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Keywords:

  • dieting behaviours;
  • pre-adolescent and adolescents;
  • practices to be slim;
  • weight and shape

Abstract

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. MATERIALS AND METHODS
  5. RESULTS
  6. DISCUSSION
  7. REFERENCES
  8. Appendix

The attitudes towards body weight and shape, desire for thinness and dieting behaviours were investigated in pre-adolescent and adolescent girls and boys (547 elementary school students, 615 junior high school students, and 470 senior high school students) aged 10–17 years in Osaka Prefecture, Japan, by a self-report questionnaire.

Forty-eight per cent of 10-year-old females and 84% of 17-year-old females categorized themselves as ‘fat’ or ‘too fat’. The fear of weight gain and desire for thinness was reported in 35% and 51% of 10-year-old girls, respectively, and increased progressively with ageing to 79% and 87% of 17-year-old girls. In contrast, these were reported by 20–30% of boys in the corresponding age groups. Some practices to be slim were found in 22% of the 10-year-old girls, and increased to 37% among the 17-year-old girls, whereas they were found in around 20% of the boys at each age. The practices to be slim were found in 32% of the girls who were 85–90% of the standard body weight (SBW) and in 14% of the girls less than 85% of the SBW. These results suggest that significant concerns about weight and shape and dieting behaviours are present in young Japanese girls and increase progressively with age. These results are compatible with those in Western society.


INTRODUCTION

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. MATERIALS AND METHODS
  5. RESULTS
  6. DISCUSSION
  7. REFERENCES
  8. Appendix

Eating disorders occur commonly in females during adolescence or in early adulthood. 1 However, recent studies suggest that eating disorders have been increasing over a wider range of ages, from prepubescence to the menopause. 2 Reflecting this tendency, the incidence of pre-pubescent cases appears to have increased in Japan. 3 The desire for thinness and fear of becoming fat, leading to weight loss or prevention of weight gain are the main clinical features of eating disorders. 4,5 Numerous investigators have suggested that dieting, or restrained eating, is one of the major contributing factors in the development of eating disorders. 6–8 In Western countries, it has been well documented that significant concerns about body weight and shape leading to dieting in order to be slim are present in pre-adolescent as well as in adolescent girls. 9–12 In Japan, however, there are few studies on eating attitudes and behaviours in pre-adolescent boys and girls. 13–16 The aim of the present study was to evaluate attitudes towards body weight and shape, desire for thinness, and weight reducing behaviour in a sample of Japanese boys and girls aged fom 10 to 17 years, and the results are compared with those in Western countries.

MATERIALS AND METHODS

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. MATERIALS AND METHODS
  5. RESULTS
  6. DISCUSSION
  7. REFERENCES
  8. Appendix

The subjects were 547 elementary school students (267 boys and 280 girls), 615 junior high school students (315 boys and 300 girls), and 470 senior high school students (127 boys and 343 girls) aged 10–17 years. The three schools taking part in this study were located in the city which has a population of approximately 200 000 people, in the southern part of Osaka Prefecture in central Japan. In 1995, the students were asked to complete questionnaires on an anonymous and voluntary basis as a part of a study on eating patterns and attitudes. The questionnaire (Appendix 1) included questions on demographic background, attitude toward the respondent’s weight and shape, desire for thinness and eating behaviours. The respondent’s self-reported present weight was converted to a percentage of standard body weight (SBW). The SBW was the average body weight in Japan. 17

The statistical analysis used Student’s t-test and Chi-squared analysis.

RESULTS

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. MATERIALS AND METHODS
  5. RESULTS
  6. DISCUSSION
  7. REFERENCES
  8. Appendix

The number of students and their height and weight are shown in Table 1. The response rate was 100%.

Table 1. . Numbers of subjects and their height and weight by gender and age group Thumbnail image of

The distribution percentage of the students SBW, converted from the respondents’ self-reported present weights, is shown in Fig. 1. Approximately 60% of all girl students have 90–110% SBW. One hundred and fifteen (16%) of the girls and 76 (12%) of the boys were less than 85% of the SBW. Forty-two (7%) of the girls and 73 (12%) of the boys were overweight.

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Figure 1. . Distribution of 20 standard body weight by gender and age. (a) Boys; (b) girls. (bsl00011), ≥ 115%; (bsl00007), 110 ≤– < 115%; (□), 90 ≤– < 110%; (bsl00003), 85 ≤– < 90%; (bsl00001), < 85.%.

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Figure 2 shows the distribution of the self-classified weight category of the students when asked to evaluate their current weight. Forty-eight per cent of 10-year-old girls and 84% of 17-year-old girls categorized themselves as ‘fat’ or ‘too fat’. Approximately 30% of boys at each age group categorized themselves as ‘fat’ or ‘too fat’.

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Figure 2. . Self-classified weight category distribution by gender and age. (a) Boys; (b) girls. (bsl00011) Too fat; (bsl00007) fat; (□) normal; (bsl00001) thin; (bsl00003) too thin.

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The prevalence of a desire for thinness and a fear of weight gain at each age group is shown in Figs 3 and 4, respectively. The desire for thinness was reported by 51% of the 10-year-old girls, and increased steadily with age to 87% of the 17-year-old girls, whereas it was reported by approximately 30% of the boys at all ages. A fear of weight gain was reported by 35% of the 10-year-old girls, and increased to 79% of the 17-year-old girls, whereas it was reported by approximately 20% of the boys at all ages.

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Figure 3. . Desire for thinness among Japanese (□) boys and (▪) girls aged 10–17 years old.

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Figure 4. . Fear of weight gain among Japanese (□) boys and (▪) girls aged 10–17 years old.

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Figure 5 shows the relationship between current body weight and desire for thinness among the respondents aged 10–12, 13–15, and 16–17 years. Less than 30% of the boys who were 90–110% of the SBW desired thinness, whereas more than 60% of the 10–12-year-old girls, more than 80% of the 13–15-year-old girls, and more than 90% of the 16–17-year-old girls who were 90–110% of the SBW desired thinness. Seventeen to 34% of the girls who were less than 85% of the SBW still reported the desire for thinness.

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Figure 5. . The relation between current body weight (% of standard body weight) and desire for thinness. (a) 10–12 years of age; (b) 13–15 years of age; (c) 16–17 years of age. (□) boys; (▪) girls.

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The relationships between practices engaged in to be slim (such as dieting, exercise, vomiting, and using laxatives or diuretics) and age and percentage SBW are shown in Fig. 6. Practices to be slim were reported by 22% of the 10-year-old girls, and increased to 37% of the 17-year-old girls, whereas they were reported by around 20% of the boys at each age. Dieting in order to be slim was reported by 5% of the 10-year-old girls, and increased to 26% of the 17-year-old girls. Dieting was reported by less than 10% of the boys at each age. Engaging in practices to be slim was reported by 32% of the girls at 85–90% of the SBW and by 14% of the girls at less than 85% of the SBW.

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Figure 6. . The relation between reported practices to be slim and (a) % standard body weight or (b) age. (□) boys; (▪) girls.

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DISCUSSION

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. MATERIALS AND METHODS
  5. RESULTS
  6. DISCUSSION
  7. REFERENCES
  8. Appendix

In this study, the desire for thinness and fear of weight gain were reported in significant proportions of pre-adolescent girls, and progressively increased to most of the adolescents girls. Engaging in practices to be slim was reported by 22% of the pre-adolescent girls, and in 14% of the girls less than 85% of the SBW. Dieting to be slim was found in 5–18% of the pre-adolscent girls, and in 7% of the girls less than 85% of the SBW. Among the boys, in contrast, practices and dieting to be slim were found in only around 20% and less than 10%, respectively, at each age.

The present study has methodological limitations. It is based on a self-report questionnaire, completely dependent on the cooperation and frankness of the subjects. However, it is often possible to obtain more accurate information about weight concerns and dieting behaviours in this way than by interview methods, as girls and boys are secretive about their eating habits due to the shame and guilt associated with the practice of weight control. With the assurance of anonymity, they might respond more frankly and admit their eating habits. In addition, the questionnaires were handed out and collected in this study by the students’ teachers. However, our samples are not necessarily representative of young Japanese women as a whole, and our results are indicative of unhealthy weight concerns and dieting behaviours among pre-adolescents and adolescents in Japan

There are a few epidemiological studies on body weight and shape concerns and dieting behaviours among pre-adolescent students in Japan. 13–16 Takeuchi et al.13 carried out a questionnaire survey of 712 junior high school students. It was found that 17.4% of the boys and 38.5% of the girls had a feeling of being too fat, which increased with age. They found that the junior high school girls strongly wished to reduce their body weight, whatever their real weights were. Ohzeki et al.14 studied the desire for thinness in 50 students, each of elementary, junior high, and senior high school age. They reported that most of boys chose the SBW as their ideal figure, whereas 44% of the elementary school girls and 86% of junior high and senior high school girls chose a weight less than 90% of the SBW, and the girls showed a stronger desire for thinness compared to the boys. Takahashi et al. investigated eating behaviours and body weight concerns among school students aged 10–12 years. 15 They found that many of these pre-adolescent girls already had a desire to reduce their body weight, and the desire for thinness increased with age. In 9% of girls less than 80% of SBW still wished to reduce their weight. Ikenaga et al. similarly reported that there was already a desire for thinness among 10-year-old girls. 16

In the present study, the fear of weight gain and the desire for thinness were reported by 35% and 51% of the 10-year-old girls and progressively increased to 79% and 87% of the 17-year-old girls. The practices to be slim such as dieting, exercise and vomiting were reported by 22% of the 10-year-old girls and 37% of the 17-year-old girls. Dieting to be slim was found in 5–18% of the pre-adolescent girls. The present results indicate that significant concerns about body weight and shape are present in many pre-adolescent girls and in most adolescent girls in Japan. These concerns were associated with the increase of practices to be slim. Significantly less concern about body weight and shape was shown by the boys. The percentages of the girls having the fear of weight gain or the desire for thinness increased steadily by age. The considerable number of the girls in pre-adolescent age group showed the desire for thinness in spite of being a low weight for their age and height. Furthermore, there are considerable numbers of pre-adolescent girls engaging practices in order to be slim.

In Western countries, there are numerous studies of the eating attitudes and behaviours among adolescent girls. It is well documented that the desire for thinness and practices to lose weight are very popular among Western adolescent girls. It has been reported that pre-adolescent girls also show significant concerns about body weight and shape which lead to dieting to be slim. 9–12 Maloney et al.10 reported that feeling overweight and taking actions leading toward thinness appear in some girls by at least 9 years of age. Schreiber et al.12 investigated 2379 girls aged 9–10 years, and found that approximately 40% of the girls were already trying to lose weight to be slim.

In the UK, there have been many studies on the prevalence of disordered eating and body image dissatisfaction among adolescents. 18–22 Sands et al.18 reported the prevalence and factors associated with eating/dieting, physical activity, and body image in a non-clinical sample of pre-adolescent (aged 10 and 11 years) school children. They found that body image views and concerns appeared before puberty, and that females in this age were more inclined to involve themselves in weight loss practices than were males. The girls who engaged in dieting behaviours are dissatisfied with their body weight and shape and had lower body esteem. Furnham and Patel 21 compared the eating attitudes and behaviours of Asian schoolgirls with British schoolgirls. They found significant concerns about weight and shape in both groups, and there was no significant differences between the British and the Asian schoolgirls in eating attitudes and behaviours.

In Australia, Rolland et al.23 studied the perceptions of 244 Australian schoolchildren for their current and ideal body sizes among aged 8–12 years. They found that a considerable proportion of the underweight children shared the desire for thinness.

These results from Western countries indicate that a desire for thinness and dieting to be slim are common in pre-adolescent girls as well as adolescent girls. The results of our study are similar to those reported in the Western countries. The age of girls who are dieting to lose weight is becoming lower in Japan as well as in Western countries.

During the past 35 years, a slim body has become increasingly desirable for young women as a symbol of beauty and success in Japan as well as in Western countries. Advertising, fashion, and films are dominated by this feminine ideal. 24,25 Therefore, the desire for thinness and dieting to be slim are common among young women in Japan. This study demonstrated that the desire for thinness and some practices to be slim have become more common even in pre-adolescent girls. Although the causal relationship between dieting and anorexia or bulimia nervosa has not been fully elucidated, dieting is often observed in the initial stage of anorexia nervosa or bulimia nervosa. Therefore, we suspect that there will be a growing tendency for pre-adolescent Japanese girls to develop eating disorders in the future.

REFERENCES

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. MATERIALS AND METHODS
  5. RESULTS
  6. DISCUSSION
  7. REFERENCES
  8. Appendix
  • 1
    Fairburn CG & Beglin SJ. Studies of the epidemiology of bulimia nervosa. Am. J. Psychiatry 1990; 147: 401 408.
  • 2
    Walford G & McCune N. Long-term outcome in early-onset anorexia nervosa. Br. J. Psychiatry 1991; 159: 383 389.
  • 3
    Takeiak Y, Honjo S, Hirano C. A clinical study of early onset anorexia nervosa. The Jap J. Dev Psychol Med. 1990; 1: 403 411(in Japanese).
  • 4
    Juschl RJ. From dietary restraint to binge-eating: Some theoretical considerations. Appetite 1990; 14: 105 109.
  • 5
    Lowe M. Row The effects of dieting on eating behavior. A three-factor model. Psychol Bull. 1993; 114: 100 121.
  • 6
    Dukes W. Is body image related to exercise? The NZ J. Sports Med. 1990; 18: 34 36.
  • 7
    Finkenberg M, Dinucci J, McCune D. Body esteem and enrollment in classes with different levels of physical activity. Perceptual Motor Skills 1993; 76: 783 792.
  • 8
    Hill AJ. Pre-adolescent dieting: Implications for eating disorders. Int Rev. Psychiatry 1993; 5: 87 100.
  • 9
    Koff E & Rierdan J. Perceptions of weight and attitudes toward eating in early adolescent girls. J. Adolescent Health 1991; 12: 307 312.
  • 10
    Maloney M, McGuire J, Daniels S, Specker B. Dieting behavior and eating attitudes in children. Pediatrics 1989; 84: 482 488.
  • 11
    Striegel-Moore R, Schreiber GB, Pike KM, Wilfley D, Rodin J. Drive for thinness in black and white preadolescent girls. Int J. Eating Disorders 1995; 18: 59 69.
  • 12
    Schreiber GB, Robins M, Striegel-Moore R, Obarzanek E, Morrison JA. Weight modification efforts reported by black and white preadolescent girls: National Heart, Lung, and Blood Institute Growth and Health Study. Pediatrics 1996; 98: 63–70.
  • 13
    Takeuchi S, Hayano J, Kamiya T, Hori R, Mukai S, Fujinami T. Body image and self-image in 712 junior-high school students. Sinshin Igaku 1991; 31: 367 373 (in Japanese).
  • 14
    Ohzeki T & Otawara H. Investigation about eating habits, eating behaviors, and the knowledge of nutrition in childhood. In: 1990 Annual Report on Anorexia Nervosa Survey Group. The Research of Anorexia Nervosa. The Ministry of Health and Welfare, Tokyo, 1990; 177–180 (in Japanese).
  • 15
    Takahashi S, Kitagawa S, Matsuzawa E. Eating habits and weight in school children. Japn J. School Health 1988; 30: 487 494 (in Japanese).
  • 16
    Ikenaga K, Kiriike N, Iwahashi T et al. Desire for thinness in the elementary school and junior high school boys and girls. Jpn. J. Clin. Psychiatry 1993; 22: 1455 1461 (in Japanese).
  • 17
    The Japanese Ministry of Health and Welfare. The report of statistical research of school health. Diichi, 1994 (in Japanese).
  • 18
    Sands R, Tricker J, Sherman C, Armatas C, Maschette W. Disordered eating patterns, body image, self-esteem, and physical activity in preadolescent school children. Int J. Eating Disorders 1997; 21: 159 166.
  • 19
    Hill AJ, Draper E, Stack J. A weight on children’s minds: body shape dissatisfactions at 9 years old. Int J. Obesity 1994; 18: 383 389.
  • 20
    Hill AJ, Oliver S, Rogers PJ. Eating in the adult world: the rise of dieting in childhood and adolescence. Br. J. Clin. Psychol 1992; 31: 95 105.
  • 21
    Furnham A & Patel R. The eating attitudes and behaviors of Asian and British schoolgirls: A pilot study. Int J. Social Psychiatry 1994; 40: 214 226.
  • 22
    Thelen MH, Powell AL, Lawrence C, Kuhnet ME. Eating and body image concerns among children. J. Clin. Psychol. 1992; 21: 41 46.
  • 23
    Rolland K, Farnil D, Griffiths RA. Body figure perceptions and eating attitudes among Australian schoolchildren aged 8–12 years. Int. J. Eating Disorders 1997; 21: 273 278.
  • 24
    Kiriike N, Nagata T, Tanaka M, Nishiwaki S, Takeuchi N, Kawakita Y. Prevalence of binge-eating and bulimia among adolescent women in Japan. Psychiatry Res. 1988; 26: 163 169.
  • 25
    Kiriike N, Nagata T, Sirata K, Yamamoto N. Are young women in Japan at high risk for eating disorders? Decreased BMI young females from 1960 to 1995. Psychiatry Clin. Neurosci. 1998; 52: 279– 282.

Appendix

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. MATERIALS AND METHODS
  5. RESULTS
  6. DISCUSSION
  7. REFERENCES
  8. Appendix

APPENDIX 1. QUESTIONNAIRE

  • 1. Sex: 1. Male 2. Female (Please circle number)

  • 2. Present age: ______years

  • 3. What is your present height and weight?

  • height ______cm, weight ______kg

  • 4. What is the most you have weighed since reaching your present height? ______years, ______kg

  • 5. What is the least you have weighed since reaching your present height? ______years, ______kg

  • 6. In your opinion, are you now? (circle one)

  • (1) too thin (2) thin (3) average (4) fat (5) too fat

  • 7. What would your ideal or desired weight be, if you could choose it? ______kg

  • 8. Do you have three regular meals every day? If no, what meals do you have? (1) Yes (2) No (Breakfast, Lunch, Dinner)

  • 9. Do you have a meal before sleeping at night? (1) Yes (2) No

  • 10. Are you afraid that your weight is uncontrollable when you get a little weight? (1) Yes (2) No

  • 11. Do you have anxiety about putting on more weight if you gain your a little weight? (1) Yes (2) No

  • 12. Do you feel fat after meals? (1) Yes (2) No

  • 13. Do you have a fear of weight gain? (1) Yes (2) No

  • 14. Do you have a desire to be thin, or to be fat?

  • (1) desire to be thin (2) sufficient (3) desire to be fat

  • 15. Why do you have a desire to be thin or fat?

  • (1) to be stylish (2) to be attractive (3) fitting into nice clothes (4) to be healthy (5) to have a good figure (6) to be fit enough to exercise (7) to prevent illness (8) standard (9) for femininity (10) to be of moderate weight (11) for muscularity

  • 16. Do you want to know how to be slim? (1) Yes (2) No

  • 17. In order to control your weight, do you skip meals or reduce the amount of meals? (1) Yes (2) No

  • 18. In order to control your weight, do you exercise? (1) Yes (2) No

  • 19. In order to control your weight, do you vomit meals? (1) Yes (2) No

  • 20. In order to control your weight, do you use laxatives or diuretics? (1) Yes (2) No

  • 21. Do you eat too much food when you are anxious or depressed? (1) Yes (2) No

  • 22. Do you ever get an uncontrollable urge to eat and eat until you feel physically ill? (1) Yes (2) No

  • 23. Have you ever had an episode of eating an enormous amount of food in a short space of time in which you felt physically ill? (1) Yes (2) No

  • 24. Do you exercise after eating too much? (1) Yes (2) No

  • 25. Do you vomit after eating too much? (1) Yes (2) No

  • 26. Do you fast or skip meals the day after eating too much? (1) Yes (2) No

  • 27. Do you use laxatives or diuretics after eating too much? (1) Yes (2) No

  • 28. Have you had your first period yet? (Only for the females) (1) Yes, at years (2) No

  • 29. Do you have regular periods? (Only for the females) (1) Yes (2) Irregular (3) Once every few months

  • (4) No (more than 3 months)

  • If you have any other type of eating or body weight problem, please describe the nature of the problem.