Development of a BMI-Assigned Stunkard Scale for the Evaluation of Body Image Perception Based on Data of the SOS Reference Study

Intramyocellular lipid use is altered with exercise in males with childhood-onset obesity despite no differences in substrate oxidation

OBJECTIVE

Compared to adulthood-onset obesity (AO), those with childhood-onset obesity (CO) are at greater risk of metabolic disease. However, the differences between these two obesity phenotypes are not clear. The aim of this study is to investigate how the age of obesity onset (CO vs. AO) affects the use of intramyocellular (IMCL) and extramyocellular (EMCL) lipids in response to exercise.

METHODS

Males with CO (n = 5) and AO (n = 5) were recruited. At the first study visit, body composition was measured via dual-energy x-ray absorptiometry (DEXA). Energy expenditure and substrate oxidation were measured via indirect calorimetry. Participants were provided with standardized meals for 3 days prior to the exercise study visit. At the exercise study visit, IMCL and EMCL were measured via magnetic resonance spectroscopy (MRS) before and after 90-minutes of moderate intensity cycling with indirect calorimetry.

RESULTS

Substrate oxidation at rest and during exercise was not different between groups. Post-exercise, a decrease in IMCL was observed in the AO group that was not demonstrated in the CO group. There were no changes in EMCL post-exercise in either group.

CONCLUSIONS

This was the first study to compare the effects of exercise on IMCL and EMCL use in males with CO and AO. The decreases in IMCL of the AO group is similar with those observed in the literature in lean individuals. We made the novel observation that with moderate intensity cycling, males with CO do not appear to use IMCL as effectively as those with AO, suggesting perturbations in IMCL metabolism.

Distortion of body image perception in the Prader-Willi syndrome: Relationship with the perceptual reasoning index

INTRODUCTION

Self-perception of body image has been scarcely evaluated in people with Prader-Willi syndrome (PWS), who, in addition to intellectual disability, are often obese. Therefore, we explored whether people with PWS can accurately identify their true image and how this self-perception is impacted by their neuropsychological profile.

METHODOLOGY

This observational study included patients with PWS with regular attendance to transdisciplinary treatment at a center specialized in the management of rare diseases. All patients were evaluated with the Stunkard scale (including silhouettes ranging from extremely skinny to extremely obese) and the WISC-IV and WAIS-III questionnaires, specifically the perceptual reasoning index (PRI).

RESULTS

Among the 21 participants, 62% misperceived their body image, most underestimating their body dimensions (actual BMI 28.0±8.3kg/m2 vs self-perceived BMI 23.2±4.7kg/m2, p=0.03). While BMI differences between accurate and inaccurate body image perception were nonsignificant (accurate 26.6±8.8kg/m2 vs inaccurate 28.9±8.1kg/m2, p=0.56), individuals with accurate perception showed both higher PRI scores (accurate 67.6±8.2 vs inaccurate 60.2±7.2, p=0.043) and, to a lesser extent, intelligence quotients (IQ) (accurate 60.0±4.9 vs inaccurate 55.0±7.5, p=0.079).

CONCLUSION

In this study, we identified distortion of body image perception as a very common finding among PWS patients, in most cases as underestimation, and influenced by the neuropsychological profile.

Development, Content Validity and Usability of a Self-Assessment Instrument for the Lifestyle of Breast Cancer Survivors in Brazil

BACKGROUND/OBJECTIVES

Breast cancer is the most common cancer among women globally, and it negatively impacts diet and quality of life, increasing the risk of recurrence. Adhering to World Cancer Research Fund (WCRF) and American Institute for Cancer Research (AICR) lifestyle guidelines, such as healthy eating habits and nutritional status, can help in primary and secondary cancer prevention. However, no questionnaire was found for self-assessment of these guidelines for the Brazilian population. The aim of this study is to carry out content validity, pilot, and usability testing of the self-administered digital instrument "PrevCancer" assessing adherence to the WCRF/AICR recommendations in Brazilian female breast cancer survivors.

METHODS

We conducted a psychometric study that involved the development of an instrument based on WCRF/AICR recommendations. Assessment of content validity involved the Content Validity Index (CVI) based on expert assessments (n = 7). The pilot study involved the System Usability Scale (SUS) after applying the developed instrument (n = 65) and anthropometric assessment for convergent validity by female participants (n = 55). The final usability test consisted of evaluating the satisfaction with the instrument of women with breast cancer (n = 14).

RESULTS

The "PrevCancer" instrument demonstrated good content (CVI = 1.0) as well as good usability and acceptability in the pilot study (mean SUS score = 88.1). The convergent validity stage demonstrated positive associations between the PrevCancer parameters and anthropometric parameters (p < 0.001). In the final usability study (mean SUS score = 90.3), participants' receptivity to the instrument was excellent.

CONCLUSIONS

The PrevCancer instrument had valid content and great usability by the target population, proving to be a useful tool for future cancer research.

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

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

Childhood body fatness and the risk of epithelial ovarian cancer: A population-based case-control study in Montreal, Canada

OBJECTIVE

To assess the association between childhood body fatness and epithelial ovarian cancer (EOC), and whether this association differs by type of EOC.

METHODS

Using data from a population-based case-control study (497 cases and 902 controls) in Montreal, Canada conducted 2011-2016, we examined the association between childhood body fatness and EOC, overall and separately for invasive vs. borderline EOCs. A figure rating scale was used to measure body fatness at ages 5 and 10. Multivariable logistic regression was used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (95% CI). Quantitative bias analyses were conducted to assess the impact of exposure misclassification and non-participation.

RESULTS

The aOR (95% CI) of overall EOC for high vs. low body fatness was 1.07 (0.85-1.34) at age 5 and 1.28 (0.98-1.68) at age 10. The associations were stronger for invasive EOC, specifically the endometrioid histological type. For borderline cancers, the aORs were below the null value with wide confidence intervals. Bias analyses did not reveal a strong influence of non-participation. Non-differential exposure misclassification may have biased aORs towards the null for invasive cancers but did not appear to have an appreciable influence on the aORs for borderline cancers.

CONCLUSIONS

Childhood body fatness may be a risk factor for invasive EOC in later adult life. Our study highlights the potential importance of examining early life factors for a comprehensive understanding of EOC development.

Perceived Body Size in Relation to 10-Year Weight Change in the Swedish Obese Subjects Intervention Study

INTRODUCTION

Body size underestimation in patients with obesity may be associated with long-term weight increase. In the current report, we analyse changes in body size perception in patients with obesity undergoing either bariatric surgery or usual obesity care, and in subgroups of patients who gain weight or maintain their body weight over 10 years.

MATERIALS AND METHODS

A total of 2,504 patients with obesity from the prospective, controlled Swedish Obese Subjects (SOS) intervention study were included in this report, 1,370 patients underwent bariatric surgery and 1,134 patients were usual care controls. Weight was measured and body size was self-estimated using the Stunkard's figure rating scale at baseline and after 0.5, 1, 2, 3, 4, 6, 8 and 10 years of follow-up. A body perception index (BPI) was calculated as estimated/measured BMI. Weight (re)gain was defined as ≥10% increase between 1 and 10 years of follow-up.

RESULTS

Body size was underestimated by 12% in the surgery and 14% in the control group (i.e., >5 BMI units) at baseline and underestimation largely persisted over 10 years in both intervention groups. When stratified by long-term weight development, weight regainers from the surgery group underestimated their body size to a larger degree compared to weight maintainers (12 vs. 9%, p < 0.001) after 10 years. Likewise weight gainers in the control group also underestimated their body size to a larger degree (17% vs. 13%, p < 0.001). In both groups, the change in BPI was significantly different between weight regainers and maintainers during follow-up (time-BPI interactions both p < 0.001).

CONCLUSION

Patients with obesity underestimate their body size and this underestimation remains long-term even after major weight loss induced by bariatric surgery. In patients with obesity who maintain their weight, regardless of treatment, underestimation of body size persists but body size perception is slightly more accurate compared to patients who gain or regain weight long-term.

Elaborating and Testing Erotic Target Identity Inversion Theory in Three Paraphilic Samples

Some men sexually attracted to types of persons (e.g., women) or things (e.g., animals) also have internalized sexual attractions: sexual arousal by the idea of being the type of person or thing to whom they are attracted. Consequently, some of these men develop erotic target identity inversions, in which they imitate, yearn to be, or identify as an instance of their erotic target. Erotic Target Identity Inversion Theory predicts that for every external erotic target to which men are attracted, a subset of men will develop an internalized sexual attraction, which may cause an erotic target identity inversion. We examined these predictions in Internet surveys of three samples of men with paraphilic sexual interests: 322 men attracted to amputees, 1501 men attracted to animals, and 402 men attracted to severely obese persons. All samples included substantial minorities of men reporting internalized sexual attractions and erotic target identity inversions specific to their external sexual attractions (e.g., men attracted to amputees who are also aroused by the fantasy of being amputees and wish to become amputees). The correlation between degree of each internalized sexual attraction and degree of its corresponding erotic target identity inversion was approximately 1.0 after correction for attenuation. In each sample, participants' specific internalized sexual attraction was positively correlated with autogynephilia, likely the most common internalized sexual attraction in men. Erotic Target Identity Inversion Theory can potentially explain a variety of otherwise puzzling phenomena, including transgender identity among female-attracted natal males and men seeking amputations of healthy limbs.

Long-term changes in body image after bariatric surgery: An observational cohort study

BACKGROUND

While body image improves in the first few months after surgery, data on long-term changes in body image after bariatric surgery are scarce and contradictory.

METHODS

We assessed body image through the Stunkard Figure Rating Scale and the Multidimensional Body-Self Relations Questionnaire-Appearance Scale, which measures appearance evaluation and orientation, overweight preoccupation, and self-classified weight. Surveys were conducted before surgery and at regular intervals until 5 years after bariatric surgery.

RESULTS

61 patients were included in the study. No patients were lost to follow-up until 18 months after bariatric surgery. At 5 years, there were 21 patients (34%) lost to follow-up. We detected an overall improvement in body image until 12-18 months post-surgery. Scores declined after 5 years post-surgery but were still higher than preoperative evaluations. Overweight preoccupation did not change throughout the follow-up period. There was a positive correlation between body weight lost and appearance evaluation. There was also a positive correlation between weight loss and the Body Areas Satisfaction Scale. There was a negative correlation between weight loss and overweight preoccupation. Appearance orientation and self-classified weight were not correlated with weight loss.

CONCLUSIONS

Body image improved after bariatric surgery but was not maintained for all 5 years after surgery.