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Obesity Concerns, Weight Satisfaction and Characteristics of Female Dieters: A Study on Female Taiwanese College Students

Department of Nutrition, Chungshan Medical and Dental College (Y.W.), Institute of Nutritional Science, Chungshan Medical and Dental College (Y.-C.H.), TAIWAN

Address reprint requests to: Yueching Wong, MS, RD, Department of Nutrition, Chungshan Medical and Dental College, 110 Sec. 1, Jien-Kuo North Road, Taichung City 402, TAWAIN, R.O.C

	ABSTRACT

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Objective: This study was designed to obtain baseline data regarding desired body weight, weight satisfaction, self-perceived weight categories, approaches to weight loss of female college students in Taiwan. The characteristics of subjects who are dieting were also assessed.

Methods: One thousand, fifty-seven female college students participated in this study. Written questionnaires were used for data collection. Students’ height and weight were also measured. Simple frequency and one-way analysis of variance (ANOVA) were used to analyze data. Post hoc analyses were performed with the LSD test when the F ratio for the ANOVA was significant at p<0.05.

Results: In general, subjects perceived themselves as being heavier than their actual weight categories. The percentage of subjects who perceived they were overweight or obese was much higher than the percentage of subjects who were actually in these categories (51.4% vs. 16.2%). Above 20% of subjects in both severely underweight and underweight categories use some methods to lose weight. More than 60% of subjects in acceptable weight categories still want to lose weight. A higher percentage of subjects chose exercise than dieting as the major weight-loss method. Subjects in the DS/D (dissatisfied/dieting) group did not score higher points for knowledge and attitude in nutrition, and they tended to measure their body weight more frequently (p<0.05), spent more time for exercise (p<0.05) and for reading nutrition information (p<0.05); they also skipped lunch (p<0.05) more frequently than others.

Conclusions: The results indicate that risk factors leading to eating disorders are common among Taiwanese college females. Dietitians, physicians and other health professionals should be on the alert to identify patients with eating disorders.

Key words: weight perception, weight satisfaction, dieting, female college students

	INTRODUCTION

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Anorexia nervosa and bulimia nervosa are major clinical problems not only in the Western countries [1,2], but also in the Eastern countries [3,4]. They are some of the most prevalent diseases in female adolescents in United States [5]. Eating disorders are especially prevalent during adolescence and early adulthood, with the most common onset occurring around age 18 [6]. Because society equates thinness with beauty and attractiveness in women, it is not surprising that women tend to be preoccupied with losing weight and achieving a slim physique at young ages [7]. Rosen and Gross [8] reported that by adolescence, 63% of girls, as compared with 16% of boys, are already trying to lose weight. The much lower percentage of boys trying to lose weight probably indicates body weight is not the main criterion for judging attractiveness in men; therefore, there is less social pressure on young boys to be thin [9].

Social judgment of appearance is partly responsible for unrealistic weight goals sought by young adults. Moreover, misperception of body weight is common in female college students [10,11,12]. Overestimation of body fatness and inappropriate body image are closely related to developing eating disorders [13]. Both unrealistic weight goals [14] and misperception of body image [15] are major risk factors responsible for the increasing incidence of eating disorders.

There are only a few cases of eating disorders reported in Taiwan each year, and the prevalence of eating disorders is unknown. Although there are no formal reports on this issue, we assumed that inadequate knowledge of symptoms and signs of eating disorders and inadequate assessment of eating behavior in the primary-care settings are two reasons for the small number of cases being reported. Maradiegue et al. [16] found that inadequate assessment of eating behavior in the clinical setting is common.

Dieting is one of the most common practices among individuals who intend to lose weight. Dieting occurs in a high percentage of females regardless of their weight category [17,18], and it is also practiced by some males [19]. Dieting is often a precursor to an eating disorder [20], and the incidence of dieting was found to be directly proportional to the prevalence of eating disorders [21].

This study was designed to obtain baseline data regarding current body weight, desired body weight, body-weight satisfaction, self-perceived weight categories, nutrition knowledge, attitude toward nutrition and prevalence of dieting in female college students in Taiwan.

	METHODS

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Sample Selection
One thousand, two-hundred and fifty female college students were selected for this study. Multiple stages sampling was used for sample selections. Random selection occurred at each of the following stages: colleges in Taiwan, schools within the colleges, majors and classes.

Instrument and Data Collection
Data was collected by administration of a written questionnaire. The questionnaire contained items to measure 1) the students’ concerns and behaviors related to body weight, 2) general nutrition knowledge, 3) attitudes toward nutrition and 4) current nutrition related practices. Three representative questions used to assess concerns and behaviors related to body weight were (1) "What is your current weight category?" Possible responses ranged from "severely underweight" to "severely overweight" on a five-point scale; (2) "Do you plan to lose weight?" Answers were yes or no. (3) If you plan to "lose weight," what method will you use for weight loss purposes? The possible responses were "dieting," "exercise," "taking medicine," and "vomiting."

The general nutrition knowledge of the subjects was assessed by 34 items divided into four domains. The domains were basic nutrition concepts (nine items), nutrient sources (nine items), disease and nutrition (nine items) and general dietary guidelines (seven items). Sample questions from the knowledge test were, "What is the best description of junk foods?" and "Which disease may be related to obesity?" A score of one was given for each correct response with a maximum score of 34 for the knowledge test.

Twenty-five questions were used to determine attitudes toward nutrition, foods and eating habits. A five-point response scale ranging from strongly disagree to strongly agree was utilized for all questions. Sample statements from this instrument were, "I should take a multiple vitamin supplement every day," and "I think that it is very important to eat breakfast every day." The best possible overall score on the attitude section of the questionnaire was 125. The reliability analysis yielded a Cronbach Alpha value of 0.72 for the knowledge test and 0.81 for the attitude scale.

Questions relating food intake and eating behavior were included in the "current nutrition practices" section. Samples questions were "How many servings of fruit do you eat in a day?" and "How many times do you skip lunch in a week?" The respondents were also asked to report two demographic characteristics: age and gender.

The research instrument was evaluated by ten professionals in health-related fields. Reviewers were asked to critique content, clarity and construction of the questionnaire. Items on the questionnaire were revised to incorporate the reviewers’ suggestions. Twenty female college students participated in a pilot test of the revised questionnaire. After completing the questionnaire, they were interviewed about the clarity and relevance of each item. Minor revisions were made to the questionnaire based on comments and responses collected during the pilot test.

Questionnaires were distributed in selected classes by research assistants. After completion of the questionnaire, height and body weight were measured by research assistants. Body Mass Index (BMI) was computed from height and weight measurements as kg/m². "Desired BMI (DBMI)" was calculated from subjects’ self reported "desired body weight (DBW)" and measured height. In order to compare the body-weight perception and weight loss methods performed among subjects in different weight categories, subjects were classified into five categories: severely underweight (BMI<16.9), underweight (16.9BMI<18.5), acceptable (18.5BMI<21.7), overweight (21.7<BMI25.1) and obese (BMI>25.1). These weight categories were classified at below 5th, 5th to 25th, 25th to 75th, 75th to 95th and above 95th percentile according to Huang’s study on the BMI distribution of 20 to 24 years old females in Taiwan [23].

To examine different characteristics among subjects who are currently dieting and not dieting, subjects were divided into three subgroups according to their reported weight satisfaction and their dieting practice. The three subgroups were (1) satisfied/not dieting (S/ND), (2) dissatisfied/ dieting (DS/D), and (3) dissatisfied/not dieting (DS/ND).

Data Analysis
The Statistical Package for the Social Science (SPSS. version 6.1, 1996) [22] was used for data compilation and statistical analysis. Values for body weight perception and weight-loss methods were calculated by simple frequency. One-way analysis of variance (ANOVA) was used to compare means among groups. Post hoc analyses were performed with the Least Significant Difference (LSD) test when the F ratio for the ANOVA was significant at p<0.05.

	RESULTS

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Study Participation and Subject Age
Out of the 1250 randomly selected subjects, 111 potential subjects were absent during the days that the test was performed. Of the 1139 questionnaires handed out, 1,057 subjects (92.8%) completed questionnaires and were given height and weight measurements. The mean subject age was 20.54±2.21 years.

Actual BMI, Desired Body Weight and Weight Perceptions
The mean body weight for all subjects was 51.10±5.93 kg and mean BMI was 19.99±2.03 whereas the mean desired body weight was 48.57±4.37 kg and the DBMI was 19.02±1.21. There were 35 subjects (3.3%), 200 subjects (18.9%), 650 subjects (61.5%), 144 subjects (13.6%) and 28 subjects (2.6%) in severely underweight, underweight, acceptable, overweight and obese categories, respectively. In general, the subjects perceived themselves as being heavier than classified according to their actual weight categories. For example, in spite of being severely underweight by objective measurement, 48.6% of subjects perceived themselves as underweight and 17.2% perceived themselves as having acceptable weight or overweight (Table 1). About 50% of subjects in the underweight category perceived themselves as having either acceptable weight or overweight (Table 1). Similarly, more than half the subjects in acceptable-weight category perceived themselves as slightly overweight or obese (Table 1).

	DISCUSSION

 
More than 20% of subjects in both the severely underweight and the underweight categories and above 50% of subjects in the acceptable-weight category indicated that they wanted to lose weight. Dissatisfaction with body weight is a well-known risk factor leading to eating disorders. The results also revealed a significant incongruity between the females’ self-perceived body-weight status and their weight categories (Table 1). Only 16.2% of subjects were overweight or obese, yet 51.4% of the subjects perceived themselves as either overweight or obese. There were 17.2% and 50.5% of subjects in the severely underweight and underweight categories who perceived themselves as having acceptable weight or being overweight, respectively. Similarly, 56% of subjects in the acceptable weight category thought they were either overweight or obese. These data are in agreement with others [10,24,25] that a much higher percentage of female subjects perceive themselves as overweight or obese than are actually overweight or obese. Individuals who perceive themselves as overweight are prone to chronic dieting and eating disorders [26].

The percentage of subjects that reported they do not plan to lose weight decreased dramatically as BMI increased (Table 2). This finding is similar to the reports of Mortenson et al. [27] and Seggar et al. [28] that there is a highly correlated inverse relationship between BMI and satisfaction with body weight. However, we did not estimate the subjects’ weight stability. It would be interesting to know the relationship among weight stability, satisfaction and dietary practices. The S/ND women weighed significantly less than either group of dissatisfied women (DS/ND or DS/D, Table 3); this is in agreement with Mortenson et al. [27]. However, other researchers [17,18] suggest that dissatisfaction with body weight is not dependent on whether a woman is overweight or not, but instead characterizes women of all weight categories.

It was interesting to find that more females chose exercise than dieting to lose weight among all weight categories. However, in this study we did not find a significant difference in the amount of exercise in subjects among all categories. Davis et al. [29] and Drewnowski et al. [17] reported that men are more likely to increase physical activity as their method to lose weight, whereas women are more likely to restrict food intake. This research was not designed to answer specifically whether young Taiwanese women are different from or similar to young women in other countries in their efforts to maintain or lose weight. More complete information on dietary intake and type and duration of daily exercises would be required to answer that question.

Mortenson et al. [27] reported that, in college females, 40% of the subjects in the food-restrained group practiced intentional vomiting for weight loss. In this study, only five (0.5%) out of all subjects reported using intentional vomiting to lose weight, substantially fewer than in the United States. However, the accuracy of this finding is questionable, given the author’s experience in a weight-loss counseling environment. The prevalence of using intentional vomiting for weight loss in young Taiwanese women awaits further investigation.

The difference between DBW and ABW was significantly larger in the DS/D group than for either the DS/ND or the S/ND group. One interpretation of this finding is that subjects in the DS/D group wanted to lose more weight compared to subjects in the other groups. This may be one of the main reasons for their dieting. The subjects in the DS/D group tended to measure their body weight more frequently than did the other subjects. They also spent more time exercising and reading nutrition information. Taken together, these results showed a greater preoccupation with creating a negative energy balance by increasing energy expenditure and decreasing energy intake. However, we did not find a significant difference among groups in frequency of eating energy-dense foods such as fried foods and meat in the present study. Others [30,31] have reported that restrained eaters consume less energy-dense food than unrestrained individuals. More frequent consumption of fruits by the dieting group, in contrast to the non-dieting group, may suggest that the dieters were attempting to reduce energy intake. This study was not designed to quantify energy intake accurately from specific food categories. Thus, it can not be determined if DS/D group members did consume energy-dense foods less frequently because they lacked knowledge concerning the energy content of these foods, because they failed to put knowledge into practice or because these foods are typically consumed in small amounts by Taiwanese women compared to women of Western cultures.

People who diet frequently to lose weight are often preoccupied with food and calorie counting and have a passion for reading literature about food and body weight. This gives the impression that they are very knowledgeable about nutrition [31]. However, our results showed that the DS/D group did not score higher in general nutrition knowledge or attitude toward nutrition than the other two groups. These results are similar to those reported by Reiff and Reiff [31]. Also, Beaumont and Chambers [32] found 25% of the subjects with eating disorders had nutritional-knowledge scores below that of controls.

Another behavior typical of weight conscious individuals is the practice of skipping lunch. The DS/D group skipped lunch more frequently than the other two groups; this finding is similar to results reported by Mortenson et al. [27]. It is commonly recognized that eating bed-time snacks can result in weight gain. In this study, the subjects, dissatisfied with their weight (DS/D and DS/ND), ate bed-time snacks less frequently than the S/ND subjects.

Smoking is another dieting strategy used by many concerned with their weight [27]. Very few subjects in this study smoked regularly (Table 3) and it appears that smoking is not practiced to lose or maintain weight among college females in Taiwan.

Alteration in menstrual regularity may also accompany or precede various clinical eating disorders. However, we did not measure the subjects’ menstrual regularity in this study. It should be interesting to include questions relevant to this in a further study.

This study showed that a high percentage of young-adult college females in Taiwan are dissatisfied with their body weight and consider themselves overweight or obese, even though they are actually underweight or have average weight based on commonly accepted weight categories. Also, a high percentage of the subjects practiced either dieting and exercise to lose weight regardless of their actual body weight category. These practices and misconceptions frequently lead to eating disorders. The problem of eating disorders in Taiwan should be attracting the attention of the health professionals such as physicians, psychologists, dietitians and educators. Widely used instruments, such as the Eating Attitudes Test (EAT) [33], the Eating Disorder Inventory (EDI) [34], the Three Factors Scale Eating Questionnaire [35] and the Diagnostic and Statistical Manual of Mental Disorder (DSM-IV) [36] are suggested tools for early recognition of eating-disorder problems and for further research.

	ACKNOWLEDGMENTS

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The authors thank Dr. Po-Chao Huang and Dr. Maurice R. Bennink for their assistance in preparation of the manuscript.

Received July 1, 1998. Accepted September 1, 1998.

	REFERENCES

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