Riesgo para desarrollar interiorización del ideal estético de la delgadez en adolescentes mexicanas Título abreviado: Asociación de riesgo e ideal estético de delgadez / Risk to develop body thin-ideal internalization in Mexican female adolescents

Resumen En mujeres se ha reportado que a mayor índice de masa corporal (IMC), mayor interiorización del ideal estético de la delgadez (IIED), y mayor seguimiento de conductas alimentarias de riesgo (CAR). El objetivo de esta investigación consistió en determinar la presencia de CAR y de IIED en mujeres adolescentes de Hidalgo, México y su asociación tanto entre ellas como con el IMC, el porcentaje de grasa corporal (PGC), los tiempos de comida (TC) y la actividad física (AF). El estudio fue de tipo transversal con un diseño no experimental descriptivo y de asociación en una muestra no probabilística de 220 mujeres de preparatoria, de entre 14 a 18 años de edad (Medad= 15.9 ± .99), quienes respondieron una batería de cuestionarios validados. Para obtener el IMC, cada participante fue pesada y medida, mientras que el PGC se obtuvo por bioimpedancia eléctrica. Los resultados arrojaron que 17.3 % de la muestra presentó riesgo moderado y 15.5 % alto de CAR; mientras que 23.2 % registró riesgo de IIED. Se encontró que el IMC aumenta significativamente 2.7 veces el riesgo de IIED y de CAR 2.5 veces; la IIED incrementa 11.8 veces el riesgo de CAR (Odd Ratio; . < .05). Se concluye que, en la muestra de estudio, las CAR y la IIED están presentes; que a mayor IIED mayor riesgo de estas y que un exceso de peso corporal, basado en el IMC, aumenta el riesgo tanto de CAR como de IIED. Es necesario que los programas de prevención para mujeres adolescentes consideren lo anterior de manera conjunta para garantizar su éxito.

Abstract It has been reported that when females increase their body mass index (BMI), body thin-ideal internalization (BTII) increased too, as well as disordered eating behaviors (DEB). The aim of this study was to assess the presence of DEB and BTII in adolescent females from Hidalgo, Mexico. We also analyze the association between both variables, and between BMI, body fat percentage (BFP), meal times (MT) and physical activity (PA). A cross-sectional non-experimental descriptive and of association study was carried out in a no probabilistic sample of 220 high school females, aged from 14 to 18 (Mage= 15.9 ± .99). Self-reported validated questionnaires in Mexican samples were used to assess each one of the variables: the Brief Questionnaire for Risky Eating Behaviors, the Attitudes toward Body Figure Questionnaire, Risk Factors Associated to Eating Disorders for Mexican Pubescents Questionnaire (only the meal times factor was used) and the short version of the International Physical Activity Questionnaire (IPAQ). BMI was obtained by measuring each subject's weight and height; the body fat percentage (BFP) was measured through Biolectrical Impedance. The protocol was revised and approved by the Ethics and Research Committee of Health Sciences Institute of the Universidad Autónoma del Estado de Hidalgo. Descriptive analyses were held, as well as Odd Ratio to estimate the risk association. Total sample showed 17.3 % of moderate risk and 15.5 % of high risk for developing DEB; 23.2 % of the sample reported risk for BTII. From the total of females with DEB (moderate and high risk) 68.6 % also scored risk of body thin-ideal internalization. According to the BMI, results showed that 29.5 % of the sample had overweight and obesity; meanwhile for the BFP in the same categories the value was 85 %. The analysis by BMI showed that adolescents with overweigh (50 % and 39.1 %, respectively) and obesity (47.4 % and 31.6 %, respectively) achieved the highest values for both, DEB and BTII. Interestingly, participants with normal BMI had also important percentages for DEB (26.9 %) as well as BTII (17.9 %). With respect to BFP, females with overweight (41.5 % and 24.4 %, respectively) and obesity (35.6 % and 25.3 %, respectively) had the highest percentages for both DEB and BTII. Again, adolescents with normal BFP showed percentages for DEB (6.4%) and BTII (9.7 %). Findings showed that 68.6 % of the participants with risk of IIED, "never" and "few times" used to eliminate the dinner, and that 80.5 % of the sample had low level for PA. We found that BMI increases significantly 2.7 times the risk of BTII as well as 2.5 times the risk of DEB; BTII increases 11.8 times the risk of DE (Odd Ratio; p < .05). From the present data, it can be concluded that DEB and BTII are present in the sample studied, and its prevalence were higher than other studies among Mexican females. We also concluded that overweight and obese subjects, for both BMI and BFP, were the ones that obtained the higher percentages of DEB and BTII. Finally, BMI increased significantly the risk of DEB and BTII, as well as BTII increased significantly the risk of DEB. It is necessary that female adolescent prevention programs take into account this in a joint way to guarantee their success.

Factores sociales en la vivencia del cuerp de mujeres con peso normal y con obesidad: rol de la madre, el padre y la pareja / Social factors that affect the corporal experience in normal weight and obse women: the mother's role, the father and the couple

El objetivo de este estudio fue describir y comparar la influencia de factores sociales, específicamente de vínculos cercanos (madre, padre y pareja), sobre la vivencia del cuerpo en mujeres jóvenes con peso normal y con obesidad. Se realizó una investigación exploratoria cualitativa y se analizaron los datos a través de codificación abierta, basada en la Teoría Fundamentada. La muestra estuvo conformada por ocho mujeres, cuatro con obesidad mórbida y cuatro normopeso, entre 20 y 25 años. Los resultados confirman que la insatisfacción corporal está presente en todas las participantes independiente de su peso corporal. Las personas cercanas ejercen presión por la delgadez, la madre estaría más centrada en lo estético, mientras el padre expresaría mayor preocupación por la salud. Las participantes se muestran vulnerables a los mensajes contradictorios de la pareja, generando inseguridad. Sin embargo, la presión de los vínculos cercanos no sería suficiente para generar cambios de hábitos. Se observa ambivalencia entre la valoración de un cuerpo delgado y otro curvilíneo, ideales que se superponen y generan malestar.

The objective of this study was to describe the influence of social factors, specifically close affective bonds (mother, father and couple), on body experience in young women with obesity and normal weight. A qualitative exploratory research was carried out and data were analyzed with Grounded Theory. A sample of eight women between 20 and 25 years old participated, four of them with morbid obesity and four with normal weight. The results confirm that body dissatisfaction is present in all the participants, which is associated with the pressure to be thin exerted by the people close to them. Mothers are more centered on the aesthetic, while fathers seem to have more concern about health. Participants are vulnerable to the couple's conflicting messages, generating insecurity. However, the pressure of the environment does not seem to be enough to change the habits. Ambivalence is observed between the appreciation of a thin body and a curvilinear one at the same time, ideals that overlap and generate discomfort.

Vivencias y significados en torno a la imagen corporal en varones chilenos / Experiencies and perceptions on body image in Chilean males

Resumen: La imagen corporal (IC) es fundamental en el desarrollo de la identidad; sin embargo, en la población masculina la evidencia empírica es escasa. El propósito de este estudio es describir las vivencias y significados asociados a la construcción de la IC en varones, a partir de una aproximación metodológica cualitativa. Participaron 16 varones de entre 15 y 25 años de edad. Los datos fueron recolectados mediante entrevistas semiestructuradas y se formaron dos grupos focales, ambos analizados por medio de codificación abierta. Los significados y procesos asociados a la IC se clasificaron en tres categorías: Cuidado de la apariencia física, Ideal estético, Autoconcepto e IC. Los participantes percibieron diferencias en su preocupación y cuidado de la apariencia física respecto a las mujeres, los varones homosexuales o los varones de generaciones previas. En la construcción de la IC destaca el papel de la motivación por resultar atractivo al sexo opuesto, con énfasis en el incremento del desarrollo muscular. No obstante, la insatisfacción corporal no representa un tópico particularmente relevante en los participantes, dado que hacen una valoración práctica de su imagen, lo que podría ser un indicador de una nueva relación con su propia masculinidad e IC que es necesario explorar.

Abstract: Body image (BI) is a core feature for identity development; nevertheless amongst male population there is scarce empirical evidence. The aim of this study was to describe the experiences and meanings associated to the construction of BI in male, based on a methodological-qualitative approach. Participated 16 young men aged 15 to 25 years. Data were collected by semi-structured interviews and two focus groups, both analised by open codification. Meanings and procedures related to BI were classified in the following categories: physical appearance care, beauty ideal, self-concept and BI. Participants perceived differences in their physical appearance care compared with women, homosexuals and men of previous generations. In BI construction it is highlighted the drive for being attractive to the opposite sex by the increase of the muscle development. However body dissatisfaction do not represent a relevant topic for participants, since they display a pragmatic value of their BI, which may be an index of a new relationship with their own masculinity and BI that must be explored.

Desarrollo y validación de una escala para medir imagen corporal en mujeres jóvenes / Development of a scale to measure body image in young women

Introduction Body image is a concept which involves the feelings, attitudes and perceptions people have about their own body, and is influenced by the adoption of social standards. Body image studies are used in the field of eating disorders research in order to analyze the degree of body dissatisfaction. However, most of the scales proposed to assess body image have been developed in Anglo-Saxon and European countries. Therefore, research on this topic in other socio-cultural contexts requires the standardization and validation of culturally adapted instruments. The aim of the present study was to determine and discuss the reliability and validity of a Mexican scale which measures body image. Additionally, comparisons regarding body dissatisfaction, internalization of the aesthetic ideal of thinness, social influence, age and Body Mass Index (BMI) were made between groups of female college students with and without disordered eating. Materials and methods The sample of this study comprised 508 female college students from the Universidad Autónoma del Estado de México, selected by means of a probabilistic stratification procedure taking into account the proportion of female students enrolled in each academic area of the university. Their average age was 20.1 years; their mean weight was 57.2 kg with an average height of 1.58 m, whereas the average BMI was 22.8. Based on the theoretical assumptions, three indicators were defined to structure the Body Image Scale: body dissatisfaction, social influence and the internalization of the aesthetic ideal of thinness, measured by a five-point Likert-type scale ranging from never (1) to always (5). A pilot study was carried out in a population of 100 college women; as a result, some adjustments were made in the instructions and in the order of the items. Additionally, a content validation was conducted through the judgments of four professional experts in the clinical mental health area. The scale contains thirty-three items; six of them refer to criticism and family pressure to maintain a slim silhouette and twelve address body dissatisfaction. The remaining fifteen items were taken from the Attitudes Towards Body Figure Questionnaire developed by Unikel, Gomez Peresmitré and Juarez. Results After using Kaiser-Meyer-Olkin's (KMO) and Bartlett's tests for establishing the factor structure of the instrument and obtaining a value of 0.94 (p<0.001), the composition of the final version of the scale consisted of twenty-six items grouped into three factors: Factor I: Body dissatisfaction, containing 10 items, with a mean of 3.1 (s.d. = 0.8), accounting for 17.9% of the variance and with a value of Cronbach's Alpha of .84. Factor II: Internalization of the aesthetic ideal of thinness, including 10 items with a mean of 3.5 (s.d.=0.9) which explained 15.2% of the variance and with a value of Cronbach's Alpha of .89. Factor III: Social influence consisted of 6 items with a mean of 3.8 (s.d.=0.8), and accounted for 9.9% of the variance and with a value of Cronbach's Alpha of .82. A discriminant analysis was performed in order to determine if there were any differences according to body image and disordered eating and to establish the predictive validity of the scale. The results indicated that 13 of the 26 items correctly classified the body image scale in 98.2% of the original grouped cases and 97.4% of the cases grouped by cross-validation. A comparative analysis using Student's t-test was conducted among students who had high and low scores in BCCAR (Brief Questionnaire to measure Risky Eating Behaviors), yielding significant differences in their scores on all three factors of the scale. This indicates that women with disordered eating show significantly higher degrees of body dissatisfaction, internalization of the aesthetic ideal of thinness and social influence than women without disorder. Discussion The results of the study showed that the Body Image Scale has acceptable levels of validity and reliability, making it an adequate instrument for differentiating between women with and without disordered eating. The results reveal that high levels of body dissatisfaction were expressed in the majority of the sample, which is consistent with a previous study performed by Baile, Raich and Garrido in Spain, where 80% of the teenage girls expressed dissatisfaction with their body image. Lamerias et al. also found that 85% of the Spanish female college students were dissatisfied with their weight. A considerable degree of internalization of the aesthetic thin body ideal was observed in the sample, as a significant percentage of the participants with body dissatisfaction referred that body weight is important for getting nice clothes and that they are willing to do anything for a slimmer body shape. Also, physical appearance and body weight are deemed necessary for feeling fine. As the difference in body image in terms of eating behaviors risk is concerned, women presenting more risk obtained higher mean scores on the body dissatisfaction, internalization of the aesthetic thin body ideal and social influence factors, which could be a consequence of their perception of disapproval and body disgust. Troisi et al. also reported having found significant negative correlations between body image satisfaction and the presence of eating disorders. The findings of the comparison between body image dissatisfaction in terms of BMI showed that women with low weight are the least satisfied, followed by the ones who present obesity. This suggests that individuals with extreme thinness tend to have greater body image dissatisfaction, whereas Mirza, Davis and Yanovsi found that persons who are overweight or obese are the most dissatisfied. Regarding the internalization of the aesthetic thin body ideal and BMI, the highest scores were obtained in underweight women, followed by the obese ones. This is consistent with what Unikel et al. refer, mentioning that a thin body is socially perceived as more attractive, and also eating less is considered to be more feminine. It is concluded that, according to the results of the study, the proposed scale constitutes an adequate instrument for measuring body image in Mexican samples. Taking some items from already validated instruments proved to be useful for integrating all dimensions of the construct. However, it is considered necessary to obtain data on concurrent validity, sensitivity and specificity values in other samples and to determine cut-off points, in order to confirm its usefulness for research on body image.

Introducción La imagen corporal es la representación mental del cuerpo que cada individuo construye en términos de sentimiento y actitudes hacia el propio cuerpo. El propósito de este estudio es: desarrollar, validar y encontrar el grado de confiabilidad de una escala para medir la imagen corporal en dos grupos de mujeres estudiantes de nivel universitario, uno con conductas alimentarias de riesgo (CAR) y otro sin ellas, así como establecer comparaciones respecto a la edad y al índice de masa corporal (IMC). Material y método El trabajo se realizó en una muestra probabilística estratificada de 508 mujeres que estudian en la Universidad Autónoma del Estado de México. Para realizar la integración del constructo de imagen corporal se definieron tres indicadores: insatisfacción corporal, influencia social e interiorización del ideal estético de delgadez. Primero se piloteó la escala de imagen corporal compuesta por 40 reactivos aplicándose a una muestra de tipo intencional en 100 mujeres universitarias de nivel superior. Una vez modificada la escala se llevó a cabo una validación de contenido a través del método de expertos. Asimismo, para medir las conductas alimentarias de riesgo se utilizó el Cuestionario Breve para medir Conductas Alimentarias de Riesgo (CBCAR) de Unikel, Bojórquez y Carreño. Para el procesamiento de los datos se llevaron a cabo análisis de consistencia interna (Alfa de Cronbach) y análisis factorial de componentes principales con rotación varimax. Para la comparación de medias se utilizó la t de Student y para la exploración de la diferencia entre las variables de imagen corporal, una prueba de análisis de varianza (Anova de una vía) y la prueba a posteriori de Scheffé para la diferenciación entre imagen corporal, edad e IMC. Resultados La composición de la versión final de la prueba fue de 26 reactivos, integrados en tres factores: El factor I se denominó insatisfacción corporal, consta de 10 reactivos con una media de 3.1 (d.e.=0.8), un total de la varianza explicada de 17.9% y un Alfa de Cronbach de 0.84. El factor II se denominó interiorización del ideal estético de delgadez, se formó por 10 reactivos, con una media de 3.5 (d.e.=0.9), varianza explicada de 15.2% y un Alfa de Cronbach de 0.89. El factor III se denominó influencia social, se formó de seis reactivos, con una media de 3.8 (d.e =0.8), varianza explicada de 9.9% y un alfa de Cronbach de 0.82. Para observar el nivel de confiabilidad total del instrumento se realizó un análisis de consistencia interna de los 26 reactivos restantes con el cual se obtuvo un valor alfa de Cronbach de 0.94. Se llevó a cabo un análisis de comparación con la prueba t de Student la cual indicó que las mujeres con CAR mostraron mayor insatisfacción corporal, interiorización del ideal estético de la delgadez e influencia social. No se presentaron diferencias estadísticamente significativas respecto a la comparación por edad, mientras que resultaron significativas las comparaciones entre el IMC y los factores de insatisfacción corporal e interiorización del ideal estético de delgadez. Discusión La evidencia indica que la escala de medición de imagen corporal cuenta con valores de validez y confiabilidad adecuados. De la misma manera se observó una validez predictiva aceptable que permitió clasificar correctamente una elevada proporción de los casos (97.4%). Estos resultados pusieron de manifiesto que la insatisfacción corporal es un factor presente en la mayoría de la muestra estudiada. Respecto a la diferencia de medias de la imagen corporal entre mujeres que presentan CAR y las que no, se encontró que en las primeras las puntuaciones fueron mayores. En cuanto a la insatisfacción corporal y el IMC, se observó que los grupos con mayor grado de insatisfacción fueron los de las mujeres con bajo peso seguidos de las mujeres con obesidad.