Differences in body image perception, eating behavior and nutritional status of college students of health and human sciences

Abstracts

INTRODUCTION: The literature reports a higher prevalence of eating disorders among undergraduate students whose majors value physical appearance, including Physical Education and Nutrition. It is possible to assume that people concerned about their weight and body image may choose to take these majors because they are personally interested in the topic. The objective of this study was to assess the body image perception, eating behavior, and nutritional status of students of health and human sciences and to compare these data. METHOD: The Eating Attitudes Test (EAT-26) and the Body Shape Questionnaire (BSQ) were administered to 127 first-year students of Nutrition and Physical Education (health sciences) and Advertising and Business Administration (human sciences) who also provided information on weight and height for calculation of their body mass index. RESULTS: We found a high prevalence of body image distortion in all groups, with no difference between areas or majors. The EAT-26 indicated higher scores in students of health than in those who studied human sciences, with the students majoring in Nutrition showing the highest scores, with statistical difference from the scores found in Advertising and Business Administration, but not in Physical Education. In addition, most students were classified as eutrophic and there were not obese individuals in any of the majors, with no significant difference between areas or majors for this variable. DISCUSSION: The high incidence of body image distortion associated with high prevalence of inappropriate eating behavior in students of health shows a possible susceptibility to the development of eating disorders.

Body image; eating behavior; nutritional status; students; eating disorders

INTRODUÇÃO: A literatura refere uma maior prevalência de transtornos alimentares em acadêmicas de cursos universitários nos quais a aparência física é importante, entre eles Educação Física e Nutrição. Supõe-se que pessoas preocupadas com seu peso e imagem corporal optem por essas áreas por terem um interesse pessoal pelo tema. O objetivo deste estudo foi avaliar a percepção da imagem corporal, o comportamento alimentar e o estado nutricional de estudantes de cursos das áreas da saúde e humanas para comparação entre estas. MÉTODO: Aplicou-se o Eating Attitudes Test (EAT-26) e o Body Shape Questionnaire (BSQ) em 127 alunas do primeiro ano dos cursos de Nutrição e Educação Física (Saúde) e de Publicidade e Propaganda e Administração de Empresas (Humanas) que forneceram dados de peso e altura para cálculo do índice de massa corporal. RESULTADOS: Encontrou-se uma grande prevalência de distorção da imagem em todos os grupos, sem diferença entre as áreas ou entre os cursos. O EAT-26 indicou maiores escores nas estudantes da saúde em relação às de humanas, com alunas de Nutrição apresentando as maiores pontuações, estatisticamente diferentes das encontradas nos cursos de Publicidade e Administração, mas não de Educação Física. Além disso, a maioria das alunas foi classificada como eutrófica, e não se encontraram mulheres com obesidade em nenhum dos cursos, não havendo diferença significativa entre áreas ou cursos para esta variável. DISCUSSÃO: A alta incidência de distorção da imagem corporal associada à grande prevalência de comportamento alimentar inadequado nas alunas da área da saúde demonstra uma possível susceptibilidade ao desenvolvimento de transtornos alimentares.

Imagem corporal; comportamento alimentar; estado nutricional; estudantes; transtornos da alimentação

BRIEF COMMUNICATION

Differences in body image perception, eating behavior and nutritional status of college students of health and human sciences

Maria Fernanda Laus^I; Rita de Cássia Margarido Moreira^II; Telma Maria Braga Costa^III

^IMestre, Nutricionista, Doutoranda, Psicobiologia, Departamento de Psicologia e Educação, Faculdade de Filosofia, Ciências e Letras, Universidade de São Paulo (USP), Ribeirão Preto, SP

^IIDoutora, Psicóloga, Professora titular, Curso de Nutrição, Universidade de Ribeirão Preto (UNAERP), Ribeirão Preto, SP

^IIIPós-Doutora, Nutricionista, Professora titular e Coordenadora, Curso de Nutrição, UNAERP

Trabalho realizado no Curso de Nutrição, Universidade de Ribeirão Preto (UNAERP), Ribeirão Preto, SP

^{Endereço para correspondência}

ABSTRACT

INTRODUCTION: The literature reports a higher prevalence of eating disorders in university courses in which physical appearance is important, among them, Physical Education and Nutrition. It is supposed that persons who are concerned about their weight and body image choose these areas for having a personal interest in the theme. The objective of this study was to assess the perception of body image, eating behavior and nutritional state of health and human sciences students to compare these two groups.

METHOD: The Eating Attitudes Test (EAT-26) and the Body Shape Questionnaire (BSQ) were applied in 127 students in the first year of the Nutrition and Physical Education courses (health sciences) and Advertising and Business Administration (human sciences), who provided data on weight and height to calculate the body mass index.

RESULTS: A great prevalence of image distortion was found in all the groups, with no existing difference between the areas or courses. The EAT-26 test indicated greater scores in health students presenting the greater scores, statistically different from those found in the courses of Advertising and Business, but not from those found in Physical Education students. Besides that, most students were classified as eutrophic and no obese women were found in any of the courses, with no existing significant difference between areas or courses for this variable.

DISCUSSION: The high incidence of body image distortion associated to the great prevalence of inadequate eating behavior in the health sciences students demonstrated a possible susceptibility to developing eating disorders.

Keywords: Body image, eating behavior, nutritional state, students, eating disorders.

INTRODUCTION

The increase in the prevalence of eating disorders (ED) has been highlighted in the last years, and in the last two decades an increase in the frequency of problems associated with body image and abnormal eating behaviors among teenagers have been observed.¹ The association of beauty, success and happiness with a thinner body has taken people to practice abusive diets and other unhealthy forms of regulating weight.²

This increase in the prevalence of EDs, mainly among the students' population, has taken numerous researchers to intensify their studies in this field of investigation searching for a profounder knowledge on the causes, evolution, the treatment, the possibilities of recuperation of these pictures, as well as on the consequences of ED for social and educational life of people assailed by them.³

People with EDs have in common the excessive preoccupation with weight and diet, frequently presenting body image distortion, abnormal eating behaviors and inadequate practices for controlling weight.⁴

Epidemiological studies have demonstrated that younger women constitute the group with greatest risk of developing these disorders, due to being more vulnerable to the pressure of sociocultural, economic, and aesthetic standards.^5,6

The literature reports, yet, a higher prevalence of ED in female students of university courses for which physical appearance is important,^7,8 among them Physical Education and Nutrition. It is supposed that people already concerned about their body weight and image may chose these areas exactly for having a personal interest on the theme;⁹ however, this hypothesis is still controversial.^7,8

Thus, the objective of this study was to evaluate the perception of body image, the eating behavior, and the nutritional state of first-year students of courses related to the areas of health and human sciences to compare between them.

METHOD

This project was approved by the Research Ethic Committee on Human Beings of the Universidade de Ribeirão Preto (UNAERP), Ribeirão Preto (SP). It is a cross-sectional study involving all the female students enrolled in the first year of the Nutrition (n = 24), Physical Education (n = 37), Advertising (n = 32), and Business Administration (n = 34) courses at UNAERP, with ages ranging from 18 to 22 years old.

The investigations on body image perception and eating behavior were performed through self-applicable questionnaires, answered individually.

Body image was evaluated through the questionnaire on body image (Body Shape Questionnaire, BSQ). Developed by Cooper et al.¹⁰ and translated and adapted for Brazil by Cordás & Neves,¹¹ this instrument measures the preoccupation with body shape, self-depreciation due to physical appearance and the sensation of being 'fat.'¹² Each question is composed by six options of answer, that vary from 'always' to 'never.' For each option chosen, points are attributed, varying from 1 to 6 (always = 6; very often = 5; often = 4; sometimes = 3, rarely = 2; never = 1). The test result is the sum of 34 items contained in the questionnaire, and the classification of results reflects the levels of preoccupation with body image. A result lower than 70 is considered a normality standard and is seen as the absence of body image distortion; results between 70 and 90 are classified as mild body image distortion; between 91 and 119, as moderate distortion; and over 110 is classified as presence of severe body image distortion.¹³

Eating behavior was evaluated also through the Eating Attitudes Test (EAT-26). This instrument was developed by Garner & Garfinkel,¹⁴ and its reduced version was proposed by Garner et al.¹⁵ The validation for Brazil was done by Bighetti,¹⁶ and the questionnaire quickly became the most applied test in epidemiological studies to track individuals supposedly susceptible to ED development, identifying clinical cases in high risk populations and individuals with abnormal preoccupations related to eating and weight.¹⁷ Each question is composed of six answer options varying from 'always' to 'never.' For each option chosen points are attributed varying from 0 to 3 (always = 3; very often = 2; often = 1; sometimes = 0; rarely = 0; never = 0). The only question that presents an inverted score is the 4th, and for more symptomatic answers, as 'always,' 'very often,' and 'often,' no points are attributed, while for the options 'sometimes,' 'rarely,' and 'never,' 1, 2, and 3 points are attributed, respectively. The result of the test is the sum of all the points attributed to the 26 items,¹⁸ with a number of positive answers equal to or over 20 being considered a risk indicator for the development of an ED.^19,20

Additionally to the application of questionnaires, the students were required to inform their weight and height at the moment of the study for subsequent classification of the nutritional state.

Data analysis was performed through evaluation scales for each of the tests and the calculation of the body mass index (BMI), with the nutritional state classification suggested by the World Health Organization (WHO)²¹ being used.

For statistic treatment, the 's t test was used for independent variables in the analysis between areas, and the ANOVA in the analysis between courses, through the Statistica software version 5.0, with confidence interval of 95% (CI95%).

RESULTS

An amount of 127 female students, with ages ranging from 18 to 22 years old, were studied. In relation to body image, a great prevalence of intense distortion was observed in all the groups (Table 1), and a more detailed statistic analysis demonstrated that body image distortion was not statistically different between health and human sciences areas (p > 0.05) (Table 2), or between the four courses studied (p > 0.05) (Table 3), indicating that the distortion exists independently of the course or area of study.

The results found in the analysis of the EAT-26 showed a high incidence of positivity, specially in the Nutrition and Physical Education courses (Table 1). A statistically significant difference was found between the areas (Table 2), with health area students presenting higher scores when compared to the human area students (p = 0.006). Besides that, the analysis performed between the four courses studied showed that the Nutrition students are those who presented the higher scores in this instrument, these values being statistically different from the ones found in the Advertising and Business Administration courses, but not Physical Education (p < 0.05) Table 3).

In relation to the nutritional state, in the Table 1 it is observed that most students were classified as presenting normal BMI and no obese women were found in any of the courses. For this variable, the measures were not statistically different between health and human science areas (p > 0.05) (Table 2), or between the evaluated courses (p > 0.05) (Table 3), indicating that the nutritional state is also dependent on the professional area.

DISCUSSION

National researches referring to eating behavior and to body image perception performed with university students are usually concerned with Nutrition and Physical Education students, but few works assess these aspects in Human Sciences students.

The findings related to body image perception demonstrate that a significant part of the women studied present some degree of body image distortion, regardless of the course or professional area. The results of this study do not corroborate data from literature, since the presence of distortion in this sample was higher than the one found by other national researches with university students.

A study performed by Pontieri et al.²² with Physical Education students discovered that 58.3% of analyzed women did not present distortion, and the severe distortion was found in 4.17% of the sample. Other study, performed by Stipp & Oliveira,² comparing the incidence of eating behavior and body image disturbances between undergraduate students of Nutrition and Psychology concluded that 54.8% of future nutritionists and 51.1% of future psychologists did not present image distortion, and the incidence of intense distortion was 6.7 and 3%, respectively.

The fact that there was no statistically significant difference in image perception between the areas shows that body image disturbances assail young women in general, and the data related to the presence of distortion among students of the four courses studied are preoccupying because of the prevalence of some degree of distortion.

This aspect becomes important since the body weight perception may influence eating behavior, considering that there is evidence that body image distortions occur in a higher frequency among women with ED.²³ Besides that, currently there are very few doubts that overvaluing weight seems to be one of the most significant risk factors for abnormal eating behaviors and inadequate practices of weight control.⁴

Results related to the application of EAT-26 in Physical Education, Advertising, and Business Administration female students corroborate data found in literature.^22,24 Nevertheless, it is observed in this study that Nutrition students showed a positivity rate of 50%, which is in relative disagreement with studies reported in national literature related to the theme, which demonstrated positivity percentages between 18 and 35% for students in this course.^2,25 Fiates & Salles,²⁶ who have compared the eating behavior of Nutrition students with that of students of other courses not related to health, arrived at a percentage of positive forms or ? 20 (EAT+) of 25.4 and 18.69%, respectively; however, this difference was not statistically significant.

It is observed, thus, that data related to EAT application differ from those in other works, since in this study a significant difference was found between eating behavior of health and human sciences students.

It is still not known for certain if the environment would have some triggering influence,^6,27 or if people already predisposed to developing ED would tend to search these occupations.²⁸ A possible explanation to be considered is that an abnormal eating pattern could be a preexisting motivation for seeking these courses,^8,9 and some authors affirm that first-year university students usually present a higher risk of developing ED,^7,29 which seems plausible in the case of this study, since the already interviewed students were still in the first semester.

Moreover, a study performed by Hughes & Desbrow³⁰ evaluating the motivations that led Nutrition students to choose this career, found out that one of the main factors reported was a previous personal experience with ED.

In relation to the nutritional state, various works have performed this survey among university female students. Data related to this variable show that the malnutrition rates among Nutrition and Advertising students were higher than those found by other authors. It is important to highlight that, although the use of weight and height reported are not a frequent practice in Brazil, possibly due to the lack of national studies and population based analyzing the validity of the information, in other works the study of validity of weight and height reported by the subjects showed a high correlation between values measured and those self-reported.^31,32

Data from the study of Bosi et al.²⁴ showed a 91% prevalence of future physical educators within the limits of normality. In relation to Nutrition students, Penz et al.²⁵ found that 75.8% of the girls in this course were within normality.

Various studies demonstrated that most Brazilian female university students present normal BMI,^22,24,25 corroborating the results found in this research with Physical Education and Business Administration students. On its turn, the high malnutrition rate found especially among Nutrition students, although statistically not different from those found in the other courses, does not agree with the literature, once the values found are much higher than those reported by other authors.

This is particularly preoccupying in the case of future nutritionists, since they intend to work in promoting health by means of encouraging healthy eating habits. Yet, some authors generally affirm that Nutrition students in more advanced semesters present better eating habits than first-year students, which may be attributed to the increase of knowledge in the area.⁹ This way, hopefully with the progress of the course these students will start eating properly, consequently recovering their nutritional state.

So, as it can be observed, this study found a high incidence of body image distortion in all the courses, regardless of the professional area, as well as the prevalence of eutrophy. However, the results concerning eating behavior demonstrated a strong tendency of abnormality in health sciences courses.

It is important to highlight that, despite not constituting a primary cause to the disease, pressure to get thin in certain professions, incremented by the expectations of a good performance, favors the expression of ED.²⁴

CONCLUSION

The high incidence of body image distortion associated to the high prevalence of improper eating behavior in the group of health sciences students shows a possible susceptibility of these students to developing EDs. On the other hand, despite the group of human sciences students having presented normal ED values, the high rates of body image distortion found are preoccupying.

CONCLUSION

The authors would like to thank the collaboration of the nutritionist Isadora Miranda Silva da Cruz for her invaluable help in data collection.

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Received in 02/03/2009.

Accepted in 07/16/2009.

No conflicts of interest declared concerning the publication of this article.

Publication Dates

• Publication in this collection
  24 May 2010
• Date of issue
  Dec 2009

History

• Accepted
  16 July 2009
• Received
  03 Feb 2009