- Email: [email protected]
Dieting and self-evaluation of figure in school-aged youth in the area of Central Slovakia
kontakt 16 (2014) e223–e227
social studies
Available online at www.sciencedirect.com
ScienceDirect journal homepage: http://www.elsevier.com/locate/kontakt
Original research article
Dieting and self-evaluation of figure in school-aged youth in the area of Central Slovakia Mária Kožuchová a,*, Martina Bašková b a b
Nursing Home Care Agency (ADOS-SRDCE s.r.o.), Jaklovce, Slovak Republic Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Institute of Midwifery, Slovak Republic
article info
abstract
Article history:
The goal of this article is to present the occurrences of dieting and self-evaluation of one's
Received 29 July 2014
personal body figure through the eyes of school-aged youth in central Slovakia. The data was
Received in revised form
collected in 25 elementary schools and two 8-year high schools in the Žilina and Banská
17 September 2014
Bystrica regions from May to June 2010. The group of respondents consisted of 1187 pupils in
Accepted 13 October 2014
three age categories: 11-year-olds (313 respondents), 13-year-olds (442 respondents) and
Available online 22 October 2014
15-year-olds (432 respondents). The standardized questionnaire created for the needs of this
Keywords:
including: gender, grade, age. The significant interaction of two variables was evaluated using
Health
the chi-quadrat test. The statistical analysis was made using STATISTICA software. Approxi-
HBSC study was used for data collection. The data collection also contained demographic data
Dieting
mately half of the respondents (53%) stated that they were not dieting because their weight was
Self-evaluation
‘‘all right’’ according to the respondent. More than half of the respondents (56.6%) thought that
School-aged youth
their figure was ‘‘just right’’. Boys more frequently perceived that their personal figure was
HBSC
‘‘just right’’. There were statistically significant differences discovered between gender and dieting ( p = 0.000) and also between gender and self-evaluation of one's personal figure ( p = 0.000). Statistically significant differences between age and dieting ( p = 0.043) were also expected. But on the contrary, no statistically significant differences in self-evaluation of personal figure and age ( p = 0.198) were found. Dieting in school-aged youth can result in changes in their cognitive, emotional and social developments. Therefore, it is necessary to consider physical and psychological consequences, including eating disorders, and to also support a healthy lifestyle which includes proper eating habits, regular physical activity and an efficient use of free time. # 2014 Faculty of Health and Social Studies of University of South Bohemia in České Budějovice. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.
* Corresponding author at: Agentúra domácej ošetrovateľskej starostlivosti (ADOS-SRDCE s.r.o.), Nová 351, 055 61 Jaklovce, Slovak Republic. E-mail address: [email protected] (M. Kožuchová). http://dx.doi.org/10.1016/j.kontakt.2014.10.001 1212-4117/# 2014 Faculty of Health and Social Studies of University of South Bohemia in České Budějovice. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.
e224
kontakt 16 (2014) e223–e227
Introduction Dieting is relatively widespread among adolescents. It is one of the most common steps in dealing with unhappiness about one's personal weight and figure [1]. Adolescents, who eat poorly and irregularly, experiment with nutritional styles, or try to lose weight using diets, can suffer from deficiency of some nutrients without any visible clinical manifestations. The quantity and quality of food also affects their mental performance, readiness, efficiency of learning and emotional states [2]. Frequently, deviations in the nutrition of children and youth and various restrictive nutrition regimes (diets) cause an insufficient intake of nutrients important to life. Moreover, in connection with irregularity in a work–rest regime, it increases fatigue [3]. In this age period, extremes in the food intake arise due to dieting. In many aspects, eating disorders are a typical problem of the modern world. Mental anorexia and bulimia represent in their manifestations a nutritional behaviour from the life-threatening restriction of food intake up to overeating or hungering. However, both disorders have a great deal in common. The following is typical for them: an intense effort to achieve a slim figure associated with a restriction of energy intake, fear of obesity and dissatisfaction with one's own body [4]. During puberty and adolescence, girls want to change their physical appearance. They have a tendency to be slim, which is often reflected in the reduction of energy intake, and many times also the reduction of protein intake. On the other hand, with many boys it is about increasing exercise due to the desire to build-up muscles. They also consume food usually with an excessive amount of proteins [5,6]. Through every-day austerity, there is stress on the organism caused by various diets as the person slowly approaches their desired goal. However, at this time it is not yet known, what impact it will have on their health condition after adolescence. Their nourishment might be rich in fruit and vegetable products, however, their diet eliminates significant nutritional components essential for the young adolescent organism [2]. These deficiencies may lead to disturbances in natural growth and development. They can manifest themselves as anaemia, malnutrition, obesity, growth disorders, and the formation of caries. They can also be related to the development of diseases in adulthood, such as diabetes mellitus, atherosclerosis, hypertension, osteoporosis, and tumour diseases. Rejection of respected values, dissatisfaction with one's own appearance are efforts to be conformable with one's chosen way of life. These often lead adolescents to a change in their diet [7]. It has been proven that dieting is also associated with negative self-confidence in adolescents [8]. It is therefore important to maintain an adequate body weight and to achieve it by proper nutrient and exercise, not by a single-sided diet [9]. Long-lasting dietary restrictions directed at reduction of body weight will be ineffective if they are not accompanied by behavioural changes having an impact on physical activity and eating habits [10]. Prospective cross-sectional surveys showed that a high percentage of adolescents, especially women, even those with a normal BMI, had been on a diet for some period of time. Starting any diet increases. The risk of an eating disorders in adolescent girls. Extreme methods of
slimming down can have unfavourable physiological effects [8]. The HBSC study (Health Behaviour in School Aged Children). The objective is to monitor health, and healthrelated school children's behaviour in their social context. The article presents selected findings of the HBSC research conducted in central Slovakia in 2010 focused on the occurrences of dieting and self-evaluation of one's personal figure in school-aged youth.
Material and methods The research sample was formulated in accordance with the criteria of the HBSC study and stratified by regions and school types (elementary school, 8-year high school). The data was acquired from 11, 13 and 15-year-old school children representative of the population in central Slovakia (Žilina and Banská Bystrica region). The group consisted of 1187 pupils (620 girls and 567 boys). The data were collected from May to June 2010. The characteristics of the sample are presented in Table 1. Respondents who met the following pre-determined criteria were included in the research group: age (11, 13 and 15-year-olds); the respondent is a pupil of an elementary school (5th–9th grade) and equivalent in 8-year high school (prima–kvinta); an informed parent's consent and participation in the respondent's research; willingness to collaborate. The HBSC study is one of the first cross-national studies adopted by the World Health Organization and now there are more than 40 collaborating countries, including Slovakia. The international questionnaire produced for the needs of the HBSC study, which had been translated into Slovak in a standard way, was used for the data collection. The questionnaire was distributed in school classes by a team of trained administrators. The individual schools were selected from the list of all elementary schools and 8-year high schools in Slovakia provided by the Institute of Information and Prognoses of Education by random sampling carried out in the HBSC Data Management Centre (Bergen, Norway). The schools were contacted by telephone and asked for consent to participate in the international HBSC study. During the phone call with the schools, which agreed to participate, we obtained approval of the school management and selected, by a random sampling, the particular classes, in which the data was collected. The legal representatives of the respondents were familiarized with the research so that they had an opportunity to express their disagreement with the participation. The participation was voluntary.
Table 1 – Characteristics of the sample. Sex
11
13
15
Total
Boys Girls
145 168
194 248
228 204
567 620
Total
313
442
432
1187
e225
kontakt 16 (2014) e223–e227
For the purposes of the study, demographic factors were analysed (i.e. sex, grade, age of the child) and also reduction of body weight and self-evaluation of their personal figure. A significant interaction of two qualitative variables was evaluated using chi-quadrat test. Hypotheses were tested at the significance level p = 0.05. The STATISTICA software was used for the statistical analysis.
Table 2 – Dieting by number of respondents. Dieting No, my weight is all right No, but I should lose some weight No, because I need to gain weight Yes
n
%
625 257 141 157
53.0 21.8 11.9 13.3
new body shape which makes them not always happy. This is especially true for girls and leads to a tendency to regulate their body weight in the form of various diets [2]. Moreover, the school age years bring major changes in the view adolescents have to their own body and in the eating habits of school children. As young as 8-year old girls state that they are not satisfied with their body. Fear of obesity and diet tendencies, thus affect the lives of ever younger children in all age categories, especially girls [4]. This fact was not, however, proven in the results of our study. It follows from the conclusions that half of the respondents (53%) state that they are not on any diet because their weight is ‘‘all right’’. Based on this, we concluded that they are satisfied with their weight. Approximately one tenth of the respondents (13.3%) state that they are on a diet (Table 2). In the percentual representation of our group, boys indicated that they were not on diet. Their numbers ranged from 55% in 11-year-olds to 67% in 15-yearolds. The number of girls who state that they are not on diet, ranged from 44% in 15-year-olds to 53% in 11-year-olds (Chart 1). Regarding the reduction of body weight, we found the biggest difference in the answer ‘‘no, but I should lose some weight’’ in boys (16.73%) and in girls (26.42%). The differences between age and dieting are statistically significant (p = 0.000), also between age and dieting (p = 0.043). Different conclusions were concluded by the results of the international HBSC study carried out in 2009/2010 in 43 countries [11] where girls aged 15 almost in all countries and regions stated more often that they were on diet compared to lower age categories. Similar conclusions are stated in the study by Miertova [1]. Adolescent girls usually want to weigh less, whereas adolescent boys want to be bigger and stronger [12]. Weight reducing diets are also closely related to the evaluation of one's own figure through the eyes of adolescent youth. Self-evaluation of one's own figure plays a significant role, reflecting itself in physical and psychological health. Pubescent development often correlates with a poorer selfevaluation of one's figure in girls, whereas boys more often evaluate their figure in a positive way [13,14]. These facts are proven by the results of our study. Of the total sample of respondents, more than half (56.6%) evaluated their figure as
Results The results analysed dieting and self-evaluation of personal body figure in a population of school-aged youth by age and sex. Frequency data (in percentage) was prepared in the form of tables and charts. The question, ‘‘Are you currently on some diet or are you doing anything else to lose weight?’’ Was answered by approximately half of the respondents (53%) that they were not dieting because their weight was ‘‘all right’’. We have described this most frequently selected alternative in view of differences between sexes and age groups. While in girls, the conviction that their weight is ‘‘all right’’, is decreasing with age from 53% in 11-year-olds to 44% in 15-year-olds. But on the contrarywith boys, the conviction that their weight is ‘‘all right’’ is increasing with age from 54% in 13-year-olds to 67% in 15-year-olds. Of the total sample of respondents, more than half (56.6%) evaluated their personal body figure as ‘‘just right’’. This most frequently selected alternative is described in the view of differences between gender and age groups. The percentage of respondents who evaluated their figure as ‘‘just right’’ ranged in girls from 52% (13-year-olds) to 59% (11-year-olds) and in boys from 55% (11-year-olds) to 62% (15-year-olds). Boys perceived their figure as ‘‘just right’’ more frequently. We found statistically significant differences between gender and dieting ( p = 0.000) and also between gender and self-evaluation of figure ( p = 0.000). We expected to find statistically significant differences between age and dieting ( p = 0.043). But on the contrary, we did not find any statistically significant relations in self-evaluation of personal figure and age ( p = 0.198).
Discussion The period of pubescence is for an adolescent a psychologically demanding period. The adolescent is getting used to their
44 %
15-years old
67 %
girls
46 %
13-years old
boys
54 % 53 % 55 %
11-years old 0
10
20
30
40
50
60
70
80
Chart 1 – Dieting by sex of respondents – dieting (no, my weight is all right).
e226
kontakt 16 (2014) e223–e227
Table 3 – Self-evaluation of figure by number of respondents. Self-evaluation of figure Too slim A bit slim Just right A bit fat Very fat
Table 5 – Relation between reduction of body weight, selfevaluation of figure and age of respondents.
n
%
56 189 663 241 22
4.8 16.1 56.6 20.6 1.9
Table 4 – Relation between body weights, self-evaluation of figure and age of respondents.
Reduction of body weight Self-evaluation of figure
x2
p
23.641 22.009
0.000 0.000
‘‘just right’’. 4.8% of respondents evaluated their personal figure as ‘‘too fat’’ and 1.9% as ‘‘very fat’’. Based on this we concluded that these respondents can manifest dissatisfaction with their personal figure (Table 3). Boys relatively more often, evaluated their personal figures as ‘‘just right’’. Based on this we concluded that they are satisfied with their personal figures. On a percentage basis, boys are more satisfied with their personal figures with increasing age (the figure evaluation as ‘‘just right’’ ranged from 55% in 11-year-olds to 62% in 15-year-olds). But on the contrary, girls are less satisfied with their personal figures as they get older (the figure evaluation as just right ranged from 59% in 15-year-olds to 54% in 11-year-olds) (Chart 2). We found statistically significant differences between self-evaluation and the gender of the respondents (p = 0.000), with the biggest difference in the answer ‘‘a bit slim’’ is in 19.60% of boys and in 13.01% of the girls, and also in the answer ‘‘a bit fat’’ in 17.27% of boys and 23.58% of the girls. Regarding age and self-evaluation of one's personal figure, the differences were not statistically significant ( p = 0.198) (Tables 4 and 5). In our study, dissatisfaction with one's personal figure was expressed more often by girls, which is also demonstrated in the results of domestic and foreign studies [e.g. 1,15–17]. In the study by Schur et al. [18], 50% of children state that they are dissatisfied with their figure and want to weigh less, and 16% state that they have tried to slim down. Jones et al. [15] based their study on a sample of 1739 girls aged 12–18. The results of the study show that as many as 47% of girls are very dissatisfied with their weight. In his study, Krch [19] found
Reduction of body weight Self-evaluation of figure
62 %
girls boys
52 %
13-years old
57 % 59 %
11-years old
55 %
46
48
50
52
54
p
13.003 11.059
0.043 0.198
dissatisfaction with their body in Czech adolescents in 34.3% of boys and 57.4% of girls. The adolescents that were dissatisfied with personal figure showed lower self-confidence and a poorer self-image. The personal body dissatisfaction of girls was increasing depending on body weight. Similar conclusions are documented by the study done by Groganova [20], in which approximately one third of boys and 60% of girls are dissatisfied with their figure. All of the above mentioned facts are also pointed out by Morris and Katzman [12], who state that the dissatisfaction with body image and unhealthy eating habits are frequent indicators in adolescent girls. Unlike boys who, over the course of adolescence, approach the cultural ideal and prefer to gain weight while girls want to lose weight [20]. Macek [21] also states that adolescent girls are less satisfied with their own body which has an impact on their poorer self-image. Girls perceive the period of pubescence and adolescence as a restrictive interference into their lives. But on the contrary, boys evaluate the pubescence changes in their appearance in a positive way. Adolescent girls occupy themselves with their body dimensions, weight and diets to a greater extent than boys. Girls, compared to boys, consider a much slimmer female figure to be attractive [6]. Krch [22] states that an inclination to engage in dieting is especially associated with the female gender. The reasons for dieting in adolescent youth may vary, but dissatisfaction with their personal figures and a desire to be slimmer is a motivational factor for most of them. The attempts to lose weight can be associated with various behavioural changes, such as changes in eating habits and also frequency of exercise. It is obvious that the perception of being overweight in adolescent youth is accompanied by a decision to try losing some weight, regardless of the fact whether they really are obese [23]. Many adolescent girls believe that they are overweight and want to weigh less [12]. This was observed also by Jones et al. [15]. They stated that as many as 80% of 18 year old girls of normal height and weight stated that they wanted to weigh less. The media has strong influence on the opinion formation regarding an ideal body image; ‘‘media education’’ [24]. Most adolescent girls do not even know what should be their normal body weight and they
54 %
15-years old
x2
56
58
60
62
64
% of those who evaluated their figure as "just right" Chart 2 – Self-evaluation of figure by sex of respondents.
kontakt 16 (2014) e223–e227
try to fight against their biologically adequate body proportions [25].
Conclusion The areas in which it is possible to influence personal health through changes in lifestyles, is a primary form of prevention [26]. In the adolescence period, girls especially start to be more and fussier about their external appearance. They are interested more in their personal figure, they monitor their body weight more attentively and organize their diet. The results of our research showed that more than half of the adolescents state they are not dieting at all and their weight is ‘‘all right’’. At the same time, more than half of adolescent youth evaluate their figure as ‘‘just right’’. Girls more frequently suffer from a feeling of dissatisfaction with their personal figure, whereas boys more frequently perceive their figure as ‘‘just right’’. Any type of dieting interferes with the life of adolescent girls and can lead to disorders in food intake regulation. The extreme pressures of society on young people who are very sensitive about the self-perception of their bodies at this time of life, causes an unhealthy decrease in the energy intake, often with an insufficient quantity of essential nutrients including minerals and vitamins. The effort to appeal to others increases the motivation and efforts of the adolescents to go on extreme diets. Therefore, at this age and in case of normal weight, it is vital not to reduce energy intake, engage in adequate sports activities and build self-confidence [27].
Conflict of interest The authors have no conflict of interest to disclose.
Acknowledgement The research was financially supported by the UK grant: 150/ 2010.
references
[1] Miertová M. Držanie diét u adolescentov. Ošetřovatelství a porodní asistence 2012;3(4):460–7. [2] Jakušová Ľ, Dostál A. Výživa adolescentiek ako budúcich matiek. In: Boledovičová M, Vörösová G, Lišková M, editors. Ošetrovateľstvo 21. storočia v procese zmien III. Nitra: Univerzita Konštantína Filozofa v Nitre; 2009. p. s.342–5. [3] Maľa P, Durdíková E, editors. Správna výživa ľudí. Košice: Univerzita veterinárneho lekárstva; 2000. [4] Krch FD, Marádová E, editors. Výchova ke zdraví: Poruchy příjmu potravy, příručka pro učitele. VÚP ve spolupráci s MŠMT ČR. 2003. Available from: http://www.msmt.cz/ vzdelavani/vychova-ke-zdravi-poruchy-prijmu-potravy? highlightWords=V%C3%BDchova+zdrav%C3%AD [cit. 19.06.13].
e227
[5] Beňo I. Náuka o výžive. Martin: Vydavateľstvo Osveta; 2008. [6] Plháková A, Míčková J. Rozdíly v percepci tělesného schématu mezi muži a ženami. Česká a slovenská psychiatrie 2000;96(6):310–5. [7] Dostál A, Jakušová Ľ, Bánovčin P. Adolescentky ako budúce matky a ich výživa z aspektu nutričnej nedostatočnosti a obsahu xenobiotík. Čes-slov pediat 2009;64(11):584–5. [8] Daee A, Robinson P, Lawson M, Turpin JA, Gregory B, Tobias JD. Psychologic and physiologic effects of dieting in adolescents. South Med J 2002;95(9):1032–41. [9] Provazník K, Komárek L, Cikrt M. Manuál prevence v lékařské praxi. Praha: Univerzita Karlova; 2004. [10] Diet, Nutrition and the Prevention of Chronic Diseases. Report of a Joint WHO/FAO Expert Consultation. Geneva: World Health Organization; 2003. [11] Social determinants of health and well-being among young people 2009/2010; 2011, Available from: http://www. euro.who.int/__data/assets/pdf_file/0003/163857/Socialdeterminants-of-health-and-well-being-among-youngpeople.pdf [cit. 09.08.12]. [12] Morris AM, Katzman DK. The impact of the media on eating disorders in children and adolescents. Paediatr Child Health 2003;8(5):287–9. [13] Cavallo F, Zambon A, Borraccino A, Raven-Sieberer U, Torsheim T, Lemma P. Girls growing through adolescence have a higher risk of poor health. Qual Life Res 2006;15 (10):1577–85. [14] Ge X, Elder Jr GH, Regnerus M, Cox Ch. Pubertal transitions, perceptions of being overweight and adolescents' psychological maladjustment: gender and ethnic differences. In Soc Psychol Quart 2001;64(4):363–75. [15] Jones JM, Bennett S, Olmsted MP, Lawson ML, Rodin G. Disordered eating attitudes and behaviours in teenaged girls: a school-based study. CMAJ 2001;165(5):547–52. [16] Krch FD, et al. Poruchy příjmu potravy. Praha: Grada Publishing; 2005. [17] Rašticová M. Prediktory nespokojenosti s tělem a souvislosti s depresí v adolescenci. E-psychologie; 2009, Available from: http://e-psycholog.eu/cislo/7/cz [cit. 16.08.13]. [18] Schur EA, Sanders M, Steiner H. Body dissatisfaction and dieting in young children. Int J Eat Disord 2000;27(1):74–82. [19] Krch FD. Vztah mezi tělesnou spokojeností a kvalitou života českých adolescentů. Psychiatrie 2000;4. Available from: http://www.tigis.cz/PSYCHIAT/PSYCH400/03krch.htm [cit. 16.03.14]. ISSN 1211-7579. [20] Grogan S. Body image: Psychologie nespokojenosti s vlastním tělem. Praha: Grada Publishing; 2000. [21] Macek P. Adolescence. Praha: Portál; 2003. [22] Krch FD. Poruchy příjmu potravy – rizikové faktory. Psychiatrie pro praxi 2004;5(1):14–6. [23] Findlay SM. Dieting in adolescence. Paediatr Child Health 2004;9(7):487–91. [24] Šupínová M, Virgulová J. Centrálna obezita – estetický, alebo zdravotný problém? In Interná medicína 2012;12 (Supplementum):10. [25] Krch FD. Poruchy příjmu potravy – mezi nadváhou a vyhublostí; 2003, Available from: http://www.pppinfo.cz/ clanek_show.asp?id=38 [cit. 17.06.13]. [26] Dimunová L, Mechírová V. Výskyt vybraných kardiovaskulárnych faktorov u sestier v košickom regióne. In: Farkašová D, Padyšáková H, Tomková I, editors. Sestry a Európske stratégie zdravia 21. Bratislava: SZU v Bratislave; 2008. p. s177–83. [27] Müllerová D, et al. Obezita – prevence a léčba. Praha: Mladá Fronta a.s; 2009.
social studies
Available online at www.sciencedirect.com
ScienceDirect journal homepage: http://www.elsevier.com/locate/kontakt
Original research article
Dieting and self-evaluation of figure in school-aged youth in the area of Central Slovakia Mária Kožuchová a,*, Martina Bašková b a b
Nursing Home Care Agency (ADOS-SRDCE s.r.o.), Jaklovce, Slovak Republic Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Institute of Midwifery, Slovak Republic
article info
abstract
Article history:
The goal of this article is to present the occurrences of dieting and self-evaluation of one's
Received 29 July 2014
personal body figure through the eyes of school-aged youth in central Slovakia. The data was
Received in revised form
collected in 25 elementary schools and two 8-year high schools in the Žilina and Banská
17 September 2014
Bystrica regions from May to June 2010. The group of respondents consisted of 1187 pupils in
Accepted 13 October 2014
three age categories: 11-year-olds (313 respondents), 13-year-olds (442 respondents) and
Available online 22 October 2014
15-year-olds (432 respondents). The standardized questionnaire created for the needs of this
Keywords:
including: gender, grade, age. The significant interaction of two variables was evaluated using
Health
the chi-quadrat test. The statistical analysis was made using STATISTICA software. Approxi-
HBSC study was used for data collection. The data collection also contained demographic data
Dieting
mately half of the respondents (53%) stated that they were not dieting because their weight was
Self-evaluation
‘‘all right’’ according to the respondent. More than half of the respondents (56.6%) thought that
School-aged youth
their figure was ‘‘just right’’. Boys more frequently perceived that their personal figure was
HBSC
‘‘just right’’. There were statistically significant differences discovered between gender and dieting ( p = 0.000) and also between gender and self-evaluation of one's personal figure ( p = 0.000). Statistically significant differences between age and dieting ( p = 0.043) were also expected. But on the contrary, no statistically significant differences in self-evaluation of personal figure and age ( p = 0.198) were found. Dieting in school-aged youth can result in changes in their cognitive, emotional and social developments. Therefore, it is necessary to consider physical and psychological consequences, including eating disorders, and to also support a healthy lifestyle which includes proper eating habits, regular physical activity and an efficient use of free time. # 2014 Faculty of Health and Social Studies of University of South Bohemia in České Budějovice. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.
* Corresponding author at: Agentúra domácej ošetrovateľskej starostlivosti (ADOS-SRDCE s.r.o.), Nová 351, 055 61 Jaklovce, Slovak Republic. E-mail address: [email protected] (M. Kožuchová). http://dx.doi.org/10.1016/j.kontakt.2014.10.001 1212-4117/# 2014 Faculty of Health and Social Studies of University of South Bohemia in České Budějovice. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.
e224
kontakt 16 (2014) e223–e227
Introduction Dieting is relatively widespread among adolescents. It is one of the most common steps in dealing with unhappiness about one's personal weight and figure [1]. Adolescents, who eat poorly and irregularly, experiment with nutritional styles, or try to lose weight using diets, can suffer from deficiency of some nutrients without any visible clinical manifestations. The quantity and quality of food also affects their mental performance, readiness, efficiency of learning and emotional states [2]. Frequently, deviations in the nutrition of children and youth and various restrictive nutrition regimes (diets) cause an insufficient intake of nutrients important to life. Moreover, in connection with irregularity in a work–rest regime, it increases fatigue [3]. In this age period, extremes in the food intake arise due to dieting. In many aspects, eating disorders are a typical problem of the modern world. Mental anorexia and bulimia represent in their manifestations a nutritional behaviour from the life-threatening restriction of food intake up to overeating or hungering. However, both disorders have a great deal in common. The following is typical for them: an intense effort to achieve a slim figure associated with a restriction of energy intake, fear of obesity and dissatisfaction with one's own body [4]. During puberty and adolescence, girls want to change their physical appearance. They have a tendency to be slim, which is often reflected in the reduction of energy intake, and many times also the reduction of protein intake. On the other hand, with many boys it is about increasing exercise due to the desire to build-up muscles. They also consume food usually with an excessive amount of proteins [5,6]. Through every-day austerity, there is stress on the organism caused by various diets as the person slowly approaches their desired goal. However, at this time it is not yet known, what impact it will have on their health condition after adolescence. Their nourishment might be rich in fruit and vegetable products, however, their diet eliminates significant nutritional components essential for the young adolescent organism [2]. These deficiencies may lead to disturbances in natural growth and development. They can manifest themselves as anaemia, malnutrition, obesity, growth disorders, and the formation of caries. They can also be related to the development of diseases in adulthood, such as diabetes mellitus, atherosclerosis, hypertension, osteoporosis, and tumour diseases. Rejection of respected values, dissatisfaction with one's own appearance are efforts to be conformable with one's chosen way of life. These often lead adolescents to a change in their diet [7]. It has been proven that dieting is also associated with negative self-confidence in adolescents [8]. It is therefore important to maintain an adequate body weight and to achieve it by proper nutrient and exercise, not by a single-sided diet [9]. Long-lasting dietary restrictions directed at reduction of body weight will be ineffective if they are not accompanied by behavioural changes having an impact on physical activity and eating habits [10]. Prospective cross-sectional surveys showed that a high percentage of adolescents, especially women, even those with a normal BMI, had been on a diet for some period of time. Starting any diet increases. The risk of an eating disorders in adolescent girls. Extreme methods of
slimming down can have unfavourable physiological effects [8]. The HBSC study (Health Behaviour in School Aged Children). The objective is to monitor health, and healthrelated school children's behaviour in their social context. The article presents selected findings of the HBSC research conducted in central Slovakia in 2010 focused on the occurrences of dieting and self-evaluation of one's personal figure in school-aged youth.
Material and methods The research sample was formulated in accordance with the criteria of the HBSC study and stratified by regions and school types (elementary school, 8-year high school). The data was acquired from 11, 13 and 15-year-old school children representative of the population in central Slovakia (Žilina and Banská Bystrica region). The group consisted of 1187 pupils (620 girls and 567 boys). The data were collected from May to June 2010. The characteristics of the sample are presented in Table 1. Respondents who met the following pre-determined criteria were included in the research group: age (11, 13 and 15-year-olds); the respondent is a pupil of an elementary school (5th–9th grade) and equivalent in 8-year high school (prima–kvinta); an informed parent's consent and participation in the respondent's research; willingness to collaborate. The HBSC study is one of the first cross-national studies adopted by the World Health Organization and now there are more than 40 collaborating countries, including Slovakia. The international questionnaire produced for the needs of the HBSC study, which had been translated into Slovak in a standard way, was used for the data collection. The questionnaire was distributed in school classes by a team of trained administrators. The individual schools were selected from the list of all elementary schools and 8-year high schools in Slovakia provided by the Institute of Information and Prognoses of Education by random sampling carried out in the HBSC Data Management Centre (Bergen, Norway). The schools were contacted by telephone and asked for consent to participate in the international HBSC study. During the phone call with the schools, which agreed to participate, we obtained approval of the school management and selected, by a random sampling, the particular classes, in which the data was collected. The legal representatives of the respondents were familiarized with the research so that they had an opportunity to express their disagreement with the participation. The participation was voluntary.
Table 1 – Characteristics of the sample. Sex
11
13
15
Total
Boys Girls
145 168
194 248
228 204
567 620
Total
313
442
432
1187
e225
kontakt 16 (2014) e223–e227
For the purposes of the study, demographic factors were analysed (i.e. sex, grade, age of the child) and also reduction of body weight and self-evaluation of their personal figure. A significant interaction of two qualitative variables was evaluated using chi-quadrat test. Hypotheses were tested at the significance level p = 0.05. The STATISTICA software was used for the statistical analysis.
Table 2 – Dieting by number of respondents. Dieting No, my weight is all right No, but I should lose some weight No, because I need to gain weight Yes
n
%
625 257 141 157
53.0 21.8 11.9 13.3
new body shape which makes them not always happy. This is especially true for girls and leads to a tendency to regulate their body weight in the form of various diets [2]. Moreover, the school age years bring major changes in the view adolescents have to their own body and in the eating habits of school children. As young as 8-year old girls state that they are not satisfied with their body. Fear of obesity and diet tendencies, thus affect the lives of ever younger children in all age categories, especially girls [4]. This fact was not, however, proven in the results of our study. It follows from the conclusions that half of the respondents (53%) state that they are not on any diet because their weight is ‘‘all right’’. Based on this, we concluded that they are satisfied with their weight. Approximately one tenth of the respondents (13.3%) state that they are on a diet (Table 2). In the percentual representation of our group, boys indicated that they were not on diet. Their numbers ranged from 55% in 11-year-olds to 67% in 15-yearolds. The number of girls who state that they are not on diet, ranged from 44% in 15-year-olds to 53% in 11-year-olds (Chart 1). Regarding the reduction of body weight, we found the biggest difference in the answer ‘‘no, but I should lose some weight’’ in boys (16.73%) and in girls (26.42%). The differences between age and dieting are statistically significant (p = 0.000), also between age and dieting (p = 0.043). Different conclusions were concluded by the results of the international HBSC study carried out in 2009/2010 in 43 countries [11] where girls aged 15 almost in all countries and regions stated more often that they were on diet compared to lower age categories. Similar conclusions are stated in the study by Miertova [1]. Adolescent girls usually want to weigh less, whereas adolescent boys want to be bigger and stronger [12]. Weight reducing diets are also closely related to the evaluation of one's own figure through the eyes of adolescent youth. Self-evaluation of one's own figure plays a significant role, reflecting itself in physical and psychological health. Pubescent development often correlates with a poorer selfevaluation of one's figure in girls, whereas boys more often evaluate their figure in a positive way [13,14]. These facts are proven by the results of our study. Of the total sample of respondents, more than half (56.6%) evaluated their figure as
Results The results analysed dieting and self-evaluation of personal body figure in a population of school-aged youth by age and sex. Frequency data (in percentage) was prepared in the form of tables and charts. The question, ‘‘Are you currently on some diet or are you doing anything else to lose weight?’’ Was answered by approximately half of the respondents (53%) that they were not dieting because their weight was ‘‘all right’’. We have described this most frequently selected alternative in view of differences between sexes and age groups. While in girls, the conviction that their weight is ‘‘all right’’, is decreasing with age from 53% in 11-year-olds to 44% in 15-year-olds. But on the contrarywith boys, the conviction that their weight is ‘‘all right’’ is increasing with age from 54% in 13-year-olds to 67% in 15-year-olds. Of the total sample of respondents, more than half (56.6%) evaluated their personal body figure as ‘‘just right’’. This most frequently selected alternative is described in the view of differences between gender and age groups. The percentage of respondents who evaluated their figure as ‘‘just right’’ ranged in girls from 52% (13-year-olds) to 59% (11-year-olds) and in boys from 55% (11-year-olds) to 62% (15-year-olds). Boys perceived their figure as ‘‘just right’’ more frequently. We found statistically significant differences between gender and dieting ( p = 0.000) and also between gender and self-evaluation of figure ( p = 0.000). We expected to find statistically significant differences between age and dieting ( p = 0.043). But on the contrary, we did not find any statistically significant relations in self-evaluation of personal figure and age ( p = 0.198).
Discussion The period of pubescence is for an adolescent a psychologically demanding period. The adolescent is getting used to their
44 %
15-years old
67 %
girls
46 %
13-years old
boys
54 % 53 % 55 %
11-years old 0
10
20
30
40
50
60
70
80
Chart 1 – Dieting by sex of respondents – dieting (no, my weight is all right).
e226
kontakt 16 (2014) e223–e227
Table 3 – Self-evaluation of figure by number of respondents. Self-evaluation of figure Too slim A bit slim Just right A bit fat Very fat
Table 5 – Relation between reduction of body weight, selfevaluation of figure and age of respondents.
n
%
56 189 663 241 22
4.8 16.1 56.6 20.6 1.9
Table 4 – Relation between body weights, self-evaluation of figure and age of respondents.
Reduction of body weight Self-evaluation of figure
x2
p
23.641 22.009
0.000 0.000
‘‘just right’’. 4.8% of respondents evaluated their personal figure as ‘‘too fat’’ and 1.9% as ‘‘very fat’’. Based on this we concluded that these respondents can manifest dissatisfaction with their personal figure (Table 3). Boys relatively more often, evaluated their personal figures as ‘‘just right’’. Based on this we concluded that they are satisfied with their personal figures. On a percentage basis, boys are more satisfied with their personal figures with increasing age (the figure evaluation as ‘‘just right’’ ranged from 55% in 11-year-olds to 62% in 15-year-olds). But on the contrary, girls are less satisfied with their personal figures as they get older (the figure evaluation as just right ranged from 59% in 15-year-olds to 54% in 11-year-olds) (Chart 2). We found statistically significant differences between self-evaluation and the gender of the respondents (p = 0.000), with the biggest difference in the answer ‘‘a bit slim’’ is in 19.60% of boys and in 13.01% of the girls, and also in the answer ‘‘a bit fat’’ in 17.27% of boys and 23.58% of the girls. Regarding age and self-evaluation of one's personal figure, the differences were not statistically significant ( p = 0.198) (Tables 4 and 5). In our study, dissatisfaction with one's personal figure was expressed more often by girls, which is also demonstrated in the results of domestic and foreign studies [e.g. 1,15–17]. In the study by Schur et al. [18], 50% of children state that they are dissatisfied with their figure and want to weigh less, and 16% state that they have tried to slim down. Jones et al. [15] based their study on a sample of 1739 girls aged 12–18. The results of the study show that as many as 47% of girls are very dissatisfied with their weight. In his study, Krch [19] found
Reduction of body weight Self-evaluation of figure
62 %
girls boys
52 %
13-years old
57 % 59 %
11-years old
55 %
46
48
50
52
54
p
13.003 11.059
0.043 0.198
dissatisfaction with their body in Czech adolescents in 34.3% of boys and 57.4% of girls. The adolescents that were dissatisfied with personal figure showed lower self-confidence and a poorer self-image. The personal body dissatisfaction of girls was increasing depending on body weight. Similar conclusions are documented by the study done by Groganova [20], in which approximately one third of boys and 60% of girls are dissatisfied with their figure. All of the above mentioned facts are also pointed out by Morris and Katzman [12], who state that the dissatisfaction with body image and unhealthy eating habits are frequent indicators in adolescent girls. Unlike boys who, over the course of adolescence, approach the cultural ideal and prefer to gain weight while girls want to lose weight [20]. Macek [21] also states that adolescent girls are less satisfied with their own body which has an impact on their poorer self-image. Girls perceive the period of pubescence and adolescence as a restrictive interference into their lives. But on the contrary, boys evaluate the pubescence changes in their appearance in a positive way. Adolescent girls occupy themselves with their body dimensions, weight and diets to a greater extent than boys. Girls, compared to boys, consider a much slimmer female figure to be attractive [6]. Krch [22] states that an inclination to engage in dieting is especially associated with the female gender. The reasons for dieting in adolescent youth may vary, but dissatisfaction with their personal figures and a desire to be slimmer is a motivational factor for most of them. The attempts to lose weight can be associated with various behavioural changes, such as changes in eating habits and also frequency of exercise. It is obvious that the perception of being overweight in adolescent youth is accompanied by a decision to try losing some weight, regardless of the fact whether they really are obese [23]. Many adolescent girls believe that they are overweight and want to weigh less [12]. This was observed also by Jones et al. [15]. They stated that as many as 80% of 18 year old girls of normal height and weight stated that they wanted to weigh less. The media has strong influence on the opinion formation regarding an ideal body image; ‘‘media education’’ [24]. Most adolescent girls do not even know what should be their normal body weight and they
54 %
15-years old
x2
56
58
60
62
64
% of those who evaluated their figure as "just right" Chart 2 – Self-evaluation of figure by sex of respondents.
kontakt 16 (2014) e223–e227
try to fight against their biologically adequate body proportions [25].
Conclusion The areas in which it is possible to influence personal health through changes in lifestyles, is a primary form of prevention [26]. In the adolescence period, girls especially start to be more and fussier about their external appearance. They are interested more in their personal figure, they monitor their body weight more attentively and organize their diet. The results of our research showed that more than half of the adolescents state they are not dieting at all and their weight is ‘‘all right’’. At the same time, more than half of adolescent youth evaluate their figure as ‘‘just right’’. Girls more frequently suffer from a feeling of dissatisfaction with their personal figure, whereas boys more frequently perceive their figure as ‘‘just right’’. Any type of dieting interferes with the life of adolescent girls and can lead to disorders in food intake regulation. The extreme pressures of society on young people who are very sensitive about the self-perception of their bodies at this time of life, causes an unhealthy decrease in the energy intake, often with an insufficient quantity of essential nutrients including minerals and vitamins. The effort to appeal to others increases the motivation and efforts of the adolescents to go on extreme diets. Therefore, at this age and in case of normal weight, it is vital not to reduce energy intake, engage in adequate sports activities and build self-confidence [27].
Conflict of interest The authors have no conflict of interest to disclose.
Acknowledgement The research was financially supported by the UK grant: 150/ 2010.
references
[1] Miertová M. Držanie diét u adolescentov. Ošetřovatelství a porodní asistence 2012;3(4):460–7. [2] Jakušová Ľ, Dostál A. Výživa adolescentiek ako budúcich matiek. In: Boledovičová M, Vörösová G, Lišková M, editors. Ošetrovateľstvo 21. storočia v procese zmien III. Nitra: Univerzita Konštantína Filozofa v Nitre; 2009. p. s.342–5. [3] Maľa P, Durdíková E, editors. Správna výživa ľudí. Košice: Univerzita veterinárneho lekárstva; 2000. [4] Krch FD, Marádová E, editors. Výchova ke zdraví: Poruchy příjmu potravy, příručka pro učitele. VÚP ve spolupráci s MŠMT ČR. 2003. Available from: http://www.msmt.cz/ vzdelavani/vychova-ke-zdravi-poruchy-prijmu-potravy? highlightWords=V%C3%BDchova+zdrav%C3%AD [cit. 19.06.13].
e227
[5] Beňo I. Náuka o výžive. Martin: Vydavateľstvo Osveta; 2008. [6] Plháková A, Míčková J. Rozdíly v percepci tělesného schématu mezi muži a ženami. Česká a slovenská psychiatrie 2000;96(6):310–5. [7] Dostál A, Jakušová Ľ, Bánovčin P. Adolescentky ako budúce matky a ich výživa z aspektu nutričnej nedostatočnosti a obsahu xenobiotík. Čes-slov pediat 2009;64(11):584–5. [8] Daee A, Robinson P, Lawson M, Turpin JA, Gregory B, Tobias JD. Psychologic and physiologic effects of dieting in adolescents. South Med J 2002;95(9):1032–41. [9] Provazník K, Komárek L, Cikrt M. Manuál prevence v lékařské praxi. Praha: Univerzita Karlova; 2004. [10] Diet, Nutrition and the Prevention of Chronic Diseases. Report of a Joint WHO/FAO Expert Consultation. Geneva: World Health Organization; 2003. [11] Social determinants of health and well-being among young people 2009/2010; 2011, Available from: http://www. euro.who.int/__data/assets/pdf_file/0003/163857/Socialdeterminants-of-health-and-well-being-among-youngpeople.pdf [cit. 09.08.12]. [12] Morris AM, Katzman DK. The impact of the media on eating disorders in children and adolescents. Paediatr Child Health 2003;8(5):287–9. [13] Cavallo F, Zambon A, Borraccino A, Raven-Sieberer U, Torsheim T, Lemma P. Girls growing through adolescence have a higher risk of poor health. Qual Life Res 2006;15 (10):1577–85. [14] Ge X, Elder Jr GH, Regnerus M, Cox Ch. Pubertal transitions, perceptions of being overweight and adolescents' psychological maladjustment: gender and ethnic differences. In Soc Psychol Quart 2001;64(4):363–75. [15] Jones JM, Bennett S, Olmsted MP, Lawson ML, Rodin G. Disordered eating attitudes and behaviours in teenaged girls: a school-based study. CMAJ 2001;165(5):547–52. [16] Krch FD, et al. Poruchy příjmu potravy. Praha: Grada Publishing; 2005. [17] Rašticová M. Prediktory nespokojenosti s tělem a souvislosti s depresí v adolescenci. E-psychologie; 2009, Available from: http://e-psycholog.eu/cislo/7/cz [cit. 16.08.13]. [18] Schur EA, Sanders M, Steiner H. Body dissatisfaction and dieting in young children. Int J Eat Disord 2000;27(1):74–82. [19] Krch FD. Vztah mezi tělesnou spokojeností a kvalitou života českých adolescentů. Psychiatrie 2000;4. Available from: http://www.tigis.cz/PSYCHIAT/PSYCH400/03krch.htm [cit. 16.03.14]. ISSN 1211-7579. [20] Grogan S. Body image: Psychologie nespokojenosti s vlastním tělem. Praha: Grada Publishing; 2000. [21] Macek P. Adolescence. Praha: Portál; 2003. [22] Krch FD. Poruchy příjmu potravy – rizikové faktory. Psychiatrie pro praxi 2004;5(1):14–6. [23] Findlay SM. Dieting in adolescence. Paediatr Child Health 2004;9(7):487–91. [24] Šupínová M, Virgulová J. Centrálna obezita – estetický, alebo zdravotný problém? In Interná medicína 2012;12 (Supplementum):10. [25] Krch FD. Poruchy příjmu potravy – mezi nadváhou a vyhublostí; 2003, Available from: http://www.pppinfo.cz/ clanek_show.asp?id=38 [cit. 17.06.13]. [26] Dimunová L, Mechírová V. Výskyt vybraných kardiovaskulárnych faktorov u sestier v košickom regióne. In: Farkašová D, Padyšáková H, Tomková I, editors. Sestry a Európske stratégie zdravia 21. Bratislava: SZU v Bratislave; 2008. p. s177–83. [27] Müllerová D, et al. Obezita – prevence a léčba. Praha: Mladá Fronta a.s; 2009.