Body-Weight Perceptions and Selected Weight-Management Goals and Practices of High School Students -- United States, 1990

Among adults, overweight is associated with elevated serum cholesterol levels, elevated blood pressure, and noninsulin-dependent diabetes and is an independent risk factor for coronary heart disease (1). Youth who are overweight and remain overweight as adults may increase their risk for certain chronic diseases in adulthood (1). However, overemphasis on thinness during adolescence may contribute to potentially harmful weight-management practices and eating disorders such as anorexia nervosa and bulimia nervosa (2,3). This report presents self-reported body-weight perceptions and selected weight-management goals and practices among high school students in the United States.

The national school-based Youth Risk Behavior Survey (YRBS) is a component of CDC's Youth Risk Behavior Surveillance System, which periodically measures the prevalence of priority health-risk behaviors among youth through comparable national, state, and local surveys (4). A three-stage sample design was used to obtain a representative sample of 11,631 students in grades 9-12 in the 50 states, the District of Columbia, Puerto Rico, and the Virgin Islands. To obtain body-weight perceptions, students were asked, "Do you think of yourself as too thin (underweight), about the right weight, or too fat (overweight)?" Weight-management goals of students were determined from responses to the question, "Which of the following are you doing about your weight: not trying to do anything about weight, trying to lose weight, trying to keep from gaining more weight, or trying to gain more weight?" Students were asked four separate questions about their weight-management practices: "During the past 7 days, how many times did you (take a diet pill, vomit on purpose, or exercise) to try to lose weight or to keep from gaining weight?" and "During the past 7 days, how many meals did you skip to try to lose weight or to keep from gaining weight?"

Male students were significantly more likely to consider themselves either the right weight (68.8%) or underweight (16.5%) than were female students (58.5% and 7.2%, respectively) (Table 1). Among both male and female students, black students were significantly less likely to consider themselves overweight than were white and Hispanic students.

Overall, female students were significantly more likely to report currently trying to lose weight (43.6%) than were male students (15.3%) (Table 2). Moreover, 27.4% of female students who considered themselves the right weight reported currently trying to lose weight. Female students were significantly more likely than male students to report having exercised, skipped meals, taken diet pills, or induced vomiting for weight management during the 7 days preceding the survey or ever (Table 2). Reported by: Div of Adolescent and School Health and Div of Nutrition, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: Overweight, inappropriate weight-management practices, and eating disorders among adolescents are important public health concerns in the United States (1,2,5). Consequently, national health objectives for the year 2000 are to "reduce overweight to a prevalence of no more than 15 percent among adolescents aged 12 through 19" (objective 2.3) (6), and to "increase to at least 50 percent the proportion of overweight people aged 12 and older who have adopted sound dietary practices combined with regular physical activity to attain an appropriate body weight" (objective 2.7) (6). Because height and weight are not measured, the YRBS cannot directly monitor these two objectives. However, data about self-reported body-weight perceptions and weight-management goals and practices provide important information to plan programs to help students maintain a healthy body weight through appropriate weight-management skills.

Race- and ethnicity-specific differences in perceptions of overweight described in this report are consistent with previous findings (7) that showed white and Hispanic females perceive themselves to be overweight more often than black females. Previous studies (5) also have indicated that normal-weight adolescent females often consider themselves to be overweight and use inappropriate weight-reducing methods. In addition, harmful weight-loss practices and negative attitudes about body size have been reported among girls as young as 9 years of age (8).

Serious long-term adverse health consequences may result from unhealthy weight-loss behaviors among youth. For example, nutritional self-deprivation by and recurrent weight fluctuations in children and adolescents may increase the likelihood of weight gain and obesity in adulthood (8). In addition, unhealthy weight-loss behaviors may be associated with nutritional deficiencies, decreases in growth velocity, and delays of pubertal and psychosocial development (8).

National health objectives for the year 2000 that address these issues include plans for sound school breakfast and lunch menus, nutrition education, and appropriate physical activity. To encourage nutritionally sound eating habits, school breakfast and lunch programs should offer menus that are consistent with the nutrition principles in the Dietary Guidelines for Americans (objective 2.17) (6). Nutrition education should be provided from preschool through 12th grade, preferably as part of quality school health education (objective 2.19) (6). In addition, daily school physical education (objective 1.8) (6) should help young persons develop a healthy body weight through physical activity.

The high prevalence of body weight dissatisfaction and the potentially harmful weight-loss practices among female students described in this report underscore the potential influences of social norms that equate thinness with attractiveness and social approval. To ensure appropriate weight-management practices among adolescents, educational programs about assessment and maintenance of healthy body weight should involve families; teachers; school administrators, nurses, and counselors; public health officials; pediatricians; and family physicians. This goal also can be addressed through family-based adolescent obesity programs (9) that support body weight acceptance and the adoption of healthy dietary and physical activity patterns.

References

1. Public Health Service. The Surgeon General's report on nutrition and health. Washington, DC: US Department of Health and Human Services, Public Health Service, 1988; DHHS publication no. (PHS)88-50210.

2. Shisslak CM, Crago M, Neal ME. Prevention of eating disorders among adolescents. American Journal of Health Promotion 1990;5:100-6.

3. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Association, 1987.

4. Kolbe LJ. An epidemiological surveillance system to monitor the prevalence of youth behaviors that most affect health. Health Education 1990;21:44-8.

5. Feldman W, Feldman E, Goodman JT. Culture versus biology: children's attitudes toward thinness and fatness. Pediatrics 1988;81:190-4.

6. Public Health Service. Healthy people 2000: national health promotion and disease prevention objectives--full report, with commentary. Washington, DC: US Department of Health and Human Services, Public Health Service, 1991; DHHS publication no. (PHS)91-50212.

7. Dawson DA. Ethnic differences in female overweight: data from the 1985 National Health Interview Survey. Am J Public Health 1988;78:1326-9.

8. Mellin LM. Responding to disordered eating in children and adolescents. Nutrition News 1988;51:5-7.

9. Epstein LH, Valoski A, Wing RR, McCurley J. Ten-year follow-up of behavioral family-based treatment of obese children. JAMA 1990;265:2519-23.

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