Effect of a Multifaceted Intervention on Children’s Body Image and the Mediating Role of Body Image in Changes in Adiposity Indicators

Author:

Lyu Jinlang12ORCID,Wan Zhongshang1,Liu Zheng1ORCID,Zhou Shuang1,Feng Xiangxian3,Gao Aiyu4,Lin Yi5,Zhang Fang6,Wang Haijun12ORCID

Affiliation:

1. Department of Maternal and Child Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing 046000, China

2. Peking University Health Science Center-Weifang Joint Research Center for Maternal and Child Health, Weifang 261000, China

3. Changzhi Medical College, Changzhi 046000, China

4. Dongcheng Primary and Secondary School Health Care Center, Beijing 236499, China

5. Urumqi Primary and Secondary School Health Care Center, Urumqi 830003, China

6. Mentougou Primary and Secondary School Health Care Center, Beijing 102300, China

Abstract

Besides genetic factors and energy-related behaviors, psycho-cultural factors are also important in obesity etiology. Previous studies have suggested that improving body image might be an effective method for managing body weight. Thus, this study aimed to evaluate the effects of a multifaceted intervention on the body image of children and explore whether body image played a mediating role in changes in adiposity indicators. This study was embedded in a cluster randomized controlled trial, involving 1287 children from 24 primary schools in three cities in China (Beijing, Changzhi and Urumqi). The 9-month multifaceted intervention on childhood obesity included five components (three targeted children and two targeted environments), and randomization was performed by an independent person who was blinded to the schools. Two indicators (body size perception and body size expectation) were chosen to characterize body image and were measured by Ma figural stimuli at baseline and the end of the trial. Changes in body image indicators were classified as conducive to weight loss or not. Other anthropometric measures and self-reported behaviors were also collected at both time points. Generalized linear mixed models were used in the analyses. Compared to the controls (n = 648), the proportion of body size perception conducive to weight loss increased in the intervention group (n = 639), with an odds ratio of 2.42 (95%CI: 1.70~3.45, p < 0.001). The proportion of body size expectation conducive to weight loss also increased more in the intervention group than in the controls (OR = 1.74, 95%CI: 1.14~2.66, p = 0.010). In children whose baseline nutritional status was “normal weight with higher BMI” or “overweight/obese”, the improvements in body size perception and body size expectation partly mediated the association between the intervention and changes in BMI, BMI Z score, waist circumference and body fat percentage (p < 0.05). This multifaceted study effectively improved the body image of children, which, in turn, led to beneficial changes in adiposity indicators. For the first time, body size perception and body size expectation have been confirmed to be important factors associated with the beneficial effect of a childhood obesity intervention, suggesting that body image components should be generalized in the future.

Funder

National Natural Science Foundation of China

National Key R&D Program of China

Publisher

MDPI AG

Subject

Food Science,Nutrition and Dietetics

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