[Test-retest reliability of the scale silhouettes figures of body image in Brazilian Longitudinal Study of Adult Health]

Exploring the Associations between Media and Instagram Interaction Patterns with Weight Bias among Undergraduate Nutrition Students in the Brazilian Nutritionists' Health Study

This study examined the association between media and Instagram interaction patterns with weight bias among undergraduate nutrition students in the Brazilian Nutritionists' Health Study. We also explored the potential mediating role of students' own body image perception in these relationships. A total of 406 students (78% women) participated in this cross-sectional analysis. Sociodemographic data, media influence, Instagram interaction patterns, body image perception, and weight bias were assessed using semi-structured questionnaires. Findings indicated that exposure to fitness content on Instagram (β = 0.17, p < 0.001) and the pursuit of an ideal athletic body (β = 0.12, p = 0.034) were associated with increased weight bias. In contrast, engagement with body diversity content (β = -0.23, p < 0.001) and perceived pressure from media to conform to appearance ideals (β = -0.24, p < 0.001) had a mitigating effect on weight bias. Notably, body image perception did not mediate these relationships (p > 0.05). In conclusion, this study revealed a link between media exposure and weight bias among undergraduate nutrition students, independent of their body image perception. Developing social media literacy programs that encourage students to critically evaluate media content is imperative to reduce weight bias. Additionally, a deeper examination of the media content that contributes to weight bias and the potential need for targeted regulatory measures is warranted.

Association of body image perception and (dis)satisfaction with adiposity in adults: The Pró-Saúde study

INTRODUCTION

Body image distortion and/or dissatisfaction may occur primarily due to body fat accumulation and/or distribution. The aim of this study was to evaluate the frequency of body image perception and (dis)satisfaction categories in adult men and women according to the adiposity classification.

METHODS

This is a cross-sectional study (n = 514; 33-79 years; 265 women) that is part of a prospective cohort (Pró-Saúde study). Adiposity measurements were determined by two methods: anthropometry, used to calculate the body mass index (BMI) and dual-energy X-ray absorptiometry (DXA), to estimate body fat percentage. Participants were grouped as "no excess adiposity" and "excess adiposity", considering BMI and body fat percentage (>30% for men, >40% for women). Perception and (dis)satisfaction with body image were evaluated using the Kakeshita scale, composed by 15 silhouettes, developed for the Brazilian population. Degree of distortion (perceived BMI - real BMI) and dissatisfaction (perceived BMI - desired BMI) were calculated.

RESULTS

A high proportion of men (58.6%; 74.3%), and especially of women (82.6%; 86.8%), presented body size overestimation and dissatisfaction due to excess weight, respectively. A relevant fraction of the women (32.6%) and men (30.8%) who were dissatisfied due to excess weight did not present excess adiposity, especially if classified by DXA. Variability in degree of distortion was hardly explained by anthropometric and DXA variables in women (<5%) and men (∼22%). Both anthropometric and DXA measurements accounted for ∼30% and ∼50% of the variability in degree of dissatisfaction among women and men, respectively.

CONCLUSION

Our results suggest a high frequency of body image distortion in Brazilian adult individuals, as well as dissatisfaction with excess weight, especially among women with excess adiposity. The findings indicate that anthropometric measurements explain much of the variability in degree of body image dissatisfaction in men, with no apparent advantage of the use of more refined DXA measurements.

Is body image perception and (dis)satisfaction associated with anthropometric profile of older women attending a senior community center?

The study aimed to assess the association between body image perception and (dis)satisfaction and the anthropometric profile of older women. Data from 60 women attending a senior community center were analyzed. Body image perception and (dis)satisfaction were considered dependent variables and were assessed using a silhouette scale constructed for the Brazilian population. The independent variables were body mass (BM), body mass index (BMI), waist circumference (WC), and calf circumference (CC). The associations were performed by logistic and linear regression models. Half of the participants overestimated their body size and 61.7% were dissatisfied due to excess weight. Overweight older women had 3.6 times higher odds to overestimate body size and 14.4 higher odds to be dissatisfied due to excess weight compared to normal-weight women. The increase in BM, BMI, WC, and CC raised mean difference between perceived and desired BMI and the odds of dissatisfaction due to excess weight. The anthropometric profile was more important to explain (dis)satisfaction than body size perception. The stimulus to changes that provide the adequacy of the anthropometric profile may reduce dissatisfaction due to excess weight among older women.

Factors associated with body image dissatisfaction in adults: a cross-sectional analysis of the ELSA-Brasil Study

The aim of this article is to assess the association between body image dissatisfaction and sociodemographic and health behaviors, according to sex. Data were analyzed for 6,289 women and 5,188 men (35-59 years), participants in the baseline of the Longitudinal Study of Adult Health (ELSA-Brasil), using multinomial regression. The odds of dissatisfaction due to feeling underweight were higher among in women with low schooling and those who only consumed fruit weekly. Moderate physical activity reduced this type of dissatisfaction by 50%. Higher odds of dissatisfaction due to overweight were seen in married women, those who practiced light physical activity, and former smokers. Men with secondary schooling and excessive alcohol consumption showed 50% higher odds of dissatisfaction due to underweight, while light or moderate physical activity increased the odds by 75% and 94%, respectively. Among men, light and moderate physical activity were also associated with increased odds of dissatisfaction due to overweight. These findings corroborate that unhealthy habits and behaviors can influence body image dissatisfaction with different patterns between women and men.

Comportamento alimentar e imagem corporal em universitários da área de saúde

RESUMO Objetivo Avaliar a associação da imagem corporal e o comportamento alimentar de universitários de uma capital do Nordeste do Brasil. Métodos Participaram da pesquisa universitários (n = 1570) da área da saúde de ambos os sexos, de quatro instituições de ensino superior. As dimensões da imagem corporal (i.e., perceptiva e atitudinal) foram avaliadas por meio da Escala de Silhuetas para adultos brasileiros; e o comportamento alimentar por meio da versão brasileira do Dutch Eating Behavior Questionnaire (DEBQ). Para a avaliação do estado nutricional, foram coletados peso corporal e estatura de modo autorreportado. A análise de associação foi feita pela regressão linear múltipla, após estratificação por sexo. Resultados Notou-se maior prevalência de universitárias do sexo feminino (72,9%), com idade média de 21,8 (DP = 4,1) anos. Foi encontrada associação entre percepção e (in)satisfação corporal com o comportamento alimentar em ambos os sexos. As mulheres que superestimaram o tamanho corporal obtiveram associação inversa com a dimensão alimentar restritiva (p = 0,001); e as insatisfeitas por magreza, associação direta entre alimentação restritiva; e inversa com o comportamento emocional (p < 0,001). Os homens que superestimaram seu tamanho corporal evidenciaram associação direta com a alimentação emocional; e entre os insatisfeitos por excesso de peso houve associação direta com a dimensão emocional (p = 0,032) e global (p = 0,046) do comportamento alimentar. Conclusões O presente estudo demonstra que a imagem corporal negativa, considerando as duas dimensões avaliadas (i.e., perceptiva e atitudinal), foi associada ao comportamento alimentar entre universitários de ambos os sexos.

Factors Associated with Body Size Perception and Body Image (Dis)Satisfaction in the Elderly: Results of the ELSA-Brasil Study

The study aimed to assess the association between body image perception and (dis)satisfaction and sociodemographic and behavioral factors in the elderly, using multinomial logistic regression. Data were analyzed for 1686 women and 1499 men participating in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Men with less schooling and women with lower per capita income showed higher odds of underestimating their body size. Former smokers of both sexes showed higher odds of overestimating their body size; lower schooling and lower per capita income decreased these odds. Increasing age, lower per capita income, and smoking increased the odds of dissatisfaction due to thinness in men, and married marital status decreased these odds. In women, low per capita income, weekly consumption of vegetables, and smoking increased the odds of such dissatisfaction. Factors that increased the odds of dissatisfaction due to excess weight in both sexes were primary or secondary schooling and former smoking. In women, low per capita income, weak physical activity, weekly consumption of vegetables, and excessive alcohol intake also increased the odds of such dissatisfaction. The results suggest that improved living conditions and the adoption of healthy behaviors can help reduce misperceived negative body image among elderly.

Body Size Judgments at 17 ms: Evidence From Perceptual and Attitudinal Body Image Indexes

Evidence related to temporal control for stimuli presentation of whole-body image is generally associated with attentional bias to ideal thin bodies. Few studies present evidence concerning whole-body stimuli recognition during fast visual exposure intervals. The aim of this study was to evaluate the accuracy and reaction times for the judgment of different sized body silhouettes presented at 17 ms in a non-clinical sample. Thirty-one participants were divided in attitudinal and perceptual body image groups based on Figure Rating Scale output and performed two experiments. First experiment assessed perception and the clarity of visual experience for human and non-human body stimuli at 17 ms. A general accuracy of 69.17% was registered with no differences between perceptual and attitudinal body image groups. These results indicated that the way participants perceive their own bodies does not influence the recognition of general visual silhouette stimuli. It was also observed that the clarity of visual experience is positively correlated to stimuli recognition accuracy. In the second experiment participants had to respond in a seven-point Likert scale if the presented image of body silhouettes were bigger, equal or thinner than their own bodies. Trials were divided in two blocks based on spatial rotation, half at 0° and half at 180°. General accuracy for body silhouettes recognition was 41.1%. Greater accuracy recognition for regular positioned stimuli was observed. Attitudinal dimension of body image was not a predictor of differential performance whereas perceptual body image groups recorded contrasting recognition performance. Distorted body image participants presented higher accuracy than undistorted body image participants, with greater accuracy to thinner silhouette figures. Women had significantly higher overall accuracy than men considering both experimental blocks. When comparing the cumulative accuracy curves across experimental trials, an exposure effect was registered only for the first experiment. Results showed that body silhouette stimuli were judged in a fast exposure interval with differential accuracy rates only for perceptual body image groups. Such evidence signals that conscious body image can be associated to implicit detection of visual human body stimuli. Future studies should further test how traditional explicit body image outputs perform within experimental approaches.

Association of body image (dis)satisfaction and perception with food consumption according to the NOVA classification: Pró-Saúde Study

The literature on body image and food consumption has generally focused on isolated food items, while overlooking the growing role of ultra-processed foods in the overall diet. The objective of this study was to assess the association of body image (dis)satisfaction and perception with food consumption, according to the NOVA classification, which takes into account the extent and purpose of industrial food processing. A silhouette scale developed considering the Brazilian adults' Body Mass Index was used to assess body image (dis)satisfaction and perception. Food consumption was evaluated using a Food Frequency Questionnaire, and its items were categorized into three groups: unprocessed or minimally-processed foods and culinary preparations; processed foods; ultra-processed foods. The association was assessed using linear regression models. A total of 514 of Brazilian university employees were evaluated. Women dissatisfied due to excess weight consumed less unprocessed or minimally-processed foods and culinary preparations (-6.6, 95% CI: -10.7; -2.5) and more ultra-processed foods (3.7, 95% CI: 0.1; 7.2) compared to satisfied. Women that overestimated their body size consumed less unprocessed or minimally-processed food and culinary preparations (-4.2, 95% CI: -7.3; -1.1), compared to those who had not distorted body image. Food consumption appears to be more strongly associated with body image (dis)satisfaction than with perception. An association was established between body image dissatisfaction and unhealthy eating habits. This relation deserves public health attention since it may contribute to the development of chronic diseases and reduce the quality of life and body image assessment could be adopted by nutritionists and other health professionals in their practice.

Body dissatisfaction and its relationship with overweight, sedentary behavior and physical activity in survivors of breast cancer

OBJECTIVES

This study aimed to verify the prevalence of body satisfaction in breast cancer survivors and the association of this variable with overweight, sedentary behavior and physical activity in this population.

STUDY DESIGN

This is a cross-sectional study realized in Presidente Prudente-Brazil. Breast cancer survivors participated in this study. Questionnaires were used to obtain data on socioeconomic status, body dissatisfaction, sedentary behavior and level of physical activity. The association between body dissatisfaction and the independent variables was verified through binary logistic regression in the unadjusted model and model adjusted by socioeconomic level.

RESULTS

A total of 102 breast cancer survivors participated in this study with a mean age of 58.2 (±10.3) years. The prevalence of body dissatisfaction was 75.7%. Body dissatisfaction was higher in women with higher BMI (pvalue = 0.003) and in woman with high sedentary behavior (p-value = 0.049). Women with overweight had 7.87 times more chance of presenting body dissatisfaction. Women who reported hormone therapy were approximately 3 times more likely to be dissatisfacted with their body.

CONCLUSION

Body dissatisfaction was associated with lower age, high sedentary behavior and overweight in breast cancer survivors in the unadjusted analysis. When adjusted for socioeconomic status, only the variables of overweight and hormone therapy were associated with body dissatisfaction.

Online platform for healthy weight loss in adults with overweight and obesity - the "POEmaS" project: a randomized controlled trial

Background

Obesity is a major health problem in Brazil affecting 19% of Brazilian adults with a rising incidence over the last 10 years. Moreover, low fruit/vegetables consumption and high sweetened beverage intake are major issues. Facing the challenge of universal healthcare access, internet-based programs have the potential to reach a large number of inhabitants, be widely accessible and cost effective. Our aim is to to assess the efficacy of a web-based platform to promote weight loss and diet and physical activity habits change in a Brazilian adult population.

Methods

We designed a three-arm parallel randomized controlled trial including 18–60 years university students or employees with 25 kg/m² minimum body mass index (BMI). Pregnancy, conditions with specific dietary requirements and participation in other weight loss programs are exclusion criteria. Participants are allocated to one of three groups: (1) waitlist with minimal intervention, (2) web-based platform, (3) web-based platform plus online dietician assistance. Assessors are blinded. Weight and BMI loss are the primary outcomes. Diet and physical activity behaviours, health perception and online activity features are secondary outcomes. The intervention comprises recommendations of diet and physical activity habits tailored to the Brazilian population and principles of behaviour change. The web-based platform has online social network and gamification features. Analysis will be on an intention-to-treat basis at 12 and 24 weeks after baseline. Differences in weight loss between groups will be performed by analysis of covariate. Linear regression will be used to assess whether treatment group allocation is an independent predictor of weight loss. The study was approved by the Federal University of Minas Gerais (UFMG) Ethics Research Committee. All participants signed an informed consent form prior to recruitment.

Discussion

We present the study protocol of a three arm parallel randomized controlled trial which aims to test the efficacy of an online platform to promote weight loss for adults with overweight and obesity. We anticipate that the adoption of healthy lifestyle habits and weight loss will be more important in participants randomized to the online platform group.

Trial registration

NCT03435445 on February 16th, 2018.

Association between Body Image Dissatisfaction and Self-Rated Health, as Mediated by Physical Activity and Eating Habits: Structural Equation Modelling in ELSA-Brasil

This study investigated whether the association between body image dissatisfaction and poor self-rated health is mediated by insufficient physical activity and unhealthy eating habits. The participants were 6727 men and 8037 women from the baseline (2008–2010) of the Longitudinal Study of Adult Health (Estudo Longitudinal de Saúde do Adulto, ELSA-Brasil). Structural equation modelling was used. Associations were found between body image dissatisfaction and poor self-rated health in both sexes. Insufficient physical activity was a mediator. However, unhealthy eating habits were found to exert a mediator effect only via insufficient physical activity. Body image dissatisfaction was found to associate, both directly and possibly indirectly, with poor self-rated health, mediated by insufficient physical activity and unhealthy eating habits. Accordingly, encouraging physical activity and healthy eating can contribute to reducing body image dissatisfaction and favour better self-rated health.

Gender and psychosocial factors associated with healthy lifestyle in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohort: a cross-sectional study

OBJECTIVES

It has been estimated that over 50% of the premature deaths occurring in Western countries can be attributed to causes rooted in lifestyle. In turn, leading a healthy lifestyle has also been associated with a wide range of psychosocial factors. Today, it is known that these differ among men and women. The present article aimed to identify, from a gender-based perspective, the psychosocial factors associated with healthy lifestyles in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohort, the largest study concerning adult health conducted in Latin America to date.

DESIGN

This cross-sectional study was conducted using ELSA-Brasil baseline data, collected between 2008 and 2010.

SETTING

Six Brazilian public higher education and research institutions.

PARTICIPANTS

The ELSA-Brasil cohort consists of approximately 15 000 employees (8218 women and 6887 men), both currently working and retired.

MAIN OUTCOME MEASURES

The lifestyle indicator was constructed by summing the scores attributed to four different behaviours.

RESULTS

The women of the ELSA-Brasil cohort have healthier lifestyles than men. In women, strong associations were found between a healthy lifestyle and age 60 years or older, Asian race and university level of education or higher. In men, being 60 years or older, of Asian or Caucasian race, having a high-school equivalent level of education or higher, being retired, having a housekeeper, having a good or very good self-perception of health and being satisfied with body image were the psychosocial factors associated with leading a healthy lifestyle.

CONCLUSIONS

The factors that influenced healthy lifestyles were found to differ among men and women, a fact that must be addressed when developing programmes designed to promote health.

Fixed-flexion knee radiography using a new positioning device produced highly repeatable measurements of joint space width: ELSA-Brasil Musculoskeletal Study (ELSA-Brasil MSK)

OBJECTIVE

To describe the performance of a non-fluoroscopic fixed-flexion PA radiographic protocol with a new positioning device, developed for the assessment of knee osteoarthritis (OA) in Brazilian Longitudinal Study of Adult Health Musculoskeletal Study (ELSA-Brasil MSK).

MATERIAL AND METHODS

A test-retest design including 19 adults (38 knee images) was conducted. Feasibility of the radiographic protocol was assessed by image quality parameters and presence of radioanatomic alignment according to intermargin distance (IMD) values. Repeatability was assessed for IMD and joint space width (JSW) measured at three different locations.

RESULTS

Approximately 90% of knee images presented excellent quality. Frequencies of nearly perfect radioanatomic alignment (IMD ≤1mm) ranged from 29% to 50%, and satisfactory alignment was found in up to 71% and 76% of the images (IMD ≤1.5mm and ≤1.7mm, respectively). Repeatability analyses yielded the following results: IMD [SD of mean difference=1.08; coefficient of variation (%CV)=54.68%; intraclass correlation coefficient (ICC) (95%CI)=0.59 (0.34-0.77)]; JSW [SD of mean difference=0.34-0.61; %CV=4.48%-9.80%; ICC (95%CI)=0.74 (0.55-0.85)-0.94 (0.87-0.97)]. Adequately reproducible measurements of IMD and JSW were found in 68% and 87% of the images, respectively.

CONCLUSIONS

Despite the difficulty in achieving consistent radioanatomic alignment between subsequent radiographs in terms of IMD, the protocol produced highly repeatable JSW measurements when these were taken at midpoint and 10mm from the medial extremity of the medial tibial plateau. Therefore, measurements of JSW at these locations can be considered adequate for the assessment of knee OA in ELSA-Brasil MSK.

Perceptions of Body Size in Mothers and Their Young Children in the Galapagos Islands

Introduction Little specific information has been published about the health of people who live in the Galapagos Islands. As part of determining the status of the nutrition transition that may be occurring in the islands mothers of young children in the Galapagos perceptions of their child's body size and therefore health status was evaluated along with actual body size. Methods This paper presents data collected as part of a pilot study that used a mixed methods approach to identify and describe health and nutrition issues for mother-child pairs on Isla Isabela in Galapagos, Ecuador. It includes participant anthropometric assessment and self-perception of body size using silhouettes for themselves and one of their children along with open-ended questions to elicit further understanding of body size perceptions. Twenty mothers of children greater than 6 months of age but less than 6 years of age were interviewed. Results The women preferred a smaller body size for themselves but a larger body size for their children. Findings of different body size combinations between mothers and children in the same household demonstrated that the island is undergoing or may be post the nutrition transition. Discussion This dual burden of body weights (especially overweight or obese mothers) in the same household with underweight, normal and overweight or obese children and the potential nutrition related chronic disease burden in the future will require more educational resources and innovative health services than are currently available for the people of the Galapagos.

Body Image and Nutritional Status Are Associated with Physical Activity in Men and Women: The ELSA-Brasil Study

The association of body image dissatisfaction and obesity with physical activity is likely to differ according to gender. To investigate this hypothesis, we conducted a cross-sectional study among the ELSA-Brasil cohort members aged 34-65 years (n=13,286). The body image dissatisfaction was present even among normal weight individuals of both sexes and was associated with lesser chances of practicing moderate physical activity in women and intense physical activity in men. Men and women with central obesity were less prone to practice physical activity of high or moderate intensity. Overweight and obese men were more likely to report vigorous physical activity while obese women were less likely to report this level of physical activity. Body images as well as nutritional status are related to physical activity in both sexes, but the association with physical activity differs by gender.

Cohort Profile: Longitudinal Study of Adult Health (ELSA-Brasil)

Chronic diseases are a global problem, yet information on their determinants is generally scant in low- and middle-income countries. The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) aims to contribute relevant information regarding the development and progression of clinical and subclinical chronic diseases, particularly cardiovascular diseases and diabetes, in one such setting. At Visit 1, we enrolled 15 105 civil servants from predefined universities or research institutes. Baseline assessment (2008–10) included detailed interviews and measurements to assess social and biological determinants of health, as well as various clinical and subclinical conditions related to diabetes, cardiovascular diseases and mental health. A second visit of interviews and examinations is under way (2012–14) to enrich the assessment of cohort exposures and to detect initial incident events. Annual surveillance has been conducted since 2009 for the ascertainment of incident events. Biological samples (sera, plasma, urine and DNA) obtained at both visits have been placed in long-term storage. Baseline data are available for analyses, and collaboration via specific research proposals directed to study investigators is welcome.