Elucidating knowledge and beliefs about obesity and eating disorders among key stakeholders: paving the way for an integrated approach to health promotion

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.

Workplace Health Promotion Embedded in Medical Surveillance: The Italian Way to Total Worker Health Program

In 2011, NIOSH launched the Total Worker Health (TWH) strategy based on integrating prevention and health promotion in the workplace. For several years now, in Italy, this integration has led to the creation of workplace health promotion embedded in medical surveillance (WHPEMS). WHPEMS projects, which are also implemented in small companies, focus each year on a new topic that emerges from the needs of workers. During their regular medical check-up in the workplace, workers are invited to fill in a questionnaire regarding the project topic, its outcome, and some related factors. Workers receive advice on how to improve their lifestyles and are referred to the National Health Service for any necessary tests or treatments. Results collected over the past 12 years from more than 20,000 participants demonstrate that WHPEMS projects are economical, sustainable, and effective. The creation of a network of occupational physicians who are involved in WHPEMS projects could help to improve the work culture, health, and safety of workers.

Prevention of high body mass index and eating disorders: a systematic review and meta-analysis

BACKGROUND

Eating disorders (EDs) and high body mass index (BMI) are two important public health issues with significant health and cost impacts. The aim of this systematic review and meta-analysis was to establish whether interventions are effective in preventing both issues.

METHODS

Electronic databases were searched up to 10 May 2021. Studies were included if they were randomised or quasi-randomised controlled trials that evaluated a preventive intervention (regardless of its aim to prevent ED, high BMI or both) and reported both EDs and BMI-related outcomes. Both narrative synthesis and meta-analysis were used to synthesise the results. Publication bias was also investigated.

RESULTS

Fifty-four studies were included for analysis. The primary aim of the studies was ED prevention (n = 23), high BMI prevention (n = 21) and both ED and high BMI prevention (n = 10). Meta-analysis results indicated that preventive interventions had a significant effect on several ED outcomes including dieting, shape and weight concerns, body dissatisfaction, negative affect, eating disorder symptoms and internalization, with effect sizes ranging from - 0.16 (95% CI - 0.27, - 0.06) to - 0.61 (95% CI - 0.29, - 0.04). Despite several studies that demonstrated positive impacts on BMI, there was no significant effect on BMI-related measures in the meta-analysis. The risk of publication bias was low for the majority of the pooled effect results.

CONCLUSION

Preventive interventions were effective for either high BMI or EDs. However, there is limited evidence to show that current preventive interventions were effective in reducing both outcomes. Further research is necessary to explore the risk factors that are shared by these weight-related disorders as well as effective prevention interventions.

LEVEL OF EVIDENCE

Level I: systematic review.

The prevalance of binge eating disorder and associated psychiatric and substance use disorders in a student population in Kenya - towards a public health approach

INTRODUCTION

Kenya in particular and Africa in general lack data on Binge Eating Disorder (BED). The overarching objective of this study is to fill that gap. Kenyans may not be aware that BED exists when a "very good" appetite is considered a sign of good health, especially if food is available either at home, in fast food shops or when communally eating together, a very common cultural practice. On the other hand where there is relatively insufficient food, it is not expected that one could be having a problem of eating too much.

METHOD

We administered the following tools and measurements to 9742 participants (high school, college and university students): 1) Researcher designed socio-demographic and economic indicator questionnaire; 2) An instrument documenting DSM-IV diagnostic criteria for BED and its various symptoms; 3) An instrument to determine DSM-IV psychiatric disorders and substance abuse;4) An instrument measuring high risk for psychosis ,affectivity and stress; 5) A WHO designed instrument measuring the severity of substance abuse for specific substances. We used descriptive and inferential analysis to determine the prevalence and association of the different variables. Independent predictors of BED were generated from a generalized linear model (p<0.05).

RESULTS

We found a prevalence of 3.2% of BED and a wide range of prevalence for BED and BED related symptoms (8.1% to 19%). The least prevalent was "To prevent weight gain from eating binge did you force yourself to vomit, or used laxatives?". The most common was "Did you often go on eating binges (eating a very large amount of food very quickly over a short period of time)." Major depression, obsessive compulsive disorder, panic disorder, agoraphobia, generalized anxiety disorder ,a positive stress screen and drug abuse were independent predictors of BED (p<0.05).

CONCLUSION

Our findings on the prevalence of BED and significant associations with various psychiatric disorders and substance use disorders are similar to those obtained in High Income Countries (HIC) using similar large-scale samples in non-clinical populations. Our findings suggest the need fora public health approach to enhance awareness of BED and to promote health-seeking behaviour towards management of BED.

Self-estimated BMI, but not self-perceived body size, accurately identifies unhealthy weight in US adults

BACKGROUND

Self-perceptions of health and disease can be a major driver of health behaviors. Improving accuracy of self-ascertainment of obesity may prompt uptake of weight-control behaviors in those with obesity.

METHODS

We assess performance of self-perceived body size ('too small', 'about right' or 'too large'), self-estimated BMI in kg/m², and sociodemographics in detecting measured BMI category (under-, normal-, overweight and obese; BMI cutpoints 18.5, 25 and 30) in first bivariate and then multivariable models.

RESULTS

Of 37,281 adults in the US from NHANES, 2, 34, 33 and 32% were under-, normal-, overweight and obese. Respectively 56, 73, 60 and 91% self-perceived as 'too small', 'about right', 'too large' and 'too large.' Of those who self-perceived as 'too small', 22% were underweight and 10% were overweight or obese. 99.7% of obese participants self-estimated a BMI in the overweight/obese range, including many who did not self-perceive as 'too large'. Among obese participants, self-perception as either 'about right' or 'too small' was more likely for those who were younger (OR for perception as 'too large' 1.01 per year, 95% confidence interval 1.00-1.01) male (OR 0.33, (0.28-0.39)) nonwhite (ORs 0.36-0.79 for different ethnicities), low-income (ORs 0.61 and 1.8 for the lowest and highest of six categories, vs. the third) or measured recently (OR 0.98 (0.96-1.0) per year since 1999). Misperception was less common, but still existed, for participants with moderate or severe obesity (ORs 2.9 (2.3-3.5) and 7.9 (5.4-12), vs. 'mild.') (all p < 0.01.) CONCLUSIONS: A tenth of adults in the US with obesity, especially those from overweight peer groups, self-perceive as normal or underweight and thus may not be motivated to control their weight. However, virtually all self-estimate an overweight or obese BMI. If measured BMI is not available, self-estimates are sufficiently accurate that interventions may rely on it to identify obesity.

Eating-Disordered Behavior in Adolescents: Associations with Body Image, Body Composition and Physical Activity

Eating disorders (EDs) represent a disparate group of mental health problems that significantly impair physical health or psychosocial functioning. The aim of this study was to present some evidence about the prevalence of eating-disordered behavior (EDB) in adolescents, and explore its associations with body image (BI), body composition (BC) and physical activity (PA) in this age group. Data from 780 adolescents participating in a health behavior in school-aged children (HBSC) study conducted in Slovakia in 2018 were used (mean age 13.5 ± 1.3; 56% boys). Differences in mean values of numerical indicators were evaluated using the independent samples t-test. Differences between nominal variables were assessed by the chi-square test. Pearson correlation was used to describe the associations between all the selected variables. EDB was positively screened in 26.7% (208/780) of adolescents, with a higher prevalence in girls (128/344, 37.2%) than in boys (80/436, 18.3%). Significantly higher means of BI, body weight (BW), body mass index (BMI), body fat mass (BFM), body fat percentage (BFP), body fat mass index (BFMI), fat free mass index (FFMI), and SCOFF questionnaire score (SCOFF QS) were found in those positively screened for EDB. Pearson correlation analysis revealed positive associations between EDB and BI, BW, BMI, BFM, BFP and BFMI. The prevalence of EDB is high in Slovak adolescents. Positive associations between EDB, BI, BMI and fat-related body composition parameters support the idea of a more integrated approach in EDs and obesity prevention and treatment. At the same time, gender differences suggest the need for considering gender-specific strategies aimed at girls and boys separately.