Health-Related Lifestyles in Relation to Body Mass Index Among Young and Middle-Aged Women in Japan.

Background: Being underweight, overweight, or obese can lead to adverse health effects. Hence, it is important to understand the specific factors that change the burden of underweight and overweight to target appropriate disease control strategies. This study was designed to examine the prevalence and factors associated with underweight and overweight among young and middle-aged women in Japan. Materials and Methods: A cross-sectional study was conducted among women aged 20-59 years who participated in health checkups at a regional health care center in 2018 and 2019 (N = 1722). The assessments included anthropometric, blood pressure measurements, and a standardized self-administered questionnaire. Multivariable logistic regression analysis assessed lifestyle factors associated with body mass index for underweight <18.5 kg/m2) and overweight/obesity (25.0 kg/m2 and above). Results: The prevalence of underweight and overweight/obesity were 12.3%, and 22.5%, respectively. No lifestyle factors were found to be significantly associated with being underweight. Having dinner within 2 hours before bed was positively associated with being overweight/obese [adjusted odds ratio (AOR): 1.448, 95% confidence interval (CI): 1.014-2.068]. Women who gained 10 kg since their 20s were more likely to fall into overweight/obesity category (AOR: 9.674, 95% CI: 1.014-2.068). Women who were using a lipid-lowering medication (AOR: 3.150, CI: 1.892-5.246) were associated with three times higher risk of being overweight/obese. Hypertension and dyslipidemia were significantly associated with overweight/obesity (AOR: 3.094, 95% CI: 2.201-4.351 and AOR: 2.498, 95% CI: 1.831-3.409, respectively). Conclusion: One in five middle-aged women was overweight or obese, whereas one in eight was underweight. In relation to the prevention of overweight/obesity, specific health promotion messages regarding eating timing should be developed.

A comparative study of the culture of thinness and nutrition transition in university females in four countries.

The purpose of this study was to examine the nutrition transition in four countries with respect to body dissatisfaction and eating styles. The target population for this study was college students in China (n=207), Japan (n=865), Jordan (n=322), and the United States (n=432). A cross-sectional survey was used to assess eating styles, disordered eating attitudes and behaviors, body esteem and dissatisfaction, and media influence. Results indicated that the Chinese sample was in an earlier stage of the nutrition transition, followed by Japan, Jordan, and the US. Interestingly, Jordanian and Chinese students exhibited the lowest level of body dissatisfaction. However, Jordanian students exhibited high levels of restrained eating similar to those seen in the Japanese and American students. The Japanese sample demonstrated a complex relationship between the culture of thinness, body dissatisfaction and eating styles. However the US sample reflected the expected levels of body dissatisfaction, high levels of restrained eating, emotional eating, and disordered eating attitudes and behaviors. Implications and suggestions for further research are discussed.

Obesity and body size preferences of Jordanian women.

The nutrition transition is associated with increased obesity rates and increased desire to be thin. This study evaluates the relationship between actual body size and desired body size among a representative sample of 800 Jordanian women. Using Stunkard's body silhouettes, women were asked to identify their current and ideal body sizes, healthy body size, and their perception of the body size preferred by men. Body mass index (BMI) calculations indicate that 53.8% of the women were overweight or obese. Their mean current body size was 5, which is consistent with the mean BMI of 26 in the sample. Although 66% of the women were dissatisfied with their body size, the desired weight loss was not extreme. Pearson correlation was positive (.858, p <.0001) between measured BMI and body silhouettes chosen as an indicator of current body size. Jordanian women seemed pulled between the traditional and Westernized body preferences. Possible cultural explanations are explored.

Young urban women and the nutrition transition in China: a familiar pattern emerges.

The purpose of this study was to assess the nutrition transition being experienced by urban Chinese college females. The self-administered cross-sectional survey was given to female students attending universities in the urban area of Xi'an, China. The survey was a collection of previously validated instruments measuring motivations for eating, disordered attitudes and behaviors, societal and media influences on body image and eating disturbances, body esteem, body dissatisfaction, and demographic questions. Results from 207 Chinese college females indicated that they had high levels of dietary restraint, despite the large proportion of participants who were considered underweight and normal weight. In addition, the results indicated that these college females ate primarily based on hunger cues. They also had a strong desire to lose weight sometimes to ultra thin and unhealthy levels, but with only moderate levels of disordered eating attitudes and behaviors. It appears that for participants in this study, at their current point in the nutrition transition, the full negative impact of Americanized media may not yet be fully internalized. The study has revealed a need for the development of health education programs to promote healthy eating styles and appropriate dieting behaviors. Future research needs to develop strategies for better understanding the impact of Americanization on the body image of women in this type of transitional population.

Classroom approach for managing dietary restraint, negative eating styles, and body image concerns among college women.

OBJECTIVE: In this exploratory study, the authors evaluated the impact of an elective college course on dieting levels, eating styles, and body image among college women. PARTICIPANTS: Participants were a convenience sample of 29 self-selected female students at a western university who were mostly white, normal-weight seniors with significant dieting experience. METHODS: The authors used valid and reliable instruments to collect data both before and after testing. An instructor conducted the program in an undergraduate course that met twice weekly for 15 weeks. Theory-based lessons focused on resisting media pressure, modifying dietary restraint, eating in response to hunger (intrinsic eating), and achieving healthy body image. Dependent variables included intrinsic eating, dieting involvement, emotional eating, body image, and self-esteem. RESULTS: A comparison of pretest and posttest scores identified significant improvements for most measures. CONCLUSIONS: A theory-driven elective course implemented within a college setting may improve women's eating styles and body image.

The forgotten dimensions in health education research.

This paper evaluates the content focus of health education research as presented in the professional literature over a 6-year period (2000-2005). The majority of research (1365 papers) addresses the physical dimension of health (79%), while other health dimensions receive less attention. It is argued that the current content focus of research in health education fails to harmonize with the multidimensional, dynamic and functional nature of health as generally defined. The goal of health education, positive behavior change, also seems less reachable without a better understanding of how nonphysical dimensions of health influence wellness behaviors. At present, there exists an opportunity for health educators to move toward research agendas that more fully appreciate the interconnectedness of various dimensions of health and that evaluate them evenhandedly. Practical application of this approach will require a partial break from the biological orientations of other health professions, new research agendas that clarify multidimensional health relationships and new programs that seek to influence outcomes in a variety of dimensions.

The impact of body mass index and Western advertising and media on eating style, body image and nutrition transition among Jordanian women.

OBJECTIVES: To identify the impact of body mass index (BMI) and Western advertising and media on the stage of the nutrition transition among Jordanian women, and to evaluate their impact on eating styles and body image. DESIGN: A randomised cross-sectional survey that included a variety of culturally measured Likert-type scales and body size images. In addition, BMI was calculated based on measured height and weight. SETTING: In the homes of the participants. The data were collected by female interviewers who worked for the Jordan Department of Statistics. SUBJECTS: The sample was based on a random and representative selection of 800 mostly urban Jordanian women. A pre-test sample of 100 women was also used to validate the instruments. RESULTS: Women tended to agree that they ate based on emotional cues. They had high levels of disordered eating attitudes and behaviours and 42.1% were considered restrained eaters. However, these women also had higher than expected body esteem levels and desired a healthy body size. As expected, being obese was associated with a desire to lose weight, being a restrained and emotional eater, and having more disordered eating attitudes and behaviours. Similarly, Western advertising and media were associated with restrained and emotional eating, desired weight loss, and disordered eating attitudes and behaviours. CONCLUSIONS: There is a need to develop health education materials that explain the influence of obesity on health and the negative psychological and physical consequences of restrained and emotional eating, building on the current cultural preferences of healthy body size. Further implications and suggestions for future research are discussed.

Cultural and western influences on the nutrition transition in Thailand.

The impact of economic development and urbanisation on nutrition and dietary changes in transitional countries has been well researched. It generally has been found that there is a positive correlation between economic development, urbanization, and negative nutrition transitions with the result of growing levels of obesity and diet related non-communicable diseases. However, the impact of Western influences and culture on specific eating styles associated with the nutrition transition has been less studied. There is limited information about cultural and Western influences on eating styles in Thailand. Recent findings suggest that Thailand may have progressed further along the nutrition transition model, in terms of unhealthy eating styles, than would be expected based on economic development. This study was designed to determine the prevalence of current eating styles and eating motivations among Thai university students. University students were chosen for evaluation as they are thought to represent the forefront of dietary trends and nutrition changes in a population. Convenience samples from four different universities in south-central and northern Thailand were selected. The following scales were used to assess eating and dieting styles and attitudes among 662 Thai undergraduate and graduate students: Motivation For Eating Scale (MFES), Eating Attitudes Test-26 (EAT-26), and Cognitive Dieting Behavior Scale (CBDS). All scales have been shown to be reliable and valid in previous research. For this study, scales were translated into Thai, reverse translated, and pilot tested to ensure cultural relevancy and the conveyance of intended meanings. Basic demographic information was also obtained, including age, gender, year in school, marital status, height and weight, and income. Results indicated that Thai students exhibit significant levels of dieting behaviour and extrinsic eating based on CBDS and MFES scores (with the exception of environmental eating). For most negative eating styles, females scored higher than males. It was also found that high levels of dieting and extrinsic eating were positively correlated with body mass index, suggesting the possible risk of future weight gain and obesity. While the occurrence of eating disordered attitudes based on EAT-26 scores was low (13%), analysis of EAT-26 scores indicated that the occurrence of eating disordered attitudes was strongly correlated with dieting behaviour among this population. The results support the need for a programme to educate Thai students, especially females, regarding healthy patterns of dieting and eating attitudes in order to prevent future weight gains and eating disorders predicted by the nutrition transition model.

Validation of the Sociocultural Attitudes Towards Appearance Questionnaire-3 among a random sample of Jordanian women.

Measuring the impact of westernization on body image is an important element in understanding body dissatisfaction and eating disorders in countries undergoing cultural transitions. The purpose of this study was to evaluate the validity and reliability of the Sociocultural Attitudes Towards Appearance Questionnaire-3, a measure of societal and media impacts on body image, in a non-western population. Factor analyses identified the same four subscales found in the original validation with high Cronbach's alpha coefficients and Guttman split-half coefficients, and low item cross-loadings. Furthermore, mean score comparisons by demographic variables on each subscale indicated that subscale scores were only affected by age. The results suggest that the Sociocultural Attitudes Towards Appearance Questionnaire-3 is a valid and reliable instrument for Jordanian women. The high level of validity and reliability for this population lends support for the possible use of this scale in other non-western populations after appropriate pretesting.

Intuitive eating and the nutrition transition in Asia.

Current models of the nutrition transition focus on demographic changes and economic development. A further influence may be the adoption of western-based perceptions of beauty that lead to potentially harmful eating behaviours which contribute to overweight, obesity, and eating disorders. This paper proposes a comprehensive model of the nutrition transition that includes western influences on perceived attractiveness and subsequent eating styles. An exploratory test of this model for Asian countries explores differences in intuitive eating as a function of economic development and the adoption of western standards of beauty. The intuitive eating scale (IES), a measure of food consumption that is primarily characterized by the satisfaction of physical hunger, was used to evaluate agreement with intuitive eating principles in the US and four Asian countries (Japan, Thailand, the Philippines, and China). Although intuitive eating scores in the US and Thailand failed to follow predicted patterns on two of the four IES subscales, scores for the other two IES subscales and the total IES score followed predicted patterns for Asian countries. Intuitive eating appears to be a valid, measurable concept that is correlated with economic development and levels of western influence in Asian countries. The tentative findings of this exploratory study support further evaluation of cultural influences as an important component of the nutrition transition.

A cross-cultural analysis of 'motivation for eating' as a potential factor in the emergence of global obesity: Japan and the United States.

This exploratory study compared motivation for eating between individuals from two different cultures that have moved through the nutrition transition at different rates and to different degrees. The analysis was based on a convenience sample of 1218 participants aged >or=18 years attending colleges in the US and Japan. The Motivation for Eating Scale (MFES) was used to evaluate different motivations for eating by nation and gender. The MFES consists of 12 items classified into three subscales: emotional, physical and environmental eating. The questionnaire used in the study also included responses about participants' motivation to lose weight, frequency of dieting, presence of previous or existing eating disorders, and frequency of exercise. Results showed no significant differences in the three MFES subscales for men in the US and Japan. For women, however, significant differences were seen for all three subscales. Women in the US were more likely to initiate eating for emotional reasons, while women in Japan were more likely to eat for physical or environmental reasons. Women and men in the US were more likely than the Japanese respondents to eat in response to watching TV or movies. These results suggest that there are national differences in the cultural environment that may impact individual motivations for eating. As such, various cultural perceptions of food should be considered in attempts to understand more fully the mechanics of the nutrition transition as it operates within a given country. By extension, public health policies and health promotion initiatives that are designed to limit the negative impacts of the nutrition transition may benefit from a greater understanding of the larger role that cultural perceptions of food may play in influencing individual motivations for eating.