Nutritional status, body image, and their association with extreme weight control behaviors among Brazilian adolescents, National Adolescent Student Health Survey 2015

Silva, Simoni Urbano da; Barufaldi, Laura Augusta; Andrade, Silvânia Suely Caribé de Araújo; Santos, Maria Aline Siqueira; Claro, Rafael Moreira

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Brasil

Revista Brasileira de Epidemiologia

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ORIGINAL ARTICLE • Rev. bras. epidemiol. 21 (suppl 1) • 2018 • https://doi.org/10.1590/1980-549720180011.supl.1 copy

Nutritional status, body image, and their association with extreme weight control behaviors among Brazilian adolescents, National Adolescent Student Health Survey 2015

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT:

Introduction:

This study aimed to analyze the association between nutritional status, body image perception, and extreme weight control behaviors among adolescents.

Methods:

This is an analytical cross-sectional study conducted in Brazil based on the National Adolescent Student Health Survey (Pesquisa Nacional de Saúde do Escolar - PeNSE) of 2015, with adolescents aged 13 to 17 years. Nutritional status and body image perception were the independent variables. The two dependent variables were vomiting or laxative use and use of medicines and other formulas for weight control in the 30 days prior to data collection. We used Poisson regression models for association, with demographic variables for control.

Results:

7.4% of adolescents (95%CI 6.7 - 8.2) reported vomiting or using laxatives, with no difference between genders. The prevalence of use of medicines and formulas was higher among boys (7.8%; 95%CI 6.6 - 8.9). The association between nutritional status and extreme behaviors was not significant. However, the prevalence of vomiting or laxative use for adolescents who considered themselves very fat was 2.3 (95%CI 1.1 - 4.7) times higher for boys and 5.3 (95%CI 3.3 - 8.6) times higher for girls, while the use of medicines and formulas was 4.0 (95%CI 2.3 - 7.1) times higher for girls who considered themselves very fat.

Conclusion:

Body image perception seems to have a greater influence on extreme behaviors than nutritional status. Strategies involving health services and schools have great potential to impact the self-esteem and health of students positively.

Keywords:
Body image; Nutritional status; Adolescent; Vomiting; Weight perception; Weight loss

	Male		Female		Total
	%	95%CI	%	95%CI	%	95%CI
Age group (years)
13 to 15	62.8	59.0 - 66.4	61.1	56.6 - 65.5	61.9	58.1 - 65.6
14 to 17	37.2	33.6 - 41.0	38.9	34.5 - 43.4	38.1	34.3 - 41.9
Administrative dependence
Public	87.5	85.5 - 89.5	86.6	84.2 - 88.7	87.1	84.9 - 89.0
Private	12.5	10.5 - 14.8	13.4	11.3 - 15.8	12.9	11.0 - 15.1
Region
North	9.6	7.9 - 11.4	8.8	7.4 - 10.5	9.2	7.7 - 10.9
Northeast	29.0	26.1 - 32.1	28.1	25.1 - 31.3	28.6	26.0 - 31.3
Southeast	40.3	36.9 - 43.9	41.7	38.1 - 45.4	41.0	38.0 - 44.2
South	13.6	12.2 - 15.2	13.6	11.8 - 15.5	13.6	12.2 - 15.1
Midwest	7.5	6.6 - 8.4	7.8	6.7 - 8.9	7.6	6.8 - 8.6
Nutritional status
Thin	3.8	3.2 - 4.5	2.4	1.9 - 3.2	3.1	2.7 - 3.6
Normal weight	72.5	70.8 - 74.2	73.8	72.1 - 75.3	73.2	72.0 - 74.3
Overweight	15.4	14.1 - 16.7	16.5	15.2 - 17.8	15.9	15.1 - 16.8
Obesity	8.3	7.3 - 9.4	7.3	6.3 - 8.3	7.8	7.0 - 8.6
Body image perception
Thin/very thin	28.6	26.8 - 30.5	26.7	25.1 - 28.2	27.6	26.4 - 28.8
Normal	56.3	54.4 - 58.2	48.6	46.7 - 50.6	52.5	51.1 - 53.8
Fat	13.5	12.1 - 15.1	21.5	20.0 - 23.1	17.5	16.4 - 18.7
Very fat	1.6	1.1 - 2.1	3.2	2.6 - 3.8	2.4	2.0 - 2.7
Extreme weight control behaviors
Vomiting or laxative use	7.6	6.6 - 8.9	7.1	6.3 - 8.0	7.4	6.6 - 8.2
Medicines, formulas, or other products	7.8	6.6 - 9.3	5.5	4.7 - 6.5	6.7	5.9 - 7.6

	Prevalence of vomiting or laxative use for weight control in the 30 days prior to data collection						Prevalence of use of medicines, formulas, or other products for weight control in the 30 days prior to data collection
	Male		Female		Total		Male		Female		Total
	%	95%CI	%	95%CI	%	95%CI	%	95%CI	%	95%CI	%	95%CI
Age (in years)
13	11.1	8.5 - 14.3	6.9	5.0 - 9.3	9.0	7.4 - 10.9	10.8	8.6 - 13.5	5.4	4.1 - 7.1	8.2	6.9 - 9.7
14	9.5	7.3 - 12.3	7.1	5.1 - 9.9	8.3	6.7 - 9.5	8.9	6.5 - 12.2	4.9	3.5 - 6.9	7.0	5.4 - 8.9
15	7.6	5.6 - 10.1	8.1	6.2 - 10.6	7.9	6.4 - 9.5	8.1	6.0 - 10.7	6.5	4.6 - 9.0	7.3	5.8 - 9.1
16	6.5	4.8 - 8.8	6.6	5.2 - 8.5	6.6	5.4 - 8.0	6.2	4.3 - 8.8	5.3	3.8 - 7.3	5.7	4.4 - 7.4
17	3.0	1.8 - 4.8	6.6	4.9 - 6.8	4.8	3.7 - 6.1	4.8	3.2 - 7.2	5.5	3.8 - 7.9	5.1	3.8 - 6.9
Administrative dependence
Public	8.2	7.0 - 9.6	7.0	6.1 - 8.1	7.6	6.8 - 8.5	8.3	7.0 - 9.9	5.5	4.6 - 6.6	6.9	6.0 - 8.0
Private	3.7	2.2 - 6.3	7.4	5.7 - 9.6	5.6	4.3 - 7.3	4.4	3.1 - 6.2	5.5	3.7 - 8.0	5.0	4.0 - 6.2
Region
North	5.9	4.2 - 8.1	7.8	5.7 - 10.4	6.8	5.2 - 8.8	6.3	4.4 - 9.0	5.5	4.1 - 7.3	5.9	4.6 - 7.5
Northeast	10.5	8.2 - 13.4	7.1	5.7 - 8.9	8.8	7.4 - 10.4	8.3	6.4 - 10.8	4.4	3.2 - 6.1	6.4	5.1 - 8.0
Southeast	6.6	4.9 - 8.7	6.7	5.3 - 8.4	6.6	5.4 - 8.1	8.2	6.0 - 11.3	5.9	4.3 - 8.0	7.1	5.5 - 9.0
South	7.5	5.6 - 9.9	7.0	5.4 - 8.9	7.2	6.0 - 8.6	7.4	5.3 - 8.7	6.7	5.0 - 8.8	7.0	5.7 - 8.6
Midwest	4.9	3.6 - 6.8	8.8	7.2 - 10.7	6.9	5.9 - 8.0	6.8	5.3 - 8.7	5.6	4.1 - 7.5	6.2	5.1 - 7.5
Nutritional status
Thin	8.2	4.3 - 15.2	0.9	0.1 - 6.4	5.4	2.9 - 9.8	10.3	6.1 - 16.8	1.0	0.1 - 7.0	6.7	4.0 - 11.0
Normal weight	7.0	5.9 - 8.3	5.8	4.9 - 6.8	6.4	5.6 - 7.2	7.3	6.0 - 8.9	4.0	3.0 - 5.3	5.7	4.7 - 6.7
Overweight	8.6	6.1 - 12.0	11.0	8.8 - 13.7	9.8	8.3 - 11.7	8.5	6.3 - 11.5	10.1	7.8 - 13.0	9.3	7.6 - 11.4
Obesity	11.2	7.2 - 16.9	13.4	9.1 - 19.4	12.2	9.2 - 16.1	9.8	6.9 - 13.8	12.4	8.9 - 17.1	11.0	8.5 - 14.1
Body image perception
Thin/very thin	9.8	7.6 - 12.5	5.0	3.7 - 6.7	7.5	6.1 - 9.1	9.6	7.3 - 12.7	3.5	2.3 - 5.5	6.7	5.2 - 8.6
Normal	5.8	4.7 - 7.1	4.3	3.5 - 5.3	5.1	4.4 - 5.9	6.5	5.3 - 8.0	3.6	2.8 - 4.7	5.2	4.4 - 6.1
Fat	9.3	6.3 - 13.4	13.6	11.1 - 16.4	11.9	10.1 - 14.0	8.2	6.3 - 10.8	10.3	8.3 - 12.8	9.5	8.1 - 11.2
Very fat	18.5	10.3 - 31.1	23.4	16.4 - 32.3	21.8	16.0 - 29.1	10.4	5.1 - 20.0	19.4	12.9 - 28.0	16.5	11.6 - 22.9

Vomiting or laxative use in the 30 days prior to data collection	Simple model				Multiple model
	Male		Female		Male		Female
	PR	95%CI	PR	95%CI	PR	95%CI	PR	95%CI
Nutritional status**
Normal weight	*	*	*	*	*	*	*	*
Thin	1.17	0.61 - 2.21	0.16	0.02 - 1.14	0.88	0.44 - 1.76	0.17	0.02 - 1.13
Overweight	1.23	0.84 - 1.79	1.90	1.43 - 2.52	1.38	0.91 - 2.08	1.15	0.81 - 1.64
Obesity	1.59	1.02 - 2.48	2.32	1.57 - 3.43	1.52	0.94 - 2.47	1.06	0.66 - 1.70
Body image perception***
Normal	*	*	*	*	*	*	*	*
Thin/very thin	1.69	1.25 - 2.30	1.17	0.80 - 1.69	1.88	1.35 - 2.61	1.27	0.88 - 1.84
Fat	1.61	1.07 - 2.42	3.16	2.37 - 4.21	1.35	0.90 - 2.02	3.06	2.17 - 4.31
Very fat	3.20	1.73 - 5.90	5.45	3.63 - 8.17	2.32	1.15 - 4.69	5.32	3.30 - 8.57

Medicines or formulas in the 30 days prior to data collection	Simple model				Multiple model
	Male		Female		Male		Female
	PR	95%CI	PR	95%CI	PR	95%CI	PR	95%CI
Nutritional status**
Normal weight	*	*	*	*	*	*	*	*
Thin	1.40	0.82 - 2.39	0.26	0.04 - 1.81	1.16	0.65 - 2.08	0.27	0.04 - 1.97
Overweight	1.16	0.84 - 1.60	2.52	1.69 - 3.76	1.30	0.91 - 1.83	1.72	1.10 - 2.68
Obesity	1.33	0.91 - 1.94	3.10	2.02 - 4.75	1.39	0.78 - 2.46	1.60	0.98 - 2.64
Body image perception***
Normal	*	*	*	*	*	*	*	*
Thin/very thin	1.48	1.09 - 2.00	0.98	0.61 - 1.57	1.58	1.15 - 2.16	1.12	0.70 - 1.79
Fat	1.27	0.91 - 1.77	2.84	2.17 - 3.72	1.11	0.69 - 1.78	2.21	1.62 - 3.00
Very fat	1.60	0.76 - 3.36	5.34	3.25 - 8.78	1.32	0.57 - 3.01	4.0	2.26 - 7.07

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[1] Corresponding author: Simoni Urbano da Silva. SRTVN 702, Via W5 Norte, Ed. PO 700, 6º andar, CEP: 70723-040, Brasília, DF, Brasil. E-mail: simoni.urbano@gmail.com