www.analesdepediatria.org
ORIGINAL ARTICLE
Satisfaction with weight and characteristics of eating disorders in high school 夽
L.G. Córdoba Caro
a,∗, L.M. Luengo Pérez
b, S. Feu
a, V. García Preciado
aaFacultaddeEducación,UniversidaddeExtremadura,Badajoz,Spain
bUnidaddeNutriciónClínicayDietética,HospitalUniversitarioInfantaCristina,Badajoz,Spain
Received14March2014;accepted12June2014 Availableonline23May2015
KEYWORDS Adolescents;
Secondaryeducation;
Diet;
Bodymassindex;
Eatingdisorder
Abstract
Introduction:Theprevalenceofdiseasesrelatedtoeatingbehaviourdisordershasincreased amongadolescents.Theobjectiveofthisstudyistoanalysethesatisfactionwithbodyweight ofschoolchildrenasregardstheirbodymassindexandthestrategiesusedtocontroltheirdiet.
Method: Atotalof1197studentsfromsecondaryeducation(12---18years)answeredaquestion- naireoneatinghabitsandbodyweightcontrol.Theirweightandheightweremeasuredand bodymassindexwascalculated.
Results:Morethantwo-thirds(68.1%)ofthestudentswhohadanadequateBMIweresatisfied withtheirweight.Greaterdissatisfactionwithweightisassociatedwithoverweight(OR=10.23) andobesity(OR=16.60).Studentswithoverweightareonadiethavingconsultedanexpert suchasaphysicianoreventhefamily,whereasamongschoolchildrenwithnormalweightthere isalargepercentageonadietwithoutconsultation.About13.87%oftheschoolchildrenhave undertakencompensatoryactivitiesduetoexcessiveeating.AnoverweightBMIisassociated, withmorethantwicetherisk(OR>2.00),withtheuseofmeasuressuchasphysicalactivity, vomiting,orfastingtocompensateanexcessiveintake.
Conclusions:Overweightandobeseschoolchildrenaremorelikelytobedissatisfiedwiththeir bodyandaremorelikelytouseployssuchasvomiting,inordertocompensatefortheexcess intake.
© 2014 Asociación Espa˜nola de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.
夽 Pleasecitethisarticleas:CórdobaCaroLG,LuengoPérezLM,FeuS,GarcíaPreciadoV.Satisfacciónconelpesoyrasgosdetrastorno delcomportamientoalimentarioensecundaria.AnPediatr(Barc).2015;82:338---346.
∗Correspondingauthor.
E-mailaddresses:[email protected],[email protected](L.G.CórdobaCaro).
2341-2879/©2014AsociaciónEspa˜noladePediatría.PublishedbyElsevierEspaña,S.L.U.Allrightsreserved.
Satisfactionwithweightandeatingdisordersinhighschool 339
PALABRASCLAVE Adolescentes;
Educación secundaria;
Dieta;
Índicedemasa corporal;
Trastornodel comportamiento alimentario
Satisfacciónconelpesoyrasgosdetrastornodelcomportamientoalimentarioen secundaria
Resumen
Introducción: Lasenfermedadesrelacionadasconlostrastornosdelcomportamientoalimen- tariohanincrementadosuprevalenciaentrelosadolescentes.Elobjetivodeesteestudioes analizarlasatisfacciónconelpesocorporaldelosescolaresenrelaciónconsuíndicedemasa corporalylasestrategiasqueutilizanparaelcontroldeladieta.
Método: Milnovecientosnoventay sietealumnosdeense˜nanzasecundariaobligatoria (12a 18a˜nos)contestaronuncuestionariosobrehábitosalimentariosydecontroldepesocorporal, ademásselespesóytalló,ysecalculóelíndicedemasacorporal.
Resultados: Un68,1%delosescolarestieneunarelacióndesatisfacciónconsupesoeíndice demasacorporaladecuados,unamayorinsatisfacciónconelpesoseasociaconelsobrepeso (OR=10,23)yobesidad(OR=16,60).Losalumnosconsobrepesohacendietaasesorándoseprin- cipalmenteporunmédicoolafamilia,mientrasqueenlosescolaresconnormopesohayun amplio porcentajequerealizadieta porsu cuenta.Un13,87%de losescolaresharealizado actividadescompensatoriasanteingestasexcesivas;uníndicedemasacorporaldesobrepeso seasociaamásdeldoblederiesgo(OR>2,00),conelempleodemedidascomolaactividad física,elvómitooelayunoparacompensarunaingestaexcesiva.
Conclusiones:Haymásposibilidadesdeinsatisfaccióncorporalenlosescolaresconsobrepeso yobesidad.Losalumnosconsobrepesotienenmásposibilidadesdeutilizarmaniobras,comoel vómito,paracompensarlosexcesosdeingesta.
©2014AsociaciónEspa˜noladePediatría.PublicadoporElsevierEspaña,S.L.U.Todoslosdere- chosreservados.
Introduction
At present, eating disorders (EDs) are the most frequent typeofpsychiatricdisorderwithphysicalrepercussionsand the third most common chronic disease in young women 15---19yearsofage1duetotheirincreasedprevalenceand severeconsequencesforaffectedpatients,2andtheyhave reachedalmostepidemicproportionsintheyoungpopula- tionofwesterncountries.3
These disordershave apsychologicalandmultifactorial aetiology,4andthetwothatarebestdefinedareanorexia nervosa(AN)andbulimianervosa(BN).
MultiplefactorsareinvolvedintheonsetofEDs,eachof whichmaybeinvolvedtoagreaterorlesserextentinthe developmentorcontinuationofthesediseases.1,5---8Thereis growingevidencethatage,self-conceptandphysicalactiv- itymayplaykeyrolesinthepathogenesisofsomeEDs.9---12 Thereareadditionalspecificfactors,knownasdietaryfac- tors,thatarebehindvoluntarychoicestoloseweight.13
In this regard, EDs are closely associated, as a cause and/oreffect,withchangesinbodyimage.14
Eatingdisordersarerelativelymorecommonin female adolescents and young women.11,15 The incidence of AN increased worldwide in the 20th century, especially in women 15---24 years of age; its incidence in Europe has remained stable since the 1970s, but it seems to have increasedinsomeSouthAmericancountries.16
Inrecentyears,therehasbeenevidenceofanincrease inthewell-establishedclinicalformsofEDsinSpain.17The prevalence ofANis approximately0.5---1%,peakingin the 15-to24-year-oldagegroup,whiletheprevalenceofBNis
higher,2---3%,8,10,18 andthe prevalenceof eatingdisorders nototherwisespecified(EDNOS) isapproximately2.7%;all ofthesepercentagesarelowerinmales.2,13,19,40Thepreva- lencesfoundinmalesintheSpanishpopulationaresimilar tothosein other countriesand comparabletothe preva- lencereportedbytheAmericanPsychologicalAssociation, and8.8%ofadolescentsareconsideredtobeatrisk.20
The combination of a negative body image with over- valuing body image is a predisposing factor for EDs14,21,22 associatedwithanincreaseinrestrictivebehaviours.23,24
Oncewereviewedthesedata,themainaimofourstudy was to analyse the body image of compulsory secondary school(ESO)studentsinBadajoz,aswellastheirbehaviours inrelationtovariablesassociatedtoweightcontrol,using thebody mass index(BMI) percentileto analyseits influ- encein thesetypes ofpathologies,in ordertobeable to implementstrategiestopreventandcontrolEDs.
Participants and methods
ParticipantsWeconductedaquantitativeepidemiologicalstudywitha non-experimentalcross-sectionalexpostfactodesign.Par- ticipants were selected by random cluster sampling. We estimatedthesamplesizewithaformulaforfiniteorknown populationswithaconfidenceinterval(CI)of95.4%.Wesur- veyedatotalof1197participants,49.9%ofwhoweremale (N=597)and50.1%female(N=600);Table1summarisesthe characteristicsofthesample.
Table1 Generalcharacteristicsofthesample.
N %
Sex
Male 597 49.9
Female 600 50.1
Agegroup
12---13 514 42.9
14---15 508 42.4
16---18 175 14.6
Socioeconomicstatusofthefamily
Low 178 14.9
Middle 740 61.8
High 279 23.3
Weightclassification
Overweight(85---97) 176 14.7
Obesity(>97) 62 5.2
Normalweight(<85) 959 80.1
Instrument
Wedesignedaquantitativequestionnairespecificallyforthis study.Itscontentswerevalidatedbyanexpertcommittee priortoitsuse.Afteranalysing theresponses, westudied theirassociationwiththeBMIpercentileoftherespondents.
Procedure
Tocollect thedata wedesigned asoftwareapplication in PHPandJavaScriptlinkedtoadatabasedesignedinMySQL.
After the researcher explained the study to the partici- pantsandtheirinformedconsentwasobtained,respondents filledoutthequestionnaireindividuallyandanonymouslyin theirclassrooms,whichtookeachparticipantapproximately 7min.Inaddition,theweightandheightofeachparticipant weremeasuredwithaMB201Plusmechanicalscale.
Statisticalanalysisofthedata
Weperformedadescriptiveanalysisandstudiedtheasso- ciation between variables by means of non-parametric mathematical models, asthe variables for which we col- lecteddatawerecategorical.We analysedtheassociation between variables by means of the chi-squared test and Cramer’sV,andusedadjustedstandardisedresiduals(ASRs) tointerprettheassociationbetweenvariables.25,26
Lateron,wedidamultinomiallogisticregressionmodel, calculatingtheoddsratios(ORs)withtheirrespective95%
CIstoestablishthestrengthoftheassociationbetweenthe variablesunderanalysis.
Results
The chi-square results showed associations between the analysed variablesand the BMI(P<.05). Generallyspeak- ing,thecalculationofCramer’sV27foundweak(ϕCbetween 0.100and0.299)andmoderate(ϕC>0.300)associationsthat
revealed trends in ourstudy. We analysed the ASRsfor a moredetailedinterpretationoftheseassociations.
Wefoundthat80.1%ofthestudyparticipantshadweights in the normal range,while 14.7% were in the overweight rangeand5.2%intheobesityrange.Ofallstudents,55.2%
reported satisfactionwith their weightand had a normal weight;therewasahigherthanexpectedproportionofsat- isfiedstudentsinthisgroup(ASR=12.2).Ontheotherhand, 9.1%and3.8%ofthetotalstudentsamplehadoverweight andobesity,respectively,andwerenotsatisfiedwiththeir weightbecause theyconsidered itexcessive; therewasa higherthanexpectednumberofstudentsforbothofthese situations(ASR>1.96).
Ofallstudents,40.1%expresseddissatisfactionwiththeir weight;of these,27.3% believed theyhad excessweight, while 12.8% believed their weightwas toolow. Wefound schoolchildren with an inappropriate association between their weight satisfaction and their BMI: 17.4% of partici- pantswithnormalweightconsideredthattheirweightwas excessivewhenitwashealthy(ASR=14.7),while27.3% of overweightstudentsand21.0%ofobesestudentsreported beingsatisfiedwiththeirweight(ASR<−1.96).
Ofallstudents,20.4%reportedhavingdietedinthelast year,ofwhich8.7%wereoverweightorobese,sothatmore overweightandobesestudentsthanexpectedhadbeenon diets(ASR=5.7and9.2,respectively).Ofallobesestudents, 33.9% reported nothaving dieted in the lastyear. At the timethedatawerecollected,9.44%of thestudentswere on a diet, of which 5.2% were in the overweight or obe- sitygroups.Thiswasgreaterthantheexpectednumberof cases inthe overweightand obesity groups (ASR=6.0 and 8.1,respectively).
Adoctororspecialistinnutritionanddieteticswascon- sultedby16.58%.Toanalysehowdietsweremanaged,we madeacontingency tableexcludingstudentsthathadnot dieted. Obese participants controlled their diet with the helpofmedicalspecialists(35.8%)ortheirmotherorfriends (37.7%).TheASRsindicatedthatthiswasmorefrequentthan expectedintheobesitygroup(ASR=4.1)andthatthisgroup hadfewerthanexpectedcasesofstudents whodietedon theirown(ASR=−2.8).Studentswithnormalweightsdieted ontheir own(43.8%) or weresupervisedbytheir mothers (34.8%); in this group of students there were fewer than expectedcasesofdietsprescribedbyadoctorornutrition- ist(ASR=−3.5)andmorecasesthanexpectedofstudents thatdietedontheirown(ASR=4.9).
Of all students, 39.93% reported engaging in other behaviours for weight control. The overweight and obe- sitygroups hadsignificantlyhigherproportionsofstudents thatengagedinbehavioursotherthandieting(ASR=5.7and 6.8,respectively),whilethisproportionwassmallerinthe normal weight group (ASR=−9.2). Among the behaviours reportedbyobesestudents,therewasa higherfrequency of engaginginphysical activity,doingsomework, orfind- ing ways to entertain themselves (ASR>1.96); while the proportion of normal weight students that used physi- cal activity and sought ways toentertain themselves was smaller(ASR<−1.96).Fifteenstudentsusedvomitingasa strategy to manage food intake, with higher proportions foundintheoverweightandobesitygroups.
Thirteenparticipantsinthestudyhadunderweight(per- centile<3rd),ofwhichonlyonereporteddietingatthetime
Satisfactionwithweightandeatingdisordersinhighschool 341 thedata werecollected, while 11reportedthinking their
weightwas toolow,2 satisfactionwith theirweight, and nonetheperceptionofhavingexcessweight.
Of all participants, 53.05% reported eating more or between mealsdepending ontheir mood; 39.18% hasfelt regret for overeating,withhigherproportions of students having felt regret in the overweight and obesity groups (ASR=6.2and5.0,respectively).The useofcompensatory behaviours for excessive intake was reported by 13.87%, andgreater proportionsofoverweightand obesestudents reportedsuchbehaviours(ASR=6.0and5.8,respectively).
Strategiesotherthandietingwereusedby38.7%ofobese studentsand28.4%ofoverweightstudents.
Twenty-three students (1.92% of the sample) engaged invomitingtocompensate forexcessiveeating.Thehigh- estproportionofstudentsthatusedvomitingwasfoundin thenormalweightgroup,1.2%ofthetotal,althoughthere weremore students thanexpected withthisbehaviour in theoverweight group(ASR=2.7).Also,3.43% usedfasting afterexcessiveeating,whichwasreportedbyalowerpro- portionofthenormalweightstudents(ASR=−2.7).Physical activityasacompensatorybehaviourwasreportedby9.18%
oftheparticipants,andthisbehaviourwasfoundinhigher proportionsofstudentsintheoverweightandobesitygroups (ASR=4.9and5.9,respectively)(Table2).
Overweight and obesity were significantly associated (P<.05)todissatisfaction withbodyweight(ORs of10.23 and 16.60, respectively) (Table 3). We found an associa- tionbetweenoverweightstudentsanddissatisfactionwitha weightperceivedastoolow,whichdenotesadistortedbody imagerelativetothereferencegroup(OR=1.94).Compared tothenormalweightgroup,overweightandobesestudents were more likely to have dieted in the past year and to becurrentlydieting(ORsrangingfrom3.70to13.92),and therisk ofdietingwasconsiderablygreater intheobesity group.
The supervision of the diet of overweight and obese studentsbyanotherindividualwassignificantlyhighercom- pared to students that had not been on a diet. But the calculatedORsshowedthattheprobabilitiesthattheirdiet wasbeingsupervisedbyahealthcareprofessional,aherbal- istorafamilymember(ORsfrom8.81to65.51)werevery high.We observedasimilartrendinoverweight students, althoughtheirprobabilitieswerenotashigh(ORsfrom2.20 to7.75).
In addition to dieting, overweight and obese students were likely to engage in alternative behaviours to lose weight(OR,3.16and4.68,respectively),andmorelikelyto usephysicalactivity,entertainmentandwork(inthecaseof obesestudents)tocontroltheirweight.Wedidnotfindasig- nificantriskofengaginginbehavioursinvolvingself-induced vomiting.
We found a significant risk in both theoverweight and the obesity group of feeling regret for eating a lot or in excess (OR 3.15 and 4.84, respectively). Overweight stu- dents engaged in the greatest number of compensatory behaviours: physical activity (3.63), vomiting (3.29) and fastingatlatermeals(2.11).Obesestudentsalsoengagedin compensatorybehaviours(6.20)buttheyonlyhadastatis- ticallysignificantgreaterprobabilityofengaginginphysical activity (6.67). Overweight students were more likely to engage in a greater number of behaviours and strategies
tocompensatefordaysofexcessiveeating,someofwhich weredangerous,likevomiting.
Discussion
Alargepercentageofthesamplehadnormalweights(80.1%) andone-fifthwereintheoverweightortheobesityrange, resultsthatarebetterthanthoseofotherstudiesconducted inSpain.28---30
Satisfactionwithbodyweightandbodymassindex Althoughtheassociationswefoundwereweak,ourfindings wereconsistentwiththetrendsobservedinotherstudiesof national31,32andinternational33scope,whichfoundsimilar percentagesofindividualsthatperceivedtheirbodyweight correctly.Inoursample,55.2%ofthestudentsreportedsat- isfactionwiththeirweightandalsohad anormal weight.
Highpercentagesofstudentsintheoverweightandobesity groups weredissatisfiedbecause theyperceived theyhad excessweight.Allofthese,whichamountedto68.1%ofthe sample,hadanadequateperceptionoftheirweightbased ontheir levelof satisfactioninrelation totheir BMI.This trendhasalsobeenobserved inotherstudies.34 Wefound moderateassociationsbetweenthedifferentBMIgroupsand bodydissatisfaction,35resultsthatwerecorroboratedbythe greaterprobabilityofbodydissatisfactioninoverweightand obesestudentscomparedtostudentswithnormalweights.
Otherstudiesthatcomparedself-image(assessedbymeans offiguredrawings)andBMIhaveobtainedsimilarresults.34
Thepercentageofbodydissatisfactioninourstudywas muchlower (39.68%) than that found in another Spanish study,inwhich 73%ofsecondaryschoolstudents reported theywouldliketochangetheirbodyimage,althoughthelat- terstudywasanalysingbodyimageasawholeandnotjust weight,which wouldaccountfor thedifferencesbetween thetwo.36Nevertheless,wefoundagreaterpercentagethan expectedofstudentsthatthoughttheyhadexcessweightin everygroupanalysed,afindingthatwasparticularlysurpris- inginthenormalweightgroup,asitrevealsdissatisfaction despitehavinganappropriateBMI.
Dieting
Only9.44%ofthestudentsweredietingatthetimeofthe study,and20.47%haddietedinthepastyear.Whenwecom- paredourresultswiththoseofastudyconductedinasimilar population,37 wenoticedthat therewasahigherpercent- ageofstudentsthatdietedinBadajoz.Ourresultsshowed anassociationofdietingwithoverweightandobesity,38with alowerpercentageofdietingstudentsinthenormalweight group.
Amongtheparticipantsinthestudywere13schoolchil- drenwithunderweight(belowthe3rdpercentile)ofwhich only1wasdietingatthetimethedatawerecollected,11 perceivedtheirweightastoolow,2weresatisfiedwiththeir weight,andnoneperceivedhavingexcessweight.Thepro- portionofstudentsthatdietedintheoverweightandobese groupswasgreaterthanexpected,suggestinganawareness ofexcessweight.
L.G.CórdobaCaroetal.
Table2 MeasureofassociationandpercentagesfortheassociationofBMIandvariablespertainingtosatisfactionwithbodyweightandstrategiesusedforweightcontrol.
Normalweight<85 Overweight85---97 Obesity>97
ϕC n %total %BMI ASR %total %BMI ASR % %BMI ASR
Areyousatisfiedwithyour weight
0.306b
No.Ithinkitistoolow 154 10.9% 13.7% 1.6 1.6% 10.8% −0.9 0.3% 6.5% −1.5
Yes.Iamsatisfied 722 55.2% 68.9% 12.2 4.0% 27.3% −9.7 1.1% 21.0% −6.5
No.IthinkIhaveexcess weight
321 14.0% 17.4% 14.7 9.1% 61.9% 11.4 3.8% 72.6% 8.4
Haveyoudietedinthepast year?
0.326b
No 952 68.4% 85.4% 10.1 9.4% 63.6% −5.7 1.8% 33.9% −9.2
Yes 245 11.7% 14.6% −10.1 5.3% 36.4% 5.7 3.4% 66.1% 9.2
Areyoucurrentlyonadiet 0.305b
No 1084 75.9% 94.7% 9.8 11.5% 78.4% −6.0 3.2% 61.3% −8.1
Yes 113 4.3% 5.3% −9.8 3.2% 21.6% 6.0 2.0% 38.7% 8.1
Whoismonitoringyourdiet? 0.308b
Adoctororprofessional 64 6.7% 11.2% −3.5 4.9% 19.0% 0.8 4.9% 35.8% 4.1
Herbalist 23 2.8% 4.7% −1.3 2.1% 8.0% 1.0 1.0% 7.5% 0.5
Iamdietingonmyown 132 26.4% 43.8% 4.9 5.4% 21.0% −3.2 2.3% 17.0% −2.8
Mymotherorafriend 149 21.0% 34.8% −1.9 12.4% 48.0% 2.2 5.2% 37.7% −0.1
Other 18 3.4% 5.6% 1.1 1.0% 4.0% −0.4 0.3% 1.9% −1.0
Haveyouengagedinany behavioursotherthan dietingtoloseweight?
0.269b
No 719 53.3% 66.5% 9.2 5.4% 36.9% −6.8 1.3% 25.8% −5.7
Yes 478 26.8% 33.5% −9.2 9.3% 63.1% 6.8 3.8% 74.2% 5.7
Whatbehavioursotherthandietinghaveyouengagedin?
Physicalactivity 0.246b
No 746 54.6% 68.2% 8.4 6.0% 40.9% −6.3 1.7% 32.3% −5.0
Yes 451 25.5% 31.8% −8.4 8.7% 59.1% 6.3 3.5% 67.7% 5.0
Vomiting 0.040
No 1182 79.3% 99.0% 1.3 14.4% 97.7% −1.3 5.1% 98.4% −0.3
Yes 15 0.8% 1.0% −1.3 0.3% 2.3% 1.3 0.1% 1.6% 1.3
Reading
No 1180 79.1% 98.7% 1.0 14.4% 97.7% −1.0 5.1% 98.4% −0.1
Yes 17 1.0% 1.3% −1.0 0.3% 2.3% 1.0 0.1% 1.6% 1.0
Doingwork 0.073a
Satisfactionwithweightandeatingdisordersinhighschool343
Table2 (Continued)
Normalweight<85 Overweight85---97 Obesity>97
ϕC n %total %BMI ASR %total %BMI ASR % %BMI ASR
No 1171 78.7% 94.4% 1.9 14.3% 90.3% −0.7 4.8% 87.1% 2.4
Yes 26 1.4% 5.6% −1.9 0.4% 9.7% 0.7 0.3% 12.9% 2.4
Findingawaytoentertain myself
0.082a
No 1118 75.6% 94.4% 2.7 13.3% 90.3% −1.8 4.5% 87.1% −2.1
Yes 79 4.5% 5.6% −2.7 1.4% 9.7% 1.8 0.7% 12.9% 2.1
Doyoueatmoreorin betweenmealsdepending onyourmood?
0.033
No 562 37.1% 46.3% −0.9 7.1% 48.3% 0.4 2.8% 53.2% 1.0
Yes 635 43.0% 53.7% 0.9 7.6% 51.7% −0.4 2.4% 46.8% −1.0
Haveyoufeltregretfor eatingmuchorinexcess?
0.242b
No 728 53.4% 66.6% 8.3 5.8% 39.8% −6.2 1.6% 30.6% −5.0
Yes 469 26.7% 33.4% −8.3 8.9% 60.2% 6.2 3.6% 69.4% 5.0
Haveyouengagedinany activityorbehaviourafter eatingmuchorexcessively andregrettedit?
0.255b
No 1031 72.4% 90.4% 8.6 10.5% 71.6% −6.0 3.2% 61.3% −5.8
Yes 166 7.7% 9.6% −8.6 4.2% 28.4% 6.0 2.0% 38.7% 5.8
Compensatorybehaviour:
vomiting
0.079a
No 1174 78.9% 98.5% 2.3 14.0% 95.5% −2.7 5.1% 98.4% 0.2
Yes 23 1.2% 1.5% −2.3 0.7% 4.5% 2.7 0.1% 1.6% −0.2
Compensatorybehaviour:
fastingatalatermeal
0.068
No 1156 77.9% 97.2% 2.3 13.9% 94.3% −1.8 4.8% 93.5% −1.3
Yes 41 2.3% 2.8% −2.3 0.8% 5.7% 1.8 0.3% 6.5% 1.3
Compensatorybehaviour:
physicalactivity
0.235b
No 1197 74.7% 93.2% 7.7 11.7% 79.5% −4.9 3.5% 67.7% −5.9
Yes 121 5.4% 6.8% −7.7 3.0% 20.5% 4.9 1.7% 32.3% 5.9
a P<.05.
b P<.01.
Table3 Resultsofthemultinomiallogisticregressionmodel(ORand95%CI)oftheassociationbetweenBMIandtheclassifi- cationofthedifferentvariablesofthequestionnaireregardingsatisfactionwithbodyweightandthestrategiesusedforweight control.
Overweight85---97 Obesity>97
Participantsatisfiedwithownweight Yes.Iamsatisfied
No.Ithinkitistoolow 1.94(1.10---3.43)a 1.49(0.48---4.66)
No.Ithinkitistoohigh 10.23(6.89---15.17)b 16.60(8.59---32.08)b Participanthasdietedinthepastyear
No 1 1
Yes 3.70(2.56---5.35)b 13.92(7.80---24.86)b
Participantcurrentlydieting
No 1 1
Yes 4.97(3.14---7.88)b 11.44(6.34---20.62)b
Whomanagedtheparticipant’sdiet?
Ihaven’tbeenonadiet 1 1
Adoctororhealthcareprofessional 7.48(3.92---14.27)b 65.51(26.55---161.60)b
Herbalist 7.75(2.99---2005)b 35.48(9.29---135.47)b
Idietedonmyown 2.20(1.29---3.78)b 8.81(3.35---23.19)b
Mymotherorafriend 6.11(3.94---9.46)b 22.461(9.78---51.60)b
Other 3.58(1.11---11.48)a 8.77(1.005---76.58)a
Participantengagedinbehavioursotherthandietingtoloseweight
No 1 1
Yes 3.44(2.460---4.82)b 5.88(3.27---10.57)b
Behavioursalternativetodiettocontrolweight Alternative:physicalactivity
No 1 1
Yes 3.16(2.27---4.41)b 4.68(2.69---8.13)b
Alternative:vomiting
No 1 1
Yes 2.21(0.70---7.20) 1.62(0.20---13.03)
Alternative:reading
No 1 1
Yes 1.75(0.55---5.54) 1.11(0.14---8.81)
Alternative:doingwork
No 1 1
Yes 1.48(0.53---4.10) 3.29(1.06---10.27)a
Alternative:findingsomeentertainment
No 1 1
Yes 1.80(1.01---3.19)a 2.40(1.08---5.34)a
Participanteatsmoreorbetweenmealsdependingonmood
No 1 1
Yes 0.89(0.63---1.25) 0.75(0.44---1.28)
Participanthasfeltregretforeatingtoomuchorinexcess
No 1 1
Yes 3.15(2.25---4.41)b 4.84(2.76---8.52)b
Participanthasengagedinanactivityorbehaviouraftereatingtoooftenortoomuchandhasregrettedit
No 1 1
Yes 3.87(2.60---5.75)b 6.20(3.54---10.86)b
Compensatorybehaviour:vomiting
No 1 1
Yes 3.29(1.35---8.04)b 1.13(0.14---8.80)
Satisfactionwithweightandeatingdisordersinhighschool 345
Table3 (Continued)
Overweight85---97 Obesity>97
Compensatorybehaviour:fastingatalatermeal
No 1 1
Yes 2.11(0.99---4.45)a 2.44(0.82---7.24)
Compensatorybehaviour:physicalactivity
No 1 1
Yes 3.63(2.32---5.68)b 6.67(3.68---12.10)b
Oddsratioadjustedforsex,ageandsocioeconomiclevel.Thecomparisongroupisthe‘‘normalweight’’group.
a P<.05.
b P<.01.
The percentageofadolescentsthatconsultedthefam- ilyphysiciantogoonadietwasverylow;however,there wasahigherproportionofstudentswithobesitythatsought weightcontrolservicesundermedicalsupervision.36 Thisis animportantaspect,asthereis evidencethatahigh per- centageofparentshavedifficultyrecognisingordetecting obesityintheirchildren.29 Ourdatacorroboratedthefind- ingspresentedattheXVIIICongressoftheSpanishSociety ofFamilyandCommunityMedicine(SEMFYC),36showingthat mostsecondaryschoolstudentsinBadajozwhowanttolose weightseektheadviceoftheirmotherorafriend,orgoon dietsontheirownwithoutpriorconsultationwithaprofes- sional,whichposesnumerousriskstotheirhealth.Thelow percentageofnormalweightdieterssupervisedbyaprofes- sionalcomparedtothe highpercentagethat dietwithout supervisionisworrisome,astheseadolescentsdonotneed tobeonaweightlossdiet.
Compensatorybehavioursforexcessiveintakes Ofallstudents,13.87%reportedbehavioursaimedatcom- pensating excess weight. The one positive aspect is that themostfrequentbehaviourtocompensateovereatingwas engaginginphysicalactivity(9.18%),asthisisthehealthiest behaviour.Wealsoobservedthatthishabitwasassociated withoverweightandobesity.
Vomiting was used by 23 schoolchildren (1.92% of the sample) as a compensatory behaviour for excessive eat- ing.TheseattitudesmaybesymptomaticofEDs.Wefound thattheriskofexhibitingthesebehaviourswasthreetimes greater in overweightstudents thanin students withnor- malweights.Thisbehaviourwasnotobservedintheobesity group, with the adjusted standardised residues revealing thattheproportioninthisgroupwaslowerthanexpected, whichdivergesfromthefindingsof otherstudies.39 Aswe can see, the percentage of students that reported self- inducingvomitingwashigherforthe item‘‘compensatory behaviour,eatingalotorinexcess’’thanforthequestion
‘‘Whatbehavioursotherthandietinghaveyouengagedin?’’
(1.92%and1.25%,respectively). Thisincrease isexpected andisusuallyfoundinpsychiatricquestionnaireswhenques- tionsarewordedindifferentways.Thesepercentagesare belowthe2---3%rangefoundinnationwidestudies17,18,40and arewithinthe 1---3%rangerecommendedbytheAmerican Psychiatric Association,40 while they are higher than the 0.8%reportedbyotherstudiesalsoconductedinSpain.2,13
Fastingwasusedby3.43%afterovereatingtocompen- sate for the excessive caloric intake. The ORs suggested thattheriskofthisbehaviouroccurringinoverweightstu- dentsistwiceashighasthatofnormalweightstudents.The compensatorybehaviouroffastingatasubsequentmealis worrisome,asitcanbeharmfulinvaryingdegreesdepend- ingonwhichmealisskippedandhowmanyhoursthefast lasts.
According to the collected data, students with over- weight have the highest percentage of bulimic traits, a findingthat is supported by others studies in populations ofverysimilarcharacteristics.31
Amongthelimitationsofthestudyarethewidthofthe CIsusedinthelogisticregressionanalysis,whichcouldbe affectedby theestablished CIor eventhesample size or thesubsetsof thesampleestablishedfor theadjustments morethan by the chosen model. However,this study can assessthedegreeofchangebasedonthecharacteristicsof theanalysedvariables.
Conflicts of interest
Theauthorshavenoconflictsofinteresttodeclare.
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