Unhealthy weight control behaviors, disordered eating, and body image dissatisfaction in adolescents from São Paulo, Brazil

Factors associated with eating disorders among Indonesian adolescents at boarding schools

OBJECTIVES

Eating disorders (EDs) are a significant global issue among adolescents, including those in boarding schools; however, this population remains under-researched. This study investigated the factors associated with EDs among Indonesian boarding school students.

METHODS

Using a cross-sectional approach, 1,400 adolescents were selected through purposive sampling. The study examined factors such as body mass index (BMI), body image, mood, loneliness, and weight loss using a modified combination of questionnaires. Data analysis was performed using logistic regression in SPSS 21 with a significance level of 0.05.

RESULTS

Four factors significantly influenced the risk of developing ED. A lower BMI (underweight or normal) decreased the risk (OR=0.2 and 0.3, respectively; CI: 0.140-0.360 and 0.231-0.524, respectively). A lower drive for leanness reduced the likelihood of EDs (OR=0.49; CI: 0.347-0.713). Lower levels of muscularity-oriented eating also decreased ED risk (OR=0.39; CI: 0.273-0.573). Conversely, unhealthy weight loss experiences significantly increased ED risk (OR=8.9; CI: 6.728-11.827).

CONCLUSIONS

These findings highlight the complex factors contributing to EDs risk, emphasizing the need for targeted interventions to address body image concerns, nutritional practices, and weight loss experiences to promote the well-being of students in boarding schools. The implementation of structured health education programs that emphasize balanced nutrition, positive body image, and healthy weight management is recommended to address eating disorders. Nursing and health professionals play key roles in the development and delivery of these programs.

The relationship between body image and nutritional behaviors in adult individuals

OBJECTIVE

Dissatisfaction with body image and maladaptive nutritional behaviors can have profound effects on psychological, social, and physical health and may pave the way for the development of eating disorders. However, research into this topic in the adult population is relatively limited. Therefore, this study aimed to examine various factors affecting dissatisfaction with body image and maladaptive nutritional behaviors in adults living in Türkiye and the relationship between these two concepts.

METHODS

This descriptive study was conducted with 3,153 adult individuals who were ≥  18 years old living in Türkiye. The data of the study, which was conducted as an online survey, were collected using the Descriptive Information Form, the Body Image Scale, and the Three-Factor Eating Questionnaire.

RESULTS

Of the participants, 70.1% were women. The mean age was 28.02 ± 9.27 (Min.: 18, Max.: 74) years. The relationship between the mean scores on the total Body Image Scale and Uncontrolled Eating (r = -0.094, p < 0.000), Emotional Eating (r = -0.171, p < 0.001), and Susceptibility to Hunger (r = -0.108, p < 0.001) scores was negative. A statistically significant and positive relationship was detected between the mean scores on the total Body Image Scale and the Cognitive Restraint score (r = 0.089, p < 0.001). Statistically significant relationships were detected in the model adjusted for age and gender between the Body Image Scale and Emotional Eating scores (B = -1.085, p < 0.000), and Cognitive Restraint scores indicated positive relationships (B = 0.848, p < 0.001).

CONCLUSION

Body image satisfaction was found to be negatively associated with uncontrolled eating, emotional eating, and susceptibility to hunger. On the other hand, a positive relationship was found between body image satisfaction and cognitive restraint. These findings highlight the critical importance of body image satisfaction on eating behaviors and provide potential insight into prevention and intervention programs to improve body image to promote adaptive eating behaviors in the adult population.

Associations of suicidal behaviors with body weight and body weight perception in Chinese adolescents: 2007-2022

PURPOSE

To estimate the time trend in the prevalence of suicidal behaviors including ideation and attempts in Chinese adolescents; to examine the association between suicidal behaviors and overweight (OW)/obesity (OB) and self-perceived weight status.

METHODS

Data from Youth Risk Behavior Surveys conducted in Ningbo in 2007, 2012, 2017 and 2022 were used for the study. A multistage sampling procedure was used to select respondents aged 12 to 19 years who participated in each survey. Repeated cross-sectional data of anthropometry, weight perception and suicidal behaviors were collected through self-administered questionnaires. A generalized linear model was used to assess associations of ideation and attempts, and weight status and self-perceived weight status.

RESULTS

The sample sizes for each survey wave were 937, 889, 1528 and 2655. The prevalence of ideation increased from 11.95% in 2007 to 18.15% in 2022, while the prevalence of attempts remained stable (4.48%-4.26%). An increasing trend in ideation and attempts was found in adolescents who were OW/obese and self-perceived OW/OB from 2007 to 2022. Self-perceived OW/OB adolescents had a significant increase in ideation. Girls had higher likelihood of ideation and attempts for both weight status and self- perceived weight status. While, adolescents aged 12.0-15.9 years had higher odds of ideation than those aged 16.0-19.9 years.

CONCLUSION

Adolescents' self-weight perception, rather than actual weight status, is a critical risk factor of increased likelihood of ideation and attempts in Chinese adolescents. Our findings can support to promote self-esteem growth in school-based health education programmes for prevention of suicidality and psychological health problems.

Unhealthy weight control behaviors and its determinants among female adolescents in Hawassa city, Sidama region, Ethiopia, 2023: school based study

BACKGROUND

The desire to control personal weight status is ever-increasing among adolescents to achieve societal desirability for thinness across developed and developing countries. The purpose of this study was to estimate the magnitude of unhealthy weight control behaviors and determinants among female adolescents.

METHOD

School based cross sectional study was conducted among 526 randomly selected female adolescent students using self-administered questionnaire. Unhealthy weight control behaviors, Body Mass Index-for-age, perceived weight status, depression symptoms and body part satisfaction were assessed. Binary logistic regression was used to analyze data and adjusted odds ratio with 95% confidence interval was used to measure strength of association.

RESULT

The overall prevalence of unhealthy weight control behaviors among female high school adolescent is 38% (95% CI: 34.0%, 42.0%). Perceived weight status (AOR = 1.82, 95% CI = 1.16-2.84), BMI for age (AOR = 3.38; 95% CI = 1.85-6.17), level of depression; mild depression (AOR = 1.81, 95% CI = 1.18-2.77) and moderate (AOR = 2.68; 95% CI = 1.11-6.47), weight related teasing (AOR = 1.69, 95% CI = 1.11-2.57)., and use social media (AOR = 3.04; 95% CI = 1.60-5.77) were remained associated factors of UWCBs among female adolescent students.

CONCLUSION

The current study has shown that more than one in three female adolescents was engaged in UWCBs. Therefore, school-based awareness creation by establishing clubs which promote healthy lifestyle should be given due emphasis. Such intervention should consider factors like; weight perception, depressive mood, weight related teasing, and social media use.

Body Weight Perceptions Among Youth From 6 Countries and Associations With Social Media Use: Findings From the International Food Policy Study

BACKGROUND

Body dissatisfaction is associated with poor psychological and physical health, particularly among young people. However, limited data exist on body size perceptions across countries and factors associated with dissatisfaction.

OBJECTIVE

This study examined dissatisfaction prevalence and associations with sociodemographics and social media use among youth in 6 countries.

DESIGN

Repeat cross-sectional national online surveys were conducted as part of the 2019 and 2020 International Food Policy Study Youth Survey.

PARTICIPANTS

The sample included 21 277 youth aged 10 to 17 years from Australia, Canada, Chile, Mexico, the United Kingdom, and the United States. Youth were recruited to complete the online survey through parents/guardians enrolled in the Nielsen Consumer Insights Global Panel and their partners' panels.

MAIN OUTCOME MEASURES

Figural drawing scales assessed self-perceived and ideal body images, with differences between scales representing body dissatisfaction.

STATISTICAL ANALYSES PERFORMED

Multinomial logistic regression models examined differences in body dissatisfaction by country, and associations with sociodemographics and either social media screen time or platforms used, including 2-way interactions with country.

RESULTS

Overall, approximately 45% of youth reported the same perceived and ideal body sizes, whereas 35% were "larger than ideal" (from 33% in Canada and Australia to 42% in Chile) and 20% were "thinner than ideal" (from 15% in Chile to 22% in Mexico). Greater social media screen time was associated with a higher likelihood of moderate-severe dissatisfaction for being "thinner than ideal" and at least mild dissatisfaction for being "larger than ideal" (P < .003 for all contrasts), with greater dissatisfaction among users of YouTube and Snapchat than nonusers (P ≤ .005 for both contrasts). Modest differences in body dissatisfaction between countries were observed for age, ethnicity, body mass index, and weight-based teasing.

CONCLUSIONS

Body dissatisfaction is prevalent among youth across diverse countries. These findings highlight the need to promote healthy body image in youth, particularly among social media users.

Association between the practice of fitness-related exercises and body image dissatisfaction in adolescents from Curitiba (PR), Brazil

OBJECTIVE

The aim of this study was to analyze the association between participation in fitness-related exercises (FRE) and body image dissatisfaction (BID) in adolescents and evaluate the interaction between physical exercise and nutritional status in this association.

METHODS

A cross-sectional study was conducted in 2015 involving 799 adolescents (10-16 years old) from 14 public schools in Curitiba (PR), Brazil. BID was assessed using the Body Shape Questionnaire and the Silhouette Scale. The FRE was classified as "does not practice," "practices ≤300 min/week," and "practices >300 min/week" by the Physical Activity Questionnaire for Adolescents. Poisson and multinomial logistic regressions, adjusted for sex, sexual maturation, and nutritional status analyzed the association of FRE and BID.

RESULTS

The BID prevalence was 28.3%; 52.4% of the adolescents wanted to reduce their silhouettes; and 48.7% did not practice FRE. Adolescents who practiced FRE >300 min/week had a 28% higher prevalence for some level of BID (PR 1.28; 95%CI 1.08-1.52) and a 46% lower chance of wanting to reduce silhouettes (OR 0.54; 95%CI 0.35-0.82), compared to nonpractitioners. There was no interaction between FRE and nutritional status in association with BID.

CONCLUSIONS

The adolescents who practice FRE >300 min/week are likely to have some level of BID and are less likely to report the desire to increase their silhouettes, regardless of their nutritional status.

Body dissatisfaction and beyond: Investigating attitudes towards calorie labels on UK food menus

In 2022 the British government made calorie labels on menus a legal requirement to encourage healthier food choices while dining out. Yet, little research has explored perceptions of calorie labels on menus in the United Kingdom or tested whether there may be groups of people vulnerable to potential negative effects of calorie labels, such as those with body dissatisfaction. This between-subjects, convergent mixed-methods study addressed these enquiries. Participants were 562 adults who completed an online survey where hypothetical food orders were made from a menu. The study found that participants who viewed a menu with calorie labels ordered fewer calories. Quantitative results did not find that participants with higher levels of body dissatisfaction were at significantly greater odds of using calorie labels to order fewer calories. However, our qualitative (thematic) analysis revealed that experiences of calorie labels could be shaped by body image concerns. Themes further drew on how calorie labels were empowering, but there were also concerns about their oversimplicity. Findings are discussed in relation to implications for future calorie labelling policies. Given the inconsistent findings amongst the limited amount of literature investigating the role of body dissatisfaction in how calorie labels are used, future research is crucial. In the meantime, as a cautionary measure, clinicians involved in supporting individuals with body or food-related concerns should be aware of the challenges their clients may experience in facing calorie labels on menus when dining out.

The unintended consequences of school-based health and nutrition policies: a systematic review

Background

Significant funding and attention are directed toward school-based health and nutrition interventions. Less attention is given to the potential unintended consequences of these policies, especially those that target children and adolescents. This systematic review aimed to elucidate the unintended consequences of school-based health and nutrition policies in the United States.

Methods

We conducted a systematic review, adhering to PRISMA guidelines, to analyze quantitative, qualitative, and mixed methods research conducted between January 2013 and September 2023. The search strategy encompassed three databases, identifying 11 articles that met the inclusion criteria.

Results

Unintended consequences were organized into four themes: disordered weight control behaviors, parental discomfort or encouragement of disordered weight control behaviors, eating disorder triggers, and financial losses. The analysis of disordered weight control behaviors indicates limited impact on youth, and we noted limited consensus in the assessment of these behaviors. We observed parent concerns about BMI screening and reporting as well as apprehensions about privacy and efficacy. There were fewer articles addressing eating disorder antecedents, although there was evidence that some youths with eating disorders considered school health class a trigger of their disorder. One study was identified that found an increase in food waste following replacement of sugar-sweetened beverages.

Implications

Findings underscore the importance of comprehensive evaluation and consideration of unintended consequences in the development and implementation of school-based health policies. Recommendations include further longitudinal research, integrating obesity prevention with eating disorder prevention, and de-implementation when unintended consequences potentially outweigh benefits, such as in BMI screening and surveillance.Systematic Review Registration: Identifier CRD42023467355. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=467355.

A cognitive dissonance body image intervention 'Free Being Me' delivered by guide leaders to adolescent girl guides in India: A pilot and acceptability trial

This pilot study assessed the acceptability and pre-post intervention effects of a cognitive dissonance-based body image intervention, Free Being Me, delivered by Guide leaders to adolescent girls in India. Girls aged 11-14 years (Mage = 12.6, N = 117), who were members of the national scouting and guiding association of India, received the intervention across five weekly 1-hour group sessions. The primary outcome (body esteem) and secondary outcomes (self-esteem, internalisation of appearance ideals, negative and positive affect, and life disengagement) were measured pre-intervention and immediately post-intervention. The intervention was acceptable. Adolescent girls reported high levels of comfort (89%), enjoyment (90%), and perceived importance (92%) with suggestions for improvement including more interactive activities. Facilitator adherence and competence delivering Free Being Me was rated good. Significant within-groups pre-post intervention improvements in body esteem (Cohen's d = 0.28) and reductions in internalisation of appearance ideals (Cohen's d = 0.49) were identified. No changes to self-esteem, negative or positive affect, or life disengagement were observed. This study suggests that Free Being Me is acceptable for community-based delivery and Guide leader format with promising pre-post intervention effects. Going forward, a randomised controlled trial is necessary to make confident interpretations on the effectiveness of Free Being Me.

Mediating Effect of Self-Control on the Relationship between Obesity-Related Stress and Weight Control Behavior among Female College Students with Overweight and Obesity

BACKGROUND

This study aimed to determine whether self-regulation acts as a mediating factor in the relationship between obesity-related stress and weight control behavior, targeting Korean female college students. Obesity-related stress and weight control behaviors are important factors affecting an individual's health and well-being, and self-control, a psychological trait, can play a pivotal role in regulating how individuals respond to stress and engage in weight management behaviors.

METHODS

This study employed a descriptive correlational design. A total of 109 female college students with overweight and obesity participated in the study. We used a self-report questionnaire to measure obesity-related stress, self-control, and degree of weight control behavior. Data were analyzed using descriptive statistics, Pearson's correlation coefficient analysis, and bootstrapping using Hayes' PROCESS macro for mediation.

RESULTS

Significant relationships between obesity-related stress and weight control behavior (r = 0.25, p < 0.001), obesity-related stress and self-control (r = -0.36, p < 0.001), and weight control behavior and self-control (r = 0.26, p < 0.001) were observed. Self-control showed an indirect mediating effect on the relationship between obesity-related stress and weight control behavior (Β = 0.37, p = 0.001).

CONCLUSIONS

Through the research results, it was confirmed that self-control is a factor that has a mediating effect in the relationship between obesity-related stress and weight control behavior among female college students with overweight and obesity. These results underscore the importance of addressing self-control strategies in interventions aimed at promoting healthy weight management among female college students with overweight or obesity.

Global Prevalence of Adolescent Use of Nonprescription Weight-Loss Products: A Systematic Review and Meta-Analysis

Importance

Use of nonprescribed weight-loss products in adolescents is a public health concern that is associated with negative physical and psychological consequences. However, the prevalence of nonprescribed weight-loss product use in adolescents is unknown.

Objective

To determine the global prevalence of nonprescription weight-loss product use in children and adolescents.

Data Sources

Four databases, including MEDLINE, PsycINFO, CINAHL (Cumulative Index of Nursing and Allied Health), and EMBASE, were searched for quantitative studies that reported prevalence data on use of nonprescription weight-loss products with no restrictions on publication date. The search was performed December 1, 2020, and updated March 6, 2023.

Study Selection

Studies were included in the meta-analysis if they reported the prevalence of weight-loss product use, were published in English, and included individuals 18 years or younger.

Data Extraction and Synthesis

Data extraction was completed by 2 independent reviewers. Data analysis determined the overall pooled proportion of weight-loss product use in total and during the past week, past 30 days, past year, or lifetime. Inverse variance heterogeneity effect models were used.

Main Outcomes and Measures

The main outcome measure was the prevalence of nonprescription weight-loss product use in adolescents for all included studies and over the past week, past month, past year, or lifetime. Subgroup analysis included separation of groups by sex, specific weight-loss product types, geographical location, and study publication time.

Results

A total of 90 articles (604 552 unique participants) were included in the meta-analysis. Of these, 50 studies (56%) were from North America. The reported prevalence of weight-loss product use in adolescents was 5.5% (96% CI, 5.5%-5.6%) overall. When identifying use of weight-loss products in the general population, prevalence was 2.0% (95% CI, 1.9%-2.1%) in the past week, 4.4% (95% CI, 4.3%-4.5%) in the past month, 6.2% (95% CI, 6.1%-6.3%) in the past year, and 8.9% (95% CI, 8.6%-9.2%) in their lifetime. Use of weight-loss products was higher among girls than boys.

Conclusions and Relevance

This meta-analysis found that use of weight-loss products occurs at high levels in adolescents, especially girls. These findings suggest that, given the ineffectiveness of these products for weight loss coupled with their harmful long-term health consequences, interventions are required to reduce use of weight-loss products in this group.

Body image dissatisfaction and its relation to body mass index among female medical students in Sudan: across-sectional study 2020-2021

BACKGROUND

Body image is mainly determined by biological, social, psychological and cultural factors thus it is a multifaceted vigorous construct. Body image is an essential aspect of girls' self-definition and individual identity. Excessive concern about body image and body image misconceptions leads to dissatisfaction, disturbed eating patterns, affecting the nutritional status and also leading to depression and anxiety disorder.

METHODS

This is a descriptive cross-sectional university-based study aiming to investigate body image dissatisfaction and its relation to BMI among female medical students at the University of Khartoum, faculty of medicine. The study was carried out between December 2020 and January 2021. Simple random sampling was applied and a two-sectioned questionnaire was used. The first part consisted of socio-demographic data and the second part contained questions to assess body image the data was. A total of 277 participants were enrolled in the study. Data was analyzed using SPSS version 20.

RESULTS

We enrolled 277 female medical students the majority of participants (53%) were considered of normal weight according to BMI, 7% considered obese, and 18% underweight. Large number of participants thought that they are not in the ideal weight according to their height (62%). (21% to 17%) of participants always feel pressure from people or society to get to a certain weight. With respect to attitude towards weight, (29%) of participants always wear clothes that don't reveal their body shape, (35%) of them always tend to wear clothes that hide their excess weight.

CONCLUSIONS

The study concluded that participants who were overweight, obese or underweight have significant increase risk for poor body image perception with odd ratio of 39, 11, and 59 respectively. Thus early and proper interventions are necessary to circumvent the impact and future repercussion of body image distortion.

Factors associated with extreme weight loss behaviors among adolescents of Northeastern Brazil: a hierarchical approach

The objective of this article is to identify the prevalence and evaluate the factors associated with extreme weight loss behaviors among adolescents of Northeastern Brazil. Cross-sectional study with 2,439 adolescents from Sample 2 (2015) of the National School-based Health Survey. Extreme weight loss behaviors, such as self-induced vomiting, laxative use and use of medicines or formulas (outcome) and independent variables were evaluated using a self-administered electronic questionnaire. The statistical analysis was performed following a hierarchical conceptual model. The prevalence of extreme weight loss behaviors in the sample was 12.1%. Among the factors that showed significant association with the outcome, we emphasize the administration model of the private school (PR = 0.62; CI = 0.46-0.84), bullying related to body appearance and for other reasons (PR = 1.62; CI = 1.19-2.20), forced sexual intercourse (PR = 2.65; CI = 1.90-3.69), insomnia (PR = 1.84; CI = 1.43-2.37), and be perceived as fat or very fat (PR = 1.90; CI = 1.50-2.42). Moderate prevalence of extreme weight loss behaviors was identified among adolescents. Socioeconomic factors, exposure to violence, mental health, and body image were associated with the adoption of these behaviors.

Using Chatbot Technology to Improve Brazilian Adolescents' Body Image and Mental Health at Scale: Randomized Controlled Trial

BACKGROUND

Accessible, cost-effective, and scalable mental health interventions are limited, particularly in low- and middle-income countries, where disparities between mental health needs and services are greatest. Microinterventions (ie, brief, stand-alone, or digital approaches) aim to provide immediate reprieve and enhancements in mental health states and offer a novel and scalable framework for embedding evidence-based mental health promotion techniques into digital environments. Body image is a global public health issue that increases young peoples' risk of developing more severe mental and physical health issues. Embedding body image microinterventions into digital environments is one avenue for providing young people with immediate and short-term reprieve and protection from the negative exposure effects associated with social media.

OBJECTIVE

This 2-armed, fully remote, and preregistered randomized controlled trial assessed the impact of a body image chatbot containing microinterventions on Brazilian adolescents' state and trait body image and associated well-being outcomes.

METHODS

Geographically diverse Brazilian adolescents aged 13-18 years (901/1715, 52.54% girls) were randomized into the chatbot or an assessment-only control condition and completed web-based self-assessments at baseline, immediately after the intervention time frame, and at 1-week and 1-month follow-ups. The primary outcomes were mean change in state (at chatbot entry and at the completion of a microintervention technique) and trait body image (before and after the intervention), with the secondary outcomes being mean change in affect (state and trait) and body image self-efficacy between the assessment time points.

RESULTS

Most participants who entered the chatbot (258/327, 78.9%) completed ≥1 microintervention technique, with participants completing an average of 5 techniques over the 72-hour intervention period. Chatbot users experienced small significant improvements in primary (state: P<.001, Cohen d=0.30, 95% CI 0.25-0.34; and trait body image: P=.02, Cohen d range=0.10, 95% CI 0.01-0.18, to 0.26, 95% CI 0.13-0.32) and secondary outcomes across various time points (state: P<.001, Cohen d=0.28, 95% CI 0.22-0.33; trait positive affect: P=.02, Cohen d range=0.15, 95% CI 0.03-0.27, to 0.23, 95% CI 0.08-0.37; negative affect: P=.03, Cohen d range=-0.16, 95% CI -0.30 to -0.02, to -0.18, 95% CI -0.33 to -0.03; and self-efficacy: P=.02, Cohen d range=0.14, 95% CI 0.03-0.25, to 0.19, 95% CI 0.08-0.32) relative to the control condition. Intervention benefits were moderated by baseline levels of concerns but not by gender.

CONCLUSIONS

This is the first large-scale randomized controlled trial assessing a body image chatbot among Brazilian adolescents. Intervention attrition was high (531/858, 61.9%) and reflected the broader digital intervention literature; barriers to engagement were discussed. Meanwhile, the findings support the emerging literature that indicates microinterventions and chatbot technology are acceptable and effective web-based service provisions. This study also offers a blueprint for accessible, cost-effective, and scalable digital approaches that address disparities between health care needs and provisions in low- and middle-income countries.

TRIAL REGISTRATION

Clinicaltrials.gov NCT04825184; http://clinicaltrials.gov/ct2/show/NCT04825184.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1186/s12889-021-12129-1.

Prevalence and associated factors of eating disorder symptoms in adolescents: a cross-sectional school-based study

PURPOSE

To estimate the prevalence of eating disorder symptoms and associated factors in adolescents between 14 and 17 years old.

METHODS

The data were obtained from a cross-sectional school-based study with 782 adolescents from public schools in Caxias do Sul, in Rio Grande do Sul, Brazil, in 2016. The Eating Attitudes Test (EAT-26) was used to investigate eating disorder symptoms. The chi-square test and Poisson regression with robust variance were performed to estimate the prevalence ratios and associations between the outcome and the variables of interest.

RESULTS

The prevalence of eating disorder symptoms was around 56.9% among adolescents and more prevalent in females. A significant association was found between eating disorders and female gender, mothers who did not study or had an incomplete elementary school, and body image dissatisfaction. To adolescents dissatisfied with being overweight, the prevalence was more than three times higher than that observed among those who did not report such dissatisfaction.

CONCLUSION

The presence of eating disorder symptoms was associated with female gender, maternal education, and body image dissatisfaction. The results show the need to identify early signs and symptoms related to changes in eating behavior and non-acceptance of their bodies in a population especially concerned with their physical appearance.

Association between dating app use and unhealthy weight control behaviors and muscle enhancing behaviors in sexual minority men: a cross-sectional study

BACKGROUND

Body image concerns are prevalent and are viewed as risk factors for engaging in unhealthy weight control behaviors (UWCBs), such as purging, fasting, and the misuse of laxatives and diet pills. Studies have also linked UWCBs to the development of eating disorders. In the United States (U.S.), sexual minority men (e.g., bisexual, gay, and men who have sex with men) are prone to UWCBs often as a result of societal pressures to achieve certain standards of appearance - of which are often perpetuated through various media platforms. A growing number of studies have explored the possible role mobile dating applications ("dating apps") play in contributing to UWCBs. To our knowledge, such studies have not explored this possible relationship between dating apps and UWCBs in sexual minority men (SMM). To fill this gap in the scientific literature, the present study assessed the association between dating app use and UWCBs and muscle enhancing behaviors among a sample of adult SMM in the U.S.

METHOD

549 SMM participated in an anonymous survey from Qualtrics Survey Panels. UWCBs and muscle enhancing behaviors were assessed through items adapted from national surveys. Body image dissatisfaction was assessed using the Male Body Attitudes Scales. Participants also reported their history of dating app use. We performed descriptive statistics, chi-square tests, and student's t-tests. Multivariable logistic regression models assessed the relationship between dating app use and UWCBs and muscle enhancing behaviors.

RESULTS

Dating app users had significantly higher body image dissatisfaction scores than non-users. Dating app users also demonstrated significantly elevated odds of engaging in four UWCBs and muscle enhancing behaviors: laxatives, diet pills, muscle-building supplements, and protein powders.

CONCLUSIONS

This is one of the first studies to assess dating app use and its association with UWCBs and muscle enhancing behaviors in SMM. Increased surveillance and detection for such behaviors among SMM, particularly those using dating apps, are needed.

The mother-daughter Shared Agency in Weight Management Scale (SAWMS): development, validation, and implications for body dissatisfaction

BACKGROUND

Much research suggests that mothers play an important role in shaping daughters' body image, yet less is known about how mother-daughter relationship dynamics in weight management affect daughters' body dissatisfaction. The current paper described the development and validation of the mother-daughter Shared Agency in Weight Management Scale (SAWMS) and examined its associations with daughter's body dissatisfaction.

METHODS

In Study 1 (N = 676 college students), we explored the factor structure of the mother-daughter SAWMS and identified three processes (control, autonomy support, and collaboration) whereby mothers work with daughters in weight management. In Study 2 (N = 439 college students), we finalized the factor structure of the scale by conducting two CFAs and assessing the test-retest reliability of each subscale. In Study 3 (same sample as Study 2), we examined the psychometric properties of the subscales and their associations with daughters' body dissatisfaction.

RESULTS

Combining results from EFA and IRT, we identified three mother-daughter dynamics in weight management-maternal control, maternal autonomy support, and maternal collaboration. However, based on various empirical results indicating poor psychometric properties of the maternal collaboration subscale, we removed it from the mother-daughter SAWMS and only evaluated the psychometric properties of the remaining two subscales (i.e., control and autonomy support). They explained a significant amount of variance in daughters' body dissatisfaction over and above the effect of maternal pressure to be thin. Maternal control was a significant and positive predictor of daughters' body dissatisfaction; maternal autonomy support was a significant and negative predictor.

CONCLUSIONS

Results suggested that maternal control in weight management was associated with daughters' increased body dissatisfaction, whereas maternal autonomy support in weight management was associated with daughters' lower body dissatisfaction. These specific ways in which mother work with daughters in weight management provide nuances in understanding young women's body dissatisfaction. Our SAWMS offers new ways to examine body image among young women through the mother-daughter relationship dynamics in weight management.

Unhealthy weight control behaviors and related factors by gender and weight status: Results from a nationally representative sample of Korean adolescents

Given the serious consequences of unhealthy weight control behaviors (UWCB) among adolescents, identifying factors contributing to it in this population is crucial. Although gender differences have been reported as UWCB-related factors, studies on weight status remain limited. Hence, using a nationally representative sample, we investigated the differences in UWCB-related factors by gender and weight status. Most sociodemographic, health-related behavior, psychosocial, and school factors were remarkably correlated with UWCB in the normal-weight female group; however, they demonstrated most inconsistent correlations in the overweight female group. Overall, this study suggests that UWCB-preventing interventions in adolescents should be customized by gender and weight status.

Disordered eating during COVID-19 pandemic is associated with nutritional status, negative mood changes, and body image in university students

Our objective was to evaluate disordered eating and associated factors in university students in the early period of the COVID-19 pandemic in Brazil. This is an analytical cross-sectional observational study, and data collection took place between May and June 2020, using an online semi-structured questionnaire. In total, 936 students were evaluated. Present signs/symptoms of the flu syndrome (OR = 1.605), negative mood changes (OR = 1.628), weight gain (OR = 1.739), obesity (OR = 3.089), follow fitness/health profile on social media (OR = 2.050), having inadequate body perception (OR = 2.416), and body dissatisfaction (OR = 2.612) increased the chances of presenting a higher score on the disordered eating scale.

The association between body image, emotional health, relationships, and unhealthy dietary behaviors among medical sciences students: A structural equation modeling analysis

AIM

Although it showed that poor body image may drive an individual to unhealthy dietary behaviors, but less is known about the role of emotional health and interpersonal relationships in this regard in different age group of population. This study aimed to investigate the association between body image, emotional health, relationships, and unhealthy dietary behaviors among medical sciences students.

METHODS

In this cross-sectional study, using a three-stage stratified sampling method, 248 Iranian medical sciences students were recruited. The participants completed self-administered questionnaires, including Youth Risk Behavior Survey Questionnaire, Adolescent Health Concerns Inventory, and Body Image Concern Inventory. The data were analyzed using SPSS-20 and structural equation modeling in the Amos software version 24.

RESULTS

The results indicate the acceptability of the goodness of fit model index. Direct association of body image with emotional health (β = 0.91, p = 0.005) and relationships (β = 0.88, p = 0.009) was significant, but any direct and indirect association between body and unhealthy dietary behaviors was not found.

CONCLUSION

This study underlines the importance of being aware of the association between body image, emotional health, and relationships Further studies are recommended to explore the relationship between these factors and unhealthy dietary behaviors in medical sciences students.

The Body Esteem Scale for Adults and Adolescents: Translation, adaptation and psychometric validation among Brazilian adolescents

A lack of rigorously validated body image measures for use among adolescents is hampering research in Brazil. This study aimed to validate a Brazilian Portuguese version of the Body Esteem Scale for Adults and Adolescents (BESAA; Mendelson et al., 2001). The BESAA was forward and back translated from English into Brazilian Portuguese before examining its factor structure, reliability, and validity among 475 adolescents (50.3% girls) aged 13 - 18 years (M_age = 15.35) from various regions across Brazil. Exploratory factor analysis identified an 18-item three-factor solution, with Appearance-Positive, Appearance-Negative, and Weight subscales. The removal of five problematic items led to a psychometrically robust model, invariant across gender and age, and was verified using confirmatory factor analysis. Test re-test reliability and internal consistency were good-to-excellent across all three factors (Cronbach's a =0.85,.88, and.89). Concurrent validity was established through significant correlations with body dissatisfaction. Convergent validity was demonstrated via significant correlations with positive and negative affect. This Brazilian Portuguese version of the BESAA is a valid, reliable, and psychometrically robust measure of body image suitable for administration among adolescents in Brazil.

Prospective Associations of Tobacco Weight Control Beliefs with E-Cigarette Use Patterns in the PATH Study

INTRODUCTION

Some adolescents report using e-cigarettes (EC) for weight-related reasons, but longitudinal studies are lacking. This study examined associations between tobacco weight control beliefs and body mass index (BMI) with EC use patterns over one year.

METHODS

Data from Waves 1 and 2 (September 2013 to October 2015) of the Population Assessment of Tobacco and Health (PATH) study were used. Questions about tobacco weight control beliefs, EC use patterns (never, ever, never to current, ever to current, current to current), cigarette and other tobacco product use, demographics, and BMI were examined among adolescent respondents across Wave 1 and Wave 2.

RESULTS

Most adolescents were never EC users (85.8%). Prevalence of EC use patterns was low across categories of use (0.6%-5.3%). Higher BMI was associated with transition from ever but not current use at Wave 1 to current use at Wave 2. Greater baseline tobacco weight control beliefs and increases in tobacco weight control beliefs were associated with most EC use patterns compared to never use.

CONCLUSIONS

Greater tobacco weight control beliefs were risk factors for e-cigarette initiation and maintenance among a nationally representative sample of adolescents. BMI was minimally associated with e-cigarette use patterns. Additional studies are needed to replicate and further examine these preliminary prospective associations between weight control beliefs and EC use.

Body dissatisfaction among undergraduate medical students in the city of Juiz de Fora, Minas Gerais, Brazil

OBJECTIVE

To assess the level of body dissatisfaction among undergraduate medical students in the city of Juiz de Fora, Minas Gerais, Brazil.

METHODS

A cross-sectional study with 232 volunteers of both sexes at a private college. The Body Shape Questionnaire was used, which is a tool based on the sum of values that allow classifying body dissatisfaction according to the following scores: less than 111, if absence of body dissatisfaction; between 111 and 138, if mild body dissatisfaction; between 139 and 167, if moderate body dissatisfaction, and from 168, if severe body dissatisfaction. In addition, the self-reported body mass index and an assertion were used to assess the degree and perception (insight) of body dissatisfaction. For the statistical analysis, descriptive comparison, and binary logistic regression tests were performed.

RESULTS

The mean result of the Body Shape Questionnaire among women was 96.0±34.1 and among men, 76.7±24.7, with 26.3% of students with some level of dissatisfaction with self-image. Most participants (76.3%) wished to have a body mass index lower than the real one. Women (odds ratio of 5.7), overweight individuals (odds ratio of 6.1), and individuals with insight into their condition (odds ratio of 89.7) were more likely to be dissatisfied with the body image measured by the Body Shape Questionnaire.

CONCLUSION

The search for a thin body among undergraduate medical students is a reality. In addition to overweight individuals, the female population has a significant level of body distortion, being recognized as the highest rate of body dissatisfaction in the sample surveyed.

Dissonance-based eating disorder prevention improves intuitive eating: a randomized controlled trial for Brazilian women with body dissatisfaction

PURPOSE

Investigate the efficacy of a dissonance-based (DB) intervention (i.e., the Body Project), during which some examples of intuitive eating were provided by peer leaders, in improving intuitive eating and targeting risk and protective factors for eating disorders (ED) among Brazilian women with body dissatisfaction.

METHODS

Participants were randomized to a four-session DB intervention (n = 38) or assessment-only control (AOC) (n = 36), and completed validated measures assessing intuitive eating, body appreciation, self-esteem, body-ideal internalization, body dissatisfaction, negative affect, and disordered eating pre-intervention, post-intervention, and at 4- and 24-week follow-ups.

RESULTS

The DB condition demonstrated significantly greater increases in intuitive eating, body appreciation and self-esteem scores compared to AOC from pre-intervention to post-intervention (between-condition Cohen's d = 0.73-0.98), 4-week (between-condition Cohen's d = 1.25-1.87) and 24-week follow-up (between-condition Cohen's d = 0.82-1.38). Also, the DB condition showed significantly greater decreases in body-ideal internalization, body dissatisfaction and disordered eating scores from pre-intervention to post-intervention (between-condition Cohen's d = 0.76-1.04), 4-week (between-condition Cohen's d = 1.27-1.71) and 24-week follow-up (between-condition Cohen's d = 1.04-1.19). Regarding negative affect, DB condition showed significantly greater reduction only at 24-week follow-up (between-condition Cohen's d = 0.60).

CONCLUSION

Results reinforce the efficacy of DB interventions in reducing ED risk factors for young women and support the preliminary efficacy of these programs in improving intuitive eating, body appreciation, and self-esteem.

LEVEL OF EVIDENCE

Level I, randomized controlled trial. ReBEC (Brazilian Registry of Clinical Trials; available at http://www.ensaiosclinicos.gov.br/ ) number of registration: RBR-2f57cs. Date of registration: June 1, 2020.

Association between weight control behaviors and diet quality among Brazilian adolescents and young adults: Health Survey of São Paulo with Focus on Nutrition, 2015

PURPOSE

Little is known about how behaviors to control weight are associated with diet quality among youth from low- and middle-income countries. The aim of this study was to examine associations between efforts to control weight (ECW) and diet quality among Brazilian adolescents and young adults.

METHODS

Data from 731 participants (17.89 ± 4.92 years, 51.1% female) of the 2015 Health Survey of São Paulo were used for this cross-sectional study. Dietary intake was assessed using a 24 h dietary recall and diet quality was calculated using the Brazilian Healthy Eating Index-Revised (BHEI-R). Participants reported their ECW, weight satisfaction, and socio-demographics. Descriptive statistics and linear regressions were calculated to investigate associations between ECW and diet quality.

RESULTS

Approximately 47.7% of participants were dissatisfied with their current weight, and 41.0% reported ECW. Reported strategies to control weight included increased physical activity, taking care of what they eat, and dieting (8.2, 3.1, and 2.5%, respectively). After adjusting for age, sex, race/ethnicity, and body mass index, reporting at least one ECW (ß = 0.08; 95% CI 0.02, 0.13), taking care of what to eat (ß = 0.15; 0.08, 0.22) and being satisfied with their weight (0.08; 0.02, 0.13) were all associated with a higher overall BHEI-R score.

CONCLUSION

Overall diet quality score showed a small increase in participants reporting ECW. Further studies should be conducted to provide strategies used by adolescents from low- and middle-income countries to control their weight. Thus, developing public health policies, and behavioral-change strategies.

LEVEL V

Cross-sectional descriptive study.

Prevalence of overweight and obesity among Brazilian adolescents over time: a systematic review and meta-analysis

OBJECTIVE

To estimate the burden of excess weight in Brazilian adolescents.

DESIGN

Systematic review with meta-analysis.

SETTING

We searched the literature in four databases (MEDLINE/PubMed, EMBASE, SciELO and LILACS). Studies were included if they had cross-sectional or cohort design and enrolled Brazilian adolescents. Studies based on self-reported measures were excluded. Random effect models were used to calculate prevalence estimates and their 95 % CI.

PARTICIPANTS

Brazilian adolescents (10 to 19 years old).

RESULTS

One hundred and fifty-one studies were included. Trend analyses showed a significant increase in the prevalence of excess weight in the last decades: 8·2 % (95 % CI 7·7, 8·7) until year 2000, 18·9 (95 % CI 14·7, 23·2) from 2000 to 2009, and 25·1 % (95 % CI 23·4, 26·8) in 2010 and after. A similar temporal pattern was observed in the prevalence of overweight and obesity separately. In sensitivity analyses, lower prevalence of excess weight was found in older adolescents and those defined using International Obesity Task Force cut-off points. The Southeast and South regions had the highest prevalence of excess weight, overweight and obesity. No significant difference in prevalence by sex was found, except for studies before the year 2000.

CONCLUSIONS

The prevalence of overweight and obesity in Brazilian adolescents is high and continues to rise. Public policies on an individual level and targeting modifications in the obesogenic environment are necessary.

Improving body image at scale among Brazilian adolescents: study protocol for the co-creation and randomised trial evaluation of a chatbot intervention

BACKGROUND

Body image concerns are prevalent among Brazilian adolescents and can lead to poor psychological and physical health. Yet, there is a scarcity of culturally-appropriate, evidence-based interventions that have been evaluated and made widely available. Chatbot technology (i.e., software that mimics written or spoken human speech) offers an innovative method to increase the scalability of mental health interventions for adolescents. The present protocol outlines the co-creation and evaluation of a body image chatbot for Brazilian adolescents via a partnership between academics, industry organisations and the United Nations Children's Fund (UNICEF).

METHODS

A two-armed fully remote randomised controlled trial will evaluate the chatbot's effectiveness at improving body image and well-being. Adolescent girls and boys (N = 2800) aged 13-18 years recruited online will be randomly allocated (1:1) into either: 1) a body image chatbot or 2) an assessment-only control condition. Adolescents will engage with the chatbot over a 72-hour period on Facebook Messenger. Primary outcomes will assess the immediate and short-term impact of the chatbot on state- and trait-based body image, respectively. Secondary outcomes will include state- and trait-based affect, trait self-efficacy and treatment adherence.

DISCUSSION

This research is the first to develop an evidence-informed body image chatbot for Brazilian adolescents, with the proposed efficacy trial aiming to provide support for accessible, scalable and cost-effective interventions that address disparities in body image prevalence and readily available resources.

TRIAL REGISTRATION NUMBER

NCT04825184 , registered 30th March 2021.

Effects of school-based "We Fit" weight control programme in adolescents

Aim

This study examined the effects of a 12‐week school‐based “We Fit” weight control programme.

Design

A nonequivalent control group was used, with a non‐synchronized pretest–posttest design.

Methods

In total, 109 Korean high school adolescents participated. The programme comprised exergaming, diet diary and counselling, health education, and social networking service‐based group discussions. Anthropometric factors, physiological factors and physical activity (daily steps and sitting time) were measured in the intervention and the control groups before and after the intervention. Programme satisfaction was assessed post‐intervention. Data were analysed using descriptive statistics; the chi‐square, Mann–Whitney U and t tests; and generalized estimating equations.

Results

The intervention group showed a significantly decreased waist circumference, increased skeletal muscle mass, increased high‐density lipoprotein cholesterol, decreased low‐density lipoprotein cholesterol and reduced weekend sitting time.

Conclusion

This study adds to the evidence for the applicability and effectiveness of healthy weight control programmes using exergames for adolescents in school settings.

Association between body weight misperception and dietary patterns in Brazilian adolescents: Cross-sectional study using ERICA data

The association between body image and eating behaviors or weight control strategies has been demonstrated in the scientific literature, but there is a lack of evidence on the association between weight misperception and food consumption indicators in adolescents. This study aimed to evaluate the association between weight misperception and dietary patterns (DPs) in the Brazilian Study of Cardiovascular Risks in Adolescents (ERICA). It was a national school-based cross-sectional study conducted among students aged 12-17 years. Data were collected in the form of anthropometric measurements, responses in self-answered questionnaires, and 24-h dietary recall. The following variables were assessed: weight underestimation and overestimation (independent variables), which were defined as the presence of a disagreement between nutritional status and self-perceived weight; dietary patterns (dependent variables), defined by a posteriori method using principal component factor analysis; and individual and demographic variables (covariates). Data analysis was performed using the Poisson regression models method, stratified by sex. A total of 52,038 adolescents with normal weights were evaluated. The weight misperception prevalence was 34.0% (95% confidence interval [CI]: 33.0, 35.0). Three DPs were identified: "Traditional Brazilian," "Processed meat sandwiches and coffee," and "Ultra-processed and sweet foods." In girls, weight underestimation was directly associated with the "Traditional Brazilian" (1.24; 95% CI: 1.08, 1.43) and "Ultra-processed and sweet foods" DPs (1.29; 95% CI: 1.09, 1.54), and overestimation was inversely associated with all the DPs. In boys, a direct association between underestimation and the "Ultra-processed and sweet foods" DP (1.29; 95% CI: 1.10, 1.51) was found. Overestimation was inversely associated with the "Traditional Brazilian" DP (0.79; 95% CI: 0.63, 0.99). The inverse association between overestimation and the "Traditional Brazilian" DP, and the direct association between underestimation and the "Ultra-processed and sweet foods" DP indicated that weight misperception was related to unhealthy eating habits in Brazilian adolescents.

Parental practices, body dissatisfaction and weight control practices in female adolescents from public schools in southern Brazil

The objective was to verify the association between body dissatisfaction (BD) - constituted by the desire to lose weight - with family and personal aspects related to the shape of the body and weight control practices in female adolescents. A cross-sectional, observational epidemiological study with adolescents aged 12-19 years, enrolled in classes of the 8th and 9th years of public schools belonging to the urban area of the city of Caxias do Sul/Rio Grande do Sul, Brazil, was conducted. A self-applicable questionnaire was used. BD was assessed using a silhouette scale. Multivariate regression was performed using Poisson regression with robust variation, hierarchically using a pre-established conceptual model, using the prevalence ratio (PR) adjusted with 95 % CI as a measure of effect. A significance level of 5 % (P ≤ 0·05) was considered. Among the 685 female students, 77·2 % had BD. The father's incentive to diet sometimes (PR 1·19; 95 % CI 1·07, 1·32; P ≤ 0·001) and always (PR 1·15; 95 % CI 1·03, 1·28; P ≤ 0·001), trying to lose weight (PR 1·63; 95 % CI 1·33, 1·99; P ≤ 0·001), dieting five times or more (PR 1·22; 95 % CI 1·09, 1·36; P ≤ 0·001) and skipping meals less than once a week (PR 1·16; 95 % CI 1·04, 1·29; P = 0·026) increased the chances of having BD. In conclusion, among the investigated parents' behaviours, only the father's incentive to go on a diet was associated with BD. Adolescent weight control practices increased the chances of having BD. Thus, it facilitates the identification of this condition at an early stage, enabling adequate treatment and prevention of health complications.

Unhealthy life habits associated with self-induced vomiting and laxative misuse in Brazilian adolescents

Adolescence is a stage in life characterized by important social, cognitive, and physical changes. Adolescents are vulnerable to various psychosocial disorders, including eating disorders. We aimed to investigate the association between unhealthy habits, sociodemographic characteristics, and the practice of self-induced vomiting or laxative misuse in a representative sample of Brazilian adolescent girls and boys. Data from 102,072 students who participated in the National Adolescent School-based Health Survey were analyzed using the dependent variable: presence or absence of self-induced vomiting and/or laxative misuse; independent variables: consumption of unhealthy and high-calorie food items, age during first sexual intercourse, and the use of tobacco, alcohol, and/or illicit drugs. Associations between exposure and outcome were estimated using Poisson's regression models stratified by sex, and including region, school, age group, and mother's educational history as adjustment variables. Eating ultra-processed foods and age during first sexual intercourse were associated with self-induced vomiting and laxative misuse only for girls; all other variables (consuming unhealthy foods and using legal or illicit substances) were associated with these behaviors for both sexes after applying adjustment variables. Early interventions focusing on changing unhealthy behaviors may prevent development of eating disorders in adolescents. Our findings demonstrate a strong association of many unhealthy habits with laxative misuse and self-induced vomiting practices in Brazilian adolescents.

Associations Between Weight Perception, Unhealthy Weight Control Behavior, and Suicidal Ideation and Planning Among Korean Adolescents: A National Cross-Sectional Secondary Analysis

PURPOSE

This study aimed to investigate the associations between weight perception, unhealthy weight control behavior, and suicidal ideation and planning and identify the role of unhealthy weight control behavior as a mediator in these associations among Korean adolescents.

DESIGN AND METHODS

This national cross-sectional secondary study used data from the 2015-2017 Korea Youth Risk Behavior Web-Based Surveys, with a final sample of 96,285 adolescents who tried to manage their weight in the 30 days prior to the surveys. A multivariate logistic regression was conducted.

RESULTS

Both adolescent groups who perceived themselves to be underweight or overweight were significantly linked to a greater likelihood of suicidal ideation and planning (COR, 95% CI = 1.249, 1.141-1.367; COR, 95% CI = 1.339, 1.282-1.399) respectively. While adolescents with perceptions of being underweight are associated with suicidal ideation and planning through the suppression effect of unhealthy weight control behavior (Pathway A: OR, 95% CI = 0.628, 0.587-0.671), adolescents with perceptions of being overweight are linked with the same through the mediation effect (Pathway A: OR, 95% CI = 1.195, 1.141-1.251).

CONCLUSIONS

Adolescents with perceptions of being overweight are highly likely to have unhealthy weight control behavior that can be linked to the possibility of suicidal ideation and planning, while adolescents with perceptions of being underweight are comparatively less likely to engage in such behavior.

PRACTICE IMPLICATIONS

It is necessary to identify the status of weight perception among adolescents and closely monitor the unhealthy weight control behavior to prevent suicidal ideation and planning.

Development and content validity of an instrument for assessing the motivation for weight loss in adolescents with overweight and obesity

Objective

To develop and validate the content of an instrument for assessing the motivation for weight loss in adolescents with overweight and obesity.

Methods

The development and validation of the instrument were conducted in five stages, for which two systematic reviews were conducted. The first one, for the identification of questionnaires assessing the motivation for weight loss, included six studies and contributed to the selection of the domains for the instrument. The second one, conducted to identify the motivations for weight loss in adolescents with overweight and/or obesity, included six studies and contributed to the selection of 17 motivations included in the initial version of the instrument. The motivations most commonly identified were: having better health, improving my appearance, improving my self-esteem and avoiding bullying. The content validity was confirmed by a committee of 12 experts from the areas of nutrition, endocrinology, psychology, and physical education. Based on these evaluations, the content validity index was calculated. Only the items with a content validity index >0.80 for practical relevance were held in the instrument.

Results

Five of the 17 motivations included in the initial version of the instrument were excluded because they had content validity index <0.80 for practical relevance. Of the 12 items held in the instrument, five were revised by experts in order to standardize wording and make the language more appropriate for adolescents. Experts categorized the items into the health, personal satisfaction, appearance and social domains.

Conclusions

This is the first instrument assessing the motivation for weight loss in adolescents with overweight and obesity in Brazil. The content validity evaluation by the panel of experts provided more practical relevance, as well as contributed to a better presentation of the items. Further psychometric testing is needed to determine reliability and construct validity of the instrument.

Fasting and refeeding cycles alter subcutaneous white depot growth dynamics and the morphology of brown adipose tissue in female rats

Intermittent food restriction (IFR) is used mainly for weight loss; however, its effects on adipose tissue are not known when alternating with an obesogenic diet. To demonstrate its effects on morphological dynamics of fat deposits, female Wistar rats were distributed into groups: standard control (ST-C), with commercial diet; DIO control (DIO-C), with a diet that induces obesity (DIO) during the first and last 15 d, replaced by a standard diet for thirty intermediate days; standard restricted (ST-R), with standard diet during the first and last 15 d, with six cycles of IFR at 50 % of ST-C; and DIO restricted (DIO-R), in DIO during the first and last 15 d, with six cycles of IFR at 50 % of DIO-C. At 105 d of life, white adipose tissue (WAT) and brown adipose tissue (BAT) deposits were collected, weighed and histology performed. The DIO-R group showed higher total food intake (DIO-R 10 768·0 (SEM 357·52) kJ/g v. DIO-C 8868·6 (SEM 249·25) kJ/g, P < 0·0001), energy efficiency during RAI (DIO-R 2·26 (SEM 0·05) g/kJ v. DIO-C 0·70 (SEM 0·03) g/kJ, P < 0·0001) and WAT (DIO-R 5·65 (SEM 0·30) g/100 g v. DIO-C 4·56 (SEM 0·30) g/100 g) than their respective control. Furthermore, IFR groups presented hypertrophy of WAT and BAT, as well as fibrosis in BAT. Thus, IFR can establish prospective resistance to weight loss by favouring changes in adipose tissue morphology, increased energy intake and efficiency. Finally, the DIO diet before and after IFR aggravates the damages caused by the restriction.