Body composition and body image -
Published by Oxford University Press on behalf of the European Public Health Association. Abstract Background: Most adolescents are less physically active than recommended, despite the strong effort of various stakeholders to promote physical activity PA.
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A flow chart regarding the selection of the sample is shown in Fig. Only native Italian adolescents with no missing data in all the three measurements were included in the study. Immigrant subjects were excluded since they were not a uniform group, but belonged to different ethnic groups.
A trained operator directly collected the anthropometric measurements according to standardized rules described in the Procedures section. General information about demographic e.
sex and age and sport participation sport practice - considered as club sports, namely planned sports activities led by staff and the amount of time involved hours per week were collected by a questionnaire.
The sport practice frequency of each subject was determined by the hours of sport training during a typical week as declared by the subject. Anthropometric characteristics height, weight, lengths, waist and hip circumferences and skinfold thicknesses were collected in the morning according to standardised procedures [ 39 , 40 ].
Height and sitting height were measured to the nearest 0. Body weight was measured to the nearest 0. Circumferences were measured to the nearest 0. Skinfold thicknesses were measured to the nearest 0. Body mass index BMI was calculated as weight in kilograms divided by the square of height in metres.
This index was used to assess the weight status of each participant: each subject was thus classified into underweight, normal weight, overweight or obese according to the Cole cut-off values by sex and age [ 37 , 38 ]. In girls, maturity status was detected by asking the girls if they have already reached menarche, and if the answer was affirmative, the date was recorded.
In boys, an estimation of the years from peak height velocity PHV , which is an indicator for the adolescent growth spurt, was made using the equation for boys developed by Mirwald and colleagues [ 45 ], which is able to predict maturity offset in youngs [ 46 , 47 ].
In accordance with Mirwald et al. Since maturity offset represents the time before or after PHV, the years from PHV were calculated by subtracting age at PHV from chronological age.
Body image perception was assessed using the Body Silhouette Chart [ 48 ]. The students were shown nine male or female silhouettes, ordered in morphology from emaciation to obesity.
Subjects were asked to select the silhouette which they believed was most similar to their own perceived current figure as well as the silhouette which they most desired ideal figure. Using the classification reported by Sánchez-Villegas et al.
The discrepancy between the perceived current figure and the ideal figure represents the degree of body image dissatisfaction FID or Feel minus Ideal Discrepancy [ 49 ]. The FID index was calculated by subtracting the score of the figure selected by children as the ideal figure from the one selected as their perceived current Fig.
A positive FID score indicates that the perceived current figure was bigger than the ideal figure and a negative score indicates that the perceived current figure was thinner than the ideal Fig. A FID score of 0 indicates no discrepancy same figure chosen as perceived current figure and as ideal.
A FAI score of zero indicates no inconsistency in weight status perception; a positive score indicates that weight status is overestimated, and a negative score indicates that weight status is underestimated.
The data analysis was performed using Statistica for Windows, version 8. The suitability of the sample size for each analysis was assessed using the G-Power software 3.
An a priori power analysis was conducted to ensure that the number of participants was representative for the purposes of this study. The outcomes parameters thus calculated detected a sample size of 44 participants, but additional subjects were involved to ensure availability of data in case of problems with data collection.
Variables normality was verified with the Shapiro—Wilk test. The means and SD of the baseline data 1 st class and in the following years 2nd and 3rd classes were calculated. Percentage frequency was determined for qualitative variables weight status. Repeated measures ANOVA was used to assess differences between the values carried out on subjects in each of the 3 years of measurement from first class to third class , while non parametric ANOVA was used to evaluate the differences among body image parameters, since they are not normally distributed.
Differences in the frequencies were tested by the chi-squared test. Backward multiple regression analysis was carried out to assess possible predictors of FID and FAI.
Anthropometric variables, sex, weight status and maturity status were included into the model. Predictors input into the model were those found to have significant associations with FID and FAI i. Table 1 shows the anthropometric and body composition characteristics of the sample during the three consecutive years in both sexes.
Considering sex differences, ANOVA showed significant differences in body proportion leg length and cormic index , in waist and hip circumferences and relative indexes WHR and WHtR , in three skinfold thicknesses suprailiac, medial calf and thigh and in the sum of skinfolds.
Greater are the differences connected with the variation of the measurement over time. Analysing these variations in more detail, considering also the post-hoc, we can observe some different trend in the two sexes.
In males, from the 1st to the 3rd class, height increment was BMI presented a slight increase. On average, WHtR remained stable over the 3 years: a small percentage of boys presented WHtR values higher than the 0.
WHR showed a significant decrease with age. In general, skinfold thicknesses remained quite stable over the 3 years, with a general tendency to decrease. Ninety-two percent of males practiced club sports. Weekly amount of club sports increased with age, with significant difference between the 1st and 3rd class.
In females, from the 1st to the 3rd class, height increment was 7. The cormic index did not show any significant variation with age, even though a tendency to increase was observed.
WHtR did not show any significant differences during the 3 years, and also the subjects with values above the cut off remained stable over the 3 years 9. Sports were practiced by Weekly amount of club sports slightly increased during the 3 years, but not significantly. Considering the prevalence of weight status in males Table 2 , no significant differences were observed among the 3 years.
Normal weight prevailed in all the considered classes, showing an increasing trend with age. A small percentage of obese boys were observed in the 1st class, but this category disappeared in the following years, and a reduction of overweight subjects was observed.
Similarly, in females the weight status prevalence did not significantly differ among the 3 years and normal weight subjects prevailed Table 2. Contrarily to males, in the 1st and 2nd classes a small percentage of underweight girls were observed.
Even if the differences were not significant, a slight increase in the prevalence of overweight in the 3rd class was observed.
According to equation of Mirwald et al. The majority of the boys were average maturers With reference to females, data regarding age at menarche showed that in the 1st class, The mean age at menarche was Body image perception showed significant differences between sexes Table 3.
The difference in the choice of perceived current figures was significant, since females have chosen thinner silhouettes than males. Body image dissatisfaction FID is greater in females.
Males presented a greater misperception of their weight status, showing a greater underestimation than females. Body image parameters did not show any significant variations with age Table 3.
In all 3 years, on average, males chose normal weight silhouettes both for the perceived current figure and the ideal figure. As a consequence, the FID score indicated no dissatisfaction with their body, especially in the 3rd class.
As regards the misperception of their weight status, FAI score indicated no variations with age; a tendency to underestimate the weight status was observed in all the three considered years. On average, the perceived current figure chosen by girls Table 3 belonged to the normal weight category, but it was in the upper extremity nearly overweight.
The mean ideal figure chosen also falls into the normal weight category, but presented lower values than the perceived current figure, as testified by positive mean values of FID, indicating a desire to be thinner.
FAI score approximated zero, indicating no inconsistency in the perception of weight status, even though with a slight tendency to underestimation, testified by negative mean values. We performed different multiple linear regression models to evaluate the impact of age, sex and BMI on body image dissatisfaction assessed by FID score and on inconsistency of weight status assessed by FAI score in the adolescents during their 3 years of middle school 1st class, 2nd class, and 3rd class.
The results of these predictive models are presented in Table 4. As regards FID, both sex and BMI are significantly associated with FID and both are positive predictors.
Body image dissatisfaction increases as BMI increases and being a female increases the dissatisfaction. In the transition to the 2nd class and 3rd class, the adolescents showed an increase of overestimation as their BMI increased. The present study considered the trends in body composition and in the prevalence of overweight and obesity, assessed using the Cole cut-off values [ 37 , 38 ], in Italian adolescents followed longitudinally over the 3 years of middle school.
In addition, another aim was to determine whether body composition and weight status during adolescence were associated with the risk of developing body image disturbance. To our knowledge, this study is the first to evaluate the longitudinal association between these parameters in young Italian adolescents.
As regards the first aim, the longitudinal variations in body composition of the subjects of the two sexes are connected with the phase of maturation they were approaching. This is reflected in the great height increment and in the prevalence of leg length growth in comparison with trunk growth.
Differential timings of growth of height, sitting height and leg length are in fact known, since with growth a change in relationship between leg length and sitting height is observed.
The growth of leg length precedes the PHV, while sitting height growth occurs after PHV [ 32 ]. The trend in parameters connected with body composition confirmed this specific stage of growth.
These data are in accordance with the body composition and fat distribution changes that occur during male adolescence [ 32 ]. The percentage of mature girls increased with age, changing from A significant increase with age was observed for all the considered parameters, with height, weight, waist and hip circumferences showing significant differences among all the considered age classes.
The height increment was lower than that observed in males, while the sitting height increment was higher than that of leg length: this reflects the different phase of maturation of the two sexes, with girls ahead compared to males.
In males, BMI remained quite stable during the three school years. The percentage of normal weight males was lower than the national data [ 51 ], which reported an incidence of Percentages of overweight boys in the present sample were higher than the national data, but a tendency to decrease with age was observed.
Obesity is slightly higher in the 1st class, but disappeared in the following years. Contrarily to the national data, there were no underweight subjects in the present sample.
In girls, BMI showed a significant increase. Even if the weight status prevalence did not significantly differ among the 3 years and normal weight subjects prevailed, a reduction in underweight prevalence and a slight increase in the prevalence of overweight with age were observed.
The percentage of normal weight girls was comparable to the national data [ 51 ], but the percentage of overweight girls was higher, and obese and underweight subjects were lower.
Regarding sex differences in weight status, females showed a higher incidence of normal weight, and a lower incidence of overweight and obesity.
The latest data [ 52 ] from the WHO Childhood Obesity Surveillance Initiative COSI reveal that in countries like Italy, Portugal, Spain and Greece, there has been an important decrease of obesity, which is attributable to a very significant effort that these countries have made in recent years in the management and prevention of childhood obesity [ 53 ], although rates are still high.
Low levels of PA in adolescents is a critical cause for the obesity epidemic in developed countries [ 53 , 54 ], and obese adolescents are generally less physically active PA than normal-weight adolescents [ 55 ]. As a consequence, increasing physical activity is probably one of the best strategies to reduce the prevalence of overweight and obesity in youth [ 56 ].
In addition, fat distribution may have more significant implications for health than the total amount of body fat. In the present study only a small percentage of subjects of both sexes presented a WHtR higher than cut-off. Visceral fatness or the accumulation of intra-abdominal adipose tissue increases cardiovascular risk in children, and it has been shown that that the most active individuals have the lowest visceral fat after adjusting for total body fat.
This suggests that PA may elicit a proportionally larger decrease in fat stored in the intra-abdominal cavity than in other regions in people with visceral fatness [ 57 , 58 ].
Cross-sectional data also suggest that PA could promote a reduction of visceral fat and trunk fat in pre-pubertal and pubertal children [ 59 , 60 ].
In this longitudinal study, sports practice is high and regular, and once again this can be traced back to the preventive campaigns that the region in which the study took place [ 61 ] has put in place to encourage the spread of a healthy lifestyle among children and adolescents.
The second aim was to assess whether the change in body composition parameters and weight status influence body image perception. In both sexes, body image perception did not show any significant variations with age and both the perceived current figure and the ideal figures were chosen fall into the category of average in normal weight silhouettes.
Nevertheless, females tend to choose a thinner ideal figure than the perceived current figure, as also testified by the FID. The average FAI index of both sexes is close to 0, implying a correct perception of their own weight status.
The data of the present study strengthen the notion that body image dissatisfaction and perception are mostly influenced by moderating factors such as sex and BMI, which should be considered in studies regarding youth.
The results of the multiple linear regression analysis showed that BMI is a common denominator for both sexes, and as it increases also body dissatisfaction increases.
With the increase of BMI, in the adolescents of the 2nd class and 3rd class, increases the overestimation of their weight status. In addition, girls are more vulnerable than males for both dissatisfaction.
In girls, fat mass increases more rapidly than in boys during adolescence. Important variations in body composition, which are influenced by age and sex, and which include BMI, subcutaneous fat and relative fat distribution [ 31 , 62 , 63 , 64 ] can be sources of dissatisfaction in body image perception.
The results of the present study are in accordance with those of other Authors [ 65 , 66 , 67 ], which showed that increased BMI is a key point in influencing body image perception.
It is associated with lower self-perceptions of social acceptance and physical appearance, and subjects who demonstrate low perceptions of self-concept are also generally less willing to participate in activities with peers [ 68 , 69 , 70 ]. The strength of this study is the three-year longitudinal design in which anthropometric parameters of the adolescents were directly measured by an expert anthropometrist, and not self-reported.
A limitation of this study could be connected to the use of standardized body silhouettes instead of computerized assessments, which allow to assess separate characteristics of body image, such as overall size or shape.
This technological method presents a good flexibility to visually represent how users perceive themselves, compared to fixed silhouettes. In addition, it allows detailed information to be gathered regarding the assessments of individual body areas [ 71 , 72 ].
Even if the silhouettes used in the present study are widely utilized in the literature [ 73 , 74 ] they do not allow the assessments of muscularity, an important aspect considered in studies on older subjects [ 75 , 76 ]. Adolescence is a complex transition stage, during which, in relation to maturation, significant changes in body composition occur.
The adolescents of the present study are in the phase where these changes take place, and where body fat percentage increases in females and decreases in males.
Even if their body image perception did not seem to change with age, associations were found between body image perception and BMI and sex. Monitoring body image perception in young adolescents, especially in females and in subjects with a high BMI, should be a priority in order to prevent nutritional disorders.
The datasets used during the current study are available from the corresponding author on reasonable request. World Health Organization. Orientation Programme on Adolescent Health for Health-care Providers. pdf, Accessed 10 June Holmbeck GN. A developmental perspective on adolescent health and illness: an introduction to the special issues.
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