Development of self-image and its components during a one-year follow-up in non-referred adolescents with excess and normal weight

Parental Responses to Online Sexual Grooming Events Experienced by Their Teenage Children

Online sexual grooming (a manipulative process in which the perpetrator locates a young person and creates an abusive relationship with the child that involves sexual exploitation) poses significant challenges to parents. This study examined how parents of adolescent victims of online sexual grooming experienced guiding their children through the event. This qualitative study, conducted in Israel, was based on semi-structured in-depth interviews with 15 parents who guided their adolescents who had been subjected to online sexual grooming. Results indicate that the parents reported a spectrum of emotions, from insecurity and guilt to a sense of control and satisfaction in managing the situation. Also, the reluctance of some parents to engage with the education system indicates potential trust issues. The study demonstrates the urgent need for targeted interventions to equip parents and educational professionals with the necessary knowledge for prevention and effective response to online sexual grooming. Implications for future research, policy, and practice are discussed.

Risk of eating disorders, changes in salivary cortisol concentrations and nutritional status of adolescents

PURPOSE

The imposition of the thin body as an ideal of beauty and the changes that occur in adolescence lead to a constant concern with adolescents' body weight, putting them at risk for eating disorders. Thus, the study sought to investigate associations between eating disorders and salivary cortisol concentrations, nutritional status and depressive symptoms in female adolescents with bulimia.

METHODS

A cross-sectional study was carried out with 1435 adolescents aged 10-19 years. The Bulimic Investigatory Test of Edinburgh (BITE) and Body Shape Questionnaire (BSQ) questionnaires were used. A follow-up study was conducted from a random selection of female adolescents diagnosed with Bulimia Development and Well-Being Assessment-(DAWBA) to assess associations with salivary cortisol concentrations and nutritional status.

RESULTS

The prevalence of body dissatisfaction among adolescents with symptoms of bulimia was 37%. There was a significant difference between salivary cortisol and bulimia (Risk Group = 0.33 ± 0.20 μg/100 ml, Diagnostic Group = 0.44 ± 0.21 μg/100 ml p = 0.040), and correlation positive between the risk of bulimia with symptoms of depression (0.355 p = 0.002) and with Body Mass Index (0.259 p = 0.028). High concentrations of salivary cortisol in bulimic adolescents may be associated with hyperactivity of the hypothalamic-pituitary-adrenal axis and depressive symptoms.

CONCLUSIONS

Nutritional status indicators cannot be used alone for the diagnosis of bulimia, since cortisol levels seem to be a reliable parameter in the identification of bulimia, provided they are used with other diagnostic criteria.

LEVEL III

Evidence obtained from cross-sectional study.

Changes in self-image after pectus carinatum brace treatment

BACKGROUND/PURPOSE

Pectus carinatum (PC) is a chest wall deformity resulting in anterior protrusion of the chest. PC does not typically result in significant physical or cardiopulmonary symptoms, but patients with this condition can experience a disturbed body image, lower self-esteem and reduced quality of life.  The purpose of this study was to investigate the relationship between self-image and non-surgical correction of PC using a brace.

METHODS

This study was a descriptive, pre-post survey design. The sample included children ages 11 to <18 years undergoing PC treatment with the dynamic compressor system. Subjects completed the modified Pectus Excavatum Evaluation Questionnaire (mPEEQ) at the onset of bracing and again once PC correction was completed.

RESULTS

Ninety-seven subjects were enrolled at the time of bracing, and 41 achieved correction and took the second survey. The mean age was 14 years and 80% were male. There was a statistically significant (p<0.001) improvement in body self-image between the first and second surveys.

CONCLUSIONS

Non-surgical correction of PC with the dynamic compressor system resulted in an improvement in the self-image of children.

PROGNOSIS STUDY

Level of Evidence II.

Relationship Between Weight Status and Self-Image Mediated by Pubertal Timing and Athletic Competence: A Cohort Study With Taiwanese Adolescents

Background

Self-image reflects overall self-acceptance in developing adolescents. Using a representative cohort of Taiwanese youth, this study aims to explore the relationship between weight status, pubertal timing, athletic competence, and adolescent self-image.

Methods

Data come from the Taiwan Youth Project that comprised a longitudinal cohort of adolescents (N = 2690, 51% males, Mage = 13.3 ± 0.5 years) surveyed annually from seventh grade. Self-image was measured by perceived satisfaction with appearance and physique. Weight status was proxied by self-reported body mass index (BMI; kg/m2). Pubertal timing was defined using the Pubertal Developmental Scale, which mainly measured physical changes in puberty. Athletic competence was assessed by experiences with participation in competitive sports and self-perceived talent for sports. Linear regression analysis was applied to test for an association between BMI and self-image. In order to test for mediating roles of pubertal timing and athletic competence, Hayes' PROCESS macro on SPSS was conducted applying 5,000 bootstrap resamples with 95% confidence intervals of the indirect effect.

Results

BMI was inversely associated with self-image in both males (β = -0.074, [-0.095, -0.053]) and females (β = -0.095, [-0.122, -0.069]). The boot-strapped 95% confidence intervals indicated statistically significant mediating effects of pubertal timing (β = -0.008, [-0.015, -0.001]) and athletic competence (β = -0.006, [-0.011, -0.002]) in the link between BMI and self-image in females, whilst only athletic competence mediated this association (β = -0.006, [-0.009, -0.002]) in males. Moreover, BMI at baseline were also associated with long-term self-image in males (β = -0.037, [-0.057, -0.017]) and females (β = 0.132, [0.073, 0.190]).

Conclusions

Understanding the mediating factors may help enhance adolescents' self-image by providing guidance on healthy weight and physical activity behaviors according to different stages of pubertal progression.

The Association between Disordered Eating Behavior and Body Image Biological Maturation and Levels of Adipocytokines in Preadolescent Girls: The Healthy Growth Study

During puberty, rapid, complex hormonal, physical and cognitive changes occur that affect body image and eating behavior. The aim of this cross-sectional study, a secondary analysis of data from the Greek Healthy Growth Study, was to explore associations of disordered eating behaviors and body image in 1206 10–12-year-old girls during pubertal maturation, with serum leptin and adiponectin levels, according to body mass index (BMI). Eating behavior and disordered eating were assessed with the Dutch Eating Behavior Questionnaire (DEBQ) and the Children Eating Attitudes Test Questionnaire (ChEAT), respectively. Associations of components of DEBQ and ChEAT with maturation according to Tanner Stage (TS) and levels of leptin and adiponectin were explored by univariate and multivariate regression analysis. Adiponectin levels in girls at TS 1 were positively associated with the “social pressure to eat” score of ChEAT. Leptin levels in girls at TS 4 were positively correlated with the “restraint eating” score of DEBQ, and the “dieting”, “body image” and “food awareness” scores of ChEAT. After adjustment for TS and BMI, only “body image” and leptin remained significant. Further research may shed light on how these hormonal changes affect eating behaviors at various pubertal stages, contributing to “TS-specific” preventive strategies for eating disorders in girls.

Quality of life of children and adolescents with clinical obesity, perspectives of children and parents

BACKGROUND/OBJECTIVES

Childhood obesity can have important psychological impacts. The objective of this study was to evaluate the Health Related Quality of Life (HRQoL) of children and adolescents with overweight and obesity. The participants were referred to an outpatient hospital-based obesity treatment. Additionally, we investigated the differences between parent- and self-reported HRQoL.

SUBJECTS/METHODS

Children and adolescents aged 3-18 years with overweight or obesity, referred by their general practitioner or youth health care physician to the pediatric outpatient clinic of Hospital Gelderse Vallei (Ede, the Netherlands) for multidisciplinary obesity treatment, were enrolled in this cross-sectional study (n = 119).

INTERVENTIONS/METHODS

Parent-proxy reported HRQoL was assessed using the Child Health Questionnaire Parental Form 50 (CHQ-PF50, n = 119) and the Infant Toddler Quality of Life Questionnaire 97 (ITQOL-97). Adolescents completed CHQ Child Form 87 (CHQ-CF87, n = 45) and Impact of Weight on Quality of Life-Kids (IWQOL-Kids, n = 38) to assess self-reported HRQoL.

RESULTS

The mean age of the children was 9.6 years (SD 4.3). Both parent-proxy reports and child self-reports showed lower HRQoL in children with a higher degree of obesity, especially in the physical domains of HRQoL (p < 0.05). Child self-reported scores were significantly lower than parent-proxy scores on the subscales 'bodily pain/discomfort' and 'general health perceptions', and significantly higher on 'behavior' and 'family cohesion' (p < 0.05).

CONCLUSIONS

Childhood obesity has a negative effect on HRQoL, especially on the physical aspects. The discordance between parent and child reports underscores the importance of using a combination of parent-proxy and child self-reports to assess HRQoL.

Body image disturbance, psychosocial adjustment and quality of life in adolescents with amputation

BACKGROUND

Physical and emotional situations experienced by amputees can affect body image and quality of life (QoL). Although adolescence is a time when appearance becomes more important, there are insufficient studies in literature examining the effect of body image disturbance (BID) on QoL and psychosocial adjustment in adolescents with amputation.

OBJECTIVE

To investigate the BID, psychosocial adjustment and QOL in adolescents with amputation.

METHODS

This cross-sectional study included individuals aged 11-18 years with amputation. The Amputee Body Image Scale was used to determine BID, the psychosocial adjustment subscale of Trinity Amputation and Prosthesis Experience Scale was used to investigate the psychosocial adjustment to amputation, and the Pediatric Quality of Life Inventory was used to determine the QoL.

RESULTS

Evaluation was made of 42 adolescents (26 boys, 16 girls) with a mean age of 14.24 ± 2.25 years. Significant correlations were found between BID and age of fitting of the first prosthesis, psychosocial adjustment and QoL (p < 0.05). 38% of the variance of QoL was predicted by perceived body image and income of the family. 34% of the variance of psychosocial adjustment was predicted by perceived body image (p < 0.05). Adolescents suffering phantom limb pain were seen to have lower QoL scores (p < 0.05).

CONCLUSION

BID is an important predictor of psychosocial adjustment and QoL in adolescent amputees. Therefore, a prosthesis that ensures the integrity of the body image should be fitted at an as early age as possible before the onset of body image disorder.

Self-perceived body image, dissatisfaction with body weight and nutritional status of Brazilian adolescents: a nationwide study

OBJECTIVES

The purpose of this study was to evaluate the agreement and risk factors for underestimation and overestimation between nutritional status and self-perceived body image and to assess the prevalence and associated factors for dissatisfaction with body weight among Brazilian adolescents.

METHODS

Students aged 12-17 years participating in the Study of Cardiovascular Risk in Adolescents ("ERICA"), a multicenter, cross-sectional, school-based country-wide study, were included (n=71,740). Variables assessed as covariates were sex, age, skin color, socioeconomic status, and common mental disorders (screened by the General Health Questionnaire, GHQ-12). Multinomial logistic regression was used to explore the association between covariates and combinations between self-perceived body image and body mass index (agreement, underestimation and overestimation). The associations between dissatisfaction with body weight and exposure variables were investigated using multivariable Poisson regression models.

RESULTS

Approximately 66% students rightly matched their body mass index with self-perceived weight (kappa coefficient was 0.38 for boys and 0.35 for girls). Agreement was higher among younger students and adolescents from low income households. Male sex, older age, and GHQ-12 score ≥3 were associated with weight overestimation. Prevalence of dissatisfaction with body weight was 45.0% (95% CI: 44.0-46.0), and higher among girls, older adolescents, those with underweight or overweight/obesity, as well as those who were physically inactive and with GHQ-12 ≥3.

CONCLUSIONS

Most of the sample rightly self-perceived their body image according to body mass index. Students with body image misperception and those dissatisfied with their weight were more likely to present a positive screening for common mental disorders.

Differences in cortisol concentrations in adolescents with eating disorders: a systematic review

OBJECTIVE

To perform a systematic review of the literature for scientific evidence of possible differences in cortisol concentrations in adolescents with eating disorders.

SOURCE OF DATA

Electronic searches were conducting in the PubMed, Scientific Electronic Library Online, Virtual Health Library, and Science Direct databases for articles published between 2007 and 2017 using the keywords, cortisol, hydrocortisone; eating disorders, bulimia, bulimia nervosa, anorexia, anorexia nervosa; adolescence, adolescent, adolescents.

SYNTHESIS OF DATA

A total of 192 articles were found. After the analysis of the eligibility criteria using the PRISMA method, 19 articles were selected for the present review. Most studies were conducted in Europe. Adolescents diagnosed with anorexia nervosa were evaluated in all studies, except one, when other eating disorders were investigated. Blood was the means used for the determination of cortisol. In ten studies, cortisol levels were higher in the group with anorexia than the control group and a reduction in cortisol levels occurred in the adolescents after being submitted to nutritional recovery.

CONCLUSIONS

Patients with eating disorders may have several clinical consequences, such as changes in body fat distribution, changes in bone mineral density, worsening of neurocognitive ability, and endocrine changes (e.g., hypercortisolemia), which in turn can lead to hyperglycemia, insulin resistance, hypertension, and increased risk of infections. The findings demonstrate that adolescents with eating disorders, especially anorexia nervosa, have increased cortisol levels, which are reduced after the treatment period. Further studies on differences in cortisol concentrations in adolescents with other eating disorders are needed, using different methods.

Self-image and psychological distress in treatment-seeking adolescents

BACKGROUND

Adolescence has been recognized as a critical period for mental health during which it is fundamental to the well-being of adolescents to provide early and appropriate mental health interventions. Self-image perceptions play a particularly relevant role during adolescence since individuals are extensively involved in reorganizing their identity and relationships. Although the self-image development implies adaptive outcomes for most adolescents, some age-related tasks can be difficult to deal with and lead to psychological suffering for a minority of them.

METHOD

This study examined how domain-specific self-image was associated with psychological distress in 128 treatment-seeking adolescents aged 13-18 (60.9% female). The adolescents completed the Offer Self-Image Questionnaire to measure their global and domain-specific self-image and the Youth-Outcome Questionnaire to assess their psychological distress.

RESULTS

Regression analyses indicated that impulse control, emotional tone, family, and social functioning significantly predict worse psychological functioning in the entire group. Moreover, significant gender differences emerged showing a more complex set of risk factors among adolescent females, thus suggesting the need for gender-targeted preventive and treatment strategies.

CONCLUSIONS

The findings highlight that adolescents' feelings and concerns about their self-image may be key factors to consider in planning, developing, and delivering effective public mental health services for adolescents.

Factors Associated With Body Image Perception Among Brazilian Students From Low Human Development Index Areas

This study aimed to evaluate sociodemographic, behavioral, and individual factors associated with body image perception in a sample of adolescents from schools in low Human Development Index areas in Brazil. This cross-sectional study included 609 boys and 573 girls (aged 11–17 years). Body image perception (nine-silhouettes scale) and sociodemographic, behavioral, and individual variables were included. Multinomial logistic regression analysis was used. Most boys (76.9%) and girls (77.5%) were dissatisfied with their body image. Body mass index status and healthy body image evaluation were significantly associated with body image dissatisfaction in both boys and girls ( p < .001), and daily fruit consumption was associated with body image dissatisfaction only in boys ( p = .035). Education and health care focused on body image can pay special attention to young people from vulnerable areas with unhealthy nutritional status and focus on strategies that enable improving the perception of a healthy body and a healthy diet.