Anne M Haase

Body image and weight control in young adults: international comparisons in university students from 22 countries

Objective:Young women in the United States and Western Europe are notoriously concerned about weight but less is known about attitudes to weight in other regions of the world. This study explores the associations between body mass index (BMI), weight perceptions, and attempts to lose weight in male and female university students from 22 countries.Methods:Data were collected from 18u2009512 university students, using standardised methods, as part of the International Health Behaviour Survey. Measures included weight, height, perception of overweight, and weight loss status. BMI was calculated from weight and height, but was categorised into gender and country-standardised deciles rather than the conventional weight categories in response to the inaccuracy of self-reports. Perceived overweight and weight loss status were plotted against country-standardised BMI deciles. The 22 countries were grouped into five geopolitical/economic areas for regional analyses: North-Western Europe and the USA, Central and Eastern Europe, the Mediterranean, Pacific Asia, South America. Perceived overweight compared across the five regions.Results:Perceived overweight increased systematically across BMI deciles in all countries. More women than men felt overweight at any decile. Women had low levels of perceived overweight in the lowest decile but rates rapidly increased to 50% by the 5th decile. Men, even in the highest deciles, were less aware that they are overweight and few of them were trying to lose weight. Women had a faster rise of weight loss attempts over the BMI deciles but nevertheless the proportion trying to lose in the highest decile did not exceed 75%. Perceived overweight profiles across BMI deciles were similar across all regions, suggesting that perceptions of overweight derive from local comparisons. The patterning for trying to lose weight was more diverse, with men and women from Asian countries showing higher levels of trying to lose weight at all deciles.Conclusions:This study shows the international consistency in perceptions of overweight in educated young men and women across diverse regions of the world. It confirms the patterning of womens overestimation of weight at lower BMI deciles and mens underestimation of weight at the higher deciles. Perceptions of overweight and attempts to lose weight were highest in the group of Asian countries where body weights are generally low, suggesting that local culture and norms could moderate attitudes to weight.

Facilitated physical activity as a treatment for depressed adults: randomised controlled trial

Objective To investigate the effectiveness of facilitated physical activity as an adjunctive treatment for adults with depression presenting in primary care. Design Pragmatic, multicentre, two arm parallel randomised controlled trial. Setting General practices in Bristol and Exeter. Participants 361 adults aged 18-69 who had recently consulted their general practitioner with symptoms of depression. All those randomised had a diagnosis of an episode of depression as assessed by the clinical interview schedule-revised and a Beck depression inventory score of 14 or more. Interventions In addition to usual care, intervention participants were offered up to three face to face sessions and 10 telephone calls with a trained physical activity facilitator over eight months. The intervention was based on theory and aimed to provide individually tailored support and encouragement to engage in physical activity. Main outcome measures The primary outcome was self reported symptoms of depression, assessed with the Beck depression inventory at four months post-randomisation. Secondary outcomes included use of antidepressants and physical activity at the four, eight, and 12 month follow-up points, and symptoms of depression at eight and 12 month follow-up. Results There was no evidence that participants offered the physical activity intervention reported improvement in mood by the four month follow-up point compared with those in the usual care group; adjusted between group difference in mean Beck depression inventory score −0.54 (95% confidence interval −3.06 to 1.99; P=0.68). Similarly, there was no evidence that the intervention group reported a change in mood by the eight and 12 month follow-up points. Nor was there evidence that the intervention reduced antidepressant use compared with usual care (adjusted odds ratio 0.63, 95% confidence interval 0.19 to 2.06; P=0.44) over the duration of the trial. However, participants allocated to the intervention group reported more physical activity during the follow-up period than those allocated to the usual care group (adjusted odds ratio 2.27, 95% confidence interval 1.32 to 3.89; P=0.003). Conclusions The addition of a facilitated physical activity intervention to usual care did not improve depression outcome or reduce use of antidepressants compared with usual care alone. Trial registration Current Controlled Trials ISRCTN16900744.

Obesity, fitness and health in Taiwanese children and adolescents.

Objective:To examine the prevalence of childhood and adolescent obesity in Taiwan and investigate the association between excess weight and physical fitness and blood pressure.Design:Cross-sectional study.Subjects:A total of 13u2009935 children and adolescents aged 6–18 years (boys: 7031, girls: 6904) were involved in the 1999 survey and 24u2009586 (boys: 12u2009367, girls: 12u2009219) were available in the 2001 survey.Measurements:Weight, height, systolic and diastolic blood pressures, and health-related fitness tests (bent-leg curl-ups, sit-and-reach test and step test) were measured.Results:The overall prevalence of obesity (including overweight) in boys was 19.8% in 1999 and 26.8% in 2001. It was lower in girls with 15.2% in 1999 and 16.5% in 2001. The normal weight group performed better (P<0.05) than the overweight/obese group in all fitness tests except in the 2001 sit-and-reach test where there were no differences between the two groups. The risk of hypertension increased nearly two times for the overweight/obese-fit group and nearly three times for the overweight/obese-unfit group compared to the normal weight-fit group (adjusted odds ratio (AOR)=1.93, 95%CI=1.514–2.451 and AOR=2.93, 95%CI=2.493–3.454, respectively).Conclusion:Overall, the findings demonstrated that there is an increasing trend in overweight/obesity prevalence for Taiwanese youth even in a 2-year period. The overweight/obese youngsters tend to have poorer muscular strength and cardiovascular endurance than the normal weight group. The overweight/obese and unfit group had a greater risk of hypertension than other groups. However, this risk was significantly lower if obese/overweight children had a higher than average level of cardiovascular fitness.

Physical activity and emotional problems amongst adolescents A longitudinal study

BackgroundPromotion of physical activity (PA) is at the top of the public health agenda. However, there are few longitudinal studies investigating the relationship between PA and children’s mental health. Therefore, we aimed to investigate the association between self-reported physical activity (PA) and emotional problems 1-year later in a cohort of schoolchildren.MethodsA total of 1,446 children aged 11–14xa0years from 39 schools in the North West of England completed a self-report questionnaire in class. Each child reported the total number of sessions of sporting activities (lasting more than 20xa0min) in which they participated during the previous week, including activities both in school and out of school. This total was averaged for the week in order to determine whether the child was physically active at recommended levels (1xa0h per day). Childhood emotional problems were measured using the Strengths and Difficulties Questionnaire (SDQ) (self-report) at baseline and 1-year later. Data on potential confounders were also collected by self-report questionnaire at baseline.ResultsIn unadjusted analyses, children who, on average, participated in at least 1xa0h of sporting activity on a daily basis had fewer emotional problems at 1-year follow-up. This attenuated substantially after adjustment for gender (girls were less active but more likely to report emotional problems than boys). After adjustment for additional confounders including emotional problems at baseline, children who met recommended levels for PA had, on average, a score on the emotional problems sub-scale that was 0.29 units lower (−0.29 (95%CI: −0.61, 0.022)) at 1xa0year follow-up compared to children who did not undertake recommended levels of PA. Children who were physical activity also had higher scores on the hyperactivity sub-scale of the SDQ 1xa0year later, but there was no evidence to support an association between PA and other behavioural problems.ConclusionsChildren who met recommended levels for PA had fewer emotional problems 1-year later, although the magnitude of this difference was reduced after adjustment for confounders, particularly gender. Future longitudinal studies need to record both PA and emotional problems at more frequent intervals in order to enable us to determine the effect of maintaining a physically active lifestyle on adolescent mental health outcomes.

Physical activity and depression in adolescents: cross-sectional findings from the ALSPAC cohort

PurposeFew studies have examined the association between physical activity (PA), measured objectively, and adolescent depressive symptoms. The aim of this study was to determine whether there is an association between objective measures of PA (total PA and time spent in moderate and vigorous PA (MVPA)) and adolescent depressive symptoms.MethodsData on 2,951 adolescents participating in ALSPAC were used. Depressive symptoms were measured using the self-report Mood and Feelings Questionnaire (MFQ) (short version). Measures of PA were based on accelerometry. The association between PA and MFQ scores was modelled using ordinal regression.ResultsAdolescents who were more physically active (total PA or minutes of MVPA) had a reduced odds of depressive symptoms [ORadj total PA (tertiles): medium 0.82 (95% CI: 0.69, 0.97); high 0.69 (95% CI: 0.57, 0.83)]; ORadj per 15xa0min MVPA: 0.92 (95% CI: 0.86, 0.98). In a multivariable model including both total PA and the percentage of time spent in MVPA, total PA was associated with depressive symptoms (ORadj total PA (tertiles): medium 0.82 (95% CI: 0.70, 0.98); high 0.70 (95% CI: 0.58, 0.85) but the percentage of time spent in MVPA was not independently associated with depressive symptoms [ORadj MVPA (tertiles) medium 1.05 (95% CI: 0.88, 1.24), high 0.91 (95% CI: 0.77, 1.09)].ConclusionsThe total amount of PA undertaken was associated with adolescent depressive symptoms, but the amount of time spent in MVPA, once total PA was accounted for, was not. If confirmed in longitudinal studies and randomised controlled trials, this would have important implications for public health messages.

The effects of physique-salient and physique non-salient exercise videos on women's body image, self-presentational concerns and exercise motivation

This experiment examined the effects of exposure to physique-salient (PS) and physique non-salient (PNS) exercise videos and the moderating influence of perceived physique discrepancies, on body image, self-presentational concerns, and exercise motivation. Eighty inactive women (M age=26) exercised to a 30 min instructional exercise video. In the PS condition, the video instructor wore revealing attire that emphasized her thin and toned physique. In the PNS condition, she wore attire that concealed her physique. Participants completed pre- and post-exercise measures of body image, social physique anxiety (SPA) and self-presentational efficacy (SPE) and a post-exercise measure of exercise motivation and perceived discrepancies with the instructors body. No main or moderated effects emerged for video condition. However, greater perceived negative discrepancies were associated with poorer post-exercise body satisfaction and body evaluations, and higher state SPA. There were no effects on SPE or motivation. Results suggest that exercise videos that elicit perceived negative discrepancies can be detrimental to womens body images.

Bristol Girls Dance Project Feasibility Trial: outcome and process evaluation results

BackgroundMany adolescent girls do not engage in sufficient physical activity (PA). This study examined the feasibility of conducting a cluster randomized controlled trial (RCT) to evaluate an after-school dance program to increase PA among 11–12u2009year old girls in Bristol, UK.MethodsThree-arm, cluster RCT. Three secondary schools were assigned to intervention arm. Intervention participants received a 9-week dance program with 2, 90-minute dance classes per week. Participants at 2 control schools received incentives for data collection. Participants at 2 additional control schools received incentives and a delayed dance workshop. Accelerometer data were collected at baseline (time 0), during the last week of the dance program (time 1) and 20u2009weeks after the start of the study (time 2). Weekly attendance, enjoyment and perceived exertion were assessed in intervention participants. Post-study qualitative work was conducted with intervention participants and personnel.Results40.1% of girls provided consent to be in the study. The mean number of girls attending at least one dance session per week ranged from 15.4 to 25.9. There was greater number of participants for whom accelerometer data were collected in control arms. The mean attendance was 13.3 sessions (maximumu2009=u200918). Perceived exertion ratings indicated that the girls did not find the sessions challenging. The dance teachers reported that the program content would benefit from revisions including less creative task time, a broader range of dance genres and improved behavioral management policies. At time 2, the 95% confidence intervals suggest between 5 and 12 minutes more weekday MVPA in the intervention group compared with the control incentives only group, and between 6 minutes fewer and 1 minute more compared with the control incentives plus workshop group. Between 14 and 24 schools would be required to detect a difference of 10 minutes in mean weekday MVPA between intervention and control groups.ConclusionsIt is possible to recruit 11–12u2009year old girls to participate in an after-school dance study. An after-school dance intervention has potential to positively affect the PA levels of 11–12u2009year old girls but an adequately powered RCT is required to test this intervention approach.

Associations between body checking and disordered eating behaviors in nonclinical women

OBJECTIVEnRecent research suggests that body checking cognitions and behaviors are differentially associated with pathological eating behaviors in clinical women. However, it is unknown whether similar associations exist in nonclinical populations. The aim of this study is to examine whether body checking (cognitions and behaviors) is associated with pathological eating behaviors in a nonclinical sample of women.nnnMETHODnValidated measures of pathological eating behaviors, body checking cognitions, and body checking behaviors were completed by 342 nonclinical university women.nnnRESULTSnWomen engaging in binging (objective and subjective), purging, restraint, and excessive exercise reported consistently higher scores across all body checking cognitions and behaviors. All body checking cognitions and behaviors independently contributed to distinguishing those who reported each behavior as opposed to those who did not. The predicted classification was most accurate for the cardinal diagnostic symptoms for bulimia-objective binging and purging.nnnDISCUSSIONnBody checking cognitions are implicated in the development of pathological eating behaviors in nonclinical populations, requiring consideration for planning prevention programs.

Participants’ experiences of facilitated physical activity for the management of depression in primary care

A qualitative study was conducted within a randomised trial of facilitated physical activity for depression based on Self-Determination Theory and motivational interviewing. Interviews were held with 19 participants at 4 months, and 12 participants were re-interviewed 8 months later. The interviews were analysed in accordance with Grounded Theory using framework. Themes consisted of the following: relationship with the physical activity facilitators, mode of facilitation, impact of contact with physical activity facilitator/assimilation and future plans, change in activity, and effectiveness of physical activity facilitator techniques. Engagement in physical activity was enhanced within an autonomy-supportive environment.

Physical activity as a treatment for depression: the TREAD randomised trial protocol

BackgroundDepression is one of the most common reasons for consulting a General Practitioner (GP) within the UK. Whilst antidepressants have been shown to be clinically effective, many patients and healthcare professionals would like to access other forms of treatment as an alternative or adjunct to drug therapy for depression. A recent systematic review presented some evidence that physical activity could offer one such option, although further investigation is needed to test its effectiveness within the context of the National Health Service.The aim of this paper is to describe the protocol for a randomised, controlled trial (RCT) designed to evaluate an intervention developed to increase physical activity as a treatment for depression within primary care.Methods/designThe TREAD study is a pragmatic, multi-centre, two-arm RCT which targets patients presenting with a new episode of depression. Patients were approached if they were aged 18-69, had recently consulted their GP for depression and, where appropriate, had been taking antidepressants for less than one month. Only those patients with a confirmed diagnosis of a depressive episode as assessed by the Clinical Interview Schedule-Revised (CIS-R), a Beck Depression Inventory (BDI) score of at least 14 and informed written consent were included in the study. Eligible patients were individually randomised to one of two treatment groups; usual GP care or usual GP care plus facilitated physical activity. The primary outcome of the trial is clinical symptoms of depression assessed using the BDI four months after randomisation. A number of secondary outcomes are also measured at the 4-, 8- and 12-month follow-up points including quality of life, attitude to and involvement in physical activity and antidepressant use/adherence. Outcomes will be analysed on an intention-to-treat (ITT) basis and will use linear and logistic regression models to compare treatments.DiscussionThe results of the trial will provide information about the effectiveness of physical activity as a treatment for depression. Given the current prevalence of depression and its associated economic burden, it is hoped that TREAD will provide a timely contribution to the evidence on treatment options for patients, clinicians and policy-makers.Trial registration: ISRCTN 16900744