of whether perceptions of being overweight were accurate or inaccurate. This research highlights the possibility that identifying oneself as overweight may act independently of body mass index to contribute to unhealthy profiles of physiological functioning and impaired health over time. These findings underscore the importance of evaluating whether weight-feedback interventions may have unforeseen adverse consequences.

Universal prevention efforts should address eating disorder pathology across the weight spectrum: Implications for screening and intervention on college campuses

PURPOSE

Given shared risk and maintaining factors between eating disorders and obesity, it may be important to include both eating disorder intervention and healthy weight management within a universal eating disorder care delivery program. This study evaluated differential eating disorder screening responses by initial weight status among university students, to assess eating disorder risk and pathology among individuals with overweight/obesity versus normal weight or underweight.

METHODS

1529 individuals were screened and analyzed. Screening was conducted via pilot implementation of the Internet-based Healthy Body Image program on two university campuses.

RESULTS

Fifteen percent of the sample had overweight/obesity. Over half (58%) of individuals with overweight/obesity screened as high risk for an eating disorder or warranting clinical referral, and 58% of individuals with overweight/obesity endorsed a ≥10-pound weight change over the past year. Compared to individuals with normal weight or underweight, individuals with overweight/obesity were more likely to identify as Black, endorse objective binge eating and fasting, endorse that eating disorder-related concerns impaired their relationships/social life and made them feel badly, and endorse higher weight/shape concerns.

CONCLUSIONS

Results suggest rates of eating disorder pathology and clinical impairment are highest among students with overweight/obesity, and targeted intervention across weight categories and diverse races/ethnicities is warranted within universal eating disorder intervention efforts. Integrating eating disorder intervention and healthy weight management into universal prevention programs could reduce the incidence and prevalence of eating disorders, unhealthy weight control practices, and obesity among university students.

Predictors of adolescents' weight misclassification: A longitudinal study

OBJECTIVE

To examine adolescents' and mothers' misclassification of the adolescents' body weight and associated early life predictors.

METHODS

Data are from a sample of women and their children who were part of a longitudinal Australian birth cohort study. We analysed data of 3925 adolescents, 3721 mothers, and 2593 mother-offspring pairs. At the 14-year follow up, we derived adolescents' body weight category (underweight, normal or overweight) based on their measured height and weight and adolescents reported their similar subjective weight categories. Similarly, mothers reported perceived weight of their adolescents' offspring. We compared objectively measured weight with subjective weight perceptions to identify misclassifications. Possible predictors of weight misclassification were taken from pregnancy, childhood and the adolescent period.

RESULTS

Almost a third of adolescents and a quarter of mothers misclassified the adolescents' body weight. Underestimation was observed more often in overweight adolescents. Overestimation was observed more often in underweight adolescents. More than a third of underweight adolescents and almost half of mothers of underweight children overestimated the adolescent's body weight. Normal weight females overestimated their body weight more than their males' counterparts. Predictor of misclassification included being female; dieting to lose weight; having over or underweight mothers; and having high level of poor mental health.

CONCLUSIONS

Findings of this study suggest that adolescent weight misclassification is common across all BMI categories. Being female, dieting to lose weight, poor mental health and maternal BMI status predict misclassification. Further studies are needed to evaluate the population health significance of weight misclassifications.

Residual Effects of Restless Sleep over Depressive Symptoms on Chronic Medical Conditions: Race by Gender Differences

BACKGROUND

Sleep and depression are comorbid problems that contribute to the development of chronic medical conditions (CMC) over time. Although racial and gender differences in the bidirectional associations between sleep, depression, and CMC are known, very limited information exists on heterogeneity of the residual effects of sleep problems over depressive symptoms on CMC across race by gender groups.

AIM

Using a life-course perspective, the present study compared race by gender groups for residual effects of restless sleep over depressive symptoms on CMC.

METHODS

We used data from waves 1 (year 1986), 4 (year 2001), and 5 (year 2011) of the Americans' Changing Lives Study (ACL). The study followed 294 White men, 108 Black men, 490 White women, and 237 Black women for 25 years. Restless sleep, depressive symptoms (Center for Epidemiological Studies-Depression scale [CES-D]), and number of chronic medical conditions (hypertension, diabetes, chronic lung disease, heart disease, stroke, cancer, and arthritis) were measured in 1986, 2001, and 2011. We employed multi-group cross-lagged modeling, with chronic medical conditions as the outcome and race by gender as the groups.

RESULTS

Major group differences were found in the residual effect of restless sleep on CMC over depressive symptoms across race by gender groups. Restless sleep in 2001 predicted CMC 10 years later in 2011 among Black women (standardized adjusted B = .135, P < .05) and White men (standardized adjusted = .145, P < .01) and White women (standardized adjusted B = .171, P < .001) but not Black men (standardized adjusted B = .001, P > .05).

CONCLUSION

Race by gender heterogeneity in the residual effect of restless sleep over depressive symptoms on CMC over 25 years suggests that comorbid poor sleep and depressive symptoms differently contribute to development of multi-morbidity among subpopulations based on the intersection of race and gender. Thus, interventions that try to prevent comorbid sleep problems and depression as a strategy to prevent medical conditions may benefit from tailoring based on the intersection of race and gender.

Body image discrepancy and subjective norm as mediators and moderators of the relationship between body mass index and quality of life

BACKGROUND AND OBJECTIVE

Despite the strength and consistency of the relationship between body mass index (BMI) and quality of life (QoL), a reduction in BMI does not necessarily lead to an improvement in QoL. Between-subject variability indicates the presence of mediators and moderators in the BMI-QoL association. This study aimed to examine the roles of body image discrepancy (BID) and subjective norm (SN) as potential mediators and moderators.

SUBJECTS AND METHODS

In 2012, 3,016 volunteers (aged ≥18 years) participated in a community-based survey conducted in the French-speaking region of Belgium. Participation was enhanced using a large multimedia campaign (which was supported by a large network of recruiters) that employed the nonstigmatizing slogan, "Whatever your weight, your opinion will count". Participants were invited to complete a web-based questionnaire on their weight-related experiences. Self-reported measures were used to calculate each participant's BMI, BID, SN, and QoL (a French obesity-specific QoL questionnaire was used to calculate the participants' physical dimension of QoL scores [PHY-QoL], psychosocial dimension of QoL scores [PSY/SOC-QoL], and their total scores). The covariates included gender, age, subjective economic status, level of education, household size, and perceived health. The mediation/moderation tests were based on Hayes' method.

RESULTS

Tests showed that the relationships between BMI and PHY-QoL, PSY/SOC-QoL, and TOT-QoL were partially mediated by BID in both males and females and by SN in females. Moreover, BID was a moderator of the relationship between BMI and PSY/SOC-QoL in males and females. SN was a moderator of the relationship between BMI and PSY/SOC-QoL in males and between BMI and total scores in males (when used without BID in the models).

CONCLUSION

BID and SN should be considered as important factors in obesity management strategies. The study shows that targeting BMI only is not sufficient to improve the QoL of overweight and obese subjects, and that other variables, including perceptual factors, should be considered.

Association between distorted body image and changes in weight status among normal weight preadolescents in Japan: a population-based cohort study

BACKGROUND

Distorted body image may be important risk factors for being underweight and overweight. The objective of this study was to investigate the association between having a distorted body image and being overweight or underweight among normal weight preadolescents in a population-based cohort study in Japan for each sex.

METHODS

The study participants were 1431 normal weight fourth-grade students (age range: 9-10 years) in Ina town, Japan from 2002 to 2007. The height and weight of each student were measured while they were in the fourth grade (at baseline) and seventh grade (3 years later). Childhood underweight and overweight were defined using the body mass index cut-off points proposed by the International Obesity Task Force. Information regarding the self-perceived weight status of each student at baseline was collected using a self-administered questionnaire. Children who were normal weight but perceived themselves as heavy or thin were regarded as having a distorted body images. A logistic regression model was used to calculate the odds ratios (ORs) and 95 % confidence interval (95 % CI) for being overweight or underweight 3 years later among those having a distorted body image at baseline.

RESULTS

Both boys and girls who perceived themselves to be heavy at baseline were at a statistically significantly greater risk of being overweight 3 years later as compared to boys and girls, respectively, who identified as being at a normal weight at baseline (boys: adjusted OR: 4.66, 95 % CI: 1.01-21.48; girls: 3.88, 1.56-9.65). Both boys and girls who perceived oneself to be thin at baseline were at a statistically significantly greater risk of bring underweight 3 years later as compared to boys and girls, respectively, who identified as being at a normal weight at baseline (boys: 5.51, 2.20-13.80; girls: 2.93, 1.40-6.11).

CONCLUSION

The results of the present study suggest that having a distorted body image in preadolescence is associated with being overweight or underweight in adolescence, among boys and girls, separately. Therefore, education regarding self-perceived weight could be important to help prevent underweight and overweight/obesity among preadolescent boys and girls in Japan.

Discordance between measured weight, perceived weight, and body satisfaction among adolescents

OBJECTIVE

To estimate prevalence, trends and persistence of discordance between measured body weight and perceived body weight and body satisfaction, and examine its association with gender, ethnicity, and family income.

METHODS

Using two-wave data from a prospective cohort study of adolescents sampled from Houston metropolitan area, aged 11-17years at baseline (n=4175) in 2000, and followed up in 2001 (n=3134). Survey logistic regression was used to compute odds ratios (OR).

RESULTS

Females, European Americans, and adolescents in families with higher income were more likely to overestimate their body weight, and to be dissatisfied with their body weight, compared with males, African Americans, or those with a lower family income, respectively. Healthy weight females had significantly elevated odds of perceiving themselves as overweight compared with healthy weight males: OR=1.82 (1.27-2.61) in Wave 1, OR=2.81 (1.82-4.34) in Wave 2, and OR=3.85 (1.58-9.38) in both waves. Similarly, healthy weight European Americans had about two times higher odds of perceiving themselves as overweight than healthy weight African Americans. Healthy weight females had over 1.5 odds of being dissatisfied with their body compared to healthy weight males. Compared with African Americans, European Americans were more likely to be dissatisfied with their body even they were within healthy weight range.

CONCLUSIONS

There was a high prevalence of discordance between actual weight and perceived weight and body satisfaction among adolescents. Discordances differed by gender, ethnicity, and family income, and should be taken into account in interventions for preventing overweight and obesity, and other undesired outcomes in adolescents.

Is there an association between adolescent sleep restriction and obesity

OBJECTIVE

This is the first prospective study of the reciprocal association between sleep restriction and weight among adolescents. Evidence on sleep duration and obesity in youth is sparse and the results have been equivocal.

METHODS

Data are from a community-based, two-wave cohort study. The setting was a metropolitan area with a population of over 4 million. The cohort consisted of 4175 youths 11-17 at baseline and 3134 of these followed up a year later. Obesity was defined as body mass index >95th percentile for children of the same age and sex. Sleep restriction was defined as 6 or fewer hours of sleep per night on weeknights or on both weekends and weeknights. Covariates examined were age, gender, family income and depression.

RESULTS

Results clearly demonstrated that there was no association between sleep restriction and obesity at baseline. In prospective analyses, sleep restriction did not increase future risk of obesity, nor did obesity increase risk of future sleep restriction.

CONCLUSIONS

These findings call into question previous research based primarily on cross-sectional data suggesting a positive correlation between sleep restriction and obesity. However, the results for adolescents in this study are supported by one study of adolescents and by studies of adults using prospective designs. At this point, there appears to be little evidence for a temporal relation between sleep duration and obesity among adults or adolescents.

Weight development from age 13 to 30 years and adolescent socioeconomic status: The Norwegian Longitudinal Health Behaviour study

Objectives

To describe the weight development and model change in body mass index (BMI), and to examine the association of adolescent socioeconomic status (SES) with change in BMI distribution in a cohort followed from adolescence through adulthood.

Methods

Participants (n = 924) from western Norway were surveyed seven times from age 13 to 30 (1990–2007). BMI was based on self-reported height and weight. Quantile regression analyses were used to model change in weight development and to investigate associations between SES (measured by parental education) and change in BMI distribution. The analyses were adjusted for curvilinearity in BMI development, gender and relevant health behaviours.

Results

Body mass index increased over time with the greatest increase in the 90th percentile. No significant associations between change in BMI and SES were observed at any of the percentiles (10th, 25th, 50th, 75th or 90th).

Conclusions

Those in the upper BMI percentile gained more weight than those in the lower percentiles indicating that these might need targeted interventions. Further investigation of the association of change in BMI and SES with better quality data might be warranted.

Gender-specific association of weight perception and appearance satisfaction with slimming attempts and eating patterns in a sample of young Norwegian adolescents

Objective

To examine gender-specific associations of weight perception and appearance satisfaction with slimming attempts and eating patterns among young Norwegian adolescents.

Design

Cross-sectional study. Adolescent dietary data were reported by parents using a retrospective FFQ. Eating patterns were identified using principal component analysis. Adolescents’ reported weight perception, appearance satisfaction and slimming attempts were analysed using cross-tabulation and Pearson’s χ2 test. Associations between perceived weight, appearance satisfaction and slimming attempts/eating patterns were examined using multiple logistic regression analysis.

Setting

Primary schools, Telemark, Norway.

Subjects

Children (n 469), mean age 12·7 (sd 0·3) years, and parents.

Results

Gender differences were observed in self-perceived weight and appearance satisfaction. Girls were most satisfied with appearance when feeling thin, boys when feeling just the right weight. Perceived overweight was the main predictor of slimming attempts across genders (adjusted OR=15·3; 95 % CI 6·0, 39·1 for girls; adjusted OR=18·2; 95 % CI 5·8, 57·3 for boys). Low appearance satisfaction was associated with slimming attempts (adjusted OR=3·3; 95 % CI 1·0, 10·5) and a dieting eating pattern (adjusted OR=2·8; 95 % CI 1·5, 5·2) in girls. Perceived underweight was associated with a junk/convenience eating pattern in boys (adjusted OR=2·8; 95 % CI 1·2, 6·4).

Conclusions

Gender differences were observed in subjective body concerns. Perceived overweight was the main predictor of slimming attempts by both genders. Different aspects of body dissatisfaction were related to different food behaviours in boys and girls. Health professionals should be aware of these gender differences when planning health promotion programmes targeting young adolescents.

Integrating fundamental concepts of obesity and eating disorders: implications for the obesity epidemic

Physiological mechanisms promote weight gain after famine. Because eating disorders, obesity, and dieting limit food intake, they are famine-like experiences. The development of the concept of meeting an ideal weight was the beginning of increasing obesity. Weight stigma, the perception of being fat, lack of understanding of normal growth and development, and increased concern about obesity on the part of health providers, parents, and caregivers have reinforced each other to promote dieting. Because weight suppression and disinhibition provoke long-term weight increase, dieting is a major factor producing the obesity epidemic. The integrated eating disorder-obesity theory included in this article emphasizes that, contrary to dieters, lifetime weight maintainers depend on physiological processes to control weight and experience minimal weight change.

Self-reported versus actual weight and height data contribute to different weight misperception classifications

OBJECTIVES

The purpose of the study was to examine potential differences between two approaches to defining adolescent weight misperception. Specifically, weight status perception was compared with self-reported weight status and actual weight status (based on body mass index percentiles calculated from self-reported and actual weights and heights, respectively). Furthermore, the accuracy of assigning weight status based on body mass index percentiles calculated from self-reported weights and heights was assessed by comparing them with actual weight status.

METHODS

Data were extracted from Team Up for Healthy Living, an 8-week, school-based obesity prevention program in southern Appalachia. Participants (N = 1509) were predominately white (93.4%) and ninth graders (89.5%), with approximately equivalent representation of both sexes (50.7% boys).

RESULTS

The study revealed significant differences between the approaches to defining weight misperception (χ(2) = 16.2; P = 0.0003).

CONCLUSIONS

Researchers should interpret study findings with awareness of potential differences based on the method of calculating weight misperception.

Body size dissatisfaction among young Chinese children in Hong Kong: a cross-sectional study

OBJECTIVE

To determine the potential predictors of body size dissatisfaction in Chinese children.

DESIGN

The Child's Body Image Scale was used to assess body size perception and dissatisfaction. BMI was calculated from objectively measured height and weight. Predictors of body size dissatisfaction were examined by logistic regression analysis.

SETTING

Hong Kong, China.

SUBJECTS

Six hundred and twenty children (53 % boys, aged 6·1-12·9 years) from a state-run primary school.

RESULTS

Female sex (adjusted OR (AOR)=1·91; 95 % CI 1·32, 2·76), age (AOR=2·62; 95 % CI 1·65, 4·16 for 8-10 years; AOR=2·16; 95 % CI 1·38, 3·38 for >10 years), overweight (AOR=6·23; 95 % CI 3·66, 10·60) and obesity (AOR=19·04; 95 % CI 5·64, 64·32) were positively associated with desire to be thinner. Size misperception was a strong predictor of body size dissatisfaction, irrespective of actual weight status (AOR=1·90; 95 % CI 1·02, 3·54 for overestimation; AOR=0·43; 95 % CI 0·27, 0·67 for underestimation).

CONCLUSIONS

Body size dissatisfaction is prevalent among Chinese children as young as 6 years. Female sex, age, overweight, obesity and overestimation of size were associated with increased desire to be thinner. These findings emphasise the importance of preventing body image issues from an early age.

A prospective study of body image dissatisfaction and BMI change in school-age children

OBJECTIVE

Body image dissatisfaction (BID) in school-age children is positively associated with weight status in cross-sectional studies; however, it is uncertain whether BID is a risk factor for the development of adiposity over time. The aim of the present study was to examine the association of BID with changes in BMI in school-age children.

DESIGN

Longitudinal study. At recruitment, children were asked to indicate the silhouette that most closely represented their current and desired body shapes using child-adapted Stunkard scales. Baseline BID was calculated as the difference of current minus desired body image. Height and weight were measured at recruitment and then annually for a median of 2·5 years. Sex-specific BMI-for-age curves were estimated by levels of baseline BID, using mixed-effects models with restricted cubic splines.

SETTING

Public primary schools in Bogotá, Colombia.

SUBJECTS

Six hundred and twenty-nine children aged 5-12 years.

RESULTS

In multivariable analyses, thin boys who desired to be thinner gained an estimated 5·8 kg/m2 more BMI from age 6 to 14 years than boys without BID (P = 0·0004). Heavy boys who desired to be heavier or thinner gained significantly more BMI than boys without BID (P = 0·003 and P = 0·007, respectively). Thin girls who desired to be heavier or thinner gained significantly less BMI than girls without BID (P = 0·0008 and P = 0·05, respectively), whereas heavy girls who desired to be heavier gained an estimated 4·8 kg/m2 less BMI than girls without BID (P = 0·0006). BID was not related to BMI change in normal-weight children.

CONCLUSIONS

BID is associated with BMI trajectories of school-age children in a sex- and weight-specific manner.

Perceived weight in youths and risk of overweight or obesity six years later

OBJECTIVE

To examine the association between perceived overweight in adolescents and the development of overweight or obesity later in life.

METHODS

This paper uses data from a prospective, two-wave cohort study. Participants are 2445 adolescents 11-17years of age who reported perceived weight at baseline and also had height and weight measured at baseline and at follow-up six years later sampled from managed care groups in a large metropolitan area.

RESULTS

Youths who perceived themselves as overweight at baseline were approximately 2.5 times as likely to be overweight or obese six years later compared to youths who perceived themselves as average weight (OR=2.45, 95% CI=1.77-3.39), after adjusting for weight status at baseline, demographic characteristics, major depression, physical activity and dieting behaviors. Those who perceived themselves as skinny were less likely to be overweight or obese later (OR=0.36, 95% CI=0.27-0.49).

CONCLUSIONS

Perceived overweight was associated with overweight or obesity later in life. This relationship was not fully explained by extreme weight control behaviors or major depression. Further research is needed to explore the mechanism involved.

Trends in overweight and obesity over 22 years in a large adult population: the HUNT Study, Norway

Some reports indicate that the obesity epidemic may be slowing down or halting. We followed body mass index (BMI) and waist circumference (WC) in a large adult population in Norway (n = 90 000) from 1984-1986 (HUNT1) through 1995-1997 (HUNT2) to 2006-2008 (HUNT3) to study whether this is occurring in Norway. Height and weight were measured with standardized and identical methods in all three surveys; WC was also measured in HUNT2 and HUNT3. In the three surveys, mean BMI increased from 25.3 to 26.5 and 27.5 kg m-2 in men and from 25.1 to 26.2 and 26.9 kg m-2 in women. Increase in prevalence of obesity (BMI ≥ 30 kg m-2) was greater in men (from 7.7 to 14.4 and 22.1%) compared with women (from 13.3 to 18.3 and 23.1%). In contrast, women had a greater increase in abdominal obesity (WC ≥ 102 cm for men and WC ≥ 88 cm for women). There was a continuous shift in the distribution curve of BMI and WC to the right, demonstrating that the increase in body weight was occurring in all weight groups, but the increase of obesity was greatest in the youngest age groups. Our data showed no signs of a halt in the increase of obesity in this representative Norwegian population.

Predictors of body mass index change from 11 to 15 years of age: the 1993 Pelotas (Brazil) birth cohort study

PURPOSE

We explored predictors of nutritional status change from 11 to 15 years of age by analyzing prospective data.

METHODS

We collected data at 11 and 15 years of age from individuals born in 1993 in Pelotas, Brazil. We assessed nutritional status using body mass index (BMI) for age in z-score according to the World Health Organization 2007 standards. Independent variables collected at 11 years of age were socioeconomic position, adolescent's perception of own weight, body dissatisfaction, and weight loss dieting.

RESULTS

Of the 4,032 adolescents whose nutritional status could be evaluated in the two follow-ups, 93% maintained their nutritional status classification from 11 to 15 years. A total of 102 (2.8%) became obese and 181 (4.5%) ceased to be obese in the 4-year period. The prevalence of obesity decreased from 11 to 15 years of age in both boys and girls. Low-income girls were more likely to become obese from 11 to 15 years of age compared with high-income ones. Among boys, those with high income were more likely to cease being obese compared those with low income. Those who perceived themselves to be obese, who wished to have a smaller silhouette, and who were on diets to lose weight were more likely to become obese or to achieve a normal BMI category at 15 years of age.

CONCLUSIONS

BMI tracks strongly in early adolescence. This finding suggests that interventions to more effectively change nutritional status should be implemented in childhood and should consider emotional aspects as well as social and biological ones.