Philippine Journal of Science 138 (1): 67-74, June 2009 ISSN 0031 - 7683
Correlates of Body Image Satisfaction Among Economically Depressed Urban Filipino Women Mildred T. Aquino*, Consuelo L. Orense, Celeste C. Tanchoco, Sofia V. Amarra, Merlyn G. Tajan, and Evelyn O. Dela Cruz Food and Nutrition Research Institute Department of Science and Technology, General Santos Avenue, Bicutan, Taguig City, Philippines The study assessed body image satisfaction with diet, body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR), age, income, and education among 251 women in a depressed urban barangay. Results showed that most women were younger, had low education, and had no occupation. Using BMI, 28.7% were overweight and obese, and 11.6% were underweight. Using WHR and WC, 59% and 13.5%, respectively, were at risk. Six out of ten women were not satisfied with their body image. Nutrient intake and adequacy between women who were satisfied and those who were not satisfied with their body image were not significantly different. Adequacy of intake was below the Recommend Energy and Nutrient Intake (RENI) for most nutrients except niacin. Women satisfied with their body image had lower BMI, WC, and WHR. Body image satisfaction was associated with BMI, WC, and WHR but WHR was the only significant variable affecting image satisfaction. Android or central body adiposity affects body image satisfaction among women because of the change in body shape brought by fat deposition. Key Words: body image, body mass index, nutrient intake-adequacy, urban Filipino women, waist-hip ratio, waste circumference
INTRODUCTION Body image is defined as “how a person feels about his appearance.” Developing and nurturing a positive body image is considered part of a healthy mental attitude and is crucial to a person’s happiness and wellness. Body image is a combination of how we perceive ourselves about basic looks and how we react emotionally in certain situations (Sloan 2006). Having a negative body image may be a contributing factor to poor self-esteem, feelings of perfectionalism, and negative eating attitudes and behaviors which have been identified as predisposing factors to eating disorders (Perez et al. 2003) Women seem to be more dissatisfied or negative about their bodies at all ages. Body dissatisfaction seems to *Corresponding author:
[email protected] [email protected] [email protected]
be remarkably stable across the entire female lifespan. Women aged 30 to 75 yrs show potential levels of body dissatisfaction just like younger women. Between 55% to 95% of women express dissatisfaction with their bodies, and chronic dieting may pose a particular health risk for women as they age (Tiggeman 1999). Being overweight and obese are sources of dissatisfaction, depression, and frustration which may lead to extreme dieting and eating disorders such as Anorexia nervosa and Bulimia. The most common assumption about the link between depression and obesity is that overweight is viewed negatively by the society resulting in discrimination even among children in schools and adults in workplaces (Margraf 2000). Females who perceived themselves to be overweight prior to puberty scored significantly higher 67
Philippine Journal of Science Vol. 138 No. 1, June 2009
on measures of eating disorders, body dissatisfaction, ascetism, drive for thinness, and perfectionism. It has been acknowledged from the results of a longitudinal study of the National Heart, Lung and Blood Institute that weight concerns and a drive for thinness at ages 11 to12 are important risk factors leading to daily smoking at ages 18 to19 years (NIH 2002). Studies show that cultural diversity in body image exists. Black and white women differed regarding their ethnic group’s ideal body image and their perceptions of how they compared with their ideal body image (Mciza et al. 2005; Pan 2000; Perez et al. 2003). Women who perceived themselves as bigger or smaller than the ideal body size for their ethnic group showed bulimic symptoms (Perez et al. 2003). Caucasian and Hispanic Americans were found to exhibit more weight-related body image disturbance than African-Americans and Asian-Americans. Studies are needed to determine whether the association between body dissatisfaction and disordered eating attitude holds in various socioeconomic groups in developing countries. Foreign studies have shown that poverty and food insecurity without hunger may be contributing factors to adult obesity. The study of Drewnowski and Specter (2004) stated that the highest rates of obesity occur among population groups with the highest poverty rates and least education. He mentioned that energy-dense foods are mostly composed of refined grains and added sugars, and fats which may be the least costly foods available to consumers. Moreover, these energy-dense foods which are high in sugar and fats are the most palatable and can easily satisfy hunger. Although poverty and food insecurity are often associated with lower food expenditures, quality of the diet is mostly affected, as there is lesser intake of fruits, vegetables and other protein sources. In another study done by Townsend et al. (2001), there was an association between food insecurity and being overweight and obese in women resulting in chronic diseases. However, aging is also associated with alterations in body weight and may have an important impact on health. According to the 6th National Nutrition Survey conducted by Food and Nutrition Research Institute (FNRI) in 2003 (FNRI 2006), undernutrition among Filipinos is still a problem; however, there has been an increased prevalence of overweight and obesity from 1998 to 2003. Among adults, 24% are overweight to obese. In addition, chronic diseases are becoming number one problem of the country. To date, only a handful of studies were conducted to determine if the condition of being overweight or obese affects the perception of body image of adult Filipino women.
68
Aquino et al.: Body Image Satisfaction of Women and Correlates
One study conducted by Hawks et al. (2005) among working women in Bacolod revealed that a significant number of women were unnecessarily concerned about reducing body size, and that this attitude was associated with eating disorder attitudes and restrictive dieting behaviors. Studies of this kind may contribute to better understanding of the relationship between body image satisfaction among economically depressed women with their dietary intake, age, annual income, education and, obesity indices. Moreover, there is a need to establish if there is such an existing body image dissatisfaction among depressed urban Filipino women, in order to guide nutrition planners plan for appropriate programs and intervention to alleviate conditions associated with overweight and obesity. The study generally aimed to assess the relationship of body image satisfaction with dietary intake, obesity indices such as body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR), and socio-demographic factors (age and annual income) among economically depressed urban Filipino women. Specifically, it aimed to: (1) determine the socio-demographic characteristics of the women; (2) determine intake of nutrients among women who were satisfied and not satisfied with their body image; (3) compare body mass index (BMI), waist circumference (WC), and waist-hip ratio (WHR) of respondents by body image satisfaction; and (4) determine which of the factors (socio-demographic, obesity indices, nutrient intake) relate to body image satisfaction.
METHODS Data from this study was taken from a previous project on body image satisfaction, dietary intake, and health outcomes in urban Filipino women (Amarra et al. 2005 unpublished report). The project was conducted in Barangay Bagong Silang, Caloocan City which is located north of the City of Manila. Bagong Silang is a relocation area where most of the households are classified as social class C, D, and E based on the classification system developed by the Philippine Statistical Association (NSCB 1974). A total of 251 women participated in the study from whom data on socio-demographic, body image satisfaction, dietary intake, weight, height, waist and hip ratio were taken. Pre-tested questionnaires were used to collect sociodemographic data and body image satisfaction. Two-day 24-hour food recall, done on a week-end and another on a weekday, was used to gather data on food intake. Detecto weighing scales and microtoise were used to take weight and height, respectively, using standard methods and techniques. A fiberglass tape measure was used to
Philippine Journal of Science Vol. 138 No. 1, June 2009
Aquino et al.: Body Image Satisfaction of Women and Correlates
get the waist and hip circumference measures. Waist circumference was taken at the narrowest point between the lowest rib and iliac crest while hip circumference was obtained at the widest circumference around the greater trochanter.
body image satisfaction. Logistic regression was used in determining which of the factors influence body image satisfaction.
Household measures of the 24-hour food intake of two non-consecutive days were recalled from the women to estimate week-day and week-end intake, as studies have shown differences of intake between these periods (Gibson 1990). Instruments such as measuring cups, ruler, and portion size models were used as a way to prompt and accurate recall of the food quantities. Household measures of the food items from the two-day food recall were translated into edible portion (EP) weights using the standard weights and measures, Food Exchange List (FEL) and actual weights.
RESULTS AND DISCUSSION
The diet was evaluated for the nutritional content in terms of energy, protein, fat, carbohydrates, dietary fiber, calcium, iron, vitamin A, thiamin, riboflavin, niacin, and ascorbic acid using the Philippine Food Composition Tables (FCT) (FNRI 1997) . A data base program was used to compute the nutrient content of the diet on a daily basis. Nutritional adequacy of the diet per respondent per day was assessed using the 2002 Recommended Energy and Nutrient Intakes (FNRI 2002). BMI was calculated from the weight in kilograms divided by the square of the height in meters. From the calculated BMI, the women were categorized into four classes based on the World Health Classification (WHO) classification: underweight for BMI
