Agreement between nutritional status and perception of body image in indigenous Khisêdjê of the Xingu Indigenous Park

Kennedy Maia dos Santos Mario Luiz da Silva Tsutsui Lalucha Mazzucchetti Patrícia Paiva de Oliveira Galvão Fernanda Serra Granado Douglas Rodrigues Luciana Yuki Tomita Raquel da Rocha Paiva Maia Suely Godoy Agostinho Gimeno About the authors

RESUMO:

Objetivos:

Verificar a concordância entre autoimagem corporal (escala de silhuetas de Stunkard et al.) e estado nutricional e avaliar a satisfação corporal em indígenas khisêdjê do Parque Indígena do Xingu.

Métodos:

Estudo transversal que incluiu 131 indígenas khisêdjê, com 20 anos ou mais. Coletaram-se dados sobre imagem corporal, índice de massa corporal e perímetro da cintura. Foram utilizados a estatística kappa, o teste χ2 (p < 0,05), as razões de prevalências brutas e ajustadas e o teste t de Student.

Resultados:

As prevalências de sobrepeso e obesidade foram, respectivamente, 42 e 5,3%. A porcentagem de satisfação com o perfil corporal foi de 61,8%, sem diferença entre os sexos. Houve boa concordância entre autoimagem real e autoimagem ideal (p < 0,001), porém baixa concordância entre a autoimagem real e ideal e o estado nutricional para ambos os sexos. Maior prevalência de insatisfação corporal por excesso de peso foi detectada entre indivíduos com obesidade central e excesso de peso.

Conclusão:

Os resultados sugerem que a autoimagem corporal avaliada por meio da escala de silhuetas de Stunkard et al. tem pouca aplicabilidade como indicador do estado nutricional de indígenas khisêdjê do Parque Indígena do Xingu.

Palavras-chave:
População indígena; Percepção; Imagem corporal; Estado nutricional

ABSTRACT:

Objective:

To determine the agreement between body self-image (based on the Stunkard figure rating scale) and nutritional status and to evaluate body satisfaction among the Khisêdjê indigenous people of Parque Indígena do Xingu (Xingu Indigenous Park).

Methods:

A cross-sectional study involving 131 natives aged 20 and older. Data on body image, body mass index and waist circumference were collected. Kappa statistics, χ2 (p < 0.05), crude and adjusted prevalence ratios and Student’s t-test were used for data analysis.

Results:

The prevalence of overweight and obesity was respectively 42 and 5.3%. The percentage of satisfaction with body profile was 61.8% with no difference between the sexes. There was good agreement between actual and ideal self-image (p < 0.001), but poor agreement between actual and ideal self-image with nutritional status for both sexes. A higher prevalence of body dissatisfaction due to overweight was detected in individuals with central obesity and overweight.

Conclusion:

The results suggest that body self-image evaluated by the Stunkard silhouette scale has little applicability as an indicator of nutritional status among the indigenous Khisêdjê of Xingu Indigenous Park.

Keywords:
Indigenous population; Perception; Body image; Nutritional status

INTRODUCTION

In all times and cultures, the body has always played an important role in building the values of societies, being one of the regulators of the relationships and behavior of individuals11. Alves D, Pinto M, Alves S, Mota A, Leirós V. Cultura e imagem corporal. Motricidade 2009; 5(1): 1-20.. The conceptions of health, beauty and aesthetics linked to the body image (BI) of an individual are associated with the sociocultural and utilitarian values of the body and can guide the value that individuals attribute to the ideal body11. Alves D, Pinto M, Alves S, Mota A, Leirós V. Cultura e imagem corporal. Motricidade 2009; 5(1): 1-20.,22. Barros DD. Body image: discovering one’s self. Hist Cienc Saude-Manguinhos 2005; 12(2): 547-54. http://dx.doi.org/10.1590/S0104-59702005000200020
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. Among indigenous people, the perception of the body and its symbolic value are present in the characteristics and modes of sociocultural organization, but the rites, values and symbols regarding the indigenous body culture are as vast as the number of existing ethnicities33. Luciano GS. O Índio Brasileiro: o que você precisa saber sobre os povos indígenas no Brasil de hoje. Ministério da Educação, Secretaria de Educação Continuada, Alfabetização e Diversidade. Brasília: LACED/Museu Nacional; 2006..

For the Khisêdjê indigenous people, the meaning of the body transcends the physical aspect, being understood as part of the universe that surrounds it. Its importance and meaning become more evident when ceremonies and festivals occur, and can be perceived through the peculiar body ornamentation, which is not related to the aesthetic aspect only but above all to identity44. Seeger A. Nature and Society in Central Brazil: The Suya Indians of Mato Grosso. Cambridge: Harvard University Press; 1981.. Among the Bororo indigenous people of Mato Grosso, the body is valued through dance, always present in the rituals of passage, with the educational purpose of transferring values, body techniques, rituals, ornaments and music to the younger generations55. Grando BS. Corpo e cultura: a educação do corpo em relações de fronteiras étnicas e culturais e a constituição da identidade Bororo em Meruri-MT. Pensar a Prática. 2006; 8(2): 163-79..

Body image is individuals’ perception of their own body, not only of what they can observe or recall, but also of their desires and aspirations66. Castro IRR, Levy RB, Cardoso LO, Passos MD, Sardinha LMV, Tavares LF, et al. Body image, nutritional status and practices for weight control among Brazilian adolescents. Ciênc Saúde Coletiva 2010; 15(Supl. 2): 3099-108. http://dx.doi.org/10.1590/S1413-81232010000800014
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,77. McCabe MP, Ricciardelli LA. Body image dissatisfaction among males across the lifespan: a review of past literature. J Psychosom Res 2004; 56(6): 675-85. https://doi.org/10.1016/S0022-3999(03)00129-6
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. However, BI is not static, and it can change according to the experiences and transformations that have occurred during the subject’s life and can be influenced by physical, psychological, environmental and cultural factors, as well as by communication means, beliefs and values88. Becker AE, Burwell RA, Gilman SE, Herzog DB, Hamburg P. Eating behaviours and attitudes following prolonged exposure to television among ethnic Fijian adolescent girls. Brit J Psychiatry 2002; 180: 509-14. https://doi.org/10.1192/bjp.180.6.509
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,99. Craig PL, Swinburn BA, Matenga-Smith T, Matangi H, Vaughn G. Do Polynesians still believe that big is beautiful? Comparison of body size perceptions and preferences of Cook Islands, Maori and Australians. N Z Med J 1996; 109(1023): 200-3.,1010. Craig P, Halavatau V, Comino E, Caterson I. Perception of body size in the Tongan community: differences from and similarities to an Australian sample. Int J Obes Relat Metab Disord 1999; 23(12): 1288-94. https://doi.org/10.1038/sj.ijo.0801069
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,1111. Williams LK, Ricciardelli LA, McCabe MP, Waqa GG, Bavadra K. Body image attitudes and concerns among indigenous Fijian and European Australian adolescent girls. Body Image 2006; 3(3): 275-87. https://doi.org/10.1016/j.bodyim.2006.06.001
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.

The figure rating scale is one of the instruments most used for self-assessment of BI, because of its low cost and ease of administration, handling and transport. Moreover, this scale provides reliability coefficients similar to those obtained with other techniques considered more accurate but have greater cost and logistical difficulty, provided that due care is taken in its application. The scale consists in the presentation of a series of silhouettes that generally vary from the thinnest to the fattest, and asking the persons being assessed to choose a figure that represents their current body and the ideal11. Alves D, Pinto M, Alves S, Mota A, Leirós V. Cultura e imagem corporal. Motricidade 2009; 5(1): 1-20.,1212. Cororve Fingeret M, Gleaves DH, Pearson CA. On the methodology of body image assessment: the use of figural rating scales to evaluate body dissatisfaction and the ideal body standards of women. Body Image 2004; 1(2): 207-12. https://doi.org/10.1016/j.bodyim.2004.01.003
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The agreement between BI and nutritional status (NS) has been investigated through epidemiological studies that take into account the observed increase in the prevalence of dissatisfaction or distortions in BI, even in conditions of normal weight1313. Conti MA, Frutuoso MFP, Gambardella AMD. Excesso de peso e insatisfação corporal em adolescentes. Rev Nutr 2005; 18(4): 491-7. http://dx.doi.org/10.1590/S1415-52732005000400005
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,1414. Kakeshita IS, Almeida SS. Relação entre índice de massa corporal e a percepção da auto-imagem em universitários. Rev Saúde Pública 2006; 40(3): 497-504. http://dx.doi.org/10.1590/S0034-89102006000300019
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,1515. Pinheiro AP, Giugliani ER. Body dissatisfaction in Brazilian schoolchildren: prevalence and associated factors. Rev Saúde Pública 2006; 40(3): 489-96. http://dx.doi.org/10.1590/S0034-89102006000300018
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. Some results point to greater dissatisfaction with BI among overweight people1313. Conti MA, Frutuoso MFP, Gambardella AMD. Excesso de peso e insatisfação corporal em adolescentes. Rev Nutr 2005; 18(4): 491-7. http://dx.doi.org/10.1590/S1415-52732005000400005
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,1414. Kakeshita IS, Almeida SS. Relação entre índice de massa corporal e a percepção da auto-imagem em universitários. Rev Saúde Pública 2006; 40(3): 497-504. http://dx.doi.org/10.1590/S0034-89102006000300019
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, while others suggest that there is a high prevalence of dissatisfaction even in normal-weight individuals1515. Pinheiro AP, Giugliani ER. Body dissatisfaction in Brazilian schoolchildren: prevalence and associated factors. Rev Saúde Pública 2006; 40(3): 489-96. http://dx.doi.org/10.1590/S0034-89102006000300018
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To date, there are no studies related to the evaluation of BI among indigenous people in Brazil; however, there are numerous studies in the literature that reveal an increase in nutritional imbalances with substantial prevalence in overweight and obesity in this population1616. Associação Brasileira de Pós-Graduação em Saúde Coletiva. Inquérito Nacional de Saúde e Nutrição dos Povos Indígenas: relatório final. Rio de Janeiro: ABRASCO; 2010.,1717. Castro TG, Schuch I, Conde WL, Veiga J, Leite MS, Dutra CLC, et al. Nutritional status of Kaingáng Indians enrolled in 12 indigenous schools in the State of Rio Grande do Sul, Brazil. Cad Saúde Pública 2010; 26(9): 1766-76. http://dx.doi.org/10.1590/S0102-311X2010000900010
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,1818. Coimbra Jr. CEA, Santos RV, Welch JR, Cardoso AM, de Souza MC, Garnelo L, et al. The First National Survey of Indigenous People’s Health and Nutrition in Brazil: rationale, methodology, and overview of results. BMC Public Health 2013; 13: 52. https://doi.org/10.1186/1471-2458-13-52
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. Up to the beginning of the 1990s, no studies indicated overweight as a problem among the indigenous populations of Brazil1919. Coimbra Jr. CEA, Santos RV, Escobar AL, editores. Epidemiologia e saúde dos povos indígenas no Brasil. Rio de Janeiro: Editora Fiocruz/ABRASCO; 2003. p. 13-47.. Since then, there is growing evidence of a notable increase in the number of cases, with wide variations according to the ethnicity evaluated1616. Associação Brasileira de Pós-Graduação em Saúde Coletiva. Inquérito Nacional de Saúde e Nutrição dos Povos Indígenas: relatório final. Rio de Janeiro: ABRASCO; 2010.,1818. Coimbra Jr. CEA, Santos RV, Welch JR, Cardoso AM, de Souza MC, Garnelo L, et al. The First National Survey of Indigenous People’s Health and Nutrition in Brazil: rationale, methodology, and overview of results. BMC Public Health 2013; 13: 52. https://doi.org/10.1186/1471-2458-13-52
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,2020. Santos KM, Tsutsui MLS, Galvão PPO, Mazzucchetti L, Rodrigues D, Gimeno SGA. Grau de atividade física e síndrome metabólica: um estudo transversal com indígenas Khisêdjê do Parque Indígena do Xingu, Brasil. Cad Saúde Pública 2012; 28(12): 2327-38. http://dx.doi.org/10.1590/S0102-311X2012001400011
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The prevalence of overweight assessed using body mass index (BMI) varies from 8.9% in the indigenous Caingangue (Rio Grande do Sul)1717. Castro TG, Schuch I, Conde WL, Veiga J, Leite MS, Dutra CLC, et al. Nutritional status of Kaingáng Indians enrolled in 12 indigenous schools in the State of Rio Grande do Sul, Brazil. Cad Saúde Pública 2010; 26(9): 1766-76. http://dx.doi.org/10.1590/S0102-311X2010000900010
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to 78% in individuals from the indigenous land of the Sangradouro/Volta Grande (Mato Grosso)2121. Gugelmin SA, Santos RV. Use of Body Mass Index to evaluate the nutritional status of Xavánte Indigenous adults, Sangradouro-Volta Grande, Mato Grosso State, Central Brazil. Cad Saúde Pública 2006; 22(9): 1865-72. http://dx.doi.org/10.1590/S0102-311X2006000900017
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. In the National Survey on Health and Nutrition of Indigenous Peoples carried out in Brazil in 2008/2009, the prevalence was 45.9% among women aged 14 to 49 years1616. Associação Brasileira de Pós-Graduação em Saúde Coletiva. Inquérito Nacional de Saúde e Nutrição dos Povos Indígenas: relatório final. Rio de Janeiro: ABRASCO; 2010.. This increase is of particular concern, given that a high BMI (over 25 kg/m2) is a major factor in determining some chronic non-communicable diseases, which supports the importance of identifying subjects with nutritional disorders2222. Prospective Studies Collaboration, Whitlock G, Lewington S, Sherliker P, Clarke R, Emberson J, et al. Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet Lond Engl 2009; 373(9669): 1083-96. https://doi.org/10.1016/S0140-6736(09)60318-4
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Thus, the increase in the prevalence of overweight observed in the last decades among different ethnicities1616. Associação Brasileira de Pós-Graduação em Saúde Coletiva. Inquérito Nacional de Saúde e Nutrição dos Povos Indígenas: relatório final. Rio de Janeiro: ABRASCO; 2010.,1717. Castro TG, Schuch I, Conde WL, Veiga J, Leite MS, Dutra CLC, et al. Nutritional status of Kaingáng Indians enrolled in 12 indigenous schools in the State of Rio Grande do Sul, Brazil. Cad Saúde Pública 2010; 26(9): 1766-76. http://dx.doi.org/10.1590/S0102-311X2010000900010
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,1818. Coimbra Jr. CEA, Santos RV, Welch JR, Cardoso AM, de Souza MC, Garnelo L, et al. The First National Survey of Indigenous People’s Health and Nutrition in Brazil: rationale, methodology, and overview of results. BMC Public Health 2013; 13: 52. https://doi.org/10.1186/1471-2458-13-52
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, as well as the meaning of the body in indigenous culture33. Luciano GS. O Índio Brasileiro: o que você precisa saber sobre os povos indígenas no Brasil de hoje. Ministério da Educação, Secretaria de Educação Continuada, Alfabetização e Diversidade. Brasília: LACED/Museu Nacional; 2006., is a well-documented issue in the literature, but there is a gap in studies related to the perception of BI among Brazilian indigenous people. It is known that BI is influenced by physical, psychological, cultural and other sociodemographic variables and that distortions in the perception of this image interfere in the health-disease process and in the choice of healthy behaviors and attitudes. Thus, investigations on the topic are relevant to identify possible distortions and assist in the planning and direction of health measures and guidance of the subjects involved.

Accordingly, the present study aimed to assess body satisfaction and to determine the agreement between BI and NS assessed by BMI among Khisêdjê indigenous people in the Xingu Indigenous Park (XIP).

METHODS

This was a cross-sectional epidemiological study that included all individuals of Khisêdjê ethnicity of both sexes, aged 20 years or older, except pregnant or sick women at the time of data collection (n = 131). In the course of this study, we counted on the consent and assistance of the professionals of the Xingu Project and the team of health professionals linked to the Federal University of São Paulo responsible for health care at XIP. Individual medical charts were used, which allowed the identification of all the inhabitants of the place and access to their health information. These records are periodically updated, which helped in the development of studies in this population, even allowing investigators to know exactly the population quantity by age.

To obtain consent to participate, a meeting was held with the community to clarify the objectives and procedures of the study, making it clear that participation would be voluntary and that at any time individuals could withdraw from being part of the investigation. Accordingly, we counted on the help of health agents and indigenous translators, and everything was duly recorded.

Data collection was carried out in the Ngojwere village, at the Wawi indigenous post, in XIP, by trained professionals during two periods: July 2010 and August/September 2011. During the second time, information was collected only from the subjects who had not been included in 2010 due to pregnancy, illness or absence from the village. The research team comprised 17 researchers and included physicians, nurses, nutritionists, physical education professionals, anthropologists and academic staff from medicine and nursing courses.

To ensure uniformity in data collection and recording, two monthly meetings on average were held with the team, between February and August 2010 (14 meetings), for training related to procedures for data collection and filling out the standard questionnaire. The forms were reviewed and coded in a meeting every day in the village, to detect failures in filling out the form and to confirm the results. In addition, the meetings were also for planning the next day’s data collection.

STUDY VARIABLES

BI was assessed using the Stunkard figure rating scale according to the silhouette matching task (SMT)2323. Mueller WH, Joos SK, Schull WJ. Alternative measurements of obesity: accuracy of body silhouettes and reported weights and heights in a Mexican American sample. Int J Obes 1985; 9(3): 193-200., which is based on a scale of silhouettes that contains nine male and nine female BIs. The subjects were asked two direct questions about their body image:

  • How do you see yourself?: a variable called actual self-image. To answer it, individuals should indicate on the sheet/card the BI/silhouette that best represents their image at that moment;

  • How would you like to look ?: a variable called ideal self-image. Individuals should indicate on the sheet/card the ideal figure they would like to have.

Satisfaction with BI was assessed through the construction of a variable called satisfaction with body profile. For this, the figure value that represented the ideal silhouette was subtracted from the figure value that represented the actual silhouette, resulting in values of -8 to +8. Accordingly, the individual was classified as: satisfied (if the result was equal to zero), dissatisfied due to being underweight (if the result was negative) and dissatisfied due to being overweight (if the result was positive)2424. Tehard B, van Liere MJ, Com Nougué C, Clavel-Chapelon F. Anthropometric measurements and body silhouette of women: validity and perception. J Am Diet Assoc 2002; 102(12): 1779-84. https://doi.org/10.1016/s0002-8223(02)90381-0
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.

For the evaluation of the NS, anthropometric measurements were taken, in duplicate, according to the procedures indicated by the World Health Organization (WHO)2121. Gugelmin SA, Santos RV. Use of Body Mass Index to evaluate the nutritional status of Xavánte Indigenous adults, Sangradouro-Volta Grande, Mato Grosso State, Central Brazil. Cad Saúde Pública 2006; 22(9): 1865-72. http://dx.doi.org/10.1590/S0102-311X2006000900017
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,2525. Stunkard AJ, Sørensen T, Schulsinger F. Use of the Danish Adoption Register for the study of obesity and thinness. Res Publ Assoc Res Nerv Ment Dis 1983; 60: 115-20.. To measure weight and height, a portable electronic scale (Líder, model P200m) and a portable wooden stadiometer (WCS, ranging from 20 to 220 cm) were used, respectively. BMI was calculated by dividing weight (in kilograms) by height (in meters) squared. For classification of NS, BMI was categorized according to the cutoff points suggested by WHO2525. Stunkard AJ, Sørensen T, Schulsinger F. Use of the Danish Adoption Register for the study of obesity and thinness. Res Publ Assoc Res Nerv Ment Dis 1983; 60: 115-20.. Excess weight values were considered BMI ≥25 kg/m2.

Waist circumference (WC) was checked in duplicate, using an inelastic, flexible and self-retracting fiberglass tape measure, with a lock and unlock button (TBW), with a scale from 0 to 150 cm, width of 0.8 cm and precision of 0.1 cm, to obtain the value of the smallest curvature located between the ribs and the iliac crest. The final value was the arithmetic mean between the measurements. The presence of central obesity was characterized BWC values ≥94 cm for men and ≥80 cm for women2626. Bissochi CO, Juzwiak CR. Avaliação nutricional e da percepção da autoimagem corporal de atletas adolescentes de voleibol. Rev Soc Bras Alim Nutr 2012; 37(1): 34-53. http://dx.doi.org/10.4322/nutrire.2012.004
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ANALYSIS OF DATA

Descriptive statistics were performed with absolute and relative frequencies and measures of position and dispersion. To assess the relationship between the groups, the χ2 test was used for categorical variables and Student’s t-test for quantitative variables. The χ2 statistic (p < 0.05) and the prevalence ratios (per point and 95% confidence interval) were used in determining the association between the variables of interest. Poisson regression was used to obtain the prevalence ratio.

To assess the agreement between actual self-image and ideal self-image and between both and NS, we determined the correspondence of the categories of figures/silhouettes to each NS category:

  • underweight: silhouettes 1, 2 and 3;

  • normal-weight: silhouettes 4, 5 and 6;

  • overweight: silhouettes 7, 8 and 9.

The agreement between actual self-image and ideal self-image was verified using the χ2 test, and the agreement of the variables related to BI with NS, using the kappa statistic. Accordingly, the NS of each individual was classified as: underweight (BMI <18.5 kg/m2), normal-weight (BMI 18.5 to 25.0 kg/m2) and overweight (BMI ³25.0 kg/m2). The Stata program (StataCorp, College Station, TX, United States) was used in the analyses. This study was approved by the Research Ethics Committee of the National Commission for Research Ethics, under assessment number 1,145,268, on June 29, 2015.

RESULTS

Of the total number of individuals evaluated (n = 131), 37.4% were female and 62.6% were male. The mean age was 37.3 ± 14.4 (SD) years, with no statistically significant difference between sexes. Table 1 shows the distribution of Khisêdjê indigenous people according to variables of interest and sex. Men, when compared to women, exhibited a higher percentage of overweight and obesity (p = 0.016). Both in the variable actual self-image and in the variable ideal self-image, there was a higher percentage of individuals who chose the figures/silhouettes 4 to 6: 54.2 and 57.3%, respectively. As for body satisfaction, 61.8% of individuals were classified as satisfied. There was no difference between the sexes.

Table 1.
Number and percentage of Khisêdjê indigenous individuals according to sex and variables of interest. Parque Indígena do Xingu (Xingu Indigenous Park), 2010-2011.

Tables 2 and 3 show the numbers, percentages and prevalence ratios (PR) of the variables of interest according to satisfaction with body profile. The main difference between the two tables is in the way the response variable was categorized. In Table 2, individuals were categorized as: satisfied or dissatisfied due to being thin. In Table 3, the subjects were classified as: satisfied or dissatisfied due to being overweight. There was no statistically significant association between the independent variables and satisfaction with body profile when it was categorized as satisfied or dissatisfied due to being thin (Table 2). However, when this variable was categorized as satisfied and dissatisfied due to being overweight, there was a higher prevalence of body dissatisfaction due to being overweight among individuals with central obesity (adjusted PR = 2.76 and 95% confidence interval (95% CI) 1.10 - 6.92) and overweight (adjusted PR = 2.77 and 95%CI 1.19 - 6.47) (Table 3).

Table 2.
Number, percentage and prevalence ratio (PR) of variables of interest according to satisfaction with body profile (satisfied; dissatisfied with being thin) among Khisêdjê indigenous individuals. Parque Indígena do Xingu (Xingu Indigenous Park), 2010-2011.
Table 3
Number, percentage and prevalence ratio (PR) of variables of interest according to satisfaction with body profile (satisfied; dissatisfied with being overweight) among Khisêdjê indigenous individuals. Parque Indígena do Xingu (Xingu Indigenous Park), 2010-2011.

Regarding the agreement between actual self-image and ideal self-image, a high proportion of concordance was found in the underweight and normal-weight categories (p <0.001) for both sexes (Table 4), but the degree of agreement between the variables actual self-image and self-image ideal and NS (BMI) was low for both sexes (Table 5). When repeating the analysis of agreement separately for individuals under the age of 40 and for those 40 or older, it was observed that the kappa value (0.4331) was statistically significant (p<0.001) only for women 40 or older, indicating moderate agreement between actual self-image and NS.

Table 4.
Agreement between actual self-image and ideal self-image among Khisêdjê individuals according to sex. Parque Indígena do Xingu (Xingu Indigenous Park), 2010-2011.
Table 5.
Agreement between self-image (actual and ideal) and nutritional status (body mass index - BMI) among Khisêdjê indigenous individuals according to sex. Parque Indígena do Xingu, 2010-2011.

DISCUSSION

The present study evaluated the perception of BI and its agreement with NS among the indigenous Khisêdjê in XIP. Based on the specific literature for the indigenous population, there has been little research related to this topic on the international level and still does not exist in Brazil. Even among non-indigenous people, most studies are restricted to specific groups, such as individuals with eating disorders and who have suffered disease-related changes in BI2727. Finato S, Rech RR, Migon P, Gavineski IC, Toni V de, Halpern R. Insatisfação com a imagem corporal em escolares do sexto ano da rede municipal de Caxias do Sul, no Rio Grande do Sul. Rev Paul Pediatr 2013; 31(1): 65-70. http://dx.doi.org/10.1590/S0103-05822013000100011
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,2828. Gonzalez GAL, Sacomani Junior E, Rondina R de C. As vivências de um grupo de pacientes com transtornos alimentares: a relação com o espelho e a imagem corporal. Rev Subj 2014; 14(3): 383-94.,2929. Prates ACL, Freitas-Junior R, Prates MFO, D’Alessandro AAB, Veloso MF. Indicadores de insatisfação relacionados à imagem corporal em pacientes submetidas à mastectomia. Rev Bras Mastologia 2014; 24(1): 23-8. http://dx.doi.org/10.5327/Z201400010005RBM
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, which makes it difficult to compare and discuss the results.

The assessment of satisfaction with body profile revealed that 61.8% of indigenous people are satisfied with their BI. In other words, most Khisêdjê answered that the BI they would like to have is that which they already had at that time. This result is confirmed by analyzing the agreement between actual self-image and ideal self-image, which revealed good agreement between the two variables. In a study with Australian indigenous youth and Anglo-European youth3030. Cinelli RL, O’Dea JA. Body image and obesity among Australian adolescents from indigenous and Anglo-European backgrounds: implications for health promotion and obesity prevention among Aboriginal youth. Health Educ Res 2009; 24(6): 1059-68. https://doi.org/10.1093/her/cyp040
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, the results also showed a high percentage of satisfaction with body profile in the two populations examined (71.2 and 72.9% for Australian indigenous men and women and 77 and 70.1% for Anglo-European men and women, respectively); also, there was no statistically significant difference between the two populations, an intriguing finding considering the cultural differences between the two populations.

Conversely, results from another study revealed that, when comparing non-aboriginal and aboriginal women in Australia, the latter perceived their weight condition more accurately, although they showed a higher prevalence of overweight, indicating that they had interest in losing weight and were more likely to consider a larger body size as ideal for women.

Even among obese aborigines, approximately 15% showed a positive BI3131. Cinelli R, O’Dea J. Body image, desired weight and body figure preferences of Aboriginal and non-Aboriginal Australian women across the lifespan. Univ Syd Pap HMHCE 2012; 1: 1-15.. A possible explanation for this is that women from traditional populations may not feel judged by Western cultural ideals3232. Snapp S. Internalization of the thin ideal among low-income ethnic minority adolescent girls. Body Image 2009; 6(4): 311-4. https://doi.org/10.1016/j.bodyim.2009.05.005
https://doi.org/https://doi.org/10.1016/...
.

In fact, while in many Western societies a small figure represents the desirable aesthetic standard, studies affirm that in some traditional societies, large body size can be socially desirable, as it is associated with better performance for work and reproduction and represents beauty, prestige, good health, wealth and high social standing1111. Williams LK, Ricciardelli LA, McCabe MP, Waqa GG, Bavadra K. Body image attitudes and concerns among indigenous Fijian and European Australian adolescent girls. Body Image 2006; 3(3): 275-87. https://doi.org/10.1016/j.bodyim.2006.06.001
https://doi.org/https://doi.org/10.1016/...
,3333. Poran MA. Denying Diversity: Perceptions of Beauty and Social Comparison Processes among Latina, Black, and White Women. Sex Roles 2002; 47: 65-82. https://doi.org/10.1023/A:1020683720636
https://doi.org/https://doi.org/10.1023/...
. Among Fijian indigenous women, broad hips represent an advantage both in reproduction and the capacity to support children, and wide legs and calves reflect absence of laziness and increased ability to work88. Becker AE, Burwell RA, Gilman SE, Herzog DB, Hamburg P. Eating behaviours and attitudes following prolonged exposure to television among ethnic Fijian adolescent girls. Brit J Psychiatry 2002; 180: 509-14. https://doi.org/10.1192/bjp.180.6.509
https://doi.org/https://doi.org/10.1192/...
,1111. Williams LK, Ricciardelli LA, McCabe MP, Waqa GG, Bavadra K. Body image attitudes and concerns among indigenous Fijian and European Australian adolescent girls. Body Image 2006; 3(3): 275-87. https://doi.org/10.1016/j.bodyim.2006.06.001
https://doi.org/https://doi.org/10.1016/...
.

Over time and with the process of modernization and media influence, the ideal BI has been changing even among traditional populations3434. Tsai G, Curbow B, Heinberg L. Sociocultural and developmental influences on body dissatisfaction and disordered eating attitudes and behaviors of Asian women. J Nerv Ment Dis 2003; 191(5): 309-18. https://doi.org/10.1097/01.NMD.0000066153.64331.10
https://doi.org/https://doi.org/10.1097/...
. Studies indicate that the preference for larger figures seen among older women belonging to traditional Pacific populations is no longer being accepted among younger women, who in turn, prioritize a slimmer body99. Craig PL, Swinburn BA, Matenga-Smith T, Matangi H, Vaughn G. Do Polynesians still believe that big is beautiful? Comparison of body size perceptions and preferences of Cook Islands, Maori and Australians. N Z Med J 1996; 109(1023): 200-3.,1010. Craig P, Halavatau V, Comino E, Caterson I. Perception of body size in the Tongan community: differences from and similarities to an Australian sample. Int J Obes Relat Metab Disord 1999; 23(12): 1288-94. https://doi.org/10.1038/sj.ijo.0801069
https://doi.org/https://doi.org/10.1038/...
. It is possible that the influence of Western culture, through the media, is causing sociocultural transformations in terms of perception and satisfaction with body profile, given that self-image is in constant transformation, where it is woven by the relations with the world surrounding it3434. Tsai G, Curbow B, Heinberg L. Sociocultural and developmental influences on body dissatisfaction and disordered eating attitudes and behaviors of Asian women. J Nerv Ment Dis 2003; 191(5): 309-18. https://doi.org/10.1097/01.NMD.0000066153.64331.10
https://doi.org/https://doi.org/10.1097/...
.

A study compared two groups of female adolescents, indigenous Fijians and Australians, between 13 and 18 years of age, and found that both groups showed a preference for being thin, dissatisfaction with overweight and concerns associated with weight gain. Despite this, Fijian girls valued a muscular body for its physical functionality, while Australian women, for its aesthetic appeal. The authors associated the increase in body dissatisfaction and desire for a slimmer figure with the introduction of television among Fijian indigenous teenagers88. Becker AE, Burwell RA, Gilman SE, Herzog DB, Hamburg P. Eating behaviours and attitudes following prolonged exposure to television among ethnic Fijian adolescent girls. Brit J Psychiatry 2002; 180: 509-14. https://doi.org/10.1192/bjp.180.6.509
https://doi.org/https://doi.org/10.1192/...
.

The present study also evaluated the prevalence of dissatisfaction with thinness and overweight between categories of different variables, with the aim of identifying possible differences between groups of individuals. There was no statistically significant association between the independent variables and dissatisfaction with being thin, but a higher prevalence of dissatisfaction with being overweight was observed among individuals with central obesity (adjusted PR = 2.76 and 95%CI 1.10 - 6.92 ) and overweight (adjusted PR = 2.77 and 95%CI 1.19 - 6.47) according to BMI. Such findings are important, as they may indicate that such conditions are already affecting the quality of life of these subjects in their daily activities. It is possible that dissatisfaction with overweight is not due to the aesthetic factor, but rather the limiting factor of the conditions that the individual is in. This is a difference between ethnic groups linked to the reasons for dissatisfaction with being overweight reported by different populations. In general, dissatisfaction with being overweight in urban populations can even influence mood, or lead to the appearance of crises and neuroses. In non-Western populations, including indigenous people, it is not always related to the fact of being overweight3535. Ramberan K, Austin M, Nichols S. Ethnicity, body image perception and weight-related behaviour among adolescent females attending secondary school in Trinidad. West Indian Med J 2006; 55(6): 388-93. https://doi.org/10.1590/s0043-31442006000600004
https://doi.org/https://doi.org/10.1590/...
.

In the present study, there was low agreement between BI and NS. Only among women 40 and older was there a moderate agreement between the two variables. These results suggest that body self-image, assessed using the Stunkard silhouette scale, had little applicability as an indicator of NS. Such findings are different from those found by McElhone et al.3636. McElhone S, Kearney JM, Giachetti I, Zunft HJ, Martínez JA. Body image perception in relation to recent weight changes and strategies for weight loss in a nationally representative sample in the European Union. Public Health Nutr 1999; 2(1A): 143-51. https://doi.org/10.1017/s1368980099000191
https://doi.org/https://doi.org/10.1017/...
, who identified a strong association of NS, assessed through BMI, with the BI figures corresponding to the proposed classification.

The results of a study that evaluated 13,595 individuals from different ethnic groups in Colombia revealed that only 3.8% of the adult indigenous population surveyed overestimated their BI with regard to NS according to BMI and that 39% underestimated self-image, while 57.2% showed agreement between the two variables3737. Rodríguez M, Gempeler J. Self-perception of body image and risk eating behaviors in Colombian indigenous people and afro-descendant population. In: Equilíbrio. Atas. Porto; 2012..

The non-agreement between actual body image and NS among the Khisêdjê observed in the present study and the existence of agreement in studies with Western populations1414. Kakeshita IS, Almeida SS. Relação entre índice de massa corporal e a percepção da auto-imagem em universitários. Rev Saúde Pública 2006; 40(3): 497-504. http://dx.doi.org/10.1590/S0034-89102006000300019
https://doi.org/http://dx.doi.org/10.159...
can be associated with sociocultural identity, which is the indicator of the subjective individual concepts and values of satisfactory BI in a given society. Thus, it is understandable that the perception of body image is different when comparing different ethnic groups.

CONCLUSION

The results revealed that, despite the high prevalence of overweight, satisfaction with BI was high in both sexes. Such findings, along with the low agreement observed between NS and actual self-image, suggest that the Khisêdjê appreciate a body profile with a larger figure compared to that idealized in Western populations. In addition, the low agreement between the two variables suggests that a figure rating scale is not an appropriate instrument for evaluating NS in the indigenous Khisêdjê in XIP. However, BMI itself as an indicator of NS, along with the cutoff points used to define overweight/obesity, needs to be the target of scientific investigations to assess its suitability for indigenous populations.

The results emphasize the importance of surveillance and control actions related to overweight and obesity, as well as the morbidities associated with these diseases.

ACKNOWLEDGMENTS

To the Khisêdjê, who made this study possible and welcomed us happily and cordially, and to all the professionals of the Xingu Project, who welcomed us in a special way.

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  • Financial support: Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP), Process No. 2010/52263-7.

Publication Dates

  • Publication in this collection
    01 June 2020
  • Date of issue
    2020

History

  • Received
    24 Sept 2018
  • Reviewed
    25 Mar 2019
  • Accepted
    03 May 2019
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