Abstract

The aim of this study was to investigate nutritional status and estimate the prevalence of weight dissatisfaction among adolescents 10 to 19 years. Population-based cross-sectional study was conducted in two-stage in Campinas, Brazil. Nutritional status was classified based on percentiles of body mass index for age recommended by the World Health Organization. Weight dissatisfaction was determined by desire to gain or lose weight. Prevalence rates and 95% confidence intervals were calculated for nutritional status and weight (dis)satisfaction. The Rao-Scale chi-squared test was used for the determination of associations with sociodemographic variables. 822 adolescents were analyzed with mean age of 14.1 years. 64.7% of the boys and 75.4% of the girls were classified as normal weight, whereas 30.5% and 22.2% with excess weight, respectively. Among the boys dissatisfied with their weight, 34.5% were normal weight, 45.3% were classified as overweight and 77.1% with obesity. Whereas the girls dissatisfied with their weight, 52.0% were classified as normal weight, 63.6% as overweight and 75.2% with obesity. The prevalence of excess weight was high, especially among the boys and younger adolescents (10-14 years). Weight dissatisfaction was more prevalent among the girls and older adolescents (15-19 years).

Key words
Adolescent; Body weight; Nutritional status; Health surveys

Introduction

The increase in the prevalence of overweight and obesity in the world has become a public health challenge¹1 Sahoo K, Sahoo B, Choudhury AK, Sofi NY, Kumar R, Bhadoria AS. Childhood obesity: causes and consequences. J Family Med Prim Care 2015; 4(2):187-192.^,22 Lobstein T, Baur L, Uauy R. Obesity in children and young people: a crisis in public health. Obes Rev 2004; 5(Supl. 1):4-85.. The number of individuals with excess weight went from 921 million in 1980 to 2.1 billion in 2013, corresponding to a 27.5% increase among adults and a 47.1% increase among children and adolescents³3 Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, Mullany EC, Biryukov S, Abbafati C, Abera SF, Abraham JP, Abu-Rmeileh NM, Achoki T, AlBuhairan FS, Alemu ZA, Alfonso R, Ali MK, Ali R, Guzman NA, Ammar W, Anwari P, Banerjee A, Barquera S, Basu S, Bennett DA, Bhutta Z, Blore J, Cabral N, Nonato IC, Chang JC, Chowdhury R, Courville KJ, Criqui MH, Cundiff DK, Dabhadkar KC, Dandona L, Davis A, Dayama A, Dharmaratne SD, Ding EL, Durrani AM, Esteghamati A, Farzadfar F, Fay DF, Feigin VL, Flaxman A, Forouzanfar MH, Goto A, Green MA, Gupta R, Hafezi-Nejad N, Hankey GJ, Harewood HC, Havmoeller R, Hay S, Hernandez L, Husseini A, Idrisov BT, Ikeda N, Islami F, Jahangir E, Jassal SK, Jee SH, Jeffreys M, Jonas JB, Kabagambe EK, Khalifa SE, Kengne AP, Khader YS, Khang YH, Kim D, Kimokoti RW, Kinge JM, Kokubo Y, Kosen S, Kwan G, Lai T, Leinsalu M, Li Y, Liang X, Liu S, Logroscino G, Lotufo PA, Lu Y, Ma J, Mainoo NK, Mensah GA, Merriman TR, Mokdad AH, Moschandreas J, Naghavi M, Naheed A, Nand D, Narayan KM, Nelson EL, Neuhouser ML, Nisar MI, Ohkubo T, Oti SO, Pedroza A, Prabhakaran D, Roy N, Sampson U, Seo H, Sepanlou SG, Shibuya K, Shiri R, Shiue I, Singh GM, Singh JA, Skirbekk V, Stapelberg NJ, Sturua L, Sykes BL, Tobias M, Tran BX, Trasande L, Toyoshima H, van de Vijver S, Vasankari TJ, Veerman JL, Velasquez-Melendez G, Vlassov VV, Vollset SE, Vos T, Wang C, Wang X, Weiderpass E, Werdecker A, Wright JL, Yang YC, Yatsuya H, Yoon J, Yoon SJ, Zhao Y, Zhou M, Zhu S, Lopez AD, Murray CJ. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014; 384(9945):766-781.. Although the increase in excess weight has occurred in both rich and poor countries, 62.0% of individuals with obesity live in developing countries³3 Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, Mullany EC, Biryukov S, Abbafati C, Abera SF, Abraham JP, Abu-Rmeileh NM, Achoki T, AlBuhairan FS, Alemu ZA, Alfonso R, Ali MK, Ali R, Guzman NA, Ammar W, Anwari P, Banerjee A, Barquera S, Basu S, Bennett DA, Bhutta Z, Blore J, Cabral N, Nonato IC, Chang JC, Chowdhury R, Courville KJ, Criqui MH, Cundiff DK, Dabhadkar KC, Dandona L, Davis A, Dayama A, Dharmaratne SD, Ding EL, Durrani AM, Esteghamati A, Farzadfar F, Fay DF, Feigin VL, Flaxman A, Forouzanfar MH, Goto A, Green MA, Gupta R, Hafezi-Nejad N, Hankey GJ, Harewood HC, Havmoeller R, Hay S, Hernandez L, Husseini A, Idrisov BT, Ikeda N, Islami F, Jahangir E, Jassal SK, Jee SH, Jeffreys M, Jonas JB, Kabagambe EK, Khalifa SE, Kengne AP, Khader YS, Khang YH, Kim D, Kimokoti RW, Kinge JM, Kokubo Y, Kosen S, Kwan G, Lai T, Leinsalu M, Li Y, Liang X, Liu S, Logroscino G, Lotufo PA, Lu Y, Ma J, Mainoo NK, Mensah GA, Merriman TR, Mokdad AH, Moschandreas J, Naghavi M, Naheed A, Nand D, Narayan KM, Nelson EL, Neuhouser ML, Nisar MI, Ohkubo T, Oti SO, Pedroza A, Prabhakaran D, Roy N, Sampson U, Seo H, Sepanlou SG, Shibuya K, Shiri R, Shiue I, Singh GM, Singh JA, Skirbekk V, Stapelberg NJ, Sturua L, Sykes BL, Tobias M, Tran BX, Trasande L, Toyoshima H, van de Vijver S, Vasankari TJ, Veerman JL, Velasquez-Melendez G, Vlassov VV, Vollset SE, Vos T, Wang C, Wang X, Weiderpass E, Werdecker A, Wright JL, Yang YC, Yatsuya H, Yoon J, Yoon SJ, Zhao Y, Zhou M, Zhu S, Lopez AD, Murray CJ. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014; 384(9945):766-781..

In Brazil, the periodic execution of health surveys has enabled monitoring the nutritional status of the population. The Vigitel (Vigitel - Surveillance System of Risk and Protection Factors of Noncommunicable Disease by Telephone Survey) showed a trend toward an increase in excess weight (42.6 to 53.8%) and obesity (11.8 to 18.9%) among adults (≥ 18 years of age) residing in Brazilian capital cities and the Federal District in the 10 years between 2006 and 2016⁴4 Brasil. Ministério da Saúde (MS). Vigitel Brasil 2016: vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico. Brasília: MS; 2017.. The National School Health Survey (Pesquisa Nacional de Saúde do Escolar - PeNSE, 2015) found that 23.7% of adolescents between 13 and 17 years of age were overweight and 7.8% were obese⁵5 Instituto Brasileiro de Geografia e Estatística (IBGE). Pesquisa Nacional de Saúde do Escolar 2015. Rio de Janeiro: IBGE; 2016.. The 2008-2009 Household Budget Survey (Pesquisa de Orçamentos Familiares - POF) reports 20.5% and 4.9% rates of overweight and obesity among adolescents between 10 and 19 years of age⁶6 Instituto Brasileiro de Geografia e Estatística (IBGE). Pesquisa de Orçamentos Familiares 2008-2009: Antropometria e Estado Nutricional de Crianças, Adolescentes e Adultos no Brasil. Rio de Janeiro: IBGE; 2010. [acessado 2017 Set 15]. Disponível em: http://biblioteca.ibge.gov.br/visualizacao/livros/liv45419.pdf.

In this epidemic of excess weight, data from the PeNSE (2015) revealed that 80.0% of students considered their body image to be important or very important, but approximately 40.0% made no attempt to alter their body weight⁵5 Instituto Brasileiro de Geografia e Estatística (IBGE). Pesquisa Nacional de Saúde do Escolar 2015. Rio de Janeiro: IBGE; 2016.. Excess weight is a disease that can cause physical and emotional harm, with consequences experienced throughout life⁷7 Baker KD, Loughman A, Spencer SJ, Reichelt AC. The impact of obesity and hypercaloric diet consumption on anxiety and emotional behavior across the lifespan. Neurosci Biobehav Rev 2017; 83:173-182.^,88 Luiz AMAG, Gorayeb R, Liberatore Júnior RDR, Domingos, NAM. Depressão, ansiedade e competência social em crianças obesas. Estud psicol (Natal) 2005; 10(1):35-39.. Children and adolescents with obesity are at greater risk of mortality, obesity in adulthood and the early development of cardiovascular disease, diabetes¹1 Sahoo K, Sahoo B, Choudhury AK, Sofi NY, Kumar R, Bhadoria AS. Childhood obesity: causes and consequences. J Family Med Prim Care 2015; 4(2):187-192.^,99 Güngör NK. Overweight and obesity in children and adolescents. J Clin Res Pediatr Endocrinol 2014; 6(3):129-143.^,1010 Goldhaber-Fiebert JD, Rubinfeld RE, Bhattacharya J, Robinson TN, Wise PH. The utility of childhood and adolescent obesity assessment in relation to adult health. Med Decis Making 2013; 33(2):163-175. and psychological problems, such as depression and anxiety⁷7 Baker KD, Loughman A, Spencer SJ, Reichelt AC. The impact of obesity and hypercaloric diet consumption on anxiety and emotional behavior across the lifespan. Neurosci Biobehav Rev 2017; 83:173-182.^,88 Luiz AMAG, Gorayeb R, Liberatore Júnior RDR, Domingos, NAM. Depressão, ansiedade e competência social em crianças obesas. Estud psicol (Natal) 2005; 10(1):35-39.^,1111 Pryor L, Brendgen M, Boivin M, Dubois L, Japel C, Falissard B, Tremblay RE, Côté SM. Overweight during childhood and internalizing symptoms in early adolescence: The mediating role of peer victimization and the desire to be thinner. J Affect Disord 2016; 15(202):203-209.. Moreover, children and adolescents with excess weight tend to have greater dissatisfaction with their bodies and want to be thin¹¹11 Pryor L, Brendgen M, Boivin M, Dubois L, Japel C, Falissard B, Tremblay RE, Côté SM. Overweight during childhood and internalizing symptoms in early adolescence: The mediating role of peer victimization and the desire to be thinner. J Affect Disord 2016; 15(202):203-209.^,1212 Michels N, Amenyah SD.Body size ideals and dissatisfaction in Ghanaian adolescents: role of media, lifestyle and well-being. Public Health 2017; 146:65-74..

Projections regarding what is considered the ideal body differ between the sexes. In girls, there is a desire for a thin body in line with the idealization imposed by social representations. The female body is expected to be attractive, slender and healthy, with a median height¹³13 Secchi K, Camargo BV, Bertoldo RB. Percepção da Imagem Corporal e Representações Sociais do Corpo. Psic: Teor e Pesq 2009; 25(2):229-236.^,1414 Duca GFD, Garcia LMT, Sousa TF, Oliveira ESA, Nahas, MV. Insatisfação com o peso corporal e fatores associados em adolescentes. Rev Paul Pediatr 2010; 28(4):340-346.. For males, the expectations are a taller body, broad shoulders and well-defined, rigid muscles, especially the biceps and abdomen¹⁴14 Duca GFD, Garcia LMT, Sousa TF, Oliveira ESA, Nahas, MV. Insatisfação com o peso corporal e fatores associados em adolescentes. Rev Paul Pediatr 2010; 28(4):340-346.^,1515 Silva MLA, Taquette SR, Coutinho ESF. Senses of body image in adolescents in elementary school. Rev Saude Publica 2014; 48(3):438-444..

Although body image is considered important and there is an expectation to achieve a body standard that corresponds to social representations, many adolescents are overweight and do nothing to change this situation. Excess weight and excessive concern with one’s physical appearance can harm one’s health. Therefore, the aim of the present study was to investigate nutritional status and estimate the prevalence of dissatisfaction with body weight among adolescents 10 to 19 years of age, testing the hypothesis that dissatisfaction with body weight differs between the sexes, age groups and classifications of nutritional status.

Methods

A population-based cross-sectional study was conducted using data from the 2008-2009 Health Survey in the city of Campinas, state of São Paulo, Brazil. This survey was conducted with the community-dwelling population living in urban areas of Campinas in the period between 2008 to 2009.

The sample was determined using a two-stage probabilistic cluster sampling procedure. In the first stage, 50 census sectors were randomly selected with probability proportional to size (number of homes). The sectors established by the Brazilian Institute of Geography and Statistics for the 2000 demographic census were used. Considering the time elapsed since the census and the present study, a survey of the homes in the selected sectors was performed for the obtainment of an updated list of addresses. Homes were randomly selected from the census sectors in the second stage.

The population of the survey was composed of three age groups: adolescents (10 to 19 years), adults (20 to 59 years) and seniors (60 years or older). The sample size was obtained considering a 50% prevalence rate, 95% confidence interval, a sampling error of 4 to 5 percentage points and a design effect of 2, totaling 1000 individuals for each age group. Expecting an 80% response rate, the sample was correct to 1250. To reach the desired sample size, 2150, 700 and 3900 homes were independently selected for interviews with adolescents, adults and seniors, respectively.

The data were collected using a questionnaire organized into 14 thematic blocks, which had been tested in a pilot study and administered by trained and supervised interviewers. The section on eating habits had items addressing reported weight and height, whether the respondents wished to change his/her body weight, how much the respondent would like to weigh, and practices performed to achieve weight loss.

The present study was limited to the data on the adolescents (10 to 19 years of age), which were divided into two age ranges: 10 to 14 and 15 to 19 years. This classification was based on the fact that the majority of individuals between 10 to 14 years are at the onset or in the middle of puberty and the majority of those between 15 and 19 years have undergone puberty and are closer to adulthood. The interviews were administered directly to the adolescents with or without the participation of their parents. The dependent variable was determined based on the answers to the following questions:

1. Would you like to gain or lose weight? (no / yes, gain weight / yes, lose weight). If the answer was “yes”, the following question was posed:

2. How much would you like to weigh?

Adolescents who reported wanting to gain or lose weight were considered dissatisfied with their body weight. Those who wanted to lose weight were categorized into two groups: those who wanted to lose < 10% and those that wanted to lose ≥ 10% of the weight reported at the time of the survey. This cutoff point was defined by the authors of the present study based on the fact that it presented the best distribution of the available data.

The following were the independent variables analyzed:

Demographic and socioeconomic characteristics: sex (male / female), age group (10 to 14 / 15 to 19 years), family income per capita using the Brazilian monthly minimum wage (BMMW) as reference (< BMMW / ≥ BMMW to < 2 times the BMMW / ≥ 2 times the BMMW) and schooling of the head of the family (0 to 7 / 8 to 11 / 12 or more years of study).

Body Mass Index (BMI): calculated from reported weight and height (kg/m²). The percentile cutoff points of BMI for age proposed by the World Health Organization were used. The adolescents were classified as underweight (< 3^rd percentile), normal weight (3^rd to 85^th percentile), overweight (> 85^th to 97^th percentile) or obese (> 97^th percentile)¹⁶16 de Onis M, Onyango AW, Borghi E, Siyam A, Nishida C, Siekmann J. Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ 2007; 85(9):660-667..

In the statistical analyses, prevalence rates and 95% Confidence Intervals (95% CI) were estimated for the classifications of nutritional status according to the sociodemographic variables. Next, the prevalence of satisfaction and dissatisfaction with weight was calculated based on nutritional status, sex and age. Associations were determined using the Rao-Scott chi-squared test with the level of significance set to 5%.

The data were entered into a database created using EpiData 3.1 (EpiData Association, Odense, Denmark) and the statistical analyses were performed using the svy module of Stata 14.0 (Stata Corporation, College Station, Texas, USA), which enables the analysis of data from complex samples.

The project for this study received approval from the Human Research Ethics Committee of the School of Medical Sciences of the State University of Campinas. Participants aged 18 years or older and parents/guardians of those under 18 years of age signed a statement of informed consent.

Results

A total of 822 adolescents were analyzed. Mean age was 14.1 years (95% CI: 13.8 to 14.3). Among the boys, 64.7% were in the normal BMI range, 17.1% were overweight and 13.3% were obese. Among the girls, 75.4% were in the normal BMI range, 15.3% were overweight and 6.9% were obese. Compared to the boys, the prevalence of the normal weight was higher and the prevalence of obesity was lower among the girls (Table 1). Significant differences were found between the two age groups (p < 0.001). The prevalence of the normal weight was higher (79.0%) and the prevalence of overweight (12.1%) and obesity (5.5%) was lower among the older adolescents (15 to 19 years of age). No significant associations were found between nutritional status and family income per capita or schooling of the head of the household (Table 1).

A total of 51.2% of the adolescents were satisfied with their weight, 14.3% wanted to gain weight, 16.2% wanted to lose < 10% and 18.3% wanted to lose ≥ 10% of their body weight. In the group of younger adolescents (10 to 14 years), 63.9% of those with normal weight, 58.2% of those classified as overweight and 30.3% of those classified with obesity were satisfied with their weight (Table 2). The prevalence of dissatisfaction with body weight was higher among the different categories of nutritional status in the group of older adolescents (15 to 19 years): 50.2% of those with normal weight, 75.2% of those with excess weight and 95.5% of those with obesity were dissatisfied with their body weight. In contrast, 49.8% of those with normal weight, 24.7% of those with excess weight and 4.4% of those with obesity were satisfied with their body weight (Table 2).

Among the boys with obesity, 22.9% reported being satisfied with their weight, 28.2% were in the younger age group (10 to 14 years) and 6.9% were in the older age group (15 to 19 years), demonstrating greater satisfaction among the younger adolescents with obesity. A total of 71.6% of the boys between 10 and 14 years of age and 93.0% of those between 15 and 19 years of age wanted to lose weight (Table 2).

Among the girls with obesity, 24.9% reported being satisfied with their weight and 34.7% were in the younger age group (10 to 14 years). A total 75.2% of the girls with obesity, 65.2% of those between 10 and 14 years of age and 99.9% of those between 15 and 19 years of age wanted to lose weight. Statistically significant differences were found in the analysis of the categories of nutritional status according to sex and age (Table 2).

Discussion

In the present study, the prevalence of overweight and obesity was high among the adolescents, especially the boys and younger adolescents (10 to 14 years). Moreover, the prevalence of satisfaction with body weight was lower among the girls and older adolescents (15 to 19 years).

A total of 17.1% and 13.3% of the boys were overweight and obese, respectively, whereas the rates were respectively 15.3% and 6.9% among the girls. These values are higher that what was expected for the cutoff points of BMI for age (> 85^th percentile), which would be 12.0% overweight and 2.9% obese¹⁶16 de Onis M, Onyango AW, Borghi E, Siyam A, Nishida C, Siekmann J. Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ 2007; 85(9):660-667.. Data from the 2008-2009 Household Budget Survey show that 15.7% and 5.8% of boys were overweight and obese, respectively, whereas these values were respectively 15.4% and 4.0% for girls⁶6 Instituto Brasileiro de Geografia e Estatística (IBGE). Pesquisa de Orçamentos Familiares 2008-2009: Antropometria e Estado Nutricional de Crianças, Adolescentes e Adultos no Brasil. Rio de Janeiro: IBGE; 2010. [acessado 2017 Set 15]. Disponível em: http://biblioteca.ibge.gov.br/visualizacao/livros/liv45419.pdf. Thus, higher rates of overweight and obesity were found in the city of Campinas compared to national data, with the exception of the overweight category among girls. Data from the PeNSE (2009) revealed that 16.0% of students in the 9^th year of basic education were overweight and 7.2% were obese¹⁷17 Instituto Brasileiro de Geografia e Estatística (IBGE). Pesquisa Nacional de Saúde do Escolar 2009. Avaliação do Estado Nutricional dos Escolares do 9º Ano do Ensino Fundamental. Rio de Janeiro: IBGE; 2010. [acessado 2017 Set 15]. Disponível em: http://biblioteca.ibge.gov.br/visualizacao/livros/liv45415.pdf
http://biblioteca.ibge.gov.br/visualizac... , which are much closer to the rates found in the present study (16.2% overweight and 10.2% with obesity).

The present findings reveal the overweight and obesity were more prevalent among the boys than the girls. A systematic review that analyzed trends in overweight and obesity between 1980 and 2013 in Canada found a greater frequency of excess weight among males (25.5% versus 22.0%), whereas the prevalence was higher among females in the Unites States (29.7% versus 28.8%), although this difference was non-significant³3 Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, Mullany EC, Biryukov S, Abbafati C, Abera SF, Abraham JP, Abu-Rmeileh NM, Achoki T, AlBuhairan FS, Alemu ZA, Alfonso R, Ali MK, Ali R, Guzman NA, Ammar W, Anwari P, Banerjee A, Barquera S, Basu S, Bennett DA, Bhutta Z, Blore J, Cabral N, Nonato IC, Chang JC, Chowdhury R, Courville KJ, Criqui MH, Cundiff DK, Dabhadkar KC, Dandona L, Davis A, Dayama A, Dharmaratne SD, Ding EL, Durrani AM, Esteghamati A, Farzadfar F, Fay DF, Feigin VL, Flaxman A, Forouzanfar MH, Goto A, Green MA, Gupta R, Hafezi-Nejad N, Hankey GJ, Harewood HC, Havmoeller R, Hay S, Hernandez L, Husseini A, Idrisov BT, Ikeda N, Islami F, Jahangir E, Jassal SK, Jee SH, Jeffreys M, Jonas JB, Kabagambe EK, Khalifa SE, Kengne AP, Khader YS, Khang YH, Kim D, Kimokoti RW, Kinge JM, Kokubo Y, Kosen S, Kwan G, Lai T, Leinsalu M, Li Y, Liang X, Liu S, Logroscino G, Lotufo PA, Lu Y, Ma J, Mainoo NK, Mensah GA, Merriman TR, Mokdad AH, Moschandreas J, Naghavi M, Naheed A, Nand D, Narayan KM, Nelson EL, Neuhouser ML, Nisar MI, Ohkubo T, Oti SO, Pedroza A, Prabhakaran D, Roy N, Sampson U, Seo H, Sepanlou SG, Shibuya K, Shiri R, Shiue I, Singh GM, Singh JA, Skirbekk V, Stapelberg NJ, Sturua L, Sykes BL, Tobias M, Tran BX, Trasande L, Toyoshima H, van de Vijver S, Vasankari TJ, Veerman JL, Velasquez-Melendez G, Vlassov VV, Vollset SE, Vos T, Wang C, Wang X, Weiderpass E, Werdecker A, Wright JL, Yang YC, Yatsuya H, Yoon J, Yoon SJ, Zhao Y, Zhou M, Zhu S, Lopez AD, Murray CJ. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014; 384(9945):766-781..

Among the girls in the present study, the prevalence of the normal BMI range was higher and the prevalence of satisfaction with body weight was lower. This may be explained by the fact that adolescent girls are more concerned with appearance, place considerable importance on being slender and are more attentive to and influenced by advertising and the opinions of friends, whereas boys internalize their ideal for larger, more muscular bodies and do not express their body concerns¹⁸18 Toro J, Gila A, Castro J, Pombo C, Guete O. Body image, risk factors for eating disorders and sociocultural influences in Spanish adolescents. Eat Weight Disord 2005; 10(2):91-97.^,1919 Hargreaves DA, Tiggemann M. 'Body image is for girls': a qualitative study of boys' body image. J Health Psychol 2006; 11(4):567-576.. Data from the PeNSE (2009) reveal that girls were most exposed to inadequate eating practices, with higher frequencies of the regular consumption (≥ 5 days a week) of treats, cookies and processed meats as well as lower frequencies of the regular consumption of milk and beans and the habit of having lunch or dinner with their mothers or guardians²⁰20 Levy RB, Castro IR, Cardoso LO, Tavares LF, Sardinha LM, Gomes FS, Costa AW. Food consumption and eating behavior among Brazilian adolescents: National Adolescent School-based Health Survey (PeNSE), 2009. Cien Saude Colet 2010; 15(Supl. 2):3085-3097.. A study conducted in a municipality in the state of Paraná (southern Brazil) involving 2562 adolescent students between 14 and 19 years of age found that boys consumed more fruits, beans and milk and ate the main meals of the day more than girls²¹21 Costa M, Cordoni Júnior L, Matsuo T. Hábito alimentar de escolares adolescentes de um município do oeste do Paraná. Rev Nutr 2007; 20(5):461-471.. The omission of meals is an inadequate behavior often adopted by the female sex in an attempt to lose weight²²22 Miranda VP, Conti MA, Carvalho PH, Bastos RR, Ferreira ME. Body image in different periods of adolescence. Rev Paul Pediatr 2014; 32(1):63-69..

While the prevalence of overweight and obesity was higher among the younger adolescents (10 to 14 years), the older adolescents (15 to 19 years) had a greater frequency of dissatisfaction with body weight in all nutritional status categories. Among the younger adolescents, only those with obesity had a high frequency of dissatisfaction with body weight (69.6%), indicating that the older adolescents were more concerned with their weight. Similar results have been reported in previous studies, in which the prevalence of overweight and obesity was higher among boys 15 to 19 years of age compared to those between 10 and 14 years of age²³23 Neutzling MB, Taddei JA, Rodrigues EM, Sigulem DM. Overweight and obesity in Brazilian adolescents. Int J Obes Relat Metab Disord 2000; 24(7):869-874. and postpubescent girls (12 to 14 years) were most dissatisfied with their bodies than prepubescent girls (10 to 11 years) due to the greater concern and attention given to body characteristics that attract the opposite sex, making girls more susceptible to dissatisfaction with their bodies²⁴24 Conti M, Gambardella A, Frutuoso M. Insatisfação com a imagem corporal em adolescentes e sua relação com a maturação sexual. Rev Bras Crescimento Desenvolv Hum 2005; 15(2):36-44.. Adolescents generally become more critical of themselves and more concerned with appearance as they get older²⁵25 Oliveira TRPR, Cunha CF. Aspectos cognitivos e emocionais de adolescentes com excesso de peso e seus responsáveis. Rev Med Minas Gerais 2008; 18(4 Supl. 1):S13-S19..

A total of 48.8% of the participants wanted to lose or gain weight. Analyzing dissatisfaction with body image, Conti et al.²⁴24 Conti M, Gambardella A, Frutuoso M. Insatisfação com a imagem corporal em adolescentes e sua relação com a maturação sexual. Rev Bras Crescimento Desenvolv Hum 2005; 15(2):36-44. found that adolescents of both sexes demonstrated concerns with weight, body size and appearance; the aspects that most caused dissatisfaction were weight, stomach and thighs among the boys and weight, chest/breasts and stomach among the girls. In a study conducted with 573 adolescents with normal weight range in the city of Campinas, Brazil, the prevalence of dissatisfaction with weight was 43.8% (95% CI: 37.9 to 49.8), with greater dissatisfaction found among the girls, adolescents between 15 and 19 years of age, those that had a larger number of appliances in the home, ex-smokers, those that consumed alcoholic beverages and those that reported a medical diagnosis of chronic diseases²⁶26 Martini MCS, Assumpção D, Barros MBA, Canesqui AM, Barros Filho AA. Are normal-weight adolescents satisfied with their weight? Sao Paulo Med J 2016; 134(3):219-227.. In a study conducted in the city of Caruaru (northeast Brazil), 80.8% of adolescent girls and 59.5% of adolescent boys with excess weight (overweight/obesity) wanted to lose weight²⁷27 Santos EMC, Tassitano RM, Nascimento WMF, Petribú MMV, Cabral PC. Satisfação com o peso corporal e fatores associados em estudantes do ensino médio. Rev Paul Pediatr 2011; 29(2):214-223.. These values are higher than those found in the present investigation.

In a study conducted in the city of Vitória (southeast Brazil), 86.0% of the adolescents were in the normal weight range and 14.0% were overweight, but 62.7% wanted to lose weight, 23.2% wanted to gain weight and 14.0% wanted to gain muscle mass, demonstrating that the individuals did not have perceptions of their bodies in line with the results of the nutritional assessment²⁸28 Braga PD, Molina MCB, Cade NV. Expectativas de adolescentes em relação a mudanças do perfil nutricional. Cien Saude Colet 2007; 12(5):1221-1228.. A study conducted with 831 students in the 8^th grade of basic education in the city of Porto Velho (northern Brazil) identified greater dissatisfaction with body image among the girls and individuals with excess weight (overweight or obesity); moreover, those classified as underweight were more satisfied with their body image than those in the normal weight range²⁹29 Evangelista LA, Aerts D, Alves GG, Palazzo L, Câmara S, Jacob MH. Percepção da imagem corporal em escolares do norte do Brasil. J Hum Growth Dev 2016; 26(3):385-392.. Analyzing more than 9000 high school students in New Zealand, researchers found that 60.6% (95% CI: 59.1 to 62.1) of the boys and 38.5% (95% CI: 37.2 to 39.9) of the girls were happy with their weight and that body satisfaction was higher among those who had friends with whom to talk, those with friends who cared about healthy eating and physical activity, those who had parents that stimulated the practice of physical exercise and the adoption of a healthy diet and those who were not teased by their families because of their weight³⁰30 Wood A, Utter J, Robinson E, Ameratunga S, Fleming T, Denny S. Body weight satisfaction among New Zealand adolescents: findings from a national survey. Int J Adolesc Med Health 2012; 24(2):161-167..

The influence of the media on the standardization of the ideal of beauty can lead to physical and emotional problems in adolescents, such as discontent with and the non-acceptance of one’s own body, the constant desire for modifications (such as plastic surgery), a distorted body image and eating disorders, especially anorexia and bulimia³¹31 Le Breton D. Adeus ao corpo: antropologia e sociedade. Campinas: Papirus; 2003.. A distorted body image (overestimated or underestimated body shape and/or size) is a frequent problem in many adolescents²⁴24 Conti M, Gambardella A, Frutuoso M. Insatisfação com a imagem corporal em adolescentes e sua relação com a maturação sexual. Rev Bras Crescimento Desenvolv Hum 2005; 15(2):36-44..

The present study has limitations that should be considered, such as the use of self-reported information regarding weight and height in adolescents, who are in a constant state of body transformation, with rapid growth and physical development. However, studies have reported a good level of agreement between measured and reported weight and height in this population, considering it valid to use self-reported information in epidemiological studies³²32 Farias Júnior JC. Validade das medidas auto-referidas de peso e estatura para o diagnóstico do estado nutricional de adolescentes. Rev Bras Saúde Matern Infant 2007; 7(2):167-174.^,3333 Pursey K, Burrows TL, Stanwell P, Collins CE. How accurate is web-based self-reported height, weight, and body mass index in young adults? J Med Internet Res 2014; 16(1):e4.. Another limitation was the fact that dissatisfaction with body weight was not measured using a scale, but rather a closed-ended question addressing whether the adolescent would like to gain or lose weight. The strengths of this study include the use of data from a population-based survey and a design with a detailed analysis to identify sociodemographic differences regarding nutritional status categories and (dis)satisfaction with body weight. Another strong point was the categorization of participants who wanted to lose weight based on the desired reduction (< 10% or ≥ 10% of body weight).

It should be pointed out that Brazil drafted a Strategic Action Plan to Combat Chronic Non-Communicable Diseases, establishing commitments and investments to reduce the prevalence of obesity among adolescents between 2011 and 2022³⁴34 Brasil. Ministério da Saúde (MS). Plano de ações estratégicas para o enfrentamento das doenças crônicas não transmissíveis (DCNT) no Brasil 2011-2022. Brasília: MS; 2011. [acessado 2017 Set 15]. Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/plano_acoes_enfrent_dcnt_2011.pdf
http://bvsms.saude.gov.br/bvs/publicacoe... . Another measure of considerable importance is the Inter-Sector Strategy for the Prevention and Control of Obesity, which sets guidelines for states and municipalities through intersectoral actions involving the participation of civil society, a healthy diet, the regular practice of physical exercise and the control of advertising, especially at schools and places frequented by adolescents³⁵35 Brasil. Ministério do Desenvolvimento Social e Combate à Fome. Estratégia Intersetorial de Prevenção e Controle da Obesidade: recomendações para estados e municípios. Brasília: Ministério do Desenvolvimento Social e Combate à Fome; 2014..

Dissatisfaction with one’s body weight can lead to inadequate health behaviors and interfere with the growth and development of adolescents. The results of the present study can contribute to the discussion of this issue and the planning of public policies. These findings can also assist health professionals in understanding the desires and anguish of each adolescent with regards to his/her weight.

In conclusion, the prevalence of excess weight was high in the present study, especially among boys and individuals between 10 and 14 years of age. No significant association was found between nutritional status and family income per capita or the level of schooling of the head of the household. The prevalence of dissatisfaction with weight was higher among the girls as well as adolescents between 15 and 19 years of age.

Acknowledgments

The authors are grateful to the Conselho Nacional de Desenvolvimento Científico e Tecnológico (National Council of Scientific and Technological Development - CNPq) for funding the study and for the master’s grant awarded to MCS Martini and to the Fundação de Amparo à Pesquisa do Estado de São Paulo (São Paulo Research Foundation - FAPESP) for the productivity grant awarded to MBA Barros. The Campinas Municipal Secretary of Health and the Secretary of Health Surveillance of the Brazilian Health Ministry funded the fieldwork of the 2008-2009 City of Campinas Health Survey.

References

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