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Revista chilena de nutrición

On-line version ISSN 0717-7518

Rev. chil. nutr. vol.44 no.4 Santiago  2017

http://dx.doi.org/10.4067/s0717-75182017000400337 

Original Article

Anthropometric profile, body composition and body image perception of adolescents with positive screening for eating disorders

Perfil antropométrico, composición corporal y percepción de la imagen corporal en adolescentes con detección positiva para los trastornos alimentarios

Roberta Stofeles Cecon1 

Sylvia do Carmo Castro Franceschini1 

Maria do Carmo Gouveia Peluzio1 

Helen Hermana Miranda Hermsdorff1 

Silvia Eloiza Priore1 

1Universidade Federal de Viçosa – Viçosa, Departamento de Nutrição e Saúde. Minas Gerais, Brasil

ABSTRACT

Our aim was to associate anthropometric profile, body composition and body image perception with a positive screening for eating disorders in adolescents aged 10 to 14 years. The screening for eating disorders was carried out using the Eating Attitudes Test (EAT-26), Children's Eating Attitudes Test (ChEAT) and Bulimic Investigatory Test Edinburgh (BITE). Weight, height and percentage of body fat were measured, the latter by a vertical bipolar bioimpedance. Body image perception was assessed using the Brazilian Silhouette Scale. The project was approved by the Ethics Committee for Human Research of the Federal University of Viçosa, Minas Gerais, Brazil. 1,300 adolescents were evaluated. The prevalence of screening for eating disorders was 5.5% (n= 71), overweight was 26.1% (n= 339) and high body fat percentage was 38.5% (n= 500). Body distortion was present in 56.9% (n= 740) of adolescents and body dissatisfaction was 79.3% (n= 1,031). Body Mass Index, the percentage of body fat and body dissatisfaction were considered risk factors for positive screening for eating disorders. It is important to evaluate the physical changes in adolescence and their implications on body dissatisfaction, the main risk factor for the development of eating disorders.

Keywords: Eating disorders; adolescents; body composition; body image

RESUMEN

El objetivo de ese estudio fue asociar el perfil antropométrico, la composición corporal y la percepción de la imagen corporal con un screening positivo de los trastornos alimentarios en adolescentes de 10 a 14 años. Se realizó la aplicación del Eating Attitudes Test (EAT-26), Children's Eating Attitudes Test (ChEAT) y Bulimic Investigatory Test Edinburg (BITE) para evaluar la detección de trastornos alimentarios. Se midió el peso, la talla, porcentaje de grasa corporal y la percepción de la imagen corporal. El proyecto fue aprobado por el Comité de Ética para la Investigación Humana de la Universidad Federal de Viçosa, Minas Gerais, Brasil. Se evaluó a 1.300 adolescentes y la prevalencia de detección de trastornos alimentarios fue del 5,5% (n= 71). La prevalencia de sobrepeso fue de 26,1% (n= 339) y porcentaje de grasa corporal alto fue 38,5% (n= 500). La distorsión corporal estuvo presente en el 56,9% (n= 740) de los adolescentes, y la insatisfacción corporal fue de 79,3% (n= 1,031). El Índice de Masa Corporal real, el porcentaje de grasa corporal y la insatisfacción corporal fueron considerados factores de riesgo para la detección positiva de trastornos alimentarios. Es importante evaluar los cambios físicos en la adolescencia y sus implicaciones en la insatisfacción corporal, factor de riesgo para el desarrollo de trastornos alimentarios.

Palabra clave: Trastornos de la conducta alimentaria; adolescentes; composición corporal; imagen corporal

INTRODUCTION

Eating disorders are complex with a multidimensional etiology, characterized by changes in consumption and eating habits as well as excessive concern with body weight and shape1,2. Treatment for eating disorders is long and difficult and relapses exceed 40%, with high morbidity and mortality rates and changes in the nutritional status of individuals with the presence of malnutrition or even obesity3.

Adolescents are considered a vulnerable group to present signs and symptoms of eating disorders due to the characteristic of changes during adolescence. Many body changes occur during puberty, which is characterized by growth spurts, weight gain and changes in body composition with the accumulation of fat in women that often results in an increase in weight and in waist and hip circumferences4-6.

Body changes associated with the influence of the media, which encourages a thin body as a form of beauty and success, can result in distortion and body dissatisfaction among adolescents. Body image disorder (distortion and dissatisfaction) is the main risk factor for the development of eating disorders as it affects self-esteem, leading adolescents to change their eating habits and sometimes develop self-restrictive diets or inappropriate methods for weight loss (appetite suppressants, laxatives, diuretics, excessive exercise, induced vomiting)7,8.

Studies of positive screening for eating disorders and its association with the anthropometric profile and body composition are of fundamental importance to better understand the possible start of this disorder in order to improve the approach and treatment of adolescents. Body image disorder also has to be better understood so that we can discuss this topic with teenagers, improving their understanding about their bodies and changes common in adolescence.

Therefore, the aim of this study was to associate the anthropometric profile, body composition and body image perception with positive screenings for eating disorders.

METHODS

A cross-sectional study with 1,300 adolescents aged 10 to 14 years of both sexes, and students from public and private schools in the urban area of the city of Viçosa, Minas Gerais, Brazil. After presenting the project to the city's Department of Education, the 23 public and private schools offering elementary education were contacted for project presentation, and authorization to perform the same was requested. After their consent, the project was presented to the students and the consent was delivered to be signed by adolescents and their parents or guardians.

To participate in the study, adolescents had to fulfill the following inclusion criteria: being between 10 and 14 years old; having the presence of axillary hair for boys; having menstrual cycles, contraceptive use for less than 2 months and not being pregnant, in the case of girls; and having no pacemaker or prosthesis.

Anthropometric profile was evaluated by measuring the weight, height, and subsequent calculation of body mass index (BMI). The nutritional status was evaluated by the Body Mass Index/Age (BMI/A), proposed by the World Health Organization (WHO), with reference values according to sex and age of the adolescent. The percentage of body fat (%BF) was obtained by a vertical bipolar bioimpedance device (Tanita) and analyzed according to Lohman (1992)9-11.

Screening for eating disorders was performed using three questionnaires:

  • Eating Attitudes Test (EAT-26), using a cutoff point equal to or higher than 20 points for positive screenings, answered by adolescents aged 13 to 1412,13.

  • Children's Eating Attitudes Test (ChEAT), adaptation of the EAT-26, answered by adolescents aged 10 to 12 years14.

  • Bulimic Investigatory Test Edinburgh (BITE), using a score equal to or greater than 15 points for screening the subclinical group15.

To evaluate body image, the Brazilian Silhouette Scale or Kakeshita Silhouette Scale was used and validated for the Brazilian population. The scale used for the population over 13 years of age is made up of 15 cards with average values of BMI ranging from 12.5 to 47.5 kg/m2 with a range of 2.5 kg/m2 between each card. The scale used for children under 13 years old has 11 cards with average values of BMI ranging from 12 to 29 kg/m2 with an interval of 1.7 kg/m216.

The Brazilian Silhouette Scale has three questions for the cards, which subsequently allowed the calculation of body distortion and dissatisfaction17:

  1. “Which figure best represents your body today?”, which represents the current BMI.

  2. “Which figure shows the body you would like to have?”, which is the desired BMI.

  3. “Which figure represents the ideal body?”

The distortion is the result of the difference between the value of current BMI and calculated BMI (ratio between weight and height squared), and dissatisfaction is based on the difference between the desired BMI and current BMI18-20.

Adolescents considered with no distortion were those who showed the difference between current BMI and calculated BMI within the range of the adult cards (≥13 years old) and children (<13 years old). Positive values of distortion indicated overestimation of the body, and negative values the underestimation of body shape16,17.

Adolescents considered satisfied showed differences between desired and current BMI equal to zero. Positive values in this difference showed dissatisfaction in order to increase body size, and negative values, dissatisfaction with the aim of reducing the body shape16,17.

The Statistical Package for the Social Sciences (SPSS) version 21.0 and Data Analysis and Statistical Software (STATA) version 11.0 were used. The statistical, descriptive, mean comparison and association analyses were performed using the chi-square test and linear regression and logistics. This study was approved by the Human Research Ethics Committee of the Federal University of Viçosa, protocol number 1.443.922.

RESULTS

Positive screening for eating disorders and anthropometric, body composition and body image perception assessments were performed in 1,300 (23.1% of total enrollment) adolescents aged 10 to 14 years. Of the total evaluated, 65.5% (n= 852) were female and the average age was 11.78±1.38 years. The prevalence of positive screening for at least one of the eating disorder questionnaires was 5.5% (n= 71).

Adequate height was identified in 98.8% (n= 1,285), according to the height/age index (H/A), and normal weight in 70.9% (n= 922) according to the body mass index/age (BMI/A). It is noteworthy that the overweight percentage in this group was 26.1% (n= 339), a prevalence considered “high exposure” by the World Health Organization (WHO).

Eutrophy, the appropriate fat percentage, according to percentage of body fat (%BF) was 54.1% (n= 703) among adolescents and the risk of overweight and overweight was 38.5% (n=500).

The presence of secondary sexual characteristics (the presence of axillary hair in boys and menstrual cycle in girls) was present in 43.9% (n= 571) of adolescents, 40.2% (n= 180) and 45.9% (n= 391) for male and female respectively.

After the eating disorders screening (EAT-26, ChEAT and BITE questionnaires), we evaluated the questions that had higher frequencies of responses with higher scores. For the EAT-26 and ChEAT questionnaires, the questions that had the highest frequency of the answer “Always”, which has the highest score (3 points), were questions 11, 12 and 14 (Chart 1). These questions are related to the desire to be skinnier and to the concern about the presence of fat in the body and to burn calories to avoid gaining weight, all related in some way to body image.

Chart 1 Most frequent questions with the answer “Always” in the EAT-26 or ChEAT questionnaires. 

Questions Answer “Always”
11. I worry about being slimmer. 21.7% (n= 282)
12. I think about burning more calories when I exercise. 20.9% (n= 272)
14. I worry about the idea of having fat on my body. 24.3% (n= 316)

Questions 11, 12 and 14 had a frequency of the response “Always” above 20%, which means that one fifth of adolescents aged 10 to 14 already had concerns about body image.

The BITE questionnaire has the options “Yes” and “No” to its 33 questions, and the frequent answer “Yes”, with a frequency of 35% or more, were the numbers 11, 16, 17, 19, 21, 23, 29 and 30 (Chart 2).

Chart 2 Most frequent questions with answers “Yes” in the BITE questionnaire. 

Questions Answer “Always”
11. Are there times when you can only think about food? 37.6% (n= 489)
16. Does the thought of becoming fat terrify you? 51.8% (n= 673)
17. Have you ever eaten lots of food very quickly (not a meal)? 35.5% (n= 461)
19. Do you worry of not having control over how much you eat? 45.9% (n= 597)
21. Are you able to leave food on your plate at the end of a meal?* 35.9% (n= 467)
23. Is the amount you eat determined by the hunger you feel?* 37.1% (n= 482)
29. If you eat too much, do you feel very guilty? 35.0% (n= 455)
30. Have you ever eaten while hiding? 40.9% (n= 532)

*Questions 21 and 23 present score (1 point) to “No” answer.

More than 50% of the sample answered “Yes” to fear of presenting overweight

A concordance test was conducted between the calculated BMI and the mean BMI values present in the cards chosen by adolescents in the Brazilian Silhouette Scale, in order to verify the agreement between the methods. The intraclass correlation coefficient (ICC) of 0.665 (p< 0.001) was found, and this correlation was considered a substantial agreement between the methods.

Body distortion was present in 56.9% (n= 740) of adolescents, 24.9% (n= 324) of them underestimated body shape and 32.0% (n= 416) overestimated body shape. Body dissatisfaction in this group was 79.3% (n= 1,031). Of those dissatisfied, 27.2% (n= 354) reported wanting to increase body size, and the other 52.1% (n= 677) wanted to reduce body size.

Comparing the groups with and without positive screening for eating disorders, we noted that a positive screening for eating disorders was more common among females, with 83.1% (n= 59). One hundred percent (100%) (n= 71) of adolescents with positive screening for eating disorders showed adequate height, compared to the group without positive screening, which showed a 98.8% (n= 1,214) adequate height (Table 1).

Table 1 Characterization of adolescents with and without positive screening for eating disorders. 

Variables (+) screening (-) screening P-value
% (n) % (n)
Gender
Female 83.1 (59) 64.5 (793) 0.001a
Male 16.9 (12) 35.5 (436)
Height
Very Low Height - 0.1 (1) 0.428b
Low Height - 1.1 (14)
Adequate Height 100 (71) 98.8 (1.214)
Body Mass Index/Age (BMI/A)
Underweight - 3.2 (39) <0.001b
Eutrophy 32.4 (23) 73.1 (899)
Overweight 26.8 (19) 15.1 (186)
Obesity 40.8 (29) 8.5 (105)
Percentage of Body Fat (%BF)
Underweight - 7.9 (97) <0.001b
Eutrophy 18.3 (13) 56.1 (690)
Overweight risk 22.5 (16) 18.9 (232)
Overweight 59.2 (42) 17.1 (210)
Secondary Sexual Characteristics (armpit hair or menstrual cycle)
No 32.4 (23) 57.4 (706) <0.001a
Yes 67.6 (48) 42.6 (523)
Body Distortion
No Distortion 28.2 (20) 43.9 (540) 0.231b
Overestimated 50.7 (36) 30.9 (380)
Underestimated 21.1 (15) 25.1 (309)
Body Satisfaction
Satisfied 2.8 (2) 21.7 (267) <0.001b
Dissatisfied (increase body size) 9.9 (7) 28.2 (347)
Dissatisfied (decrease body size) 87.3 (62) 50.0 (615)

aChi-Square Test;

bChi-Square Test for Linear Trend;

(+) = positive; (-) = negative.

According to the BMI/A index, none of the adolescents with a positive screening for eating disorders presented low weight, but 67.6% (n= 48) were classified as overweight, and obesity reached 40.8% (n= 29) in that group. In the group without a positive screening for eating disorders, the prevalence of normal weight was 73.1% (n= 899), excess weight was 23.6% (n= 291), and obesity was 8.5% (n= 105) (Table 1).

In the group with positive screening for an eating disorder, no teenager had low weight in relation to body fat, and the risk of overweight coupled with overweight had a prevalence of 81.7% (n= 58), a higher value than that presented by the group without a positive screening for an eating disorder, which was 36.0% (n= 442) (Table 1).

The secondary sexual characteristics, typical of the stage of puberty, were more prevalent in the group with positive screening for eating disorders, with a prevalence of 67.6% (n= 48) of adolescents, when compared to the group without a positive screening, which showed values of 42.6% (n= 523) (Table 1). The increased prevalence of these characteristics in the group with positive screening can be explained by its association with an anthropometric profile (χ2= 3.39; p= 0.001) and fat composition (χ2= 7.10; p< 0.001).

Regarding the perception of body image, the ratings of distortion and body dissatisfaction were more prevalent in the group positive screening for eating disorders, with values of 71.8% (n= 51) and 90.1% (n= 64) versus 56.1 % (n= 689) and 71.8% (n= 882), respectively. What draws attention to the values of distortion and body dissatisfaction is that 50.7% (n= 36) of the 71.8% of adolescents with body distortion overestimated the shape of their body, and 87.3% (n= 62) of the 90.1% dissatisfied with body image wished to reduce their weight and body shape (Table 1).

The group with positive screening for eating disorders also presented higher median: weight, BMI of the chosen card as current body, and the score of the different scales of the EAT-26 or ChEAT questionnaires compared to the group without a positive screening.

A correlation was found between anthropometric profile, body composition and body image perception with scores on the EAT-26, ChEAT and BITE questionnaires, showing that excess weight (r= 0.173, p< 0.001 and r= 0.292, p< 0.001), as well as high fat percentage (r= 0.289, p< 0.001 and r= 0.304, p< 0.001), were positively correlated with the score of the EAT-26, ChEAT and BITE, respectively.

Distortion (r= 0.156, p< 0.001) and body dissatisfaction (r= -0.238, p< 0.001) also positively correlated with the scores of the questionnaires, and as teenagers distorted and overestimated their body size, the final score of the BITE questionnaire increased. The same happened with dissatisfaction, as adolescents showed dissatisfaction with body shape and desired to decrease the body size, the final score of the questionnaires also increased.

Dissatisfaction was correlated with the anthropometric profile, showing higher weight, BMI and %BF, of unhappy adolescents who wanted to reduce their body size, which reinforces the role of dissatisfaction as a predisposing factor and maintenance of eating disorders.

An association was found between the presence of axillary hair in males and menstrual cycle in females with the positive screening for eating disorders χ2= 17.10; p< 0.001), showing that the body changes common to puberty may be a risk factor for body dissatisfaction and was considered an indirect risk factor for the development of an eating disorder. The nutritional status according to BMI/A (χ2= 9.30; p< 0.001) and %BF (χ2= 8.83; p< 0.001) was also associated with positive screening.

All anthropometric, body composition and body image perception variables were used in the logistic regression model in order to see which of them would be able to predict the occurrence of positive screening for eating disorders. Regarding the regression model involving anthropometric variables, the calculated BMI was positively associated with a positive screening for an eating disorder, increasing by 1.16 times (95% CI: 1.02-1.32) the odds of having a positive screening for each increase of 1 kg/m2 (Table 2).

Table 2 Model of positive screening for eating disorders in adolescents aged 10 to 14 years. 

Variables Odds Ratio (OR) 95% CI P-value
Anthropometric Model
Weight (kg) 1.03 0.99-1.07 0.114
Real BMI (kg/m2) 1.16 1.02-1.32 0.020
Body Composition Model
%BF 1.16 1.12-1.20 <0.001
Body Image Perception Model
Current BMI 1.22 1.16-1.27 <0.001
Desired BMI 0.90 0.82-0.99 0.035
Ideal BMI 0.96 0.88-1.05 0.406
Distortion and Dissatisfaction Model
Distortion 1.14 0.84-1.55 0.384
Dissatisfaction 4.23 2.40-7.47 <0.001

Logistic Regression Test

The %BF was also significantly associated with a positive screening, increasing by 1.16 times (95% CI: 1.12-1.20) the odds of positive screening for each 1% increase in body fat. In relation to the regression model with body perception variables, current BMI was positively associated with positive screening, while desired and ideal BMI were negatively associated. Each increase of 1 kg/m2 in current BMI was associated with 1.22 times (95% CI: 1.16-1.27) higher odds of a positive screening for eating disorders and each 1 kg/m2 increase in the value of ideal and desired BMI was associated with a decrease of 10 and 4% respectively in the odds for positive screening. Body dissatisfaction related to the desire to reduce body measurements was also associated with a positive screening, increasing the odds by 4.23 times (95% CI: 2.40-7.47) (Table 2).

DISCUSSION

The prevalence of positive screening for eating disorders of 5.5% (n= 71) found in this study differs from data in the literature. A screening study conducted in the same city with students in the intermediate and late phase of adolescence (15-19 years) found a prevalence of 20.6%, and several other studies using various screening methods describe prevalence ranging from 14.6% to 33.5%1,21-24.

The difference in the prevalence found in this study may be explained by the fact that there is a higher incidence of positive screening for eating disorders and even diagnosis in adolescents closer to adulthood, as well as the lack of studies with individuals in early adolescence. Other reasons for the wide variation in values of a positive screening prevalence for eating disorders are the methods used and their respective cutoff points2,25.

The population of children, pre-adolescents and even younger adolescents may have lower prevalence of positive screening for eating disorders or even diagnosis. This occurs because the criteria present in the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Diseases, despite having updated diagnosis criteria, have an increased focus on young adults and, in the case of screening questionnaires, few are validated, specific for a child population, preadolescents or adolescents under 15 years of age2.

Despite presenting lower prevalence compared to literature data, the value of 5.5% draws attention because it is regarding individuals from 10 to 14 years of age, early adolescence, in which there are physical, psychological and hormonal changes that, if not understood by the adolescents, may act as risk factors for the appearance of body dissatisfaction, the main triggering factor of eating disorders. This body dissatisfaction or even fear of overweight are among the main signs and symptoms present in screening questionnaires.

In the BITE questionnaire, the most frequent responses were related to food self-control, which may indicate compulsive behavior related to stress or relief of some frustration. Pivetta and Gonçalves-Silva reported that there are few studies in Brazil related to binge eating in adolescents, and those performed with adults in treatment for weight loss indicate 15-22% for compulsive behavior26.

It is important to pay attention to binge eating because it can be the beginning of an eating disorder, especially in overweight individuals who present this type of behavior when they fail in treatment for overweight or in performing a restrictive diet, or as a way to relieve psychological distress related to body image and excessive concern with overweight26.

In addition to the questions regarding binge eating, the question that reached more than 50% of “Yes” answers in the BITE questionnaire refer to the fear of becoming fat, which agrees with the most frequent questions of the EAT-26 and ChEAT questionnaires.

The concern of becoming fat and having a high %BF may come from the fact that 26.1% of adolescents in this study were overweight according to BMI/A and 38.5% were at risk for overweight according to %BF. The classification of nutritional status according to BMI/A corroborates studies that show the national nutritional transition from the 1970's to the present day, with the reduction of malnutrition and the continued rise of overweight27.

The 2008-2009 Household Budget Survey in Brazil found a prevalence of 20.5% of overweight in adolescents 10-19 years of age, and 4.9% obesity. The National Research of School Health conducted in 2009 with students between 13 to 15 years old showed that the main nutritional problem of this population was overweight/obesity, which reached 23.2%: 16.0% overweight and 7.2% obese28,29.

Comparing the groups with and without a positive screening for eating disorders, excess weight was evident in the group with positive screening, with an obesity prevalence of 40.8% versus 8.5% in the group without positive screening. The %BF was also higher, with values of 81.7% of overweight risk and overweight compared to 36.0% of those without a positive screening for an eating disorder.

Arenas and Martínez reported that children and adolescents with overweight showed higher values of body dissatisfaction and low self-esteem. High BMI values associated with weight concerns, managing to predict body dissatisfaction in adolescents and signs or symptoms of an eating disorder1,30-32.

In addition to the association seen between overweight and the onset of body dissatisfaction, it is important to evaluate the construction of beauty ideals in adolescence and the physical, social and psychological influences that affect the relationship of the teenager with body image, as a negative perception of body image at this stage may result in the development of an eating disorder32.

Studies on body image have been published since the 1980's. Body image is a multidimensional construct with emphasis not only on the body's physical structure, but on the mental representation, and on the way we perceive, think, and act in relation to our body. When we evaluate body image perception, we can break down this assessment into distortion and dissatisfaction, the first being a change in the way the individual perceives his/her body and the latter being more related to feelings and thoughts about the body32,33.

Distortion and body dissatisfaction were evaluated using cards of the Brazilian Silhouette Scale, a method that presents a substantial agreement when the average BMI values of the cards are compared with the calculated BMI values (ratio of weight to height squared).

The distortion values were lower than those of dissatisfaction, both among the total adolescents evaluated and comparing the groups with and without a positive screening for an eating disorder. It is noteworthy that over 50% of adolescents from the positive screening group overestimated their body shape, which may be related to the non-acceptance of the body and the common changes of puberty, as well as media and social network influences, which emphasize the slim body as beautiful34,35.

In a study conducted by Arenas and Martínez30, 48-55% of children and adolescents evaluated would like to reduce their body size, regardless of the degree of overweight, choosing slimmer silhouette scales that even represented underweight. Liberali et al.35, found 15.6% overweight among female adolescents aged 14-17 years, with a 52.1% distortion in this group of students and 27.1% screened positive for an eating disorder. All three variables were associated with each other.

Berner et al.31 found a positive correlation between %BF and body dissatisfaction, data similar to those found in this study, in which adolescents who wanted to reduce their body size had a high percentage of body fat.

Concern with body image, which can result in distortion and dissatisfaction, often begins in early puberty6. In this study, the characteristics that marked pre- and post-puberty were the presence of axillary hair in boys and menstrual cycle in girls. The group with a positive screening for eating disorders showed a higher prevalence of these characteristics.

Puberty is a phase of physiological changes with changes in body composition, which makes adolescents in this phase vulnerable to others’ opinions and more concerned with body shape due to growth spurt and changes in all measurements6.

Scherer et al. verified the association of body image with the age of menarche in adolescents, and those who presented menarche at early ages were more dissatisfied, with a desire to have a leaner body, becoming more likely to present symptoms of eating disorders. In studies by Kaczmarek and Trambacz-Oleszak, body dissatisfaction was associated with the different phases of the menstrual cycle of adolescents 12 to 18 years18,37. In the current study, the features mentioned above (the presence of axillary hair and menstrual cycle) were associated with the presence of a positive screening for eating disorders which was also associated with body dissatisfaction.

CONCLUSION

In the current study, body dissatisfaction was significantly related to positive screening for eating disorders and was related to the anthropometric profile, body composition and physiological factors of adolescence.

Adolescence is considered a transition phase and generally has higher body dissatisfaction. Thus, health professionals have to properly guide teenagers to understand the common changes during this period and in this way break the vicious circle of altered nutritional status, body dissatisfaction, restricted diets, failure in successfully executing fad diets, binge eating as a form of relief, and permanence of altered nutritional status.

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Recibido: 18 de Abril de 2017; Revisado: 12 de Junio de 2017; Aprobado: 31 de Agosto de 2017

Dirigir correspondencia a: Roberta Stofeles Cecon. Doutora. Universidade Federal de Viçosa – Viçosa, Departamento de Nutrição e Saúde. Minas Gerais, Brasil. Rua Vereador José Valentino da Cruz, n.69, apto 401, Bairro: Centro, Viçosa, Minas Gerais – CEP: 36.570-000 E-mail: rscecon@yahoo.com.br

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