Body image and quality of life in post massive weight loss body contouring patients

Objective: Because post‐bariatric surgery patients undergo massive weight loss, the resulting skin excess can lead to both functional problems and profound dissatisfaction with appearance. Correcting skin excess could improve all these corollaries, including body image. Presently, few data are available documenting body image and weight‐related quality of life in this population. Research Methods and Procedures: Eighteen patients who underwent both bariatric surgery and body contouring completed our study. Both established surveys and new surveys designed specifically for the study were used to assess body perception and ideals, quality of life, and mood. Patients were surveyed at the following time‐points: pre‐body contouring (after massive weight loss) and both 3 and 6 month post‐body contouring. Statistical testing was performed using Student's t test and ANOVA. Results: The mean age of the patients was 46 ± 10 years (standard deviation). Quality of life improved after obesity surgery and was significantly enhanced after body contouring. Three months after body contouring, subjects ascribed thinner silhouettes to both current appearance and ideal body image. Body image also improved with body contouring surgery. Mood remained stable over 6 months. Discussion: Body contouring after surgical weight loss improved both quality‐of‐life measurements and body image. Initial body dissatisfaction did not correlate with mood. Body contouring improved body image but produced dissatisfaction with other parts of the body, suggesting that as patients become closer to their ideal, these ideals may shift. We further developed several new assessment methods that may prove useful in understanding these post‐surgical weight loss patients.     

The Relationship Between Body Image Discrepancy and Body Mass Index Across Ethnic Groups

Objective: This study sought to examine at what body mass index (BMI) body image discrepancy (BD) was reported in a community sample of 389 white, Hispanic, and black women. In addition, we assessed the trajectory of the BMI–BD relationship as BMI increases by ethnic group. Research Methods and Procedures: All participants were assessed on height and weight and completed the Figure Rating Scale. Results: We found no difference in the proportion of women in each ethnic group reporting BD. However, white women experienced BD at a lower BMI level (BMI = 24.6), and below the criterion for overweight (BMI = 25). In contrast, black and Hispanic women did not report BD until they were overweight (BMIs of 29.2 and 28.5, respectively). Compared with black and white women, Hispanic women registered increases in BD at smaller increases in BMI. Discussion: These findings could have unhealthful implications for weight control behavior. The results encourage a closer look at ethnicity and BD, and their relationship to obesity and weight control.     

Changes in Prevalence of Overweight and in Body Image among Fijian Women between 1989 and 1998**

Objective: To investigate changes in prevalence of overweight and obesity and in body image among ethnic Fijian women in Fiji during a period of rapid social change and the relationship between changes in body image and BMI. Research Methods and Procedures: The study design was a multiwave cohort study of BMI in a traditional Fijian village over a 9.5‐year period from 1989 to 1998. Cohorts were identified in 1989 (n = 53) and in 1998 (n = 50). Selection criteria included Fijian ethnicity, female gender, age of at least 18 years, and residence in a specific coastal Fijian village in 1989 and 1998, respectively. Assessments consisted of measurement of height and weight, collection of demographic data by written survey, and administration of the Nadroga Language Body Image Questionnaire. Results: The prevalence of overweight and obesity was significantly different between the cohorts, increasing from 60% in 1989 to 84% in 1998 (p = 0.014). In addition, the age‐adjusted mean BMI was significantly higher in 1998 compared with 1989 (p = 0.011). Finally, there were significant between‐cohort differences in multiple measures of body image, which were mostly independent of BMI. Discussion: At 84%, the prevalence of overweight and obesity in this community sample of Fijian women is among the highest in the world. The dramatically increased prevalence over the 9.5‐year period studied corresponds with rapid social change in Fiji and significant shifts in prevailing traditional attitudes toward body shape.     

Body‐Image Perceptions among Urban Native American Youth

Objective: This study investigated body‐image perceptions among Native American youth. Research Methods and Procedures: A modified and validated body‐image measure for use with Native American youth was utilized in a cross‐sectional assessment of 155 urban Native American youth attending an after‐school program in Minneapolis, Minnesota. The youth (ages 5 to 18 years) expressed their perceptions of current and ideal body image, which allowed assessment of satisfaction or dissatisfaction. Body sizes perceived as healthy or most likely to develop diabetes were also communicated. Heights and weights were measured, and body mass index was calculated. Results: When asked to identify their ideal body figure, younger children selected thinner figures than adolescents, and overweight youth chose ideal figures similar to those of normal‐weight youth. The mean body dissatisfaction of the youth was ±0.99 and ±1.49 body figures for boys and girls, respectively. Examination of the direction of body dissatisfaction revealed that 41% of the boys and 61% of the girls expressed a desire to be thinner. Those expressing the greatest dissatisfaction were overweight girls (>95th percentile). On a scale from one to eight, the median of the body image viewed as the healthiest was 4.0, whereas that most likely to develop diabetes was 8.0. Discussion: These results suggest that urban Native American youth are dissatisfied with their body size and that most acknowledge the diabetes risk associated with overweight, which implies that they may be receptive to obesity prevention measures.     

Development and Validation of the Body Size Scale for Assessing Body Weight Perception in African Populations

Background

The social valorisation of overweight in African populations could promote high-risk eating behaviours and therefore become a risk factor of obesity. However, existing scales to assess body image are usually not accurate enough to allow comparative studies of body weight perception in different African populations. This study aimed to develop and validate the Body Size Scale (BSS) to estimate African body weight perception.

Methods

Anthropometric measures of 80 Cameroonians and 81 Senegalese were used to evaluate three criteria of adiposity: body mass index (BMI), overall percentage of fat, and endomorphy (fat component of the somatotype). To develop the BSS, the participants were photographed in full face and profile positions. Models were selected for their representativeness of the wide variability in adiposity with a progressive increase along the scale. Then, for the validation protocol, participants self-administered the BSS to assess self-perceived current body size (CBS), desired body size (DBS) and provide a “body self-satisfaction index.” This protocol included construct validity, test-retest reliability and convergent validity and was carried out with three independent samples of respectively 201, 103 and 1115 Cameroonians.

Results

The BSS comprises two sex-specific scales of photos of 9 models each, and ordered by increasing adiposity. Most participants were able to correctly order the BSS by increasing adiposity, using three different words to define body size. Test-retest reliability was consistent in estimating CBS, DBS and the “body self-satisfaction index.” The CBS was highly correlated to the objective BMI, and two different indexes assessed with the BSS were consistent with declarations obtained in interviews.

Conclusion

The BSS is the first scale with photos of real African models taken in both full face and profile and representing a wide and representative variability in adiposity. The validation protocol proved its reliability for estimating body weight perception in Africans.     

Validity of Six Field and Laboratory Methods for Measurement of Body Composition in Boys

Objective: To determine the validity of the following six body composition methods against a reference method (three‐component model): air displacement plethysmography (BODPOD); estimation from body density using BODPOD; skinfold thickness using the Slaughter equations; bioelectrical impedance, both leg‐leg (TANITA) and hand—foot (Bodystat) approaches; and total body water. Research Methods and Procedures: Forty‐two healthy white 10‐ to 14‐year‐old boys (mean age, 12.9 ± 1.0 years) were enrolled in this study. Measures of body fat percentage and body fat mass derived from the three‐component model were used as the reference method. Validity of all of the other methods was assessed by comparison against the reference by calculation of biases and limits of agreement. Results: Mean body fatness measured using the reference method was 16.4 ± 11.6% and 8.7 ± 7.0 kg. Estimates of fatness from total body water had the narrowest limits of agreement relative to the reference (+0.9 ± 5.0% body fat; +0.5 ± 2.9 kg fat mass). For all other methods tested, we observed large biases and very wide limits of agreement. Discussion: This study suggests that the validity of newer field and laboratory methods for estimation of body composition is poor in adolescent boys. For applications where high accuracy of estimation at the individual level is essential, only reference methods would be acceptable.     

Does Ethnicity Influence Body-Size Preference? A Comparison of Body Image and Body Size

Objective: Obesity is most common in the United States among women of ethnic minority groups (black and Hispanic). Researchers have hypothesized that these subcultures are more accepting of overweight figures. The purpose of this study was to examine body image and body size assessments in a large community sample of men and women. Research Methods and Procedures: Participants were 801 women and 428 men: 23% Asian, 45% Hispanic, 17% black, and 15% white. The figure rating scale was used to rate: body dissatisfaction, attractive male and female shapes, acceptable female size, and perceptions of underweight to obese female figures. Results: Controlling for age, education, and body weight, no ethnic differences were found for men. Asian women reported less body dissatisfaction than the other groups. Women were more dissatisfied with their size than men and chose thinner female figures as attractive and acceptable. Discussion: Ethnicity, independent of age, education, and body weight, does not influence preference for female and male shapes or tolerance for obesity.     

The effect of obesity management on body image in patients seeking treatment at medical centers

Objective: Body image dissatisfaction is common in treatment‐seeking patients with obesity. We aimed to investigate the effects of obesity management on body image in patients with obesity attending Italian medical centers for weight loss programs. Research Methods and Procedures: A total of 473 obese patients seeking treatment in 13 Italian medical centers (80% females; age, 45.9 ± standard deviation 11.0 years; BMI, 36.8 ± 5.7 kg/m²) were evaluated at baseline and after a 6‐month weight loss treatment. Body uneasiness, psychiatric distress, and binge eating were tested by Body Uneasiness Test (BUT, Part A), Symptom CheckList‐90 (SCL‐90), and Binge Eating Scale (BES), respectively. Results: At 6‐month follow‐up, the percentage weight loss was significantly higher in men (9.0 ± 6.3%) than in women (6.8 ± 7.3%; p = 0.010). Both men and women had a significant improvement in BUT Global Severity Index and in all of the BUT subscales with the exception of the Compulsive Self‐Monitoring subscale. Linear regression analysis selected baseline psychological and behavioral measures (global score of BUT and SCL‐90) and improved psychiatric distress and binge eating as independent predictors of changes in basal body dissatisfaction in females, whereas in males, changes were associated only with baseline BUT‐Global Severity Index score, binge eating, and its treatment‐associated improvement. Pre‐treatment BMI and BMI changes did not enter the regression. Discussion: Obesity treatment, even with a modest degree of weight loss, is associated with a significant improvement of body image, in both females and males. This effect depends mainly on psychological factors, not on the amount of weight loss.     

Race Differences in Accuracy of Self‐Reported Childhood Body Size Among White and Black Women

Objective: To assess the relation of self‐reported current and recalled preadolescent body size to measured BMI (kilograms per meter squared) and interviewer's assessment of body size. Research Methods and Procedures: This was a prospective cohort study of 1890 white and black women who were 9 to 10 years old at time of enrollment and were followed up 10 to 13 years later. At baseline, subjects had their weight and height measured and were asked to indicate their current body size from a series of nine pictograms. A sample of the subjects also had their body size evaluated by interviewers. At the young‐adult follow‐up visit, subjects were asked to recall their body size at 9 and 10 years old and to indicate their current weight, height, body size, and level of concern with weight. Results: Among the women with interviewer assessments, 84% of the white women and 67% of black women recalled a body size that was within one body size of the interviewer's assessment. Independent of weight status in childhood or at follow‐up, black women were 3 times more likely than white women to recall a body figure that was more than one figure leaner than the shape they reported at baseline (odds ratio = 3.5, 95% confidence interval 2.8 to 4.5) or than the interviewer's rating at baseline (odds ratio = 3.4, 95% confidence interval 2.4 to 4.9). Discussion: The results suggest that the use of body figures to recall childhood size are best suited for ranking subjects in terms of BMI. The higher rate of underestimation of size by black women suggests that body figure ratings work best for white women.     

Body Dissatisfaction and Binge Eating in Obese Women: The Role of Restraint and Depression

Objective: This study examined the association between body dissatisfaction and binge eating, and the mediating role of restraint and depression among obese women. Research Methods and Procedures: Participants were obese women taking part in a cognitive-behavioral treatment program who completed self-report measures at baseline (n = 89) and post-treatment follow-up (n = 69). Results: At baseline, body dissatisfaction was strongly correlated with binge eating score. This was partly a direct effect and partly mediated by depression. No mediating effect of restraint was observed. Over the treatment period, a reduction in body dissatisfaction was associated with a reduction in binge-eating score. As in the cross-sectional data, there was evidence for mediation by change in depression with the greatest improvement in binge eating among those who became more restrained and less depressed. Discussion: These results suggest that it would be valuable to address psychological well-being, and especially body image, as part of the management of binge-eating behavior in obesity.     

The Body Mass Index-Mortality Relationship in White and African American Women

Objective : To examine the association of body mass index to all-cause and cardiovascular disease (CVD) mortality in white and African American women. Research methods and procedures : Women who were members of the American Cancer Society Prevention Study I were examined in 1959 to 1960 and then followed 12 years for vital status. Data for this analysis were from 8,142 black and 100,000 white women. Body mass index (BMI) was calculated from reported height and weight. Associations were examined using Cox proportional hazards modeling with some analyses stratified by smoking (current or never) and educational status (less than complete high school or high school graduate). Results : There was a significant interaction between ethnicity and BMI for both all-cause (p<0.05) and CVD mortality (p<<0.001). BMI (as a continuous variable) was associated with all-dause mortality in white women in all four groups defined by smoking and education. In black women with less than a high school education, there were no significant associations between BMI mortality. For high school-educated black women, there was a significant association between BMI and all-cause mortality. Among never smoking women with at least a high school education, models using the lowest BMI as the reference indicated a 40% higher risk of all-cause mortality at a BMI of 35.9 in black women vs. 27.3 in white women. Discussion : The impact of BMI on mortality was modified by educational level in black women; however, BMI was a less potent risk factor in black women than in white women in the same category of educational status.     

Regional body volumes, BMI, waist circumference, and percentage fat in severely obese adults

Objective: This study presents total body volume (TBV) and regional body volume, and their relationships with widely used body composition indices [BMI, waist circumference (WC), and percentage body fat (% fat)] in severely obese adults (BMI ≥35 kg/m²). Research Methods and Procedures: We measured TBV, trunk volume (TV), arm volume (AV), leg volume (LV), and WC and estimated % fat in 32 severely obese persons with BMI 36 to 62 kg/m² (23 women; age, 19 to 65 years; weight, 91 to 182 kg) and in 58 persons with BMI <35 kg/m² (28 women; age, 18 to 83 years; weight, 48 to 102 kg) using a newly validated 3‐day photonic image scanner (3DPS, Model C9036–02, Hamamatsu Co., Japan) and calculated TV/TBV, AV/TBV, and LV/TBV. Results: Men had significantly larger TBV and higher TV/TBV and AV/TBV, but significantly lower LV/TBV than women, independently of BMI. TV/TBV increased while AV/TBV and LV/TBV decreased with increasing BMI, WC, and % fat, and the rate of increase in TV/TBV per % fat was significantly greater in severely obese individuals than in individuals with BMI <35 kg/m². The relationships for TBV with % fat were much lower than with BMI or WC. Conclusion: Body volume gains were mainly in the trunk region in adults, irrespective of sex or BMI. For a given BMI, WC, or % fat, men had a significantly larger TV than women. The implication is that men could have higher health risks due to having higher trunk body weight as a proportion of total body weight compared with severely obese or less severely obese women.     

Body Image Partially Mediates the Relationship between Obesity and Psychological Distress

Objective: Body image is considered as a potential mediator of the relationship between obesity and psychological distress. Research Methods and Procedures: One hundred ten men and women in a residential weight control facility completed the Multidimensional Body Self-Relations Questionnaire, the Beck Depression Inventory, the Rosenberg Self-Esteem Scale, and the Binge Eating Scale. Results: For both men and women, body-image satisfaction partially mediated the relationship between degree of overweight and depression/self-esteem. Discussion: Sociodemographic factors that may influence the relationships among weight, body image, and depression/self-esteem are discussed.     

Realistic Weight Perception and Body Size Assessment in a Racially Diverse Community Sample of Dieters

Recently, a shift in obesity treatment away from emphasizing ideal weight loss goals to establishing realistic weight loss goals has been proposed; yet, what constitutes “realistic” weight loss for different populations is not clear. This study examined notions of realistic shape and weight as well as body size assessment in a large community-based sample of African-American, Asian, Hispanic, and white men and women. Participants were 1893 survey respondents who were all dieters and primarily overweight. Groups were compared on various variables of body image assessment using silhouette ratings. No significant race differences were found in silhouette ratings, nor in perceptions of realistic shape or reasonable weight loss. Realistic shape and weight ratings by both women and men were smaller than current shape and weight but larger than ideal shape and weight ratings. Compared with male dieters, female dieters considered greater weight loss to be realistic. Implications of the findings for the treatment of obesity are discussed.     

Relationship of Body Composition to Body‐Fatness Estimation in Japanese University Students

Objective: To examine the relationship between self‐estimated whole body size and fatness and whole body and regional composition, and the relationship between self‐estimated whole body fatness and self‐estimated regional fatness in Japanese university students. Research Methods and Procedures: This was a cross‐sectional study using Japanese university students (110 men and 79 women). The percentage of body fat, fat mass (FM), and fat‐free mass (FFM) were measured by underwater weighing and used as body composition variables. Subcutaneous fat thicknesses were determined at seven sites by ultrasonography to estimate regional body composition, and six circumferences and four breadths to estimate regional size. Relative body size and fatness were self‐estimated using a questionnaire. Results: Only women tended to estimate themselves as being fatter than they actually were. Self‐estimated body fatness moderately correlated with the percentage of body fat (men, r = 0.41; women, r = 0.40) FM (men, r = 0.50; women, r = 0.51), and body mass index (r = 0.56 for men and 0.56 for women). After adjusting for the percentages of body fat and FM, self‐estimated fatness correlated with body mass index (r = 0.31 for men and r = 0.37 for women). Among self‐estimated regional fatness, self‐estimated abdominal fatness had the strongest correlation with self‐estimated whole body fatness in both genders. Discussion: The low correlation between estimated and actual body fatness in both genders indicates that Japanese university students, especially women, inaccurately estimate their percentage of body fat. In fact, both men and women primarily estimate their whole body fatness by body weight relative to height.     

"Whatever feels good in my soul": body ethics and aesthetics among African American and Latina women

Ethnicity-specific differences in body aesthetic ideals and body satisfaction have been cited as a potential explanation for interethnic differences in the prevalence and presentation of eating disorders. It has been widely hypothesized that such ethnically based differences in aesthetic body ideals mitigate cultural pressures that contribute to body disparagement and disordered eating among white women. However, mechanisms by which a cultural milieu may be protective against the development of disordered eating remain poorly understood. This study investigated relationships among ethnicity, self-representation, and body aesthetic ideals among 18 college-educated black and Latina women through analysis of focus group discussion data. Rather than confirming body aesthetic ideals different from those of white culture, study respondents reframed the discussion about body aesthetics to one of body ethics. That is, study subjects both contested ideologies defining thinness and whiteness as inherently beautiful and espoused a body ethic of self-acceptance and nurturance that rejects mainstream cultural pressures to reshape bodies to approximate aesthetic ideals promulgated in the media. We conclude that understanding body image concerns from the standpoint of body ethics, rather than body aesthetics, may be a more productive and inclusive approach to the study of ethnically diverse women's embodied experience. Ultimately it is anticipated that this will better illuminate the complex relationships among ethnicity, culture, and risk for body image and eating disorders.     

Social interactions, body image and oral health among institutionalised frail elders: an unexplored relationship

doi: 10.1111/j.1741‐2358.2011.00523.x Social interactions, body image and oral health among institutionalised frail elders: an unexplored relationship Objectives: This paper draws on theories of ageing, body image and disfigurement, to explore the potential for relationships between oral health, body image and social interactions between institutionalised elders. Background: Social relationships are important at all stages of life. A positive body image increases confidence in social interactions, which contributes substantially to health, well‐being and quality of life. Body image can be negatively impacted by oral conditions, particularly those that are appearance related and do not meet cultural ideals. Results: Typically, the oral health of frail elders in long‐term care facilities is poor, but to what extent poor oral health and dysfunction influence body image, and social behaviours is unclear. Conclusions: We conclude that there is the potential for poor oral health conditions to contribute negatively to the social well‐being in this population, but suggest that it requires further investigation.     

Visceral Adipose Tissue in Women: Longitudinal Study of the Effects of Fat Gain,Time, and Race

Objective: To determine the effects of fat gain, time, and race on the accumulation of visceral adipose tissue (VAT) in a group of normal‐weight premenopausal women. Research Methods and Procedures: Sixty‐five women participated in the study (32 African American and 33 white). The mean age of subjects was 34 ± 6 years (range, 22 to 47 years). Eligible subjects were women who had body mass indices <25 kg/m² at baseline and who had completed evaluations at baseline and at follow‐up year 1, without intervention. A subset of subjects was reevaluated annually for up to 4 years. Body composition was assessed by DXA, and VAT was determined from a single computed tomography scan. A linear mixed model was used to examine changes in VAT over time, with total body fat as a covariate Results: Total fat mass was not significantly different between races at baseline and increased significantly in both groups over time (p < 0.001). Time‐related increases in total body fat were greater in African‐American women (p < 0.01). VAT was significantly higher in white women at baseline (p < 0.01) and increased significantly over time in both races (p < 0.01), but remained higher in white women (p < 0.001). Increases in VAT, relative to total body fat, were greater than the increases in total body fat over time, independent of age and race (p < 0.001). Discussion: Gaining total body‐fat mass results in a higher increase in VAT, relative to total body fat, regardless of race and age, although African‐American women maintain a lower VAT levels across time.     

Prediction of Body Fat by Anthropometry in Older Chinese People

Objective: To derive regression equations for fat percentage by using simple anthropometric measurements applicable in normal and immobile (cannot stand or walk) older people. Research Methods and Procedures: The study population comprised 352 females and 261 males, apparently well and community‐dwelling, aged 69 to 82 years. Fifty‐one females and 27 males were recruited for external validation. Body weight, standing height, arm span, triceps and biceps skinfold thicknesses (SFTs), and midarm circumference were measured. The reference method of total body fat percentage was dual‐energy X‐ray densitometry. Predictive equations for fat percentages were derived by stepwise multiple linear regression on anthropometric indices and gender. Results: Upper‐limb SFTs, body mass index, and gender yielded the more predictive equation. The SEE was 4.1% weight. There was a significant trend of underestimation in overweight subjects, especially in females. The equation using SFTs and midarm circumference was less reliable but more applicable to older immobile people and those with significant kyphoscoliosis. Conclusions: The combination of body mass index and upper‐limb SFTs gives reliable prediction of fat percentages in older Chinese people, except in the obese.     

Relationship among Habitual Tea Consumption,Percent Body Fat,and Body Fat Distribution

Objective: To disclose the possible relationship between habitual tea consumption and changes in total body fat and fat distribution in humans. Research Methods and Procedures: A cross‐sectional survey of 1210 epidemiologically sampled adults (569 men and 641 women) were enrolled in our study. Tea consumption and other lifestyle characteristics were obtained by structured questionnaires. Percent body fat (BF%) was measured using bioelectrical impedance analysis. Body fat distribution was assessed using waist‐to‐hip ratio (WHR). Results: Among the 1103 analyzed subjects, 473 adults (42.9%) consumed tea once or more per week for at least 6 months. The habitual tea drinkers were male‐dominant, more frequently current smokers, and alcohol or coffee drinkers than the nonhabitual tea drinkers. Habitual tea drinkers for more than 10 years showed a 19.6% reduction in BF% and a 2.1% reduction in WHR compared with nonhabitual tea drinkers. The multiple stepwise regression models revealed that men, older age, higher BMI, and current smokers were positive factors for BF% and WHR. In contrast, longer duration of habitual tea consumption and higher total physical activity were negative factors for BF%. Longer duration of habitual tea consumption, higher socioeconomic status, and premenopausal status were negative factors for WHR. Discussion: An inverse relationship may exist among habitual tea consumption, BF%, and body fat distribution, especially for subjects who have maintained the habit of tea consumption for more than 10 years.