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Balancing body perception during growth and development
Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Health and Developmental Care, Center for Public Health.
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Among children and adolescents, the drive to be slender and the fear of being fat is a growing public health concern. This trend stands in contrast to the increasing prevalence of overweight reported worldwide. Both feeling too fat and being overweight are associated with physical, psychological and social health-related issues from a shortand long-term perspective. The aim of this thesis is to study body perception in relation to actual body size and the bodily changes that occur naturally during puberty. Another objective is to identify risk factors for overweight, overweight perception and unhealthy eating habits in childhood and adolescence.

This thesis describes the prevalence of 1) perception of overweight, 2) overweight/obesity and 3) unhealthy eating habits in Finland and Sweden. We compare our results with the World Health Organization (WHO) Health Behaviour in Schoolchildren (HBSC) survey in 2001/2002 and 2009/2010. Our cross-sectional studies were performed on a female cohort of 11-18 year old girls in Finland and a cohort of boys and girls 7-17 years in Sweden.

In both Finland and Sweden, the prevalence of overweight increased over time, especially among boys. Also perception of overweight increased over time – not just among girls, but also among boys. We found social inequality in overweight, particularly in boys in relation to maternal socioeconomic status. No social inequality, but age and gender differences were found in relation to perception of overweight, where girls older than 13 years showed the highest prevalence. Body perception among girls agreed better with international reference values for waist circumference (WC) than for body mass index (BMI). Breast development and acne increased the risk for overweight perception, particularly among non-overweight girls. Perception of overweight was the strongest risk factor for dieting and skipping breakfast in both boys and girls. These behaviours were more common among adolescents than among younger boys and girls. Skipping breakfast was related to unbalanced food consumption patterns in both sexes, but in a gender-specific way.

We have shown that body perception during growth and development relates to a complex age- and gender-specific balance between body size, stage and timing of pubertal maturation, eating habits as well as parental and peer influences. From a broader perspective, improving adequate body perception entails optimising this balance by influencing one or more of the individual, societal and environmental factors that determine health outcomes among children and adolescents, tracking into adulthood.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2015. , 73 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1482
National Category
Pediatrics Nutrition and Dietetics Public Health, Global Health, Social Medicine and Epidemiology Clinical Medicine
Identifiers
URN: urn:nbn:se:liu:diva-123861DOI: 10.3384/diss.diva-123861ISBN: 978-91-7685-947-6 (print)OAI: oai:DiVA.org:liu-123861DiVA: diva2:893077
Public defence
2015-12-10, Berzeliussalen, Campus US, Linköping, 13:00 (English)
Opponent
Supervisors
Available from: 2016-01-12 Created: 2016-01-12 Last updated: 2016-01-13Bibliographically approved
List of papers
1. Waist circumference in relation to body perception reported by Finnish adolescent girls and their mothers
Open this publication in new window or tab >>Waist circumference in relation to body perception reported by Finnish adolescent girls and their mothers
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2009 (English)In: ACTA PAEDIATRICA, ISSN 0803-5253, Vol. 98, no 3, 501-506 p.Article in journal (Refereed) Published
Abstract [en]

Aim: To study how waist circumference (WC) relates to body perception in adolescent girls and to maternal perception of the girls body size.

Methods: Three hundred and four girls, 11-18 years, were measured for height, weight and WC. 294 girls provided self-report data on weight, height and body image before anthropometric measurements. Paired data from 237 girls and mothers on perception of the girls body size were collected.

Results: In girls, self-reported weight indicated awareness of actual body size. The girls body perception showed an overestimation of body size relative to international reference values for body mass index (BMI) (p < 0.05), but not for WC. Girls body perception exceeded that of their mothers (p < 0.05). Maternal perception agreed better than the girls perception with international reference values for BMI (p < 0.05). No significant difference between mothers and girls were found concerning agreement of body perception with international reference values for WC.

Conclusion: WC rather than BMI agrees with perception of body size, possibly due to its relation to abdominal fat at different ages. For effective prevention and treatment programmes for weight-related health problems among adolescent girls, we recommend measuring WC to diminish the discrepancy between measured and perceived body size.

Keyword
Adolescent girls, Body mass index, Body perception, Maternal perception, Waist circumference
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-16890 (URN)10.1111/j.1651-2227.2008.01112.x (DOI)
Available from: 2009-02-22 Created: 2009-02-20 Last updated: 2016-01-12
2. Overweight perception among adolescent girls in relation to appearance of female characteristics
Open this publication in new window or tab >>Overweight perception among adolescent girls in relation to appearance of female characteristics
2014 (English)In: Paediatrics and Health, ISSN 2052-935X, Vol. 2, no 1, 1-7 p.Article in journal (Refereed) Published
Abstract [en]

Background: Overweight perception has been shown to be important for health related adolescent behavior, particularly in girls. Body perception may be affected by bodily changes, especially changes visible for others. Female pubertal development is characterized by many physical changes, such as accelerated growth and altered body fat distribution. This study examined the role of appearance of female characteristics in the risk for overweight perception among healthy adolescent girls.

Methods: 220 girls, aged 11–16, provided self-reports on body perception and pubertal maturation before anthropometric measurements of height, weight, hip and waist circumference (WC). Logistic regression modeling was used to study the appearance of pubertal characteristics in relation to body perception.

Results: Of the 76 girls (35%) perceiving themselves as overweight, only 14 and 36 girls were overweight according to body mass index and waist circumference respectively. Girls reporting breast development and acne (n=144) were more likely to perceive themselves as overweight than girls who did not report this appearance (n=76). These findings persist after adjusting for overweight according to WC. Non-overweight (n=170) rather than overweight girls reporting characteristics (n=50) were at risk of perceiving themselves overweight.

Conclusions: Girls may confuse natural changes occurring during adolescent development with being overweight. It is therefore important to improve the understanding about the physical changes that normally occur during puberty along with the girls' own perception of these bodily changes among girls themselves, their parents, at schools, and other healthcare services.

Place, publisher, year, edition, pages
Herbert Open Access Journals, 2014
Keyword
Adolescent girls, self-reports, body perception, female pubertal development, anthropometric measurements
National Category
Clinical Science
Identifiers
urn:nbn:se:liu:diva-113130 (URN)10.7243/2052-935X-2-1 (DOI)
Available from: 2015-01-12 Created: 2015-01-12 Last updated: 2016-01-12
3. Social inequality and age-specific gender differences in overweight and perception of overweight among Swedish children and adolescents: a cross-sectional study
Open this publication in new window or tab >>Social inequality and age-specific gender differences in overweight and perception of overweight among Swedish children and adolescents: a cross-sectional study
2015 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 15, no 628Article in journal (Refereed) Published
Abstract [en]

Background: Overweight among children and adolescents related to social inequality, as well as age and gender differences, may contribute to poor self-image, thereby raising important public health concerns. This study explores social inequality in relation to overweight and perception of overweight among 263 boys and girls, age 7 to 17, in Vaxjo, Sweden. Methods: Data were obtained through a questionnaire and from physical measurements of height, weight and waist circumference [WC]. To assess social, age and gender differences in relation to overweight, the independent sample t- and chi-square tests were used, while logistic regression modeling was used to study determinants for perception of overweight. Results: Social inequality and gender differences as they relate to high ISO-BMI [Body Mass Index for children] and WC were associated with low maternal socioeconomic status [SES] among boys less than 13 years [mean age = 10.4; n = 65] and with low paternal education level among boys = 13 years [mean age = 15.0; n = 39] [p less than 0.05]. One suggested explanation for this finding is maternal impact on boys during childhood and the influence of the father as a role model for adolescent boys. The only association found among girls was between high ISO-BMI in girls = 13 years [mean age = 15.0; n = 74] and low paternal occupational status. Concerning perception of overweight, age and gender differences were found, but social inequality was not the case. Among boys and girls less than 13 years, perception of overweight increased only when overweight was actually present according to BMI or WC [p less than 0.01]. Girls = 13 years [mean age = 15.0] were more likely to unrealistically perceive themselves as overweight or "too fat," despite factual measurements to the contrary, than boys [p less than 0.05] and girls less than 13 years [mean age = 10.4; n = 83] [p less than 0.001]. Conclusions: The association between social inequality and overweight in adolescence in this study is age-and gender-specific. Gender differences, especially in perception of overweight, tend to increase with age, indicating that adolescence is a crucial period. When planning interventions to prevent overweight and obesity among children and adolescents, parental SES as well as age and gender-specific differences in social norms and perception of body weight status should be taken into account.

Place, publisher, year, edition, pages
BioMed Central, 2015
Keyword
Social inequality; Overweight; Obesity; Perception of overweight; Childhood; Adolescence
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-120339 (URN)10.1186/s12889-015-1985-x (DOI)000357559600001 ()26156095 (PubMedID)
Note

Funding Agencies|Erik Johan Ljungberg Educational Fund; County Council of Ostergotland; Medical Research Council of Southeast Sweden [FORSS-233111]

Available from: 2015-07-31 Created: 2015-07-31 Last updated: 2017-12-04
4. Feeling ‘too fat’ rather than being ‘too fat’ increases unhealthy eating habits among adolescents – even in boys
Open this publication in new window or tab >>Feeling ‘too fat’ rather than being ‘too fat’ increases unhealthy eating habits among adolescents – even in boys
2016 (English)In: Food & Nutrition Research, ISSN 1654-6628, E-ISSN 1654-661X, Vol. 60, 29530Article in journal (Refereed) Published
Abstract [en]

Background: Adolescence is a period of gender-specific physical changes, during which eating habits develop. To better understand what factors determine unhealthy eating habits such as dieting to lose weight, skipping meals and consumption of unhealthy foods, we studied how physical measurements and body perception relate to eating habits in boys and girls, before and during adolescence.

Methods: For this cross-sectional study, we obtained data from both written questionnaires and physical measurements of height, weight and waist circumference (WC).

Results: Dieting to lose weight and skipping breakfast were more common among adolescents than among younger boys and girls (p<0.05). The strongest risk factor for dieting in both boys and girls was perception of overweight, which persisted after adjusting for age and for being overweight (p<0.01). Another independent risk factor for dieting behaviour was overweight, as defined by body mass index (BMI) among boys (p<0.01) and WC among girls (p<0.05). In both boys and girls, skipping breakfast was associated with both a more negative body perception and higher BMI (p<0.05). Skipping breakfast was also associated with age- and gender-specific unhealthy eating habits such as skipping other meals, lower consumption of fruits and vegetables, and higher consumption of sweets and sugary drinks (p<0.05).

Conclusion: Body perception among adolescents is an important factor relating to unhealthy eating habits, not only in girls, but even in boys. Focus on body perception and eating breakfast daily is crucial for the development of healthy food consumption behaviours during adolescence and tracking into adulthood.

Place, publisher, year, edition, pages
Co-Action Publishing, 2016
Keyword
Body image, overweight, adolescent behaviour, food habits, prevention
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-123852 (URN)10.3402/fnr.v60.29530 (DOI)000370126700001 ()
Note

On the day of the defence date the status of this article was Manuscript.

Funding agencies:  Erik Johan Ljungberg Educational Fund; County Council of Ostergotland; Medical Research Council of south-east Sweden [FORSS-233111]

Available from: 2016-01-11 Created: 2016-01-11 Last updated: 2017-12-01Bibliographically approved

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