STUDENT NUMBER: 0301561E MASTERS OF EDUCATION FACULTY OF HUMANITIES-DISCIPLINE OF SPECIALISED EDUCATION / The purpose of this study was to examine whether: actual and ideal body mass index (BMI) scores, perception of a weight problem, racial identity, physical exercise, weight control behaviour and stage of pubertal development predict levels of global self-esteem in average academic achieving English speaking middle-class adolescent females. The sample consisted of 90 females, ranging in age from 13 years 3 months to 18 years 7 months who were attending Benoni High School. BMI was measured and desired BMI based on self-reported weight and height. Self-perception of having a weight problem was evaluated by one question: “Do you see yourself as having a weight problem?” Self-esteem was measured in two ways: firstly participants completed the Rosenburg Self-esteem Scale and secondly homeroom teachers were asked to give a score of global self-esteem. A significant association was found between global self-esteem and: a perceived weight problem, actual BMI and race. No significant association was found between global self-esteem and: weight control behaviour; physical exercise, age of menarcheal onset and ideal BMI. KEY WORDS Global self-esteem, adolescent females, BMI, racial identity, weight control behaviour, physical exercise and pubertal development

Discourses surrounding the idea of the Freshman 15 are prevalent within the press and popular media. While college weight gain and eating and exercise practices have been attended to through the collection of survey data, to date no one has linked these trends to wider social and economic processes or contextualized them within the lives of college students. This thesis provides a description of the ways in which 22 college women came to anticipate and experience weight gain during their freshman year of college, as well as the practices they adopted that contributed to weight changes. I analyze this interview data through a discussion of the concept of risk, personal responsibility, and ideas about the female body, while pointing to broader political economic pressures that are changing the ways in which universities provide dining and recreation services to students.

Thesis (MNutr (Interdisciplinary Health Sciences. Human Nutrition))--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: Background: Poor body image perception and body dissatisfaction has been found to be a risk factor for eating disorders. Studies have found that signs of distorted body image perception and body dissatisfaction can be detected in children as young as 8 or 9 years old. Aim: The current study served to assess the extent of this problem in Northeastern Johannesburg, South Africa, in order to allow for the necessary intervention steps (e.g. development of school-based programmes) to deal with this problem to be put in place. Method: The study was a cross-sectional analytical study with a descriptive component. Two hundred and four girls (81.37% Black, 15.20% White and 3.43% Coloured or Indian) aged between 96 and 119 months in primary schools in Northeastern Johannesburg were selected for this study using systematic random sampling. They were required to complete a questionnaire about their body image perception and weight control behaviours, as well as undergo anthropometric measurements (i.e. weight and height). Results: This study found that the subjects placed much importance on being thin, with subjects stating that they thought if a girl was thin she would be more popular (63.96%), have better self esteem (69.63%), be more attractive (69.11%), be more feminine (73.80%) and be healthier (66.84%). When asked to identify the girl from a silhouette drawing that most resembled themselves, 45.00% of the subjects were able to accurately identify which girl’s size most resembled their own, whereas 48.50% saw themselves as thinner than they are and 6.50% saw themselves as fatter than they are. In addition, the majority of subjects (69.61%) said that they were very happy with their weight and the majority (74.88%) classified it as “just right.” However, despite these findings, there was still significant body dissatisfaction evident in the group with 50.25% of the subjects wanting to be thinner, 28.57% wanting to be fatter and only 21.18% not wanting to be thinner or fatter than they currently are. Of the subjects participating in the study, 50.98% had tried to lose weight in the past and 28.71% had tried to gain weight. Also, various factors (i.e. media, cultural, family and peer influences), were shown to have a significant influence on the subjects’ body image perception. Other factors such as socioeconomic status and physical activity level had no significant link with the subjects’ body image perception. Conclusion: There is a significant problem with poor body image perception and resultant weight control behaviours in this age group. Clearly, there is a need for body image improvement programmes to be put in place in primary schools so as to prevent preadolescent girls from moving towards a lifetime of suffering with body dissatisfaction or, even worse, developing a life-threatening eating disorder. / AFRIKAANSE OPSOMMING: Agtergrond: ’n Swak liggaamsbeeld en liggaamsontevredenheid is bekende risikofaktore vir die ontwikkeling van eetsteurnisse. Volgens studies kan tekens van ’n verwronge liggaamsbeeld en liggaamsontevredenheid reeds by jong kinders, van 8 of 9 jaar, bespeur word. Doel: Hierdie studie het gepoog om die omvang van dié probleem in die noordooste van Johannesburg, Suid-Afrika, te bepaal ten einde die nodige intervensiemaatreëls te tref (byvoorbeeld om skoolgebaseerde programme te ontwikkel) om die probleem die hoof te bied. Metode: Die studie is ’n dwarssnit analitiese studie met ’n beskrywende komponent. Met behulp van sistematiese, ewekansige steekproefneming is 204 laerskoolmeisies (81.37% Swart, 15.20% Wit en 3.43% Bruin of Indiër) van tussen 96 en 119 maande uit die noordooste van Johannesburg as proefpersone vir die studie gekies. Die meisies moes elk ’n vraelys oor hul liggaamsbeeld en gewigsbeheergedrag invul sowel as antropometriese meting van gewig en lengte ondergaan. Resultate: Die studie het gevind dat die proefpersone baie waarde daaraan heg om maer te wees. Hulle reken onder meer dat, indien ’n meisie maer is, sy waarskynlik gewilder sal wees (63.96%), ’n beter selfbeeld sal hê (69.63%), aantrekliker sal wees (69.11%), vrouliker (73.80%) en gesonder sal wees (66.84%). Toe hulle op ’n profielskets ’n meisie moes uitwys na wie hulle dink hulle die meeste lyk, kon 45.00% van die proefpersone akkuraat uitwys watter meisie se grootte die meeste met hulle s’n ooreenstem, terwyl 48.50% hulself as maerder en 6.50% hulself as vetter beskou het as wat hulle werklik is. Die meerderheid van die proefpersone (69.61%) was oënskynlik gelukkig met hul gewig en die meeste (74.88%) het hul gewig as “net reg” beskryf. Tog, ondanks dié bevindinge, was daar steeds beduidende liggaamsontevredenheid by die groep: 50.25% van die subjekte wil maerder wees, 28.57% vetter en slegs 21.18% nie maerder óf vetter as wat hulle tans is nie. Van die studiedeelnemers het 50.98% al voorheen probeer gewig verloor, terwyl 28.71% al probeer gewig aansit het. Verskeie faktore (soos media-, kulturele, gesins- en portuurinvloede) blyk ook ’n beduidende impak op die proefpersone se liggaamsbeeld te hê. Daarenteen toon ander faktore, soos sosio-ekonomiese status en vlak van fisieke aktiwiteit, geen wesenlike verband met die proefpersone se liggaamsbeeld nie. Gevolgtrekking: Hierdie ouderdomsgroep blyk ’n beduidende probleem met ’n gebrekkige liggaamsbeeld en gevolglike gewigsbeheergedrag te hê. Daar is duidelik ’n behoefte aan programme om laerskoolmeisies se liggaamsbeeld te verbeter ten einde te voorkom dat preadolessente meisies weens liggaamsontevredenheid ’n leeftyd van swaarkry tegemoetgaan of, selfs erger, ’n lewensgevaarlike eetsteurnis ontwikkel.

O objetivo desta tese é avaliar o impacto do estilo de vida materno no ganho de peso durante a gestação e na sua evolução durante o pós-parto. Inicialmente, foi realizada uma revisão da literatura sobre os indicadores utilizados para computar as mudanças de peso ocorridas durante a gestação e o pós-parto (artigo I). Posteriormente, utilizou-se o modelo de regressão logística para avaliar a associação entre a abstinência ao fumo durante o pré-natal e o ganho de peso gestacional (GPG) excessivo, segundo as recomendações do Institute of Medicine (IOM), em 1.249 mulheres que deram à luz a recém-nascidos vivos a termo em 1984/85 em Estocolmo, Suécia (artigo II). Em seguida, foi utilizado o modelo de regressão linear múltipla para avaliar o efeito do GPG excessivo no índice de massa corporal (IMC) materno 15 anos após o parto. A população elegível para análise foi constituída de 483 mulheres suecas, que foram acompanhadas desde o nascimento da criança índice em 1984/85 até 1999/2000 (artigo III). Por último, uma revisão sistemática com a utilização de metanálise foi realizada para apreciar o efeito da dieta, exercício ou ambos na perda de peso no pós-parto (artigo IV). A diversidade de indicadores utilizada para computar o GPG e a retenção de peso no pós-parto dificulta a interpretação e comparação dos resultados de pesquisas sobre o tema. A baixa qualidade dos registros obstétricos e a escolha inadequada do indicador são consideradas as possíveis causas da não associação entre o ganho de peso materno e os desfechos gestacionais encontrada em alguns estudos (artigo I). Ex-fumantes apresentam 1,8 vezes mais chance de GPG excessivo em relação às mulheres não fumantes, mesmo após o ajuste pelas variáveis de confusão, como o consumo de álcool, atividade física, entre outras (artigo II). Mulheres que tiveram GPG excessivo apresentaram maior retenção de peso 15 anos após parto (10,0 kg) do que as mulheres que ganharam peso conforme os limites recomendados pelo IOM (6,7 kg). Mesmo após o controle pelas variáveis de confusão, o GPG excessivo provocou um aumento significativo de 0,72 kg/m2 no IMC materno (artigo III). Mulheres aconselhadas a praticarem exercícios aeróbicos durante o pós-parto não perderam, significativamente, mais peso que as mulheres alocadas no grupo controle (diferença de média ponderada (DMP): 0,00; IC 95%: -8,63/ 8,63). Mulheres alocadas no grupo dieta (DMP: -1,70; IC 95%: -2,08/ -1,32) ou dieta e exercício (DMP: -2,89; IC 95%: -4,83/ -0,95) perderam, significativamente, mais peso que as mulheres alocadas no grupo controle. Nenhuma das estratégias de intervenção para perda de peso no pós-parto (exercício; dieta; dieta e exercício) provocou efeitos adversos à saúde materno-infantil (artigo IV). Os achados apontam para a importância da identificação precoce de mulheres sob-risco GPG excessivo. Os profissionais de saúde devem fornecer aconselhamento adequado durante o pré-natal para o controle do GPG e motivar as mulheres a perderem o peso retido durante o pós-parto. Assinala-se também que os profissionais de saúde devem recomendar programas de modificação do estilo de vida relacionados à dieta combinada ao exercício físico para perda de peso durante o pós-parto e, consequentemente, para a prevenção da obesidade associada ao ciclo reprodutivo. / The aim of this thesis is to evaluate the impact of maternal life style on gestational weight gain (GWG) and maternal weight development during postpartum. Firstly, an overview of the literature on indicators used to measure weight changes during and after pregnancy was carried out (article I). Secondly, a multivariate logistic regression model was used to assess the association between prenatal smoking cessation and excessive GWG, according to the Institute of Medicine (IOM) recommendations, in 1.249 women who delivered a term infant in 1984/85 in Stockholm, Sweden (article II). Thirdly, a multivariate linear regression model was used to assess the effect of excessive GWG on maternal body mass index (BMI) at 15 years postpartum. The study population was composed of 483 Swedish women who were followed from delivery date of the index child in 1984/85 to 1999/2000 (article III). Finally, a systematic review with meta-analysis was conducted to appraise the effect of diet, exercise or both on postpartum weight loss (article IV). Comparisons among studies and the interpretation of research findings are complicated due to the variety of indicators used to calculate the GWG and postpartum weight retention. The reasons for non-significant associations between GWG and gestational outcomes were probably owing to poor quality of obstetrics records and selection of wrong indicators to compute GWG (article I). Former smokers were 1,8 times more likely to gain excessive weight during pregnancy than nonsmokers, even after accounting for confounding factors, including alcohol consumption, physical activity to mention a few (article II). Postpartum weight retention at 15 years follow-up was higher among women who gained excessive weight during pregnancy (10,0 kg) than who gained weight according to IOM recommendations (6,7 kg). After accounting for confounding factors, women who gained excessive weight during pregnancy had a significant increase of 0.72 kg/m2 in BMI at 15 years follow-up compared to women who gained within recommendations (article III). Women who exercised did not significantly lose more weight than women in the control group (weighted mean difference (WMD) 0,00; 95% CI 8,63 to 8,63). Women who took part in a diet (WMD 1,70; 95% CI 2,08 to 1,32) or diet plus exercise (WMD 2,89; 95% CI 4,83 to 0,95) program lost significantly more weight than women in the control group. The interventions (diet; exercise; diet and exercise) did not adversely affect the maternal and child health (article IV). The findings indicate the relevance of early identification of women at risk of excessive GWG. Health care providers should give women appropriate advice for controlling GWG and motivate them to lose pregnancy-related weight during postpartum. Additionally, health care providers should recommend women to engage in diet combined with physical activity programs in order to lose postpartum weight and consequently prevent obesity associated with childbearing.

abstract: There is a growing trend among community samples of young, adult women to initiate drug use for weight loss (Boys, Marsden, & Strang, 2001; Mendieta-Tan, Hulbert-Williams, & Nicholls, 2013). Research has suggested that consequential weight loss may maintain drug use (Cohen, et al., 2010; Ersche, Stochl, Woodward, & Fletcher, 2013; Sirles, 2002), which is compounded by women's perception that drugs are convenient and guarantee weight loss (Mendieta-Tan, et al., 2013). Stimulants, including cocaine, amphetamine, methamphetamine, and ecstasy, are notable drugs of use among college students (Johnston, et al., 2014; Teter, McCabe, LaGrange, Cranford, & Boyd, 2006). With known appetitive and metabolic effects, stimulants may be particularly attractive to college women, who are at elevated risk for increased body dissatisfaction and experimenting with extreme weight loss techniques (Grunewald, 1985; National Eating Disorder Association, 2013). A preliminary epidemiological study of 130 college women between 16- and 24-years old (Mage = 18.76, SDage = 1.09) was conducted to begin to investigate this phenomenon. Results showed women who reported use for weight control (n = 19, 14.6 %) predominantly used stimulants (68.4%), and this subgroup was severely elevated on global and subscales of eating pathology compared with college norms. Moreover, the odds of stimulant use were doubled when women engaged in a compensatory behavior, such as excessive exercise, self-induced vomiting, and laxative use. Although preliminary, these results suggest that a desire for weight control may be associated with stimulant use among college women. Women engaging in more extreme weight loss behaviors are at high risk for initiating and maintaining illicit stimulant use for weight-related reasons. / Dissertation/Thesis / Masters Thesis Psychology 2016

O objetivo desta tese é avaliar o impacto do estilo de vida materno no ganho de peso durante a gestação e na sua evolução durante o pós-parto. Inicialmente, foi realizada uma revisão da literatura sobre os indicadores utilizados para computar as mudanças de peso ocorridas durante a gestação e o pós-parto (artigo I). Posteriormente, utilizou-se o modelo de regressão logística para avaliar a associação entre a abstinência ao fumo durante o pré-natal e o ganho de peso gestacional (GPG) excessivo, segundo as recomendações do Institute of Medicine (IOM), em 1.249 mulheres que deram à luz a recém-nascidos vivos a termo em 1984/85 em Estocolmo, Suécia (artigo II). Em seguida, foi utilizado o modelo de regressão linear múltipla para avaliar o efeito do GPG excessivo no índice de massa corporal (IMC) materno 15 anos após o parto. A população elegível para análise foi constituída de 483 mulheres suecas, que foram acompanhadas desde o nascimento da criança índice em 1984/85 até 1999/2000 (artigo III). Por último, uma revisão sistemática com a utilização de metanálise foi realizada para apreciar o efeito da dieta, exercício ou ambos na perda de peso no pós-parto (artigo IV). A diversidade de indicadores utilizada para computar o GPG e a retenção de peso no pós-parto dificulta a interpretação e comparação dos resultados de pesquisas sobre o tema. A baixa qualidade dos registros obstétricos e a escolha inadequada do indicador são consideradas as possíveis causas da não associação entre o ganho de peso materno e os desfechos gestacionais encontrada em alguns estudos (artigo I). Ex-fumantes apresentam 1,8 vezes mais chance de GPG excessivo em relação às mulheres não fumantes, mesmo após o ajuste pelas variáveis de confusão, como o consumo de álcool, atividade física, entre outras (artigo II). Mulheres que tiveram GPG excessivo apresentaram maior retenção de peso 15 anos após parto (10,0 kg) do que as mulheres que ganharam peso conforme os limites recomendados pelo IOM (6,7 kg). Mesmo após o controle pelas variáveis de confusão, o GPG excessivo provocou um aumento significativo de 0,72 kg/m2 no IMC materno (artigo III). Mulheres aconselhadas a praticarem exercícios aeróbicos durante o pós-parto não perderam, significativamente, mais peso que as mulheres alocadas no grupo controle (diferença de média ponderada (DMP): 0,00; IC 95%: -8,63/ 8,63). Mulheres alocadas no grupo dieta (DMP: -1,70; IC 95%: -2,08/ -1,32) ou dieta e exercício (DMP: -2,89; IC 95%: -4,83/ -0,95) perderam, significativamente, mais peso que as mulheres alocadas no grupo controle. Nenhuma das estratégias de intervenção para perda de peso no pós-parto (exercício; dieta; dieta e exercício) provocou efeitos adversos à saúde materno-infantil (artigo IV). Os achados apontam para a importância da identificação precoce de mulheres sob-risco GPG excessivo. Os profissionais de saúde devem fornecer aconselhamento adequado durante o pré-natal para o controle do GPG e motivar as mulheres a perderem o peso retido durante o pós-parto. Assinala-se também que os profissionais de saúde devem recomendar programas de modificação do estilo de vida relacionados à dieta combinada ao exercício físico para perda de peso durante o pós-parto e, consequentemente, para a prevenção da obesidade associada ao ciclo reprodutivo. / The aim of this thesis is to evaluate the impact of maternal life style on gestational weight gain (GWG) and maternal weight development during postpartum. Firstly, an overview of the literature on indicators used to measure weight changes during and after pregnancy was carried out (article I). Secondly, a multivariate logistic regression model was used to assess the association between prenatal smoking cessation and excessive GWG, according to the Institute of Medicine (IOM) recommendations, in 1.249 women who delivered a term infant in 1984/85 in Stockholm, Sweden (article II). Thirdly, a multivariate linear regression model was used to assess the effect of excessive GWG on maternal body mass index (BMI) at 15 years postpartum. The study population was composed of 483 Swedish women who were followed from delivery date of the index child in 1984/85 to 1999/2000 (article III). Finally, a systematic review with meta-analysis was conducted to appraise the effect of diet, exercise or both on postpartum weight loss (article IV). Comparisons among studies and the interpretation of research findings are complicated due to the variety of indicators used to calculate the GWG and postpartum weight retention. The reasons for non-significant associations between GWG and gestational outcomes were probably owing to poor quality of obstetrics records and selection of wrong indicators to compute GWG (article I). Former smokers were 1,8 times more likely to gain excessive weight during pregnancy than nonsmokers, even after accounting for confounding factors, including alcohol consumption, physical activity to mention a few (article II). Postpartum weight retention at 15 years follow-up was higher among women who gained excessive weight during pregnancy (10,0 kg) than who gained weight according to IOM recommendations (6,7 kg). After accounting for confounding factors, women who gained excessive weight during pregnancy had a significant increase of 0.72 kg/m2 in BMI at 15 years follow-up compared to women who gained within recommendations (article III). Women who exercised did not significantly lose more weight than women in the control group (weighted mean difference (WMD) 0,00; 95% CI 8,63 to 8,63). Women who took part in a diet (WMD 1,70; 95% CI 2,08 to 1,32) or diet plus exercise (WMD 2,89; 95% CI 4,83 to 0,95) program lost significantly more weight than women in the control group. The interventions (diet; exercise; diet and exercise) did not adversely affect the maternal and child health (article IV). The findings indicate the relevance of early identification of women at risk of excessive GWG. Health care providers should give women appropriate advice for controlling GWG and motivate them to lose pregnancy-related weight during postpartum. Additionally, health care providers should recommend women to engage in diet combined with physical activity programs in order to lose postpartum weight and consequently prevent obesity associated with childbearing.

The overall aim of this master thesis was to get an overview on how milk and dairy consumption affect development of the metabolic syndrome, and from this review to formulate a milk product with potentially beneficial effects. A cluster of metabolic abnormalities such as insulin resistance and type 2 diabetes, hypertension, obesity and dyslipidaemia are known as the metabolic syndrome. Epidemiological studies performed to investigate the relation between milk and dairy intake and the metabolic syndrome, suggests that low-fat milk and dairy intake have a positive effect in the prevention of the disease. Many dairy components might contribute to this effect. There are promising effects seen by whey amino acids on the glucose and insulin control, but the long-term effects are warranted. Low-fat milk and dairy as part of a diet rich in fruits and vegetables have the most blood pressure reducing effect. This beneficial effect is in part believed to be due to the calcium content of milk and dairy products. In addition, it is also hypothesised that calcium plays an important roll in weight management. However, the evidence up to date is contradictorily. Weight control, on the other hand, can be improved by affecting satiety. Acute intervention studies show that whey, in particular, alfa-lactalbumin, is more satiating than other proteins, resulting in a lower energy intake in a subsequent meal. It is of interest to the dairy industry to provide milk and dairy consumers with milk products that have beneficial effects on wellness and health. Therefore, based on the literatured reviewed on milk and dairy intake and the metabolic syndrome, a milk product with beneficial effects on weight was formulated and developed.

Many people use smoking as a weight control mechanism and do not want to quit because they fear weight gain. These weight-concerned smokers tend to be female, are significantly less likely to stop smoking, are less likely to join smoking cessation programs, and will relapse more often than smokers who are not weight-concerned. Research suggests that a woman’s confidence in her ability to control her weight after quitting relates positively with her intention to quit smoking. Likewise, success in smoking cessation has been associated with increased self-efficacy for weight control. It has been shown that success in changing one negative health behavior may trigger success in changing another, causing a synergistic effect. Recently research has focused on interventions for weight-concerned smokers who are ready to quit smoking. The present study investigated the effect of a cognitive based weight control program on self-efficacy for weight control and the effect on smoking behavior for a group of female weight concerned smokers. Two hundred and sixteen subjects who wanted to lose weight but who were not ready to quit smoking were recruited to participate in a 12-week, cognitive-behavioral weight control program consisting of twelve one-hour sessions. Subjects were randomly assigned to either 1) the weight-control program (intervention group), or 2) the control group. Results of this study demonstrated that subjects in the intervention group increased self-efficacy for weight control, which was associated with improved healthy eating index scores, weight loss, increased self-efficacy for quitting smoking, a decrease in number of cigarettes smoked and triggered positive movement in stage of change towards smoking cessation compared to the control subjects. For these subjects, positive changes in self-efficacy for one behavior (weight control) appeared to have a positive effect on their readiness to change another health behavior (smoking cessation). Further study of the psychological variables that influence weight-concerned female smokers’ decisions to initiate changes in these behaviors and their ability to maintain those changes are warranted.

京都大学 / 新制・課程博士 / 博士(医学) / 甲第23377号 / 医博第4746号 / 新制||医||1051(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 川上 浩司, 教授 近藤 尚己, 教授 万代 昌紀 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

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