Examining the Relationships Between Weight-Related Self-Monitoring and Eating Disorder Risk Among College Students

Hahn, Samantha L ProQuest Dissertations & Theses University of Mich 2020 해외박사(DDOD)

Weight-related self-monitoring involves tracking one’s weight, physical activity, and/or dietary intake. Millions of individuals engage in weight-related self-monitoring, with college students among the most likely users. Despite widespread weight-related self-monitoring, there is little research evaluating its consequences. Of particular concern is the potential for weight-related self-monitoring to increase eating disorder risk. The aims of this dissertation were to: 1) understand how undergraduate and graduate college students use methods of dietary self-monitoring and self-weighing with one another, and examine whether certain patterns of weight-related self-monitoring methods are associated with eating disorder risk, 2) examine how college freshmen use technology-based weight-related self-monitoring, and determine how patterns of technology-based weight-related self-monitoring are associated with eating disorder behaviors, and 3) identify the extent to which technology-based dietary self-monitoring increases eating disorder risk among female undergraduate students. Aim 1 drew from a large cohort of students from 12 universities across the United States and used latent class analysis to identify patterns of weight-related self-monitoring. Methods of weight-related self-monitoring that were assessed included knowing nutrition facts, knowing calorie facts, counting calories, and self-weighing. Eating disorder risk was measured using the Eating Disorder Examination Questionnaire. Results of Aim 1 suggest differences in patterns of weight-related self-monitoring by gender. Among females, four patterns were identified: “no weight-related self-monitoring”, “all weight-related self-monitoring” methods, “knowing nutrition/calorie facts”, and “self-weigh only”. For females, all patterns of weight-related self-monitoring were associated with higher eating disorder risk compared to “no weight-related self-monitoring”. Among males, three patterns were identified: “no weight-related self-monitoring”, “all weight-related self-monitoring” methods, and “all weight-related self-monitoring but calorie counting”. Among males, only those represented by the “all weight-related self-monitoring” pattern demonstrated elevated risk for eating disorders. For Aim 2, latent class analysis was again used to identify patterns in use of the following weight-related self-monitoring tools: apps for a specific diet or exercise plan, wearable fitness tracker, online fitness tracker, online food journal, self-weighing, and a weight tracking app. Three patterns of technology-based weight-related self-monitoring were identified among females: “no weight-related self-monitoring”, “all weight-related self-monitoring”, and “food and exercise self-monitoring”. Those categorized by the “all weight-related self-monitoring” pattern were more likely to engage in eating disorder behaviors than those in the “no weight-related self-monitoring” pattern. Among males, three patterns were also identified: “no weight-related self-monitoring”, “all weight-related self-monitoring”, and “exercise self-monitoring”. There were no relationships between these patterns and eating disorder behaviors among males. Finally, for Aim 3, undergraduate female students were randomly assigned to either monitor their eating for 30 days using the MyFitnessPal app or continue to be naive to dietary self-monitoring. Eating disorder risk was measured using the EDE-QS at baseline and post-intervention. No difference in eating disorder risk was seen between groups at post-intervention, suggesting that participating in a 30-day trial of dietary self-monitoring did not affect eating disorder risk among undergraduate females. Overall, findings from this dissertation indicate that specific patterns of weight-related self-monitoring are associated with concurrent eating disorder risk, particularly among women. Assessing methods of weight-related self-monitoring among young adults may be useful to identify individuals at elevated risk for eating disorders. However, a short-term trial of dietary self-monitoring among college women naive to dietary self-monitoring did not increase eating disorder risk immediately post-intervention. Future research is needed to understand whether there are any specific sub-populations for whom weight-related self-monitoring is problematic.

Weight Stigma in Sexual Minority Women and Its Relation to Health and Health Behaviors

Gonzalez, Alejandra The University of Iowa ProQuest Dissertations & Th 2023 해외박사(DDOD)

Weight stigma negatively impacts the health and health behaviors of individuals. It has been associated with physical and mental health outcomes in different populations. However, no studies have examined weight stigma in sexual minority women (SMW). SMW have unexplained health outcomes that have led to health disparities when compared to heterosexual populations. Limited research has been conducted to help understand the frequency of health disparities present in SMW. One of the health disparities present in SMW are the rates of obesity and overweight compared to heterosexual women. This could make SMW more susceptible to weight stigma. Therefore, the purpose of this research is to explore the prevalence of weight stigma in a sample of SMW and examine the relationship of weight stigma to health and health behaviors.Weight stigma is the mistreatment of others because of their weight and/or body size. Despite the ongoing evidence of the negative effects weight stigma can have, it remains an accepted form of discrimination and mistreatment in society including work environments and the healthcare field. There are two forms of weight stigma, external and internal weight stigma. External weight stigma is experiencing things such as discrimination and teasing. Internal weight stigma is feeling ashamed and negatively about self.The Health Equity Promotion Model (HEPM) was used to guide this research. The application of weight stigma to HEPM helps to view it in a holistic matter where individual's social positions (e.g. race, age, income) can influence and determine who weight stigma is experienced. As individuals experience weight stigma, they may be affected in behavioral, psychological, social and biological ways, which are labeled as health promotion or adverse pathways in the model. Engaging in these pathways can then affect health outcomes. For example, individuals who are exposed to weight stigma eat more calories which can then affect their cardiovascular health.The cross-sectional study included 3,821 total participants with 459 identified as SMW. The sample was primarily non-Hispanic weight and ages 18-44 who completed an online survey that measured external and internal weight stigma, health outcomes, and health behaviors. External weight stigma was measured using a series of five questions and internal weight stigma was measured using the Weight Bias Internalized Scale (WBIS). The prevalence of external weight stigma ranged from n=118-259 (26-64%), depending on the question and for internal weight stigma it was n=264 (57%). Overall bisexual women had the highest prevalence of internal weight stigma (n=162, 35%). Bisexual women also had the highest prevalence of external weight stigma for all questions. When examining demographic characteristics as predictors of weight stigma, overweight, obesity, and gay/lesbian sexual identity significantly predicted internal weight stigma. Being overweight or obese means having two to five odds higher of having internal weight stigma. For external weight stigma demographic predictors depended on the question but for all being obese was a predictor of having any kind of external weight stigma. When examining health outcomes hyperglycemia (n=289, 63%), chronic pain (n=112, 24%), and hypertension (n=92, 20%) were the most commonly reported physical health issues. Anxiety and depression diagnosis were reported by over 50% of this sample of SMW. The most common health behaviors reported were being up to date on routine health screenings and partaking in past diet or exercise to lose weight (>70%). Internal weight stigma and external weight stigma due to teasing were significantly associated with all mental health outcomes. When furthering analyzing the relationship of stigma to health outcomes and health behaviors there were only a few that were significant. Internal weight stigma predicted having two to four higher odds of hypertension, anxiety, depression, and eating disorders. Only external weight stigma due to discrimination predicted hypercholesteremia. For health behaviors, having internal weight stigma, external weight stigma due to discrimination, and treated less predicted at two higher odds of delaying or avoiding healthcare due to weight. The opposite was true for predicting drinking and exercise were having internal weight stigma and/or external weight stigma due to discrimination meant lower odds of partaking in these activities.

The relation between weight changes and alanine aminotransferase levels in a nonalcoholic population

윤지은 연세대학교 대학원 2007 국내박사

Nonalcoholic fatty liver disease (NAFLD) is one of the most common forms of chronic liver disease. Obesity is the single most common condition found in association with NAFLD. Obesity is also a risk factor for elevation of serum liver enzymes, reflecting hepatic injury. Of these liver enzymes, alanine aminotransferase (ALT) has been used as a marker of NAFLD.A few studies have shown an association between weight change and serum ALT levels. However, weight change (gain or loss) was assessed at only one or two points of time, and this may be partly explained by the benefit of fewer observations. This has led to a question as whether weight change in several repeated data is associated with a risk of ALT abnormality. In the present study, which utilized selected data from a prospective cohort, the Korean Cancer Prevention Study (KCPS), I attempted to determine association between changes in weight and the risk of abnormal ALT levels in a nonalcoholic population.The cohort study was performed on participants among 1,329,525 Koreans between the ages of 30 and 95 years who had at least one routine medical examination through the National Health Insurance Corporation (NHIC) between 1992 and 1995. Of the study participants, 241,334 nonalcoholic healthy subjects aged 30 to 44 years who had completed an examination in 1992, and who had body weight measurement data for at least four of the seven visits up to 2004 were included.Abnormal ALT level was defined as ALT ≥40 IU/L. Three dimensions of weight changes were used in these analyses; these were the slope, initial value (intercept), and fluctuation of weight. The slope of weight was classified into five group based on quintiles in order to assess the associations between weight changes and ALT levels. The odds ratios (OR) and 95% confidence intervals (CI) were assessed using the generalized estimating equation (GEE) model to determine the risk of ALT abnormality.The mean age of study subjects was 36.5 years for men and 35.2 years for women. An increased slope of weight was associated with ALT abnormality. A higher slope of weight was associated with substantially increased risk for abnormal ALT (OR for highest vs. lowest quintiles, 2.58 [95% CI, 2.50 to 2.66] for men; OR for highest vs. lowest quintiles, 2.30 [95% CI, 2.12 to 2.49] for women). Increased ALT abnormality was also strongly associated with increased initial weight and weight fluctuation. Initial weight and weight fluctuation were found to be independent risk factors for ALT abnormality, and modified the association between ALT abnormality and the slope of weight. More specifically, an increase in the slope of weight was significantly associated with a change in abnormal ALT risk among those who had low initial weight and among men with mild weight fluctuation.In conclusion, these longitudinal data indicate a strong association between weight change and the risk of ALT abnormality. A higher slope of weight was strongly associated with an increased risk of ALT abnormality. The association between the slope of weight and ALT abnormality was modified by initial weight and weight fluctuation.

Sex-Based Differences in Weight Misperception and its Related Factors among Korean Children and Adolescents : 한국 아동 청소년의 체중 오인과 그 관련요인에 있어서 성별 차이

Shin, Anna 연세대학교 일반대학원 2016 국내박사

본 연구의 목적은 한국 아동의 부모가 자녀의 체중을 오인하고 있는 정도를 파악하고, 이러한 체중 오인과 관련된 사회인구학적 요인들에 있어서 성별 차이를 탐색해 보고자 함이다. 국민건강영양조사의 최근 5개년(2009-2013) 자료를 기반으로, 6-11세 아동 3,228명을 연구 대상으로 선정하였다. 부모의 체중 오인과 관련된 사회인구학적 요인들을 탐색하기 위해 Generalized Logit Model을 이용하였다. 남아 부모의 27.4%와 여아 부모의 23.7%는 자녀의 체중을 오인하고 있었다. 남아와 여아의 부모 모두 자녀의 체중을 실제 체중보다 더 낮게 판단하고 있었다. 부모의 체중 오인은 연령, BMI, 거주지, 엄마 자신의 체중에 대한 인지, 부모의 비만 여부와 같은 사회인구학적 요인들과 관련이 있었다. 특히, 부모의 비만은 여아에서만 유의한 변수로 나타났다. 부모의 자녀에 대한 체중 오인 패턴을 성별로 이해함으로써, 아동의 체중관리를 위한 바람직한 중재프로그램을 시작할 수 있을 것이다. 본 연구의 또 다른 목적은 한국 청소년이 자신의 체중을 오인하고 있는 정도를 파악하고, 이러한 체중 오인과 관련된 사회인구학적 요인들에 있어서 성별 차이, 체중 오인과 건강관련 변수들과의 관련성에 있어서 성별 차이를 살펴 보고자 함이다. 국민건강영양조사의 최근 5개년(2009-2013) 자료를 기반으로, 12-18세 청소년 3,385명을 연구 대상으로 선정하였다. 체중 오인과 관련된 사회인구학적 요인들을 탐색하기 위해 Generalized Logit Model을 이용하였고, 체중 오인과 건강관련 변수들과의 관련성을 파악하기 위해 각각의 Logistic Regression Model을 적용하였다. 전반적으로 남아의 26.2%, 여아의 27.9%가 자신의 체중 상태를 잘못 분류하였다. 남녀 모두 자신의 체중을 실제 체중보다 더 높게 판단하고 있었다. 특히, 여아의 경우, 실제 체중보다 자신의 체중을 더 높게 판단하는 경향이 더 낮게 판단하는 경우보다 4배 이상 더 많았다. 체중 오인은 성별, 연령, BMI, 가구당 소득, 엄마의 교육수준, 거주지, 가족수 등과 같은 사회인구학적 요인들과 연관이 있었다. 가구당 소득은 남아에서, 엄마의 교육수준, 거주지, 가족수는 여아에서 체중 오인과 관련이 있었다. 체중 과대평가(overestimation)는 여아에서 부적절한 체중관리행위와 관련이 있었으나, 남아에서는 체중 과대평가(overestimation) 및 과소평가(underestimation) 모두 부적절한 체중관리행위와 관련이 있었다. 정기적으로 격렬한 운동을 하는 남아는 체중을 과대평가할 가능성이 더 낮았고, 음주 경험이 있는 여아는 그렇지 않은 여아에 비해 체중을 과대평가할 가능성이 더 높았다. 청소년의 체중 오인의 성별 특성 및 건강관련 요인들과의 관련성에 대한 이해를 바탕으로, 청소년 및 부모들을 대상으로 성별에 따른 개별적인 중재 프로그램들을 고안할 수 있을 것이다. The purpose of this study was to quantify the extent of parental misperception of their child’s weight, and to explore sex-based differences in socio-demographic factors associated with parental misperception among Korean children. Data on 3,228 children aged 6-11 years were collected from the Korea Health and Nutrition Examination Survey (KNHANES) datasets (2009-2013). The generalized logit model was used to explore sex-based differences in socio-demographic factors associated with parental misperception. Overall, 27.4% of parents of boys and 23.7% of parents of girls misclassified their child’s weight status. Parents of both boys and girls were more likely to underestimate rather than overestimate their child’s weight. Parental misperception was associated with socio-demographic factors such as age, BMI, place of residence, maternal perception of their own weight, and parental obesity. Particularly, parental obesity was a significant variable only among girls. Understanding parental misperception patterns depending on sex might be the initial step towards desirable interventions for weight control. Another purpose was to quantify the extent of weight misperception, to explore sex-based differences in socio-demographic factors associated with weight misperception, and to examine sex-based differences in the relationship between weight misperception and health-related factors among Korean adolescents. We selected data on 3,385 adolescents aged 12-18 years from the KNHANES datasets (2009-2013). The generalized logit model was used to explore the relationship between weight misperception and socio-demographic factors, and separate logistic regression models were fitted to examine the association between weight misperception and health-related factors. Overall, 26.2% of boys and 27.9% of girls misclassified their weight status. Both boys and girls were more likely to overestimate rather than underestimate their weight. Particularly, girls were more than four-times more likely to overestimate rather than underestimate their weight. Weight misperception was associated with socio-demographic factors, such as gender, age, BMI, household income, maternal education level, place of residence, and number of family members. Household income was linked to weight overestimation and underestimation among boys. Maternal education level, place of residence, and number of family members were significant variables among girls. Weight overestimation was related to inappropriate weight control practice among girls. However, among boys, both weight underestimation and overestimation were associated with inappropriate weight control practice. Vigorous exercise was negatively associated with weight overestimation only among boys. Drinking experience was also positively associated with weight overestimation among girls. Based on understanding the characteristics of sex-based differences in weight misperception patterns and their association with health-related factors, individualized intervention programs according to sex could be devised for adolescents and their parents.

Association of short-term weight change with all-cause and cause-specific mortality

권소윤 성균관대학교 일반대학원 2023 국내석사

Weight gain is known to be associated with an increased risk of mortality, and although the importance of weight loss is emphasized in some metabolic diseases such as type 2 diabetes and fatty liver, paradoxically, weight loss is also known to be associated with an increased risk of mortality. This study analyzed whether short-term weight changes are associated with all-cause mortality and cause-specific mortality rates. A total of 645,260 subjects aged between 40 to 80 who had undergone general health checkups twice within a 2-year interval between January 2009 and December 2012 were analyzed. The results of Cox regression analysis showed that the group with weight gain or weight loss within a short period of time was associated with an increase in overall cause-specific mortality compared to the group with stable weight. The hazard ratios and 95% confidence intervals for the severe weight loss, moderate weight loss, moderate weight gain, and severe weight gain groups were 2.05 (1.93–2.16), 1.21 (1.16–1.25), 1.12 (1.08–1.17), and 1.60 (1.49–1.70), respectively. In subgroup analyses based on obesity status, age over 65, sex, regular exercise, and metabolic syndrome, the U-shaped relationship between weight change and mortality remained. This U-shaped relationship was also observed in cause-specific mortality. In decreased waist circumference group (<-2.5cm), the weight loss was associated with an increased risk of mortality compared to the weight gain, and there was no significant difference in waist circumference change within the weight loss group in terms of mortality risk. Finally, when tracking weight changes between the second and last health check-up, even if there was weight loss between the first and second check-up, if the weight was subsequently regained, the increment of all-cause mortality attenuated compared to those who did not experience weight loss. 체중 증가는 사망 위험성의 증가와 연관이 있는 것으로 알려져 있고, 비록 당뇨병, 지방간 등의 일부 대사성 질환에서 체중 감량의 중요성이 강조되고 있으나 역설적으로 체중 감소도 사망 위험성의 증가와 연관이 있는 것으로 알려져 있다. 본 연구는 단기간 내 발생한 체중 변화가 전체 사망률 및 원인 별 사망률과 연관이 있는지 분석한 후향적 코호트 연구로 2009년 1월부터 2012년 12월 사이 2년 간격으로 건강검진을 받은 40세에서 80세 사이 한국인을 대상으로 평균 8.4년을 추적하였고, 콕스 회귀 분석(Cox regression analysis) 결과 단기간 내의 체중 증가 혹은 체중 감소가 있는 그룹은 체중이 변화하지 않은 그룹에 비해 전체 원인 사망률 증가와 연관되어 있었다. 심한 체중 감소, 중간 체중 감소, 중간 체중 증가, 심한 체중 증가 그룹에서 위험비와 95% 신뢰구간은 각각 2.05(1.93–2.16), 1.21(1.16–1.25), 1.12(1.08–1.17), 1.60(1.49–1.70)였다. 비만 여부, 65세 이상, 성별, 규칙적인 운동 여부, 대사증후군 여부로 나누어 하위그룹 분석을 진행하여도 체중 변화와 사망률 사이의 U자형 관계는 유지되었다. 이러한 U자형 관계는 각각의 원인 별 사망률에서도 유사하게 나타났다. 허리 둘레의 증가 혹은 감소 여부를 포함하여 분석을 진행한 결과 체중 감소 그룹이 증가 그룹에 비하여 사망 위험이 증가하였고, 같은 체중 감소 그룹 내에서 허리 둘레의 증가 혹은 감소는 사망 위험에 있어 유의한 차이가 없었다. 마지막으로 두번째 검진과 마지막 검진 사이의 체중 변화를 추적하였을 때, 비록 첫번째 검진과 두번째 검진 사이 체중감소가 있던 군이더라도 이후 체중을 회복한 경우에는 그렇지 않은 군에 비해 전체 사망률의 증가현상이 감소되는 것을 관찰할 수 있었다.

Weight Stigma: Cross-Sectional and Longitudinal Associations with Disordered Eating and Weight-Related Health Behaviors in an Ethnically/Racially and Socioeconomically Diverse Sample of Adolescents and Young Adults

Hooper, Laura University of Minnesota ProQuest Dissertations & T 2022 해외박사(DDOD)

This dissertation used a health equity lens to examine whether experiencing weight teasing is associated with disordered eating behaviors (DEBs), health behaviors, and weight status in an ethnically/racially and socioeconomically diverse sample of youth. It also investigated whether positive family/parenting factors are protective for DEBs in youth who experience weight stigma.1,534 Project EAT 2010-2018 participants were surveyed as adolescents (Mage=14.4 years) and eight years later. Participants were asked about weight-stigmatizing experiences (e.g., weight teasing). Outcomes included DEBs (e.g., unhealthy weight control behaviors, chronic dieting, binge eating), health behaviors (e.g., physical activity, sleep duration, nutrition habits), and weight status. Regression models were adjusted for sociodemographic characteristics and weight status. Interaction terms and stratified models assessed whether family/parenting factors buffered DEB risk in adolescents who experienced weight stigma.Experiencing weight teasing was significantly associated with higher prevalence of DEBs and high weight status, cross-sectionally during both adolescence and young adulthood, and longitudinally. Effects of weight teasing were similar across ethnic/racial and socioeconomic subgroups. Black Indigenous, and People of Color (BIPOC) and youth from low socioeconomic backgrounds had higher prevalence of weight teasing, DEBs, and high weight, when compared to their respective counterparts. There was evidence that positive family/parenting factors operate as effect modifiers in cross-sectional relationships between weight stigma and DEBs, although these factors were primarily protective for adolescents who did not experience weight stigma.Findings provide evidence that weight teasing is a risk factor for DEBs and high weight status, and that BIPOC youth and youth from low socioeconomic backgrounds are disproportionately affected by weight teasing, DEBs, and high weight status, suggesting weight-stigmatizing experiences may create barriers to health, especially for youth who are already underserved. Positive family/parenting factors did not entirely offset the effects of weight stigma on DEBs, which may reflect the strength of weight stigma as a risk factor for DEBs. Published guidelines provide recommendations for how to decrease weight stigma experienced by youth. Future research should build upon these guidelines and include qualitative, solutions-oriented methods aimed at understanding how families, healthcare providers, and policymakers can decrease weight stigma and its effects on diverse populations of youth.

Unhealthy weight control behaviors and related factors by gender and weight status: Results from a nationally representative sample of Korean adolescents

배은정 서울대학교 대학원 2023 국내박사

Adolescence is a period of extremely rapid and diverse growth and development, and changes in the bodies of adolescents can make them self-conscious about their body shape. When they perceive that their changing body does not match the thin ideal, adolescents may engage in unnecessary or unhealthy strategies to control their weight. Regrettably, the proportion of adolescents using unhealthy tactics such as fasting, vomiting, the use of laxatives or diuretics, or diet pills, has reached 44% worldwide, indicating that these are now prevalent strategies. Given the negative physical and psychological consequences of unhealthy weight control behaviors, it is extremely important to identify the factors associated with such behaviors in this population. Thus far, multiple studies have uncovered a range of factors and identified gender differences in the extent to which they influence unhealthy weight control behaviors. However, studies that examine how these factors vary according to weight status are limited. Therefore, using a nationally representative sample of Korean adolescents, this study aimed to identify whether sociodemographic, health-related behavioral, psychosocial, and school factors are differentially associated with unhealthy weight control behaviors according to gender and subdivided weight status. To achieve this, the data of 18,159 adolescents who completed the Korea Youth Risk Behavior Survey were extracted for analysis. A complex sample logistic regression analysis was performed to identify factors related to unhealthy weight control behaviors among adolescents. Odds ratios and 95% confidence intervals were obtained from the logistic regression models and disaggregated by gender and weight status. The results revealed that factors associated with unhealthy weight control behaviors were not consistently associated across weight groups. In normal-weight male adolescents, consumption of fast food three or more times per week, current alcohol use, underestimation of weight status, and experience of depressive symptoms or violent victimization were related to a higher risk of UWCB. By contrast, regular breakfast consumption lowered the risk of UWCB in this group. In overweight male adolescents, experience of depressive symptoms was correlated with a higher risk of UWCB, whereas regular breakfast consumption and experiences of nutrition education were correlated with a lower risk. In obese male adolescents, experience of depressive symptoms or violent victimization were correlated with a higher risk of UWCB, but regular breakfast was a protective factor for UWCB. All health-related behavioral, psychosocial, and school factors were related to UWCB in normal-weight female adolescents. However, in overweight female adolescents, the only risk factor for UWCB was the experience of depressive symptoms, and only regular breakfast consumption was a protective factor. In the case of obese female adolescents, fast food consumption three or more times per week, current smoking, and experiencing depressive symptoms or violent victimization were risk factors for UWCB. By contrast, consuming vegetables three or more times a day and physical education classes that involved physical exercise three or more times a week were protective factors for UWCB. The results suggest that the establishment of intervention strategies to prevent and manage unhealthy weight control behaviors in adolescents should be differentiated according to weight status as well as gender. 청소년기는 가장 빠른 성장과 발달이 이루어지면서 체형에 대한 자의식이 형성되는 시기이다. 청소년들은 변화하는 신체가 마른 이상적 체형과 일치하지 않는다고 인식할 때 불필요하거나 건강에 해로운 전략으로 체중조절을 시도할 수 있다. 단식, 구토, 이뇨제 및 완화제의 사용, 처방되지 않은 다이어트 약 복용 등의 부적절한 체중조절 행동은 전 세계적으로 만연해 있으며, 부적절한 전략으로 체중 감소를 시도하는 청소년의 비율이 44%에 이른다고 보고되고 있다. 부적절한 체중조절 행동의 부정적인 신체적 ∙ 심리적 결과를 고려할 때, 이 인구집단에서의 부적절한 체중조절 행동과 관련된 요인을 식별하는 것이 매우 중요하다고 할 수 있다. 지금까지 많은 연구들이 청소년의 부적절한 체중조절 행동에 영향을 미치는 다양한 요인들을 확인하고 관련 요인들의 성별 차이를 입증하였다. 그러나 이러한 요인들이 체중상태에 따라 어떻게 달라지는지에 대한 연구는 제한적이다. 따라서 본 연구는 우리나라 청소년을 대표하는 표본을 이용하여 성별과 체중상태에 따른 사회인구학적, 건강관련 행위, 심리사회적, 학교 관련 요인들과 건강하지 못한 체중조절 행동 간의 상관성의 차이를 확인하고자 하였다. 본 연구는 2019년 청소년건강행태조사 데이터를 활용하였으며, 분석을 위해 18,159명의 청소년 데이터가 산출되었다. 부적절한 체중조절 행동 관련 요인을 확인하기 위해 복합표본 로지스틱 회귀분석을 수행하고 성별과 체중 상태로 분류된 로지스틱 회귀 모델에서 승산비와 95% 신뢰구간을 산출하였다. 분석 결과 부적절한 체중조절 행동과 관련된 요인들은 각 체중 그룹 간에 일관된 결과를 나타내지 않았다. 정상체중의 남자 청소년의 경우 주 3회 이상 패스트푸드 섭취, 현재 음주, 체중상태의 과소평가, 우울 증상과 폭력 피해의 경험이 부적절한 체중조절 행동의 위험요인인 반면 규칙적인 아침식사는 보호요인으로 나타났다. 과체중의 남자 청소년의 경우 우울 증상 경험은 부적절한 체중조절 행동 시도의 위험을 높였으나 규칙적인 아침식사와 영양교육은 그 위험을 낮추는 것으로 확인되었다. 우울 증상이나 폭력 피해 경험은 비만의 남자 청소년의 높은 부적절한 체중조절 행동 시도 위험과 관련 있었지만, 규칙적인 아침 식사는 그 위험을 낮추었다. 정상 체중의 여자 청소년의 경우, 건강관련 행위, 심리사회적, 학교 관련 요인의 모든 변수들이 부적절한 체중조절 행동과 관련이 있었다. 그러나 동일한 성별임에도 불구하고 과체중의 여자 청소년의 경우에는 우울 증상 경험만이 부적절한 체중조절의 위험요인이었으며, 규칙적인 아침식사만이 보호요인으로 확인되었다. 비만 여자의 청소년의 경우 주 3회 이상 패스트푸드 섭취, 현재 흡연, 우울 증상이나 폭력 피해 경험이 부적절한 체중조절 행동 시도의 위험을 높였으며, 반대로 하루 3회 이상의 야채 섭취와 일주일에 3회 이상의 체육수업에서의 직접적인 운동은 그 위험을 낮추는 것으로 나타났다. 따라서 본 연구의 결과는 청소년의 부적절한 체중조절 행동의 예방과 관리를 위한 중재전략은 성별뿐만 아니라 체중상태에 따라서도 차별적으로 수립되어야 함을 시사한다.

체급별 운동선수의 급속체중감량이 신체구성과 근력에 미치는 영향

민진아 경북대학교 대학원 2007 국내박사

The purpose of this study was to investigate the effects of rapid weight reduction through diet and exercise on body composition, biological changes and exercise performance in muscle strength. 10 athletes were selected as subjects who have no experiences of disease or medication. They were divided into two trials that the rapid weight reduction trial was given 3 days and the gradual weight reduction was given 14 days to reduce their 6 % of the first measured body weight. This study was done two times on pre and post in rapid and gradual weight reduction trials for comparison of body composition and biological changes and exercise performance in muscle strength. Body composition was measured in Y hospital by DEXA. Blood-gatherings was done by clinicians pre and post in rapid and gradual weight reduction trials. The collected materials were marked by mean and standard error and all statistical treatments are done by two-way ANOVA within trials in SPSS 12.0 program. The results are as followings; -There are no significant differences between body compositions composed of the body weight, BMI, %body fat, fat mass and lean body mass on the pre and post after rapid and gradual weight reduction trials. -Concentration of glucose and TG were significant decreased after each trial and concentration of FFA was increased in each trials as well as in pre and post. -In metabolic hormone, concentration of insulin was significant decreased after rapid weight reduction trial while concentration of glucagon was increased after gradual weight reduction trial and there was no significant difference in concentration of epinephrine in each trials but concentration of norepinephrine was increased in each trials as well as in pre and post. -There were no significant differences between immuno-globulins composed of Ig A and Ig M. While water balance hormones were significant increased in each trials. -There were no significant differences exercise performances composed of peak torque and fatigue index in pre and post weight reduction. As we see the results, we can conclude that there are no significant differences exercise performances after rapid and gradual weight reduction trials when subjects was reduced their 6 % body weight. However, we could also see that biological changes were measured irregularly. Especially in the water balance hormones they should be more stable. Therefore we can suggest it is desirable that danger of weight reduction should be recognized in order to keep homeostasis. Later, it is necessary that the additional research be done related bone materials. 본 연구는 급속감량 시 체급경기선수들의 생리적 변화를 알아보기 위하여 급속감량 (3일), 점증감량 (14일)으로 구분하여 자기 몸무게의 6 % 체중감량 전 ․ 후의 신체구성 및 근력의 변화에 대해 분석하였다. 본 연구의 대상자는 D대학교에 재학 중인 체급별 경기선수(레슬링, 태권도)를 대상으로 하였다. 대상자는 총 10명이며, 신체적 질병이나 약물 투여 경험이 없는 건강한 대상자이다. 감량 기간에 따라 급속 (rapid)감량과 점증 (gradual)감량으로 분류하였으며, DEXA법을 이용한 신체구성과 Cybex를 이용하여 근력과 근지구력을 측정하였다. 모든 통계처리는 SPSS 12.0 통계프로그램을 이용하였으며 집단별, 시기별로 측정 항목의 평균과 표준오차를 산출하였다. 집단의 평균 간의 차이와 시기간의 차이를 분석하기 위하여 two-way ANOVA (analysis of variance)를 실시하였다. 결과적으로 체급별 경기선수에게 있어서 급속 체중감량 시 근력에 대한 운동수행능력의 변화는 유의한 차이를 나타내지 않았다. 체중감량 시 신체구성의 변화에서 감량 전 보다 감량 후 감소의 경향이 나타나긴 하였으나 6 % 체중감량은 운동수행능력에 영향을 끼치지는 않았다. 그러나 혈중 에너지 기질에서 글루코스와 중성지방의 농도가 감소하고 유리지방산의 농도가 유의하게 증가한 것은 과도한 식이제한으로 인한 체중감량에 기인한 것으로 사료되며, 또한 면역글로불린에 농도에서 유의한 변화는 나타나지 않았지만 체수분 조절호르몬에 있어서는 급속감량집단에서 레닌과 알도스테론의 농도가 유의하게 높게 나타나 탈수의 위험이 급속감량집단에서 높게 나타나므로 급속감량집단에서 채액 보존이 중요하게 작용할 것이라 생각된다. 따라서 급속체중감량은 근력에 대한 운동수행능력에서 유의한 변화를 나타내진 않았으나, 빈번히 사용되는 과도한 식이제한과 운동에 의한 비정상적 체중감량의 반복은 인체에 부정적인 영향을 끼칠 것이다. 그러므로 본 연구의 결과를 바탕으로 과학적인 감량방법 모색과 처방이 해결방안에 도움이 될 수 있을 것이며, 향후 생화학적 골대사 지표를 통한 골함량과 골밀도와 같은 골대사에 미치는 영향을 파악하는 것도 체중감량의 심층적인 연구에 도움이 될 수 있을 것이다.

VOCAL 기법을 이용하여 측정한 태아 허벅지 부피 계측의 출생 체중 예측 효용성 : Efficacy of Fetal Thigh Volumetry in Predicting Birth Weight Using the Virtual Organ Computer-aided AnaLysis (VOCAL) Technique

박재희 순천향대학교 대학원 2013 국내석사

목적: 본 연구는 출생 체중을 예측하는데 이용되는3차원적(3D) 방법인 VOCAL 기술과 2차원적 (2D) 공식들을 통해 태아 허벅지 부피를 계산하는 방법들의 정확성을 비교하였다. 방법: 2008년 5월부터 2010년 4월까지 한 대학병원에서 초음파 검사 후 72시간 이내에 분만한 84명의 임산부들을 대상으로 전향적, 그리고 단면적으로 연구를 시행하였다. 태아들의 양쪽마루뼈 지름, 배 둘레, 그리고 대퇴골 길이를 2D 초음파로 측정하였다. 그 후, 3D초음파와 VOCAL 프로그램을 이용하여 태아 허벅지 부피를 측정하였다. 모계의 임신력, 체질량 지수, 그리고 허벅지 둘레 등의 임상 자료를 기록하였다. 측정된 모든 계측치와 실제 출생 체중간의 상관관계를 분석하였고, 출생 체중을 예측하는 데에 있어서 3D초음파와 2D 초음파를 비교하고자 태아 허벅지 부피를 이용한 방법과 Hadlock II 방법의 민감도와 특이도를 이용하였다. 마지막으로, 추정된 출생 체중과 실제 출생 체중간의 차이를 paired t-tests를 이용해 분석해 보았다. 결과: 본 연구에 포함된 임산부의 대부분 (61.9%)은 30대였다. 3차원 초음파로 측정된 태아의 허벅지 부피를 이용하여 추정된 태아의 체중과 실제 출생 체중간에는 유의한 상관관계가 있었다. 모계의 체질량 지수와 태아의 허벅지 둘레가 실제 출생 체중과 유의한 상관관계가 있었지만, Hadlock II 공식을 이용하여 추정한 태아 체중이 가장 큰 상관관계를 보이고 있었다. 실제 저체중 출생아를 예측하는데 있어서, 태아의 허벅지 둘레를 이용한 공식과 Hadlock Ⅱ 방법은 모두 낮은 민감도를 보였지만, 과체중 출생아를 예측하는데 있어서는 태아의 허벅지 둘레를 이용한 방법이 Hadlock Ⅱ 방법 보다 더 나은 민감도를 보였다. 두 방법 모두 저체중 출생아를 예측하는데에는 매우 높은 특이도를 보이고 있었다. 결론: 본 연구는 3D 초음파의 VOCAL 방법을 검증하고, 3D 초음파를 이용하여 태아 체중의 예측을 주제로 하는 문헌들을 살펴보았다. 결론적으로, 3D 초음파의 VOCAL 방법을 이용하여 태아의 허벅지 부피를 측정하면 태아의 체중을 더 정확하게 추정할 수 있고, 이 방법은 추후 산전 진찰시 필수적인 항목이 될 가능성이 있다. Efficacy of Fetal Thigh Volumetry in Predicting Birth Weight Using the Virtual Organ Computer-aided AnaLysis (VOCAL) Technique Junsik Park Department of Obstetrics and Gynecology Graduate School of Soonchynhyang University Asan, Korea (supervised by Professor Tae-Hee Kim) Objectives: The present study was conducted to compare the accuracy of formulas used to calculate fetal thigh volume (TV) using the Virtual Organ Computer-aided AnaLysis (VOCAL) technique with that of other commonly used two-dimensional formulas predicting birth weight. Methods: This was a prospective, cross-sectional study of 84 pregnant women with 72 h of delivery evaluated at a university hospital between May, 2008 and April, 2010. In these patients, fetal biparietal diameter (BPD), abdominal circumference (AC), and femur length (FL) were measured by two-dimensional ultrasonography (2DUS). After 2DUS measurement, three-dimensional ultrasonography (3DUS) was also used to determine fetal thigh volume (TV) with estimates computed using the VOCAL program. Maternal features, such as number of previous gestations, BMI, and thigh circumference were documented. Correlation between all measured parameters and actual birth weight was determined using Pearson’s correlation coefficient. Regression analysis with correlation coefficients was used to determine relationships among parameters. We compared the sensitivity and specificity of the fetal TV formula for prediction of infants ≤ 2.5 and ≥ 3.5 kg with those of the Hadlock II equation. Finally, differences between estimated fetal weight and actual birth weight were assessed by paired t-tests. Results: Most of the participants (61.9%) were in their thirties. The correlation between fetal weight predicted by the three-dimensional equation of TV and the actual birth weight was significant. Although maternal BMI and infant TC correlated with actual birth weight, the Hadlock II equation exhibited the greatest correlation. While both fetal TV and the Hadlock II equation exhibited a low sensitivity for detection of low-birth-weight infants, fetal TV was a more sensitive method of detecting high-birth-weight infants than the Hadlock II equation. However, both methods were highly specific for detection of low-birth-weight infants. Conclusions: In the present study, we validated the 3DUS-VOCAL method and reviewed the literature regarding use of 3DUS to estimate fetal birth weight. Based on these results, it is clear that using 3DUS-VOCAL to measure fetal TV provides more accurate estimation of fetal birth weight, and has the potential to become an essential prenatal assessment tool.

한국 청소년의 체중조절에 따른 혈액 생화학적 특성 및 영양소 섭취 : 제7기(2016〜2018) 국민건강영양조사 자료를 활용하여

황지원 전북대학교 교육대학원 2022 국내석사

Objectives: The purpose of this study was to examine the biochemical characteristics, intake of energy, and nutrients by weight control of Korean adolescents aged 12 to 18 years. Methods: Data from the 7th (2016∼2018) Korea National Health and Nutrition Examination Survey(KNHNES) were used for the study. A total of 1,281(670 boys, 611 girls) subjects were included, and they were divided into four groups according to their weight control. We examined general characteristics (gender, age, house income, region of residence, skipping or not-skipping breakfast, lunch, dinner, frequency of eating-out), anthropometric characteristics (height, weight, weight status), blood biochemical characteristics (fasting plasma glucose, creatinine, blood urea nitrogen, triglycerides, cholesterol, HDL-cholesterol, hemoglobin, and hematocrit), the quantitative intake of energy and nutrients using the Korean Dietary Reference Intakes (KDRI), and the qualitative index of nutrition quality (INQ) and nutrition adequacy ratio (NAR) and mean nutrition adequacy ratio (MAR) of the four groups. Results: There were significant differences between the four groups classified in this study in gender, age, and skipping dinner, subjective body type recognition of weight control, weight control method. There were significant differences in anthropometric characteristics for both boys and girls (except for girls' height). There were significant differences in blood biochemical characteristics, nutritional intake. In the case of boys, there were significant differences in fasting blood glucose, creatinine, triglyceride, total cholesterol, and HDL-cholesterol. There was a significant difference in the evaluation frequency for each section in the mean of triglyceride, total cholesterol, and HDL-cholesterol. There were significant differences between the 4 groups in the quantitative intake of vitamin A, phosphorus, and iron according to the KDRI value, daily food intake according to vitamin A and food group according to the NAR. There were no significant differences in blood biochemical properties for girls. Quantitative intake of protein, iron, potassium, sodium according to KDRI level, qualitative intake of vitamin A and calcium by INQ and quantitative intake of vitamin A by NAR There was a significant difference between the 4 groups. Conclusions: In Korean adolescents, when analyzed by gender, it was found that female students were more interested in weight control than male students and made more effort to lose or maintain weight. Weight control in adolescents is thought to affect triglyceride, total cholesterol, HDL-cholesterol, creatinine, protein, vitamin A, calcium, phosphorus, iron, and sodium intake. Incorrect weight control affects growth. Continuing education at school and at home should be expanded so that adolescents can maintain a healthy body through proper weight control.