The Effects of Physical Activity and Dietary Habits and BMI on the Perception of Body Image on High School

Adolescents in Southern California Between Genders

Running Head: Effects of Eating and Exercise Habits on Adolescent Body Perception

Authors: Marian E. McIntosh Hannah Coe Jaque Perez Caroline Reeve Shiloah Fuller, BS School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA 92182

Shiloah Fuller Department of Exercise and Nutritional Sciences San Diego State University 5500 Campanile Drive San Diego, CA, 92192-7251 shiloahkvat@gmail.com

Abstract

The objective of this study was to compare associations between physical activity and dietary habits on BMI and self-image in male and female adolescents. A survey including questions about demographics, lifestyle, and dietary habits were included in a food frequency survey questionnaire that was distributed to 1266 San Diego High School students between the age of 13-18. The surveys were collected and analyzed by IBM SPSS computer software. The results showed that the average BMIs of the males and females were within normal ranges, yet even though the mean was in normal range, males BMI were still significantly higher, even though their physical activity time was higher with a P value of <.0001. Generally, females viewed themselves as more overweight than males, with a P values of <.0001 and <.05. Females had overall healthier dietary habits but engaged in less vigorous exercise than males.

Key Words: Adolescents, BMI, Food Frequency, Dietary Habits, Physical Activity Introduction The adolescent obesity epidemic has continued to become a growing issue in the United

States. According to the Center for Disease Control, the prevalence of obesity in adolescents has tripled within the past three decades(1). In recent years, public health movements to improve adolescent health behaviors and decrease the obese population have been created and implemented throughout the U.S. Scientific studies concerning health habits and body weight have been conducted in order to improve Americans knowledge about the underlying issues of obesity. The trending sedentary behavior of many adolescents has shown to have negative effects on body mass index (BMI). One study suggests that for every one hour increase of television viewing per day in females results in a .22 increase in BMI. Although not as significant in males, for every one hour increase in television viewing, their BMI was shown to increase by .13 (2). The amount of television viewing per day could be reversed and examined in another view in terms of physical activity; assuming less television time is reflected in an increase in physical activity. Another study examined the quality of life in adolescence based on the physical activity. Those that achieved at least sixty minutes of physical activity per day scored significantly higher on the European Quality of Life Scale as opposed to those that did not meet the recommendation of sixty minutes (3). A limitation for this study, however, could be argued that the specific type of physical activity was not evaluated which is why physical activity types will be determined in this study. Another major contributor to adolescent obesity is the dietary behavior of American teenagers. Commonly consumed diet soft drinks have been examined in relation to BMI in a recent study involving adolescent subjects. Using a food frequency model, researchers found that females who consumed diet carbonated soft drinks had higher BMIs than those who avoided diet soft drinks (2). Foods choices similar to soft drinks such as processed and high fat foods need to be examined to determine if BMI reflects such dietary habits. Diet choices in

adolescents have also been attributed to mass media such as television and advertisements. Results of a study examining the correlation between food advertisements on TV and adolescent exposure found that the relationship was negatively associated with healthy dietary choices across the board (4). The effect of dietary habits on body image in teenagers has also been studied in terms of adolescent females. A study examined two ethnic groups, Hispanic-American girls and AfricanAmerican girls and evaluated their diet using a 24-hour recall as well as their body image satisfaction. Using Fallon and Rozins Body Image Checklist the researchers found that the Hispanic-American girls had a lower body image score than the African-American girls but they consumed more lipids and saturated fat in their diet. The African-American girls had a significantly higher body image score although the scientist found no correlation between their score and their lipid consumption (5). While the findings in this study were significant in relation to ethnic differences, our study will further body image analysis in terms of genders rather than ethnic background. Dietary habits such as meal skipping, binge eating and unhealthy dieting and its association with adolescent weight to adult obesity was studied over the course of ten years in a longitudinal study. Researchers considered dietary habits of adolescent males and females using surveys. The surveys question the subjects body image and eating practices. After ten years, higher prevalence of obesity occurred in subjects who practiced unhealthy dieting and who had negative body image. A result of 51% obesity was present in the subjects at the end of the study which was a 25% increase from the baseline of 26% obese in the beginning of the study (6). The results of the studies examined yield similar results but seize to compare all of the factors influencing obesity and dietary habits in one setting. The purpose of the following study was to evaluate gender differences between physical

activity, dietary habits and body image and their effect on BMI in Southern California adolescents. This study consisted of two hypotheses. The first is that increased physical activity levels will positively influence food choice and meal frequency and negatively influence BMI. The second hypothesis is that adolescents who perceive themselves as heavy will eat healthier food choices, skip more meals, and have higher rates of being overweight than adolescents who dont perceive themselves as being heavy.

Methods: Procedure The Institutional Review Board of San Diego State University approved the studys protocol. SDSU students underwent an IRB certification to be able to explain the directions to the participants. The data obtained for this study came from participants in high schools, after school programs, and junior high schools. Students from three randomly selected schools in the San Diego County were asked to participate in a voluntary survey. Parental consent forms were distributed and participant assent forms were offered prior to the administration of the surveys, however, filling out the forms was not necessary to partake in the survey. Prior to the distribution of the questionnaire, the survey distributors explained how to fill out each section and what each section consisted of. The purpose of the study was thoroughly explained to the participants before the survey began, as were the benefits to society and the risk of feeling discomfort in answering personal questions about their bodies. After explaining the purpose of the investigation, it was emphasized that participation was voluntary and that if they chose to withdraw from the study at any time, they would not be penalized in any way by the school or SDSU. The surveys were then passed out, and participants were given as much time as they

needed in filling out the survey and given any assistance they required in understanding the questions. The surveys were then collected and brought back to SDSU for data analysis. Participants There were a total of 1266 voluntary participants consisting of San Diego County junior high and high school students who chose to partake in the study. The volunteers were adolescents between the ages of 13-18. Table 1 shows the number of participants based on the questions that were answered. 1284 participants answering their age. 1240 participants answered their weight. 1246 participants answered with their height. 1216 BMIs were calculated based on the information given by the participants. The results show that teenage females have higher values than teenage males. There is a significant percentage of females with a higher BMI, as well as an increased height and age compared to the participating males, with a p-value of .001 indicating a high significance in the data. The distribution between the ethnicity of the students that participated in the study is presented in Table 1 and furthermore in Figure 1. The participants were of mixed ethnicities consisting of White/Caucasian, Hispanic, African American, Asian, and other with no major differences by gender.

Survey Demographic questions in our survey consisted of asking the participants age, gender, height, weight, eating habits, perception of body image. The participants would write in the survey their own gender, age, height, and weight. Physical activity was assessed through the survey questionnaire which consisted of participants indicating how many days a week they exercised along with the duration, and

exertion level of physical activity. The levels of physical activity were divided into three categories of physical activity exertion levels, which were distributed as follows: category 3 indicated that the participant performed a vigorous level of exercise which consisted of 481 minutes per week or more of physical activity. Category 2 indicated that the participant would perform moderate level of strenuous exercise, with the physical activity per week ranging from 181 to 480 minutes. Finally, category 1 indicated a mild level of exercise which ranged from 0 to 180 minutes of physical activity per week. Each category was divided into frequencies of third percentiles. In order to assess our participants body image, our questionnaire had one question that consisted of asking participants how they perceived their physical appearance.The participants would choose one of five categories to describe their Body Image appearance. The five categories were very thin, thin, fit, a little overweight, or very fatty. The participants would check off one of the five categories according to how they personally thought their body image to be. The students dietary habits were analyzed through the food frequency questionnaire that had a total of 55 food items. The participants answered the food frequency questionnaire based upon how often they consumed certain meals and food types in a specific amount of time during the year. The answers were divided into sections based upon how many times in a single day, week, month or year they consumed the specific food item, or if they ever ate the food at all. The foods featured on the questionnaire included such items as breakfast cereals, soups, fish, meats, poultry, dairy products, fruits and vegetables, and coffee, tea, fruit juices, soft drinks.

Statistical Analysis IBM SPSS software was used to generate a Chi-squared evaluation of the categories

between genders including: physical activity; food choice; and body image. To look at the differences between genders in height ,weight, age, BMI and exercise length, and frequency, Independent Sample T-tests, also generated by IBM SPSS Software for Windows (Armonk NY. USA), were used.

Results: Physical Activity Levels The results from Table 2 show longer lengths of exercise time with males than with females, with a mean difference of roughly 23 minutes, as well as more days with exercise and more exercise per week, with males averaging 153 minutes more of exercise per week than females. The results of Figure 2 show a P Value of less than .0001, which indicates a significant difference in physical activity levels between males and females. These results show that males are more likely to participate in vigorous activity, category 3, than females. Incidentally, both genders are approximately equally likely to participate in moderate, category 2, levels of exercise, though with a slightly higher percentage in the female population.

Body Image The results of Figure 3 show the P value to be less than .0001. The P value of < .0001 shows that body image value between males and females is significantly different. Males are more likely than females to describe their bodies as fit. Females are more likely than males to describe their bodies as a little overweight.

Food Frequency Questionnaire The results of the food frequency questionnaire showed the different types of food intake

between genders. Males are more likely to have a high intake of the following: cereal, hamburgers, pizza, meat, processed meat, eggs, fish, shellfish, crab and whole milk. Females are more likely to have a higher intake of the following: salad, fruits, green vegetables, yellow vegetables, cruciferous vegetables and other types of vegetables. The P-Values of <.05 and <.001 show strong evidence of a significant difference between food choices between genders. See Table 3 for data. Discussion The results of this study were consistent with the authors hypothesis, that populations who viewed themselves as heavy, would have healthier food choices. The authors second hypothesis, that increased physical activity positively influences food choices, was inconsistent with the data, since males consistently had higher physical activity levels than females, yet consumed diets higher in fat and simple sugars. Results revealed that males have higher levels of physical activity than females as well as a diet higher in high fat foods and lower in consumption of fruits and vegetables. Possible causes for the results could be cultural differences between genders and the perception of male teenagers that higher physical activity allows for more leniency in their diets. In addition, the findings showed that females had a greater prevalence of perceiving themselves in an overweight body category in comparison to males. A study by Quick et al. suggests that over the course of a decade adolescents with unhealthy dietary habits and poor body image resulted in an increased prevalence in obesity(6). According to the Center for Disease Control(CDC), adequate levels of physical activity and healthy eating habits are key preventers of excessive weight gain and obesity in young adults(1). Our results demonstrated in relation to this study that young adults have a slightly higher BMI with an average of 23 for a male with a standard deviation of 4.47 while the average BMI for

girls 22.06 and a standard deviation of 3.99. In correlation the collected data reveals that no female claimed to be overweight. However, the results show that males, having a higher BMI with the standard deviation of 4.4, were overweight on average. The body image of the participants demonstrated that the females thought of themselves as overweight when compared to the males, yet had a lower BMI, which suggests females are more conscious of health and body choices than males. This provides insight into why female dietary habits were healthier than males. Although in Talpades study the results showed that poor body image was correlated in increase saturated fat and lipid consumption, in this study the results showed that females had a lower BMI yet had a lower perception of body image(5). Assuming that the females subjects in Talpades study had a higher BMI from high consumption of fat, our study found that female subjects BMI were within normal range in correlation to having a diet rich in fruits and vegetables. The findings of our study reinforce that having a diet with a high intake of fruits and vegetables has a positive correlation with having a normal average BMI. In De Vets study, their subjects diet choice were analyzed in relationship to their exposure to television ads. The study showed that the amount of exposure to TV ads was negatively associated with a healthy diet (4). In this study, one factor that was taken into consideration was the correlation between physical activity and dietary choices. Our females subjects participated in a moderate level of physical activity, and reflected a normal BMI average. The majority of our male subjects participated in a vigorous level of physical activity, however, their BMI range falls into the overweight category. A possible explanation for their high BMI could be the lower amount of fruits and vegetables in their diets when compared to the female subjects, since their diet consisted of mostly regular soda, whole milk, pizza, and

processed meats. The means of our results show that having a diet rich in fruits and vegetables, rather than a diet high in unhealthy snacks, correlates with having a BMI at a normal range, although performing at a vigorous level of physical activity appeared to have a correlation with having a higher BMI. Boyles study was focused on the consumption of diet and soft drinks in adolescent females in relation to their BMI, using a food frequency questionnaire to configure the amount of diet-carbonated soft drinks. Boyle found that subjects with higher BMIs chose to consume more diet- carbonated soft drinks than compared to those who avoided soft drinks altogether (3). In our study, we found that males consumed more regular soda in comparison to diet soda; when compared to our female subjects. Although their BMIs were higher, it is possible that the consumption of unhealthy food choices, such as processed meats, pizza, and soft drinks, was counteracted by their vigorous level of physical activity. The results of our study show that there is a correlation of having a higher BMI, when consuming a diet rich in unhealthy food choices such as processed meats, pizza, soft drinks and whole milk especially in males. Possible limitations for this study are primarily related to the honesty of survey responses. It is possible that the participants were embarrassed by or unaware of their actual weight and filled in incorrect responses. To ensure accuracy the children could have been weighed before taking the survey, for more accurate measurements of weight and and BMI calculations. Overall our results neither supported nor disproved the hypothesis as necessary correlations were not evaluated. A secondary analysis based on the information collected via surveys should include a BMI calculation for each category of PA, food frequency, and self image to properly determine any correlation. Correlations between physical activity, genetics, work hours and food choices should also be calculated for further research. The differences

between ethnicities and their food choices and physical activity are possible subjects for further research.

Tables and Graphs Table 1- Demographic Data Between Genders AgeMale Age- Female Weight-Male Weight- Height- H B B Female Male e MM i I I g - h M t a F - l e Fe m e a m l a e l e 777 454 7 4 7 9 5 6 2 1 5 1 2 2 6 3 2 2 . .

470

814

463

Mean

15.94

15.70

69.50

58.16

173.37

. 1 0 2 7 6 8 8

Table 2- Exercise Levels Between Genders Male Exercise Days per week- Mean Exercise Length (min)- Mean PA/Week (min)Mean 3.90 111.791 548.5335 Female 3.42 88.314 395.4509 Standard Deviation .012 21.93 204.97 P-Values .165 .001 <.001

*The p-values of Exercise Length and PA/Week of indicate that the results are significant between genders in terms
of duration rather than frequency

*Figure 2 represents the results of question 25 on the questionnaire, where the participants were asked the degree of
exercise they normally received, with 1 representing a low level of exercise, 2 representing a moderate level, and 3 representing a vigorous level. The P-value of <.0001 shows that the physical activity levels between males and females is significantly different.

*Figure 3 represents the results of question 33 on the questionnaire, which asked the participants what they thought of their own body image, with five answers to choose from. Category 1 represents those who saw their own body as being very thin, category 2 represents the thin body image, category 3 represents the fit body image, category 4 represents the a little overweight body image, and category 5 represents the very fatty body image. The p value of <.0001 shows that the value of body image between males and females is significantly different.

Table 3- Food Frequency Questionnaire

Food Cereal Hamburger Pizza Meat Processed Meat Eggs Fish Shellfish Crab Salad Green Veggies Yellow Veggies Crucif. Veggies Other Veggies Fruits Whole Milk Regular Soda

P-Value: Male Dominant Intake <.05 <.001 <.05 <.001 <.001 <.05 <.001 <.05 <.05

P-Value: Female Dominant Intake

<.001 <.001 <.05 <.05 <.05 <.05 <.001 <.001

*Table 2 represents the results of the food questionnaire. The P value <. 0001 and <. 05, show that there is a significant difference in food choice consumption by both genders. Males consumed foods such as whole milk, meat, and processed meats the most whereas females would eat more salads, and vegetables than males.

References

1. Centers For Disease Control and Prevention.(2013). Health Effects of Childhood Obesity.retrieved from: http://www.cdc.gov/healthyyouth/obesity/facts.htm. Accessed on April 30, 2013. 2. Forshee R, Anderson P, Storey M. The role of beverage consumption, physical activity, sedentary behavior, and demographics on body mass index of adolescents. Int J Food Sci Nutr. 2004;55(6)456-478. 3. Boyle S, Jones G, Walters S. Physical activity, quality of life, weight status and diet in adolescents. Quality of Life Research. 2010; 19(7):943-954. 4. de Vet E, de Ridder D, de Wit J. Environmental correlates of physical activity and dietary behaviours among young people: a systematic review of reviews. Obesity Reviews. 2011;(12):130-142. 5. Talpade M. Hispanic versus African American girls: Body image, nutrition, and puberty. Adolescence. 2008;43(169):119-127. 6. Quick V, Wall M, Larson N, Haines J, Neumark-Sztainer D. Personal behavioral and socio-environmental predictors of overweight incidence in young adults: 10-yr longitudinal findings. Int J Behav Nutr Phys Act. 2013;10(1):37-49. 7. (Armonk, NY, USA). IBM SPSS Statistics software for Windows.