Abstracts
Objective:
To analyze body image in different periods of adolescence.
Methods:
This cross-sectional study enrolled students aged ten to 19 years old of public schools in small districts of Minas Gerais, Southeast Brazil. The Body Shape Questionnaire (BSQ), the Body Dissatisfaction Assessment Scale for Teenagers and the Silhouette Scale for Teenagers (SST) were used. Adolescence phases were classified according to the subjects' ages. Weight and height were measured in order to calculate the body mass index and the nutritional status. Results were analyzed by logistic regression.
Results:
The study emolled 531 teenagers (318 females). The average age was 15.6±
2
.2 years and 84.6% were eutrophic. The prevalence of body dissatisfaction varied from 28.9% (BSQ) to 78.9% (SST). Overweight adolescents presented greater dissatisfaction (BSQ: OR 3.66, p<0.001; SST: OR 4.108, p<0.001). Dissatisfaction also occurred for females and those at the early adolescence (p<0.05).
Conclusions:
A low prevalence of dissatisfaction with the body image was observed among adolescents in small towns of Minas Gerais; however, most of them wished a different silhouette than the current one. The results showed that younger adolescents had higher dissatisfaction than their peers, as well as female and overweighed adolescents.
body image; adolescent; sex; nutritional status; adolescent health
Objetivo:
Investigar la imagen corporal en distintos periodos de la adolescencia.
Métodos:
Estudio transversal con estudiantes de diez a 19 años de escuelas de la red pública de municipios de pequeño porte del interior de la Zona de Bosque de Minas Gerais (Brasil). Se aplicaron el Body Shape Questionnaire (BSQ), la Escala de Evaluación de Insatisfacción Corporal para Adolescentes y la Escala de Silueta para Adolescentes (ESA). Se clasificó el periodo de la adolescencia por la edad. La masa corporal y la estatura fueron medidas para el cálculo del índice de masa corporal y del estado nutricional. Se realizaron análisis descriptivo, inferencias y regresión.
Resultados:
Participaron 531 adolescentes (318 muchachas). El promedio de edad fue de 15,6±2,2 años y 84,6% eran eutróficos. La prevalencia de insatisfacción corporal varió del 28,9% (BSQ) al 78,9% (ESA). Individuos con exceso de peso presentaron mayor posibilidad de insatisfacción (BSQ: OR 3,66, p<0,001; ESA: OR 4,108, p<0,001). Lo mismo pasó con muchachas e individuos en el periodo inicial de la adolescencia (p<0,05).
Conclusiones:
La prevalencia de insatisfacción con la imagen corporal fue baja entre los adolescentes de las ciudades pequeñas de Minas Gerais, pero la mayoría deseaba una silueta distinta de la actual. Los resultados mostraron mayor insatisfacción entre los participantes en el periodo inicial de la adolescencia, así como en los del sexo femenino y en aquellos con exceso de peso.
imagen corporal; adolescente; sexo; estado nutricional; salud del adolescente
Objetivo:
Investigar a imagem corporal em diferentes períodos da adolescência.
Métodos:
Estudo transversal com estudantes de dez a 19 anos de escolas da rede pública de municípios de pequeno porte do interior da Zona da Mata Mineira. Aplicaram-se o Body Shape Questionnaire (BSQ), a Escala de Evaluación de Insatisfación Corporal para Adolescentes e a Escala de Silhueta para Adolescentes (ESA). Classificou-se o período da adolescência por meio da idade. A massa corporal e a estatura foram mensuradas para o cálculo do índice de massa corpórea e do estado nutricional. Os resultados foram avaliados por regressão logística.
Resultados:
Participaram 531 adolescentes (318 meninas). A média de idade foi de 15,6±2,2 anos e 84,6% eram eutróficos. A prevalência de insatisfação corporal variou de 28,9% (BSQ) a 78,9% (ESA). Indivíduos com excesso de peso apresentaram maior chance de insatisfação (BSQ: OR 3,66, p<0,001; ESA: OR 4,108, p<0,001). O mesmo ocorreu para meninas e indivíduos no período inicial da adolescência (p<0,05).
Conclusões:
A prevalência de insatisfação com a imagem corporal foi baixa entre os adolescentes das cidades pequenas de Minas Gerais, porém a maioria desejava uma silhueta diferente da atual. Os resultados mostraram maior insatisfação entre os participantes no período inicial da adolescência, assim como nos do sexo feminino e naqueles com excesso de peso.
imagem corporal; adolescente; sexo; estado nutricional; saúde do adolescente
Introduction
Adolescence is a developmental stage of a human being in which the process of biopsychosocial maturation occurs intensively( 11. Papalia DE, Feldman RD. Desenvolvimento humano. 12th ed. São Paulo: McGraw Hill/Artmed; 2013. ). The World Health Organization (WHO)(2) adopts the chronological criteria, defining adolescence as the life span from 10 to 19 years, 11 months and 29 days. It can be divided into three periods: early (10-13 years), middle (14-16 years) and late (17-21 years) adolescence( 33. WHO; UNICEF. Breastfeeding and maternal medication: recommendations for drugs in the 8th WHO Model List of Essential Drugs. Geneva: WHO; 1995. ). Childhood and adolescence are periods of life marked by great vulnerability, because they represent stages in which the human being is growing and developing, both physically and intellectually( 44. McCabe MP, Ricciardelli LA. A longitudinal study of pubertal timing and extreme body change behaviors among adolescent boys and girls. Adolescence 2004;39:145-66. ).
During the periods of adolescence, morphological changes occur in both sexes( 55. Siervogel RM, Demerath EW, Schubert C, Remsberg KE, Chumlea WC, Sun S et al. Puberty and body composition. Horm Res 2003;60 (Suppl 1):36-45. ). Such sudden changes in physical appearance may influence adolescents' assessment of their body image( 66. Santos EM, Tassitano RM, Nascimento WM, Petribú MM, Cabral PC. Body satisfaction and associated factors among high school students. Rev Paul Pediatr 2011;29:214-23. ), which is a multidimensional construct involving the accuracy of the perception that the person has regarding body shape and size, along with the feelings this representation may cause( 44. McCabe MP, Ricciardelli LA. A longitudinal study of pubertal timing and extreme body change behaviors among adolescent boys and girls. Adolescence 2004;39:145-66. ). The concern with weight is a major factor associated with increased body dissatisfaction( 66. Santos EM, Tassitano RM, Nascimento WM, Petribú MM, Cabral PC. Body satisfaction and associated factors among high school students. Rev Paul Pediatr 2011;29:214-23. , 77. Del Duca GF, Garcia LM, Sousa TF, Oliveira ES, Nahas MV. Body weight dissatisfaction and associated factors among adolescents. Rev Paul Pediatr 2010;28:340-6. ). It is observed that the physical form considered attractive may not be achieved successfully and thus some actions are taken to achieve a possible satisfaction. However, these attitudes are often harmful to health, such as unhealthy eating behaviors, inappropriate practices of weight control, overuse of diuretics and laxatives, vomiting, and strenuous physical activity( 88. Alves E, Vasconcelos Fde A, Calvo MC, Neves Jd. Prevalence of symptoms of anorexia nervosa and dissatisfaction with body image among female adolescents in Florianópolis, Santa Catarina state, Brazil. Cad Saude Publica 2008;24:503-12. ). To evaluate this negative feeling in relation to body image, the researcher may use culturally adapted instruments for the adolescent population. Questionnaires and self-assessment scales are best suited to evaluate the components of body image, both in epidemiological studies and in clinical studies( 99. Thompson JK. The (mis)measurement of body image: ten strategies to improve assessment for applied and research purposes. Body Image 2004;1:7-14. ).
Some studies( 66. Santos EM, Tassitano RM, Nascimento WM, Petribú MM, Cabral PC. Body satisfaction and associated factors among high school students. Rev Paul Pediatr 2011;29:214-23.
7. Del Duca GF, Garcia LM, Sousa TF, Oliveira ES, Nahas MV. Body weight dissatisfaction and associated factors among adolescents. Rev Paul Pediatr 2010;28:340-6.
8. Alves E, Vasconcelos Fde A, Calvo MC, Neves Jd. Prevalence of symptoms of anorexia nervosa and dissatisfaction with body image among female adolescents in Florianópolis, Santa Catarina state, Brazil. Cad Saude Publica 2008;24:503-12.
9. Thompson JK. The (mis)measurement of body image: ten strategies to improve assessment for applied and research purposes. Body Image 2004;1:7-14. - 1010. Pelegrini A, Petroski EL. The association between body dissatisfaction and nutritional status in adolescents. Human Moviment 2010;11:51-7. ) were conducted among Brazilian adolescents, but there are few national studies investigating body image in different periods of adolescence( 1111. Pereira EF, Graup S, Lopes AS, Borgatto AF, Daronco LS. Body image perception in children and adolescents with different socio-economic status in the city of Florianópolis, in the state of Santa Catarina, Brazil. Rev Bras Saude Mater Infant 2009;9:253-62. ). Accordingly, the aim of this study was to assess body image of adolescents living in small municipalities in the state of Minas Gerais, in the early, middle, and late periods of adolescence, according to sex and nutritional status.
Method
This is a descriptive cross-sectional and observational study, and the population consisted of adolescents( 22. World Health Organization. Nutrition in adolescence: issues and challenges for the health sector: issues in adolescent health and development. Geneva: WHO; 2005. ) of both sexes, regularly enrolled at public schools in small municipalities( 1212. Brasil - Instituto de Pesquisa Econômica Aplicada. Série Caracterização e Tendências da Rede Urbana do Brasil. Brasília: IPEA; 2001. ) in the countryside of Zona da Mata Mineira. We found nine municipalities with a population lower than five thousand inhabitants in the above region( 1313. Brasil -Instituto Brasileiro de Geografia e Estatística [homepage on the Internet]. Censo 2000 -cidades [cited 2009 May 5]. Available from: http:// www.ibge.com.br/cidadesat
Available from: http:// www.ibge.com.br/...
) and, subsequently, the researcher visited the schools to get the consent from the direction to conduct the research and to collect information on the number of adolescents, ages, and sex.
We used a cluster sample, from a universe of nine schools (clusters) and a finite population of 1,015 students. To calculate the sample size, significance was established at 5%, an absolute accuracy of 5.5 percentage points in the variable reference response - the score of the Body Shape Questionnaire (BSQ)( 1414. Conti MA, Cordás TA, Latorre MR. A study of the validity and reliability of the Brazilian version of the Body Shape Questionnaire (BSQ) among adolescents. Rev Bras Saude Mater Infant 2009;9:331-8. ) - and the maximum variability observed in the literature as the expected standard deviation, corresponding to the female sex (standard deviation: 34.3 points)( 1414. Conti MA, Cordás TA, Latorre MR. A study of the validity and reliability of the Brazilian version of the Body Shape Questionnaire (BSQ) among adolescents. Rev Bras Saude Mater Infant 2009;9:331-8. ). Thus, we came to the minimum sample size of 129, already with the finite-population correction.
To allow independent interferences for the three periods of adolescence, considering each one as stratum, the initial sample size was multiplied by three (for the periods of adolescence), which generated a minimum sample size of 387 students. The following municipalities were selected by simple random sampling (SRS): Goianá (n=191), Tabuleiro (n=207), Belmiro Braga (n=130), and Pequeri (n=124). The late number of analyzed students was 651.
Among the 651 evaluated participants, 120 individuals were excluded: eight lived in another municipality, two made use of controlled medications, 27 claimed not having permission from the parents, 43 did not hand over the term of consent signed by parents, and 40 attended only one day of data collection. At the end, the research involved 531 students, a greater number than the recommended by the sample calculation.
The instruments selected for body image assessment were those with transcultural adaption for Brazilian adolescents: The Body Shape Questionnaire (BSQ)( 1414. Conti MA, Cordás TA, Latorre MR. A study of the validity and reliability of the Brazilian version of the Body Shape Questionnaire (BSQ) among adolescents. Rev Bras Saude Mater Infant 2009;9:331-8. ), the Escala de Evaluación de Insatisfación Corporal para Adolescentes (EEICA)( 1515. Conti MA, Slater B, Latorre MR. Validity and reproducibility of Escala de Evaluación da Insatisfación Corporal para Adolescentes. Rev Saude Publica 2009;43:515-24. ), and the Silhouette Scale for Adolescents (SSA)( 1616. Conti MA, Latorre MR. Study of validity and reliability of one contour rating scale to adolescence. Psicol Estud 2009;14:699-706. ).
The BSQ( 1414. Conti MA, Cordás TA, Latorre MR. A study of the validity and reliability of the Brazilian version of the Body Shape Questionnaire (BSQ) among adolescents. Rev Bras Saude Mater Infant 2009;9:331-8. ) is a questionnaire consisting of 34 questions in a Likert-like self-report scale, with six response options (1 - never to 6 - always), and four levels of dissatisfaction with physical appearance, following the model proposed by Cordás and Castilho( 1717. Cordás TA, Castilho S. Body image on the eating disorders - evaluation instruments: "Body Shape Questionnaire". Psiquiatr Biol 1994;2:17-21. ), according to the scores: free of body dissatisfaction - below 80 points; mild dissatisfaction - from 80-110 points; moderate dissatisfaction - 110 to 140 points; and severe dissatisfaction - equal to or above 140 points.
The EEICA( 1515. Conti MA, Slater B, Latorre MR. Validity and reproducibility of Escala de Evaluación da Insatisfación Corporal para Adolescentes. Rev Saude Publica 2009;43:515-24. ) provides information about the frequency of behaviors related to care and bodily perception and the social and family influences on body dissatisfaction. The scale consists of 32 self-report questions in a Likert-like scale, with six response options (1 - never to 6 - always). The score ranges from zero to 96 points and, the higher the score, the greater the body dissatisfaction.
The SSA( 1616. Conti MA, Latorre MR. Study of validity and reliability of one contour rating scale to adolescence. Psicol Estud 2009;14:699-706. ) consists of nine figures of silhouettes for each sex. The categorization of the level of satisfaction (LS) was performed by the difference in the choice between the ideal silhouette (IS) and the real silhouette (RS). Adolescents who presented a difference equal or below zero (LS=0) were classified as satisfied, and those with a difference different than zero (LS≠ 0) were classified as dissatisfied.
Age and sex were self-reported and the classification of body mass index (BMI) [weight (kg)/height (m)2] was used as the primary assessment of nutritional status. The categorization of the adolescence period was performed as proposed by the WHO( 33. WHO; UNICEF. Breastfeeding and maternal medication: recommendations for drugs in the 8th WHO Model List of Essential Drugs. Geneva: WHO; 1995. ): early period (Early) - 10 to 13 years; middle period (MP) - 14 to16 years; and late period (LP) - 17 to 21 years. Anthropometric data were collected with adolescents wearing a physical education uniform, barefoot, and weighed on an electronic platform scale (G-Tech(r)), with a capacity for 150kg and 100g-graduation. Placing the teenager in the middle of the platform, two measures were assessed( 1818. Gordon CC, Chumlea WC, Roche AF. Stature, recumbent length, and weight. In: Lohman TG, Roche AF, Martorell R, editors. Anthropometric standardization reference manual. Champaing: Human Kinetics Books; 1988. p. 3-8. ). Subsequently, each student went to the wall-mounted stadiometer, in the upright position, leaning against the back wall, looking forward, feet together and heels touching. Two measures for height were assessed, and we considered the mean of this value( 1818. Gordon CC, Chumlea WC, Roche AF. Stature, recumbent length, and weight. In: Lohman TG, Roche AF, Martorell R, editors. Anthropometric standardization reference manual. Champaing: Human Kinetics Books; 1988. p. 3-8. ). Nutritional status was categorized according to the percentile values for age and gender( 1919. De Onis M, Onyango AW, Borghi E, Siyam A, Nishida C, Siekmann J. Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ 2007;85:660-7. ): low BMI - percentiles below 3; eutrophic - between 3 and 85; overweight - between 85 and 97; and obesity - percentile above 97.
A descriptive analysis was performed using frequency, mean values, and standard deviations. For the analysis of body dissatisfaction, adolescence was categorized by periods, creating three strata according to sex. For males: MEP (male early period), MMP (male middle period) and MLP (male late period); for females: FEP (female early period), FMP (female middle period) and FLP (female late period).
As the numerical variables were not normal by the Kolmogorov-Smirnov test, we chose the application of non-parametric tests. The chi-square, in the case of ordinal factors, and the Fisher exact test for the nominal factor, were applied to examine the associations of adolescence, sex, and nutritional status as well as the frequency of subjects classified as satisfied and dissatisfied by the SSA and the BSQ.
The variation in scores of dissatisfaction with body image between different periods of adolescence and between groups of nutritional status was evaluated by the Kruskal-Wallis test and the post hoc Bonferroni's test. To compare the mean scores of the instruments between both sexes and groups related to the adolescence period, we applied the MannWhitney's U test.
Then, a model of binary logistic regression was adjusted to determine which of the independent variables had a significant association (risk or protection) with the SSA or the BSQ classifications of body dissatisfaction, according to the interpretation of values for Odds Ratio (OR) and significance (p).
These analyzes were based on the variables male sex, Early Period and low BMI, and eutrophic. To meet the requirement of the dichotomy of the response variable, the BSQ was reorganized into two categories: satisfied (classified as free of body dissatisfaction) and dissatisfied (with some level of dissatisfaction: mild, moderate, or severe). The same was used for the nutritional status variable, which had the four categories grouped into two: underweight and eutrophic; overweight and obesity. The statistical software Statistical Package for the Social Sciences (SPSS), version 17.0, was used with a level of significance of 5% for the respective analyses.
This study was approved by the Research Ethics Committee of Universidade Federal de Juiz de Fora (protocol n. 1612.302.2008; opinion 416/2008) and its implementation is in accordance with Resolution n. 196/96 from the Brazilian National Health Council.
Results
The mean age of the adolescents was of 15.6±2.2 years; 158 (28.7%) were in the EP, 290 (52.6%) in the MP and 103 (18.7%) in the LP. Among all participants, 233 (42.3%) were male and 318 (57.7%) female. The results of weight, height, BMI, and nutritional status classification for the period of adolescence are available in Table 1.
In the assessment by the BSQ, 392 (71.1%) subjects were satisfied with their body image, while 159 (28.9%) were dissatisfied - 100 (18.1%) with mild dissatisfaction, 41 (7.4%) with moderate dissatisfaction, and 18 (3.3%) with severe body dissatisfaction. The evaluation of the SSA showed that 116 (21.1%) adolescents were satisfied with their body image (SSA=0), while 435 (78.9%) were dissatisfied (SSA≠ 0).
The mean score of body dissatisfaction of the BSQ, EEICA, and the SSA are shown in Table 2. It was found that individuals in the MP were more dissatisfied in comparison to adolescents in the MP and the LP (EEICA and SSA - p<0.001). There were also differences between the sexes, with greater dissatisfaction in female than in male adolescents in the evaluation of all instruments (p<0.05). Overweight and obese adolescents were also more dissatisfied in comparison to those with low BMI (BSQ - p<0.001).
Specifically girls in the EP of adolescence had the highest prevalence of body image dissatisfaction among the three observed periods (EEICA - p=0.002; SSA - p=0.005) (Table 3). According to the classification of BSQ, female adolescents in the LP were more often classified as with free and low dissatisfaction in comparison to those in the EP. Regarding male adolescents, the significance of variation in body dissatisfaction by the analysis of the BSQ presented a value of p=0.05, and those in the EP were more dissatisfied than those in MP and LP (SSA - p=0.006).
Of the 435 adolescents classified as dissatisfied by the SSA, 60.8% wanted a smaller silhouette than the current and 39.2%, a greater one. Finally, it was observed that some adolescents classified as eutrophic also expressed body dissatisfaction (BSQ - 25%; SSA - 76%), especially girls, and 33% of eutrophic adolescents revealed dissatisfaction with their body image (BSQ) (Table 2).
The binary logistic regression model, from the OR risk estimator, confirmed that female adolescents, in the EP, with overweight or obesity had a significant association with body dissatisfaction (Table 4). The model according to the SSA showed that females were more dissatisfied than male adolescents (OR 1.49; p=0.063). Regarding adolescents in the MP and LP they presented, respectively, 70% (OR 0.29; p<0.001) and 76% (OR 0.23; p<0.001) less change of being dissatisfied compared to those in the EP. The overweight and obese adolescents were more likely to be dissatisfied compared to individuals with low and normal BMI (OR 4.10; p=0.003). The model according to the BSQ showed that female adolescents were more likely to be dissatisfied compared to males (OR 2.89; p<0.001). Regarding the period of adolescence, those in the MP and EP showed, respectively, 56% (OR 0.65; p=0.050) and 45% (OR 0.43; p=0.000) less chance of feeling dissatisfied compared to adolescents in the LP. The overweight and obese, in turn, were more dissatisfied compared to adolescents with low and normal BMI (OR 3.66; p<0.001).
Discussion
In the present study, the prevalence of dissatisfaction with body image was low among adolescents in small municipalities of Minas Gerais (BSQ) compared to other adolescents from other regions of Brazil( 1414. Conti MA, Cordás TA, Latorre MR. A study of the validity and reliability of the Brazilian version of the Body Shape Questionnaire (BSQ) among adolescents. Rev Bras Saude Mater Infant 2009;9:331-8.
15. Conti MA, Slater B, Latorre MR. Validity and reproducibility of Escala de Evaluación da Insatisfación Corporal para Adolescentes. Rev Saude Publica 2009;43:515-24. - 1616. Conti MA, Latorre MR. Study of validity and reliability of one contour rating scale to adolescence. Psicol Estud 2009;14:699-706. ). However, the results showed some factors related to dissatisfaction, such as the early period of adolescence, sex, and overweight. Regarding the early period, this dissatisfaction might have manifested by the difficulty that teenagers have to create an identity with their body image, due to the morphological and biopsychosocial changes that happen during puberty( 2020. Smolak L. Body image in children and adolescents: where do we go from here? Body Image 2004;1:15-28. ). In female adolescents, this effect may be even more intense, as they may feel more vulnerable to sociocultural pressures to achieve an ideal body shape, often difficult to obtain( 2121. Matias TS, Rolim MK, Kretzer FL, Schmoelz CP, Andrade A. Corporal satisfaction associated with physical activity practice during adolescence. Motriz 2010;16:370-8. ). For Maloney et al ( 2222. Maloney MJ, McGuire J, Daniels SR, Specker B. Dieting behavior and eating attitudes in children. Pediatrics 1989;84:482-9. ), the teenager in the age range of 10 to 13 years may be more concerned with their image and body language, turning their attention to weight reduction. The adolescents seem to increase their personal expectations after menarche, being more dissatisfied with changes related to the accumulation of body fat( 44. McCabe MP, Ricciardelli LA. A longitudinal study of pubertal timing and extreme body change behaviors among adolescent boys and girls. Adolescence 2004;39:145-66. , 2323. Araújo CL, Dumith SC, Menezes AM, Hallal PC. Measured weight, self-perceived weight, and associated factors in adolescents. Rev Panam Salud Publica 2010;27:360-7. ).
Regarding male adolescents, the majority wanted a greater silhouette than the actual figure. Interestingly, in this group the maturation process is characterized by decreased accumulation of body fat and increased fat-free mass( 2424. Castro IR, Levy RB, Cardoso LO, Passos MD, Sardinha LM, Tavares LF et al. Body image, nutritional status and practices for weight control among Brazilian adolescents. Cienc Saude Coletiva 2010;15 (Suppl 2):3099-4108. ). Perhaps that is why this dissatisfaction tends to decline with advancing puberty( 2424. Castro IR, Levy RB, Cardoso LO, Passos MD, Sardinha LM, Tavares LF et al. Body image, nutritional status and practices for weight control among Brazilian adolescents. Cienc Saude Coletiva 2010;15 (Suppl 2):3099-4108. , 2525. Presnell K, Bearman SK, Stice E. Risk factors for body dissatisfaction in adolescent boys and girls: a prospective study. Int J Eat Disord 2004;36:389-401. ). While the standard for the female ideal body is thin, for boys the propagated model is a muscular and lean body( 2525. Presnell K, Bearman SK, Stice E. Risk factors for body dissatisfaction in adolescent boys and girls: a prospective study. Int J Eat Disord 2004;36:389-401. , 2626. Jones DC, Vigfusdottir TH, Lee Y. Body image and the appearance culture among adolescent girls and boys: an examination of friend conversations, peer criticism, appearance magazines, and the internalization of appearance ideals. J Adolescent Res 2004;19:323-39. ).
In this research, we observed that female adolescents had higher body dissatisfaction compared to their peers in the analysis of all instruments (BSQ, EEICA, and SSA). Moreover, they showed nearly twice the chance of presenting body dissatisfaction in relation to the opposite sex (SSA - OR 1.494; p<0.001 and BSQ - OR 2.893; p<0.001). Jones et al ( 2626. Jones DC, Vigfusdottir TH, Lee Y. Body image and the appearance culture among adolescent girls and boys: an examination of friend conversations, peer criticism, appearance magazines, and the internalization of appearance ideals. J Adolescent Res 2004;19:323-39. ) warns that the female adolescent, even with an adequate weight or below the ideal, tends to feel fat or disproportionate, featuring a distorted perception of body image.
Overweight adolescents were more dissatisfied with their body image. According to the adjusted model, these students were four times more likely to present body image dissatisfaction (SSA - OR 4.108; p<0.001 and BSQ - OR 3.66; p<0.001) compared to their peers. This result is in line with previous studies and shows the seriousness of the situation, because these adolescents are at risk of diseases such as diabetes, hypercholesterolemia, among others, which can cause serious impairments in the emotional sphere, especially those related to their body acceptance( 77. Del Duca GF, Garcia LM, Sousa TF, Oliveira ES, Nahas MV. Body weight dissatisfaction and associated factors among adolescents. Rev Paul Pediatr 2010;28:340-6. , 2525. Presnell K, Bearman SK, Stice E. Risk factors for body dissatisfaction in adolescent boys and girls: a prospective study. Int J Eat Disord 2004;36:389-401. ).
Studies such as those by Mattos and Luz(27) discussed obesity in the prospect of human and social sciences, emphasizing the importance that the thin body has in society, as it seems to be the only type currently valued and recognized, causing suffering and illnesses in subjects that do not fit the body type without fat accumulation. According to these researchers, a worked out body seems to be more valued and recognized. This overvaluation of thinness transforms fat into a symbol of moral failure and the obese becomes increasingly stigmatized as an unwelcome being in society( 2727. Mattos RS, Luz MT. Surviving to the stigma of fat: a socio-anthropological study on obesity. Physis 2009;19:489-507. ).
Studies in Brazil showed that body satisfaction in adolescents and children ranges from a 64- 82%( 2828. Pelegrini A, Petroski The association between body dissatisfaction and nutritional status in adolescents EL. Hum Movt 2010;11:51-7. ). Conti et al (14) found a mean of 73.2±36.4 points on the BSQ in adolescents in the metropolitan region of São Paulo. Ours results with adolescents from small municipalities in the Zona da Mata Mineira presented a mean of 67.6±30.0 points of BSQ. Del Duca et al (7) evaluated 5,028 adolescents from public schools in the state of Santa Catarina and found that 52.9% selected an ideal silhouette different than that selected as real; among these 16.7% (95%CI 15.7-17.7) were dissatisfied with their weight and would like to increase it, and 36.2% (95%CI 34.9-37.5) would like to decrease it. Regarding the adolescents in the municipalities of Minas Gerais in this study, 78.9% were dissatisfied with their body image by SSA because they wanted a different silhouette than the real one. Of these, 60.8% wanted a smaller silhouette, which demonstrates the desire for a thinner body type also in adolescents from rural municipalities.
The results indicate that body dissatisfaction is a reality in the lives of adolescents, and the morphological changes occurring during adolescence, sex, and nutritional status are factors related to such negative feelings of body image. However, the study had some methodological limitations that should be considered, as, for instance, the cross-sectional design, which did not allow causal inferences to be made. Still, it was important to identify factors that may influence the dissatisfaction with body image of adolescents from small municipalities. Epidemiological and school-based studies are essential to provide information on the dynamics of the adolescent, assisting educators and health professionals with the issue.
It was found that the prevalence of dissatisfaction with body image was low in adolescents from small municipalities of Minas Gerais; however, the majority wanted a different silhouette. The results showed that students in early adolescence showed greater dissatisfaction in relation to other periods, as well as females and overweight adolescents. Studies such as the present one can provide information about the main factors associated with body dissatisfaction among adolescents, and avoid behaviors adopted as a result, which can be harmful to adolescents when they seek, at all costs, a physical appearance considered ideal.
We are thankful to all schools for the availability and for the encouragement of students to participate in this research.
References
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1Papalia DE, Feldman RD. Desenvolvimento humano. 12th ed. São Paulo: McGraw Hill/Artmed; 2013.
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2World Health Organization. Nutrition in adolescence: issues and challenges for the health sector: issues in adolescent health and development. Geneva: WHO; 2005.
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3WHO; UNICEF. Breastfeeding and maternal medication: recommendations for drugs in the 8th WHO Model List of Essential Drugs. Geneva: WHO; 1995.
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4McCabe MP, Ricciardelli LA. A longitudinal study of pubertal timing and extreme body change behaviors among adolescent boys and girls. Adolescence 2004;39:145-66.
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5Siervogel RM, Demerath EW, Schubert C, Remsberg KE, Chumlea WC, Sun S et al. Puberty and body composition. Horm Res 2003;60 (Suppl 1):36-45.
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6Santos EM, Tassitano RM, Nascimento WM, Petribú MM, Cabral PC. Body satisfaction and associated factors among high school students. Rev Paul Pediatr 2011;29:214-23.
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7Del Duca GF, Garcia LM, Sousa TF, Oliveira ES, Nahas MV. Body weight dissatisfaction and associated factors among adolescents. Rev Paul Pediatr 2010;28:340-6.
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8Alves E, Vasconcelos Fde A, Calvo MC, Neves Jd. Prevalence of symptoms of anorexia nervosa and dissatisfaction with body image among female adolescents in Florianópolis, Santa Catarina state, Brazil. Cad Saude Publica 2008;24:503-12.
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9Thompson JK. The (mis)measurement of body image: ten strategies to improve assessment for applied and research purposes. Body Image 2004;1:7-14.
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10Pelegrini A, Petroski EL. The association between body dissatisfaction and nutritional status in adolescents. Human Moviment 2010;11:51-7.
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Publication Dates
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Publication in this collection
Jan-Mar 2014
History
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Received
01 Aug 2013 -
Accepted
06 Oct 2013