Weight Control Behaviors, Health-related Quality of Life and Nutritional Status by Overestimation of Body Image among Young Korean Females: Data from the Fifth Korea National Health and Nutrition Examination Survey, 2010–2011

Seulki Park; Taisun Hyun; Hongmie Lee

doi:10.5720/kjcn.2015.20.5.362

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Research Article: Korean Journal of Community Nutrition 2015;20(5):362-374.
DOI: https://doi.org/10.5720/kjcn.2015.20.5.362
Published online: January 20, 2015

¹⁾Department of Food Science & Nutrition, Daejin University, Pochoeon, Keonggi, Korea

²⁾Department of Food and Nutrition, Chungbuk National University, Cheongju, Chungbuk, Korea

†Corresponding author Hongmie Lee Department of Food Science & Nutrition, Daejin University, 1007, Hoguk-ro, Pocheon-si, Gyeonggi 11159, Korea Tel: (031) 539-1862 Fax: (031) 539-1860 E-mail: hmlee@daejin.ac.kr

• Received: August 20, 2015 • Revised: September 22, 2015 • Accepted: October 13, 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract
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Abstract

Objectives
This study was performed to investigate the effects of overestimation of their own body shape on weight control behaviors, mental condition, physical activity, dietary behavior, health-related quality of life, and nutritional status among young Korean females. Methods: A total of 1,514 women aged 20–39 years who are not pregnant and lactating among those who participated in the Fifth Korea National Health and Nutrition Examination Survey (2010∼2011), were analyzed and grouped into underestimation (n=120), normal estimation (NE, n=840), and overestimation (OE, n=554), based on their body perception compared to actual percent ideal body weights. Variables were compared between OE group and NE group. Results: The subjects in OE group were significantly younger (29.5 vs. 30.5 years, respectively p < 0.05) and had lower body mass index (20.9 vs. 22.2 respectively, p < 0.01), health-related quality of life measured by EQ-5D (EuroQol-5 Dimension)(0.97 vs. 0.98 respectively, p < 0.05), nutrition adequacy ratio (NAR) of protein (0.91 vs. 0.93 respectively, p < 0.05), phosphorous (0.93 vs. 0.96 respectively, p < 0.05), and iron (0.70 vs. 0.75 respectively, p<0.01), and index of nutrition quality (INQ) of iron (0.84 vs. 0.89 respectively, p < 0.05) compared to those in the NE group. The results of logistic regression showed that unmarried status (OR 1.32; 1.01∼1.72) and severely underweight/underweight status (OR 1.94; 1.01∼3.75)/(OR 1.81; 1.34∼2.45) were significantly related to the probability of overestimation by the subjects. Significantly more women in OE group practiced fasting, skipping meals, and taking prescribed pills to lose body weights and had skipped breakfast compared to those in the NE group. Conclusions: The results of this study suggested that the Korean young women's distorted perception of own body shape may be associated with undesirable weight control behavior, low quality of life, and lower nutritional status. Therefore, nutrition education for this group should include information on correct body shape perception and its importance.
Keywords: weight perception; health-related quality of life; nutrition intake

Table 1.

The distribution of the study participants according to weight status and subjective weight perception

Subjective weight perception	Weight status
Subjective weight perception	Severe under weight	Under weight	Normal weight	Over weight	Obese	Total
Very thin	24 (42.9)^1)a2)	10 (4.5)^c	−	−	−	34 (662.7)
Somewhat thin	27 (50.0)^b	119 (42.6)^a	21 (2.4)^c	−	−	167 (611.9)
Normal	3 (7.1)^b	164 (52.0)^b)	450 (57.9)^a	13 (8.2)^c	3 (2.0)^c	633 (641.2)
Somewhat fat	−	2 (0.9)^b	315 (38.0)^b	133 (71.9)^a	73 (35.7)^c	523 (632.7)
Very fat	−	−	13 (1.7)^b	30 (19.9)^b	114 (62.3)^a	157 (611.5)
Total	54 (64.2)	295 (20.3)	799 (50.2)	176 (12.1)	190 (13.2)	1,514 (100.0)

¹⁾N (%) 2) a: 840 (56.4%) of total 1,514 estimated own weight status normally, b: 554 (35.5%) of total 1,514 overestimated own weight, c: 120 (8.1%) of total 1,514 underestimated own weight, all of whom were not included for further analysis

Table 2.

The distribution of the study participants according to weight perception and weight status

Actual weight status	Weight perception
Actual weight status	Under estimation	Normal estimation	Over estimation	Total
Severe underweight	−	24 (13.2)	30 (16.8)	54 (114.2)
Underweight	110 (11.3)¹⁾	119 (15.3)	166 (30.3)	295 (120.3)
Normal weight	121 (14.8)	450 (51.5)	328 (56.1)	799 (150.2)
Overweight	113 (12.4)	133 (15.5)	30 (16.8)	176 (112.1)
Obese	176 (61.5)	114 (14.5)	−	190 (113.2)
Total	120 (18.1)	840 (56.4)	554 (35.5)	1,514 (100.0)

¹⁾N (%)

Table 3.

General characteristics of the study participants by weight perception

Variables	Weight perception			P-value
	Normal estimation	Over estimation	Total
	(n=840)	(n=554)	(n=1,394)
Age (year)	130.5± 0.25¹⁾	129.5± 0.33	130.1± 0.21	< 0.019∗
Height (cm)	160.6± 0.22	161.0± 0.29	160.7± 0.18	< 0.252
Weight (kg)	157.3± 0.51	154.2± 0.35	156.1± 0.35	< 0.001∗∗∗
PIBW²⁾ (%)	103.0± 0.87	196.9± 0.58	100.6± 0.59	< 0.001∗∗∗
BMI³⁾ (kg/m²)	122.2± 0.19	120.9± 0.12	121.7± 0.13	< 0.001∗∗∗

¹⁾Mean± SE 2) Percent ideal body weight 3) Body mass index ∗: p < 0.05, ∗∗∗: p < 0.001 by Student's t test.

Table 4.

Odds ratios for prevalence of overestimation according to general characteristics of the study participants

General characteristics		N (%)	OR (95% CI)¹⁾
Age group	30∼39	355 (50.6)	1.00
Age group	20∼29	199 (49.4)	1.13 (0.88∼1.45)
Marital status	Married	351 (52.6)	1.00
Marital status	Unmarried	203 (47.4)	1.32 (1.01∼1.72)
Region	Urban area	500 (91.0)	1.00
Region	Rural area	54 (69.0)	1.48 (0.94∼2.32)
Income level	Low	119 (35.6)	1.00
	Mid-low	149 (26.2)	1.27 (0.88∼1.83)
	Mid-high	139 (25.4)	1.14 (0.81∼1.59)
	High	147 (22.8)	1.21 (0.83∼1.77)
Educational level	Elementary school	2 (60.4)	1.00
	Middle school	7 (62.1)	2.48 (0.32∼19.12)
	High school	211 (39.1)	1.40 (0.24∼8.10)
	College	334 (58.4)	1.73 (0.30∼9.90)
Body shape	Normal weight	328 (56.1)	1.00
	Severe underweight	30 (66.8)	1.94 (1.01∼3.75)
	Underweight	166 (30.3)	1.81 (1.34∼2.45)
	Overweight	30 (66.8)	0.40 (0.25∼0.66)
Occupation	Unemployed	290 (48.1)	1.00
	Administrator	110 (20.5)	0.98 (0.70∼1.39)
	Office job	65 (13.1)	0.79 (0.53∼1.18)
	Sales and service	65 (12.9)	0.99 (0.67∼1.49)
	Labor	24 (65.4)	0.83 (0.42∼1.66)

¹⁾Odds ratio (95% confidence interval)

Table 5.

Experience and methods of weight control by weight perception

Variables	Weight perception			P-value
	Normal estimation	Over estimation	Total
	(n=840)	(n=554)	(n=1,394)
Weight control to lose or maintain
Yes	557 (68.2)¹⁾	386 (67.7)	963 (68.0)	0.859
No	263 (31.8)	168 (32.3)	431 (32.0)	0.859
Method used for weight control
Exercise
Yes	354 (61.9)	227 (56.7)	581 (59.9)	0.176
No	223 (38.1)	159 (43.3)	382 (40.1)	0.176
Fasting
Yes	5 (60.5)	12 (63.3)	17 (61.6)	0.001∗∗
No	572 (99.5)	374 (96.7)	946 (98.4)	0.001∗∗
Reducing food intakes
Yes	394 (67.8)	278 (68.5)	672 (68.1)	0.848
No	183 (32.2)	108 (31.5)	291 (31.9)	0.848
Skipping meals
Yes	70 (13.8)	67 (20.1)	137 (16.2)	0.048∗
No	507 (86.2)	319 (79.8)	826 (83.8)	0.048∗
Un-prescribed pills
Yes	2 (60.4)	6 (61.7)	8 (60.9)	0.099
No	575 (99.6)	380 (98.3)	955 (99.1)	0.099
Prescribed pills
Yes	29 (65.4)	33 (10.4)	62 (67.4)	0.039∗
No	548 (94.6)	353 (89.6)	901 (92.6)	0.039∗
Herbal medicine
Yes	19 (63.0)	18 (65.8)	37 (64.1)	0.066
No	558 (97.0)	368 (94.2)	926 (95.9)	0.066
Health functional food
Yes	31 (64.8)	31 (67.5)	62 (65.8)	0.142
No	546 (95.2)	355 (92.5)	901 (94.2)	0.142
One-food diet
Yes	14 (62.2)	8 (62.2)	22 (62.2)	0.961
No	563 (97.8)	378 (97.8)	941 (97.8)	0.961

¹⁾N (%) ∗: p < 0.05, ∗∗: p < 0.01 by χ

²test

Table 6.

Mental condition and quality of life by weight perception

Variables	Weight perception			P-value
	Normal estimation	Over estimation	Total
	(n=840)	(n=554)	(n=1,394)
Feeling stress
Much	282 (36.7)¹⁾	198 (40.1)	480 (38.0)	0.313
A little	558 (63.3)	356 (59.9)	914 (62.0)	0.313
Feel depressed
Yes	102 (14.5)	78 (15.1)	180 (14.7)	0.795
No	738 (85.6)	476 (84.9)	1,214 (85.3)	0.795
Thinking of suicide
Yes	113 (15.1)	96 (19.6)	209 (16.9)	0.115
No	727 (84.9)	458 (80.4)	1,185 (83.1)	0.115
Counseling at a mental clinic
Yes	2 (63.6)	12 (62.1)	34 (63.1)	0.206
No	818 (96.4)	542 (97.9)	1,360 (96.9)	0.206
EQ-5D²⁾	0.98± 0.00³⁾	0.97± 0.00	0.97± 0.00	0.025∗
EQ-VAS⁴⁾	74.7± 0.55	73.5± 0.71	74.2± 0.43	0.177

¹⁾N (%) 2) Euro Quality of Life – 5 Dimension 3) Mean± SE 4) Euro Quality – visual analog scale ∗: P < 0.05 by Student's t-test

Table 7.

Dietary habits by weight perception

Variables	Weight perception			P-value
	Normal estimation	Over estimation	Total
	(n=840)	(n=554)	(n=1,394)
Skip breakfast
Yes	279 (38.4)¹⁾	222 (46.8)	501 (41.6)	0.008∗∗
No	561 (61.6)	332 (53.2)	893 (58.4)	0.008∗∗
Skip lunch
Yes	85 (12.5)	68 (14.1)	153 (13.1)	0.517
No	755 (87.5)	486 (85.9)	1,241 (86.9)	0.517
Skip dinner
Yes	71 (69.7)	45 (68.7)	116 (69.3)	0.566
No	769 (90.3)	509 (91.3)	1,278 (90.7)	0.566
Have breakfast with family
Yes	392 (52.7)	295 (60.9)	687 (55.9)	0.011∗
No	448 (47.3)	259 (39.1)	707 (44.1)	0.011∗
Have lunch with family
Yes	173 (20.4)	110 (18.9)	283 (19.8)	0.532
No	667 (79.6)	444 (81.1)	1,111 (80.2)	0.532
Have dinner with family
Yes	619 (67.9)	408 (67.0)	1,027 (67.6)	0.741
No	221 (32.1)	146 (33.0)	367 (32.4)	0.741
Know about nutrition labels
Yes	794 (93.8)	521 (93.1)	1,315 (93.5)	0.705
No	46 (66.2)	33 (66.9)	79 (66.5)	0.705
Use nutrition labels when food is consumed
Yes	407 (51.3)	283 (52.9)	690 (51.9)	0.626
No	386 (48.7)	238 (47.1)	624 (48.1)	0.626
Eating out (times/week)	3.53± 0.29²⁾	3.44± 0.13	3.49± 0.10	0.574

¹⁾N (%) 2) Mean± SE ∗: p < 0.05, ∗∗: p < 0.01 by χ

²test

Table 8.

Daily nutrients intakes and macronutrients energy ratio by weight perception

Variables	Weight perception			P-value
	Normal estimation	Over estimation	Total
	(n=840)	(n=554)	(n=1,394)
Energy (kcal)	1,813.02± 232.6¹⁾2	1,736.02± 240.1	1,722.02± 225.3	0.160
Protein (g)	68.72± 222.1	65.02± 222.1	64.82± 221.4	0.249
Fat (g)	44.82± 221.4	45.02± 221.6	42.52± 221.1	0.921
Carbohydrates (g)	280.02± 224.3	264.02± 225.8	267.02± 223.6	0.024∗
Dietary fiber (g)	6.12± 220.2	5.92± 220.3	6.02± 221.2	0.676
Calcium (mg)	449.02± 211.3	445.02± 214.9	446.02± 228.8	0.810
Phosphorous (mg)	1,054.02± 219.8	1,022.02± 227.7	1,020.02± 216.0	0.372
Iron (mg)	12.62± 220.3	11.82± 220.5	12.12± 220.3	0.170
Sodium (mg)	4,384.02± 114.0	4,289.02± 154.0	4,233.02± 295.3	0.634
Potassium (mg)	2,680.02± 253.7	2,589.02± 274.9	2,619.02± 244.6	0.342
Vitamin A (μgRE)	719.02± 225.6	688.02± 240.3	697.02± 223.7	0.513
Carotene (μg)	3,455.02± 132.0	3,407.02± 219.0	3,409.02± 130.0	0.842
Retinol (μg)	118.02± 227.3	108.02± 226.3	114.02± 225.3	0.283
Vitamin B₁ (mg)	1.23± 220.03	1.20± 220.03	1.18± 220.03	0.867
Vitamin B₂ (mg)	1.16± 220.03	1.14± 220.03	1.15± 220.02	0.149
Niacin (mg)	15.52± 220.4	15.62± 220.5	15.12± 220.3	0.949
Vitamin C (mg)	99.32± 223.9	98.62± 224.1	99.82± 223.2	0.900
Macronutrients energy ratio (%)
Carbohydrates	63.32± 220.5	62.12± 220.6	63.22± 220.4	0.172
Protein	15.12± 220.2	14.72± 220.2	14.92± 220.2	0.283
Fat	21.32± 220.4	22.42± 220.5	21.52± 220.3	0.061

¹⁾Mean± SE adjusted for age, weight, BMI, marital status, and weight status ∗: P < 0.05 by Student's t-test

Table 9.

NAR and MAR by weight perception

Variables	Weight perception			P-value
	Normal estimation	Over- estimation	Total
	(n=840)	(n=554)	(n=1,394)
NAR¹⁾
Protein	0.93± 0.01²⁾	0.91± 0.01	0.92± 0.01	0.026∗
Calcium	0.63± 0.01	0.61± 0.02	0.61± 0.02	0.365
Phosphorous	0.96± 0.01	0.93± 0.01	0.95± 0.01	0.036∗
Iron	0.75± 0.01	0.70± 0.02	0.73± 0.01	0.007∗∗
Vitamin A	0.74± 0.02	0.71± 0.02	0.73± 0.01	0.181
Vitamin B₁	0.85± 0.01	0.82± 0.01	0.84± 0.01	0.122
Vitamin B₂	0.82± 0.01	0.78± 0.01	0.80± 0.01	0.608
Niacin	0.85± 0.01	0.83± 0.01	0.84± 0.01	0.102
Vitamin C	0.99± 0.04	0.99± 0.04	1.00± 0.03	0.900
MAR³⁾	0.84± 0.01	0.81± 0.01	0.83± 0.01	0.095

¹⁾Nutrient adequacy ratio 2) Mean± SE adjusted for age, weight, BMI, marital status and weight status 3) Mean nutrient adequacy ratio ∗: p < 0.05, ∗∗: p < 0.01 by Student's t-test

Table 10.

Index of nutrition quality by weight perception

Variables	Weight perception			P-value
	Normal perception	Over perception	Total
	(n=840)	(n=554)	(n=1,394)
Protein	1.13± 0.01¹⁾	1.14± 0.02	1.14± 0.01	0.936
Calcium	0.73± 0.01	0.74± 0.02	0.74± 0.01	0.965
Phosphorous	1.18± 0.12	1.18± 0.12	1.18± 0.01	0.863
Iron	0.89± 0.02	0.84± 0.02	0.88± 0.01	0.014∗
Vitamin A	0.89± 0.02	0.87± 0.02	0.89± 0.02	0.544
Vitamin B₁	1.01± 0.01	1.00± 0.02	1.00± 0.01	0.847
Vitamin B₂	0.96± 0.02	0.95± 0.01	0.96± 0.01	0.469
Niacin	1.02± 0.03	1.01± 0.01	1.02± 0.01	0.609
Vitamin C	1.15± 0.04	1.14± 0.04	1.15± 0.03	0.926

¹⁾Mean± SE adjusted for age, weight, body mass index, marital status, and weight status ∗: P < 0.05 by Student's t-test

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Weight Control Behaviors, Health-related Quality of Life and Nutritional Status by Overestimation of Body Image among Young Korean Females: Data from the Fifth Korea National Health and Nutrition Examination Survey, 2010-2011

Korean J Community Nutr. 2015;20(5):362-374. Published online October 31, 2015

DOI: https://doi.org/10.5720/kjcn.2015.20.5.362

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Table 1.

The distribution of the study participants according to weight status and subjective weight perception

Subjective weight perception	Weight status
Subjective weight perception	Severe under weight	Under weight	Normal weight	Over weight	Obese	Total
Very thin	24 (42.9)^1)a2)	10 (4.5)^c	−	−	−	34 (662.7)
Somewhat thin	27 (50.0)^b	119 (42.6)^a	21 (2.4)^c	−	−	167 (611.9)
Normal	3 (7.1)^b	164 (52.0)^b)	450 (57.9)^a	13 (8.2)^c	3 (2.0)^c	633 (641.2)
Somewhat fat	−	2 (0.9)^b	315 (38.0)^b	133 (71.9)^a	73 (35.7)^c	523 (632.7)
Very fat	−	−	13 (1.7)^b	30 (19.9)^b	114 (62.3)^a	157 (611.5)
Total	54 (64.2)	295 (20.3)	799 (50.2)	176 (12.1)	190 (13.2)	1,514 (100.0)

Table 2.

The distribution of the study participants according to weight perception and weight status

Actual weight status	Weight perception
Actual weight status	Under estimation	Normal estimation	Over estimation	Total
Severe underweight	−	24 (13.2)	30 (16.8)	54 (114.2)
Underweight	110 (11.3)¹⁾	119 (15.3)	166 (30.3)	295 (120.3)
Normal weight	121 (14.8)	450 (51.5)	328 (56.1)	799 (150.2)
Overweight	113 (12.4)	133 (15.5)	30 (16.8)	176 (112.1)
Obese	176 (61.5)	114 (14.5)	−	190 (113.2)
Total	120 (18.1)	840 (56.4)	554 (35.5)	1,514 (100.0)

¹⁾N (%)

Table 3.

General characteristics of the study participants by weight perception

Variables	Weight perception			P-value
	Normal estimation	Over estimation	Total
	(n=840)	(n=554)	(n=1,394)
Age (year)	130.5± 0.25¹⁾	129.5± 0.33	130.1± 0.21	< 0.019∗
Height (cm)	160.6± 0.22	161.0± 0.29	160.7± 0.18	< 0.252
Weight (kg)	157.3± 0.51	154.2± 0.35	156.1± 0.35	< 0.001∗∗∗
PIBW²⁾ (%)	103.0± 0.87	196.9± 0.58	100.6± 0.59	< 0.001∗∗∗
BMI³⁾ (kg/m²)	122.2± 0.19	120.9± 0.12	121.7± 0.13	< 0.001∗∗∗

¹⁾Mean± SE 2) Percent ideal body weight 3) Body mass index ∗: p < 0.05, ∗∗∗: p < 0.001 by Student's t test.

Table 4.

Odds ratios for prevalence of overestimation according to general characteristics of the study participants

General characteristics		N (%)	OR (95% CI)¹⁾
Age group	30∼39	355 (50.6)	1.00
Age group	20∼29	199 (49.4)	1.13 (0.88∼1.45)
Marital status	Married	351 (52.6)	1.00
Marital status	Unmarried	203 (47.4)	1.32 (1.01∼1.72)
Region	Urban area	500 (91.0)	1.00
Region	Rural area	54 (69.0)	1.48 (0.94∼2.32)
Income level	Low	119 (35.6)	1.00
	Mid-low	149 (26.2)	1.27 (0.88∼1.83)
	Mid-high	139 (25.4)	1.14 (0.81∼1.59)
	High	147 (22.8)	1.21 (0.83∼1.77)
Educational level	Elementary school	2 (60.4)	1.00
	Middle school	7 (62.1)	2.48 (0.32∼19.12)
	High school	211 (39.1)	1.40 (0.24∼8.10)
	College	334 (58.4)	1.73 (0.30∼9.90)
Body shape	Normal weight	328 (56.1)	1.00
	Severe underweight	30 (66.8)	1.94 (1.01∼3.75)
	Underweight	166 (30.3)	1.81 (1.34∼2.45)
	Overweight	30 (66.8)	0.40 (0.25∼0.66)
Occupation	Unemployed	290 (48.1)	1.00
	Administrator	110 (20.5)	0.98 (0.70∼1.39)
	Office job	65 (13.1)	0.79 (0.53∼1.18)
	Sales and service	65 (12.9)	0.99 (0.67∼1.49)
	Labor	24 (65.4)	0.83 (0.42∼1.66)

¹⁾Odds ratio (95% confidence interval)

Table 5.

Experience and methods of weight control by weight perception

Variables	Weight perception			P-value
	Normal estimation	Over estimation	Total
	(n=840)	(n=554)	(n=1,394)
Weight control to lose or maintain
Yes	557 (68.2)¹⁾	386 (67.7)	963 (68.0)	0.859
No	263 (31.8)	168 (32.3)	431 (32.0)	0.859
Method used for weight control
Exercise
Yes	354 (61.9)	227 (56.7)	581 (59.9)	0.176
No	223 (38.1)	159 (43.3)	382 (40.1)	0.176
Fasting
Yes	5 (60.5)	12 (63.3)	17 (61.6)	0.001∗∗
No	572 (99.5)	374 (96.7)	946 (98.4)	0.001∗∗
Reducing food intakes
Yes	394 (67.8)	278 (68.5)	672 (68.1)	0.848
No	183 (32.2)	108 (31.5)	291 (31.9)	0.848
Skipping meals
Yes	70 (13.8)	67 (20.1)	137 (16.2)	0.048∗
No	507 (86.2)	319 (79.8)	826 (83.8)	0.048∗
Un-prescribed pills
Yes	2 (60.4)	6 (61.7)	8 (60.9)	0.099
No	575 (99.6)	380 (98.3)	955 (99.1)	0.099
Prescribed pills
Yes	29 (65.4)	33 (10.4)	62 (67.4)	0.039∗
No	548 (94.6)	353 (89.6)	901 (92.6)	0.039∗
Herbal medicine
Yes	19 (63.0)	18 (65.8)	37 (64.1)	0.066
No	558 (97.0)	368 (94.2)	926 (95.9)	0.066
Health functional food
Yes	31 (64.8)	31 (67.5)	62 (65.8)	0.142
No	546 (95.2)	355 (92.5)	901 (94.2)	0.142
One-food diet
Yes	14 (62.2)	8 (62.2)	22 (62.2)	0.961
No	563 (97.8)	378 (97.8)	941 (97.8)	0.961

¹⁾N (%) ∗: p < 0.05, ∗∗: p < 0.01 by χ

²test

Table 6.

Mental condition and quality of life by weight perception