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Body weight dissatisfaction and its correlates among Brazilian adolescents

INSATISFAÇÃO COM PESO CORPORAL E CORRELATOS ENTRE ADOLESCENTES BRASILEIROS

OBJECTIVE:

This study examined the prevalence of body weight dissatisfaction and its relationship to physical activity and nutritional status in adolescents.

METHOD:

The study enrolled 2,288 adolescents. The dependent variable was body weight dissatisfaction. The independent variables were physical activity and nutritional status. The confounders were gender, and economic condition. Associations between dependent and independent variables were analyzed through the chi-square test and the magnitude of the associations was estimated by Poisson regression.

RESULTS:

A total of 56.6% of adolescents were not satisfied with their weight, with 17.9% wanting to increase it, while 37.7% wanted to decrease their weight. In boys and girls, body weight dissatisfaction was associated with nutritional status, abdominal obesity and physical activity in crude analyses. After adjustments, nutritional status and abdominal obesity remained significantly associated to body weight dissatisfaction in both sexes.

CONCLUSION:

A high prevalence of body weight dissatisfaction was identified, which was associated with the nutritional status and abdominal obesity in adolescents.

KEYWORDS:
dissatisfaction; body weight; adolescents; obesity; physical activity


RESUMO

OBJETIVOS:

Esse estudo teve como objetivo analisar a prevalência de insatisfação com o peso corporal e sua relação com atividade física e estado nutricional em adolescentes.

MÉTODO:

O estudo envolveu 2.288 adolescentes. A variável dependente foi a insatisfação com o peso corporal. As variáveis independentes foram a atividade física e estado nutricional. Os fatores de confusão foram: sexo e condição econômica. As associações entre as variáveis dependentes e independentes foram analisadas por meio do teste do qui-quadrado e a magnitude das associações foi estimada pela regressão de Poisson.

RESULTADOS:

Um total de 56,6% dos adolescentes não se declararam satisfeitos com seu peso, 17,9% queriam aumentar, enquanto que 37,7% queriam diminuir o seu peso. Entre meninos e meninas, a insatisfação como peso corporal associou-se com o estado nutricional, obesidade abdominal e atividade física em análises primárias. Após os ajustes, o estado nutricional e a obesidade abdominal permaneceram significativamente associados à insatisfação com o peso corporal em ambos os sexos.

CONCLUSÕES:

Uma elevada prevalência de insatisfação com o peso corporal foi identificada e associada com o estado nutricional e com obesidade abdominal em adolescentes.

UNITERMOS:
insatisfação com o peso corporal; adolescentes; obesidade; atividade física

INTRODUCTION

In the last decades, epidemiological data have evidenced a decrease in the prevalence of individuals classified as underweight and an increase in overweight individuals.11 Monteiro CA, Conde WL, Popkin BM. Income-specific trends in obesity in Brazil: 1975-2003. Am J Public Health. 2007;97(10):1808-12. Currently, overweight individuals and obesity have been reported in the literature as major public health concerns, observed not only in adults,22 Howel D. Trends in the Prevalence of Abdominal Obesity and Overweight in English Adults (1993-2008). Obesity (Silver Spring). 2012;20(8):1750-2. but also in pediatric populations,33 Christofaro DG, Andrade SMA, Fernandes RA, Ohara D, Dias DF, Freitas Júnior IF, et al. Prevalence of risk factors for cardiovascular diseases among students of Londrina - PR: differences between economic classes. Rev Bras Epidemiol. 2011;14(1):27-35.

4 Fernandes RA, Casonatto J, Christofaro DG, Ronque ER, Oliveira AR, Freitas Júnior IF. Risk of overweight in adolescents from different socioeconomic levels. RevAssoc Med Bras. 2008;54(4):334-8.
-55 Mushtaq MU, Gull S, Abdullah HM, Shahid U, Shad MA, Akram J. Prevalence and socioeconomic correlates of overweight and obesity among Pakistani primary school children. BMC Public Health. 2011;11:724. since it has been related to cardiovascular and psychological disorders.66 Parham ES. Promoting body size acceptance in weight management counseling. J Am Diet Assoc. 1999;99(8):920-5.,77 Liu W, Lin R, Liu A, Du L, Chen Q. Prevalence and association between obesity and metabolic syndrome among Chinese elementary school children: a school-based survey. BMC Public Health. 2010;10:780.

Obesity has been associated with a high prevalence of dissatisfaction with body weight,88 Shriver LH1, Harrist AW, Page M, Hubbs-Tait L, Moulton M, Topham G. Differences in body esteem by weight status, gender, and physical activity among young elementary school-aged children. Body Image. 2013;10(1):78-84. determined by whether the individualwas not satisfiedwith their body weight. In Iceland, it was observed that 50% of women and 35% of men were dissatisfied with their body weight, with most wanting to reduce their weight.99 Matthiasdottir E, Jonsson SH, Kristjansson AL. Body weight dissatisfaction in the Icelandic adult population: a normative discontent? Eur J Public Health. 2012;22(1):116-21. High prevalence of dissatisfaction with body weight was also observed in adolescents from 24 countries in Europe, Canada and the United States.1010 Al Sabbah H, Vereecken CA, Elgar FJ, Nansel T, Aasvee K, Abdeen Z, et al. Body weight dissatisfaction and communication with parents among adolescents in 24 countries: international cross-sectional survey. BMC Public Health. 2009;9:52.

The practice of physical activity has been associated with psychological benefits (optimism, satisfaction with life, and decreased depressive symptoms)1111 Lee H, Kim Y. Effects of an Obesity Intervention Integrating Physical Activity and Psychological Strategy on BMI, Physical Activity, and Psychological Variables in Male Obese Adolescents. Behav Med. 2014:1-8.,1212 Kovacs E, Piko BF, Keresztes N. The interacting role of physical activity and diet control in Hungarian adolescents' substance use and psychological health. Subst Use Misuse. 2014;49(10):1278-86. in youths. However, the association between physical activity and body weight dissatisfaction is less clear. While one study did not find a significant association (considering all physical activities at least 60 min per day, five days per week),1313 Al Sabbah H, Vereecken C, Abdeen Z, Coats E, Maes L. Associations of overweight and of weight dissatisfaction among Palestinian adolescents: findings from the national study of Palestinian schoolchildren (HBSC-WBG2004). J Hum Nutr Diet. 2009;22(1):40-9. another study identified significant association between physical activity levels and body weight dissatisfaction.1414 Reel JJ, Greenleaf C, Baker WK, Aragon S, Bishop D, Cachaper C, et al. Relations of body concerns and exercise behavior: a meta-analysis. Psychol Rep. 2007;101(3 Pt 1):927-42. Part of this controversy may be related to the types of physical activities assessed. In fact, Reel et al.1414 Reel JJ, Greenleaf C, Baker WK, Aragon S, Bishop D, Cachaper C, et al. Relations of body concerns and exercise behavior: a meta-analysis. Psychol Rep. 2007;101(3 Pt 1):927-42. in a meta-analysis showed that in adults the types of exercise can influence the perception that the individual has of his body. According to these authors, pairing anaerobic exercises with weight training has greater effects when compared to only aerobic exercise.

However in adolescents little is known about the effect of different types of physical activities (e.g. leisure or sports) upon dissatisfaction with body weight. Therefore, the purpose of this study was to evaluate the prevalence of body weight dissatisfaction and its relationship with nutritional status and different types of physical activity in adolescents.

METHODS

Sample

Londrina is the third largest city of southern Brazil (approximately 500,000 inhabitants) and has a high human development index (HDI) = 0.84. Approximately 97,000 school children and adolescents are enrolled in elementary and high school. In this epidemiological study, the minimum sample size of 1,534 subjects was estimated considering a prevalence of body dissatisfaction of 45.6%,1515 Khor GL, Zalilah MS, Phan YY, Ang M, Maznah B, Norimah AK. Perceptions of body image among Malaysian male and female adolescents. Singapore Med J. 2009;50(3):303-11. error of 3%, 95% confidence interval (z = 1.96) and design effect of 1.5 (design effect was considered because the classes, instead of students, were taken as a unit of measurement). The schools selected were part of two epidemiological studies in the schools of Londrina, one conducted in 2007 and the other conducted in 2011.

In the first study 10 schools were randomly selected according to the five regions of the city (north, south, east, west and central regions). In the second study, the 6 schools in the central region that most received students from different areas of the city were selected. Thus, data collection included 16 schools. A total of 2,288 individuals agreed to participate and were granted parental permission to take part in the study. The study protocol had been previously approved by the Ethical Research Committee of the State University of Londrina and all parents/adolescents signed written consent forms.

Data collection

Adolescents answered the questionnaire in the classroom. Researchers informed the participants of the study objectives, and remained in the classes while students were filling out the questionnaires, in order to clarify doubts.

The questionnaire included demographic and economic information. For the definition of economic class, the "Economic Classification Criteria of Brazil" in the year 2011 was employed (Brazilian Association of Research Companies - ABEP).1616 Instituto Brasileiro de Opinião Pública e Estatística [Internet]. Levantamento sócio econômico-2011-IBOPE. http://www.abep.org/novo/CMS/Utils/FileGenerate.ashx?id=46.
http://www.abep.org/novo/CMS/Utils/FileG...

These criteria consider the presence of material goods and maids at home and the education level of the household head. Based on scores obtained from the sum of the scores assigned to items, the analyzed adolescents were grouped into the following economic classes A1, A2, B1, B2, C1, C2, D and E. For analysis, they were grouped into a high economic class (A1, A2, B1, B2) and low socioeconomic class (C1, C2, D and E).

Body weight dissatisfaction

Body weight dissatisfaction was assessed via two questions: 1) "Are you satisfied with your current weight?" If not: 2) "Would you like to increase or decrease your current body weight? "For statistical analysis, answers were categorized as "0" if the answer was "I am satisfied with my body weight" and as "1" if it was "I am not satisfied, I would like either to increase or decrease my body weight". The reproducibility of this question was tested in a subsample and showed good reproducibility (Kappa = 0.84).

Physical activity

Physical activity (PA) was assessed using the questionnaire developed by Baecke et al.1717 Baecke JA, Burema J, Frijters JE. A short questionnaire for the measurement of habitual physical activity in epidemiological studies. Am J Clin Nutr. 1982;36(5):936-42. In a validation study, the physical activity score provided by the questionnaire was significantly related to energy expenditure provided by the doubly labeled water method: r = 0.69 and P = 0.001.1818 Philippaerts RM, Westerterp KR, Lefevre J. Doubly labelled water validation of three physical activity questionnaires. Int J Sports Med. 1999;20(5):284-9. Baecke's questionnaire evaluates PA through three different domains: school activities, sports, and leisure time activities. Through a Likert scale, the Baecke's questionnaire assesses the frequency of different types of physical activity ranging from never through sometimes to very often. The questionnaire also considers the practice of sports by the number of hours per week and the number of months per year engaged in sports. At the end of the questionnaire, a score is provided for each of the three domains of physical activity and adding the scores of the three domains renders a score for the total physical activity of the subject. In this study, the leisure physical activity and sports practice score was taken into account and the adolescents were stratified into quartiles according to their scores. Adolescents were considered physically active if they had been classified in the highest quartile (Q4) and sedentary if classified in the lower quartiles (Q1, Q2 and Q3).

Nutritional status

Overweight status was identified through body mass index values [BMI in kg/m22 Howel D. Trends in the Prevalence of Abdominal Obesity and Overweight in English Adults (1993-2008). Obesity (Silver Spring). 2012;20(8):1750-2.]. Body weight was measured by a digital scale (with a maximum capacity of 150 kg) to the nearest 0.1 kg; height was measured by a wall-mounted stadiometer (with a maximum length of 2 meters) to the nearest 0.1 cm. BMI standardized values adjusted by sex and age as proposed by Cole et al.1919 Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ. 2000;320(7244):1240-3. were used to indicate overweight status. Waist circumference was measured by a metallic tape (to the nearest mm) and the cutoffs adjusted by age and sex proposed by Taylor et al.2020 Taylor RW, Jones JE, Williams SM, Goulding A. Evaluation of waist circumference, waist-to-hip, and the conicity index as screening tools for high trunk fat mass, as measured by dual-energy X-ray absorptiometry, in children aged 3-19y. Am J Clin Nutr. 2000;72(2):490-5. were used to discriminate abdominal obesity.

Statistical analyses

Descriptive statistics for numerical variables were mean ± standard deviation. Prevalence was presented as a categorical variable. Associations between dependent and independent variables were analyzed through the chi-square test (Yates' correction was applied if necessary) and the magnitude of the associations was estimated by Poisson regression with robust variance. Significance was set at p < 5%.

RESULTS

Of the 2,288 adolescents analyzed in our study, 54.85% were female (n = 1,255) and 45.15% were male (n = 1,033). Their ages ranged from 10 to 17, with a mean value of 14.1. Girls were older than boys (p = 0.008). Mean waist circumference in boys was approximately 4cm higher than in girls. Leisure physical activity was higher in boys than girls (Table 1).

Table 1
General characteristics of the sample stratified by sex.

Among the adolescents, 1,017 (44.4%) were satisfied with their weight and 56.6% (1271) were not: 17.9% desired a weight increase, while 37.7% wanted a decrease. Table 2 shows associations between the sexes.

Physical activity at leisure time and sports physical activity were marginally associated with body weight dissatisfaction, and these associations remained marginal even after adjustments for sex, economic condition and BMI.

Table 2
Association between sex, dependent and independent variables

There were positive associations between body weight dissatisfaction and BMI and abdominal obesity (Table 3). More than 70% of the adolescents classified as overweight also had abdominal obesity, and this variable remained significant even after the adjustment for BMI.

Table 3
Association between body weight dissatisfaction and independent variables

DISCUSSION

The main results of this study were: abdominal obesity was associated with body weight dissatisfaction independently of BMI; physical activity was not associated with body weight dissatisfaction. The prevalence of overweight individuals observed in this study (18.3%) was similar to previous studies conducted in Brazil.2121 de Pinho L, Botelho AC, Caldeira AP. Associated factors of overweight in adolescents from public schools in Northern Minas Gerais State. Brazil. Rev Paul Pediatr. 2014;32(2):237-43.,2222 Ferreira Marques CD, Ribeiro Silva RC, Machado ME, Portela de Santana ML, Castro de Andrade CR, Pinto Ede J, et al. The prevalence of overweight and obesity in adolescents in Bahia. Brazil. Nutr Hosp. 2013;28(2):491-6. However, the prevalence of body dissatisfaction was higher (56.6%) and this corroborates other studies.2323 Santana ML, Silva RC, Assis AM, Raich RM, Machado ME, Pinto EJ, et al. Factors associated with body image dissatisfaction among adolescents in public schools students in Salvador. Brazil. Nutr Hosp. 2013;28(3):747-55.

24 Petroski EL, Pelegrini A, Glaner MF. Reasons and prevalence of body image dissatisfaction in adolescents. Cien Saude Colet. 2012;17(4):1071-7.
-2525 Pinheiro AP, Giugliani ER. Body dissatisfaction in Brazilian schoolchildren: prevalence and associated factors. Rev Saude Publica. 2006;40(3):489-96.

The higher prevalence of body weight dissatisfaction in girls than in boys has already been previously described for youths in Brazil2323 Santana ML, Silva RC, Assis AM, Raich RM, Machado ME, Pinto EJ, et al. Factors associated with body image dissatisfaction among adolescents in public schools students in Salvador. Brazil. Nutr Hosp. 2013;28(3):747-55.

24 Petroski EL, Pelegrini A, Glaner MF. Reasons and prevalence of body image dissatisfaction in adolescents. Cien Saude Colet. 2012;17(4):1071-7.
- 2525 Pinheiro AP, Giugliani ER. Body dissatisfaction in Brazilian schoolchildren: prevalence and associated factors. Rev Saude Publica. 2006;40(3):489-96. and in other countries.2626 Xie B, Unger JB, Gallaher P, Johnson CA, Wu Q, Chou CP. Overweight, body image, and depression in Asian and Hispanic adolescents. Am J Health Behav. 2010;34(4):476-88. It partly reflects the socio-cultural pattern of the western world society in which women must be thin, while men may have a more robust body.2727 Leit RA, Pope HGJ, Gray JJ. Cultural expectations of muscularity in men: The evolution of playgirl centerfolds. Int J Eat Disord. 2001;29(1):90-3. Additionally, exposure to fashion magazine-originated advertising campaigns was associated with increased body weight dissatisfaction among girls aged 10-14.2828 Martin MC, Gentry JW. Stuck in the model trap: the effects of beautiful models in ad on female pre-adolescents and adolescents. J Advertising. 1997;26(2):19-33.

Independently of sex, overweight status was highly associated with body weight dissatisfaction, which has been consistently shown in the literature.2929 Ferrari EP, Minatto G, Berria J, Silva SF, Fidelix YL, Ribeiro RR, et al. Body image dissatisfaction and anthropometric indicators in male children and adolescents. Eur J Clin Nutr. Eur J Clin Nutr. 2014 Dec 3. [Epub ahead of print].

30 Austin SB, Haines J, Veugelers PJ. Body satisfaction and body weight: gender differences and sociodemographic determinants. BMC Public Health. 2009;27(9):313.
-3131 Kostanski M, Fisher A, Gullone E. Current conceptualisation of body image dissatisfaction: Have we got it wrong? J Child Psychol Psychiatry. 2004;45(7):1317-25. Thus, the association between being overweight and obesity and body weight dissatisfaction occurs from an early age; thus preventive actions targeting the psychological disorders related to obesity should be initiated within the pediatric population.3232 Alexius SL, Olinto MT, Henn RL, Pattussi MP. The association between self perceptions of psychological well-being and overweight in Brazilian children. Matern Child Nutr. 2012;8(2):267-74. This study also showed that association between abdominal obesity and body weight dissatisfaction was to be expected, since abdominal obesity and general obesity are highly correlated. Interestingly, abdominal obesity was associated with body weight dissatisfaction independently of general obesity. It suggests that the increased amount of body fat located in the abdominal region has an independent effect over body image. Future studies should investigate this issue.

The novelty of this study was that leisure and sports physical activity were not associated with body weight dissatisfaction. The study of Al Sabbah et al.1313 Al Sabbah H, Vereecken C, Abdeen Z, Coats E, Maes L. Associations of overweight and of weight dissatisfaction among Palestinian adolescents: findings from the national study of Palestinian schoolchildren (HBSC-WBG2004). J Hum Nutr Diet. 2009;22(1):40-9. including more than 17,000 Palestinians adolescents also observed that dissatisfaction with body weight was not related to physical activity. In the same way. Shriver et al,88 Shriver LH1, Harrist AW, Page M, Hubbs-Tait L, Moulton M, Topham G. Differences in body esteem by weight status, gender, and physical activity among young elementary school-aged children. Body Image. 2013;10(1):78-84. in a study of American children, found no association between physical activity and global and appearance-related body esteem. On the other hand, Kruger et al,3333 Kruger J, Lee CD, Ainsworth BE, Macera CA. Body size satisfaction and physical activity levels among men and women. Obesity (Silver Spring). 2008;16(8):1976-9. after evaluating 10,021 men and women found that physically active men had higher body satisfaction than sedentary ones. Similar findings were also observed in women.

These discrepancies may have occurred in the different types of assessment of body satisfaction (different types of questionnaire and silhouette scales) as well the ways of assessing physical activity. One of the possible reasons to be considered would be the fact that boys are much more active when compared to girls3434 Christofaro DG, Ritti-Dias RM, Chiolero A, Fernandes RA, Casonatto J, de Oliveira AR. Physical activity is inversely associated with high blood pressure independently of overweight in Brazilian adolescents. Scand J Med Sci Sports. 2013;23(3):317-22. and this could influence this relationship.

One limitation of this study is its cross-sectional design that prevents the evaluation of causality. Another limitation is that silhouette scale assessment was not performed. It is suggested that future studies should evaluate the dissatisfaction with body weight in different regions of the country, because in the present study only adolescents in a single city in the southern region of Brazil were evaluated. However strengths should also be highlighted. The study was conducted within a school population in one of the largest cities in southern Brazil and the BMI measurement was obtained directly.

CONCLUSION

In summary, we detected a high prevalence of dissatisfaction, which is affected by general and abdominal obesity. Physical activity (leisure time and sports) was not associated with body weight dissatisfaction.

REFERENCES

  • 1
    Monteiro CA, Conde WL, Popkin BM. Income-specific trends in obesity in Brazil: 1975-2003. Am J Public Health. 2007;97(10):1808-12.
  • 2
    Howel D. Trends in the Prevalence of Abdominal Obesity and Overweight in English Adults (1993-2008). Obesity (Silver Spring). 2012;20(8):1750-2.
  • 3
    Christofaro DG, Andrade SMA, Fernandes RA, Ohara D, Dias DF, Freitas Júnior IF, et al. Prevalence of risk factors for cardiovascular diseases among students of Londrina - PR: differences between economic classes. Rev Bras Epidemiol. 2011;14(1):27-35.
  • 4
    Fernandes RA, Casonatto J, Christofaro DG, Ronque ER, Oliveira AR, Freitas Júnior IF. Risk of overweight in adolescents from different socioeconomic levels. RevAssoc Med Bras. 2008;54(4):334-8.
  • 5
    Mushtaq MU, Gull S, Abdullah HM, Shahid U, Shad MA, Akram J. Prevalence and socioeconomic correlates of overweight and obesity among Pakistani primary school children. BMC Public Health. 2011;11:724.
  • 6
    Parham ES. Promoting body size acceptance in weight management counseling. J Am Diet Assoc. 1999;99(8):920-5.
  • 7
    Liu W, Lin R, Liu A, Du L, Chen Q. Prevalence and association between obesity and metabolic syndrome among Chinese elementary school children: a school-based survey. BMC Public Health. 2010;10:780.
  • 8
    Shriver LH1, Harrist AW, Page M, Hubbs-Tait L, Moulton M, Topham G. Differences in body esteem by weight status, gender, and physical activity among young elementary school-aged children. Body Image. 2013;10(1):78-84.
  • 9
    Matthiasdottir E, Jonsson SH, Kristjansson AL. Body weight dissatisfaction in the Icelandic adult population: a normative discontent? Eur J Public Health. 2012;22(1):116-21.
  • 10
    Al Sabbah H, Vereecken CA, Elgar FJ, Nansel T, Aasvee K, Abdeen Z, et al. Body weight dissatisfaction and communication with parents among adolescents in 24 countries: international cross-sectional survey. BMC Public Health. 2009;9:52.
  • 11
    Lee H, Kim Y. Effects of an Obesity Intervention Integrating Physical Activity and Psychological Strategy on BMI, Physical Activity, and Psychological Variables in Male Obese Adolescents. Behav Med. 2014:1-8.
  • 12
    Kovacs E, Piko BF, Keresztes N. The interacting role of physical activity and diet control in Hungarian adolescents' substance use and psychological health. Subst Use Misuse. 2014;49(10):1278-86.
  • 13
    Al Sabbah H, Vereecken C, Abdeen Z, Coats E, Maes L. Associations of overweight and of weight dissatisfaction among Palestinian adolescents: findings from the national study of Palestinian schoolchildren (HBSC-WBG2004). J Hum Nutr Diet. 2009;22(1):40-9.
  • 14
    Reel JJ, Greenleaf C, Baker WK, Aragon S, Bishop D, Cachaper C, et al. Relations of body concerns and exercise behavior: a meta-analysis. Psychol Rep. 2007;101(3 Pt 1):927-42.
  • 15
    Khor GL, Zalilah MS, Phan YY, Ang M, Maznah B, Norimah AK. Perceptions of body image among Malaysian male and female adolescents. Singapore Med J. 2009;50(3):303-11.
  • 16
    Instituto Brasileiro de Opinião Pública e Estatística [Internet]. Levantamento sócio econômico-2011-IBOPE. http://www.abep.org/novo/CMS/Utils/FileGenerate.ashx?id=46.
    » http://www.abep.org/novo/CMS/Utils/FileGenerate.ashx?id=46
  • 17
    Baecke JA, Burema J, Frijters JE. A short questionnaire for the measurement of habitual physical activity in epidemiological studies. Am J Clin Nutr. 1982;36(5):936-42.
  • 18
    Philippaerts RM, Westerterp KR, Lefevre J. Doubly labelled water validation of three physical activity questionnaires. Int J Sports Med. 1999;20(5):284-9.
  • 19
    Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ. 2000;320(7244):1240-3.
  • 20
    Taylor RW, Jones JE, Williams SM, Goulding A. Evaluation of waist circumference, waist-to-hip, and the conicity index as screening tools for high trunk fat mass, as measured by dual-energy X-ray absorptiometry, in children aged 3-19y. Am J Clin Nutr. 2000;72(2):490-5.
  • 21
    de Pinho L, Botelho AC, Caldeira AP. Associated factors of overweight in adolescents from public schools in Northern Minas Gerais State. Brazil. Rev Paul Pediatr. 2014;32(2):237-43.
  • 22
    Ferreira Marques CD, Ribeiro Silva RC, Machado ME, Portela de Santana ML, Castro de Andrade CR, Pinto Ede J, et al. The prevalence of overweight and obesity in adolescents in Bahia. Brazil. Nutr Hosp. 2013;28(2):491-6.
  • 23
    Santana ML, Silva RC, Assis AM, Raich RM, Machado ME, Pinto EJ, et al. Factors associated with body image dissatisfaction among adolescents in public schools students in Salvador. Brazil. Nutr Hosp. 2013;28(3):747-55.
  • 24
    Petroski EL, Pelegrini A, Glaner MF. Reasons and prevalence of body image dissatisfaction in adolescents. Cien Saude Colet. 2012;17(4):1071-7.
  • 25
    Pinheiro AP, Giugliani ER. Body dissatisfaction in Brazilian schoolchildren: prevalence and associated factors. Rev Saude Publica. 2006;40(3):489-96.
  • 26
    Xie B, Unger JB, Gallaher P, Johnson CA, Wu Q, Chou CP. Overweight, body image, and depression in Asian and Hispanic adolescents. Am J Health Behav. 2010;34(4):476-88.
  • 27
    Leit RA, Pope HGJ, Gray JJ. Cultural expectations of muscularity in men: The evolution of playgirl centerfolds. Int J Eat Disord. 2001;29(1):90-3.
  • 28
    Martin MC, Gentry JW. Stuck in the model trap: the effects of beautiful models in ad on female pre-adolescents and adolescents. J Advertising. 1997;26(2):19-33.
  • 29
    Ferrari EP, Minatto G, Berria J, Silva SF, Fidelix YL, Ribeiro RR, et al. Body image dissatisfaction and anthropometric indicators in male children and adolescents. Eur J Clin Nutr. Eur J Clin Nutr. 2014 Dec 3. [Epub ahead of print].
  • 30
    Austin SB, Haines J, Veugelers PJ. Body satisfaction and body weight: gender differences and sociodemographic determinants. BMC Public Health. 2009;27(9):313.
  • 31
    Kostanski M, Fisher A, Gullone E. Current conceptualisation of body image dissatisfaction: Have we got it wrong? J Child Psychol Psychiatry. 2004;45(7):1317-25.
  • 32
    Alexius SL, Olinto MT, Henn RL, Pattussi MP. The association between self perceptions of psychological well-being and overweight in Brazilian children. Matern Child Nutr. 2012;8(2):267-74.
  • 33
    Kruger J, Lee CD, Ainsworth BE, Macera CA. Body size satisfaction and physical activity levels among men and women. Obesity (Silver Spring). 2008;16(8):1976-9.
  • 34
    Christofaro DG, Ritti-Dias RM, Chiolero A, Fernandes RA, Casonatto J, de Oliveira AR. Physical activity is inversely associated with high blood pressure independently of overweight in Brazilian adolescents. Scand J Med Sci Sports. 2013;23(3):317-22.

Publication Dates

  • Publication in this collection
    Feb 2015

History

  • Received
    20 Nov 2014
  • Reviewed
    15 Dec 2014
  • Accepted
    03 Feb 2015
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