Dietary behaviors, physical activity and sedentary lifestyle associated with overweight and obesity, and their socio-demographic

correlates, among Pakistani primary school children Obesity is a global epidemic and children are the worst affected with an estimated ten percent of school-aged children being overweight and one quarter of these being obese worldwide [1,2]. The 2004 World Health Assembly at Geneva called for specific actions to halt the epidemic that is now penetrating the developing countries including Pakistan, mainly in the affluent urban population [3,4]. Targeted interventions, tailored to local circumstances and involving communities, should begin early in life [5]. Association of overweight and obesity with diet- and activity-related factors is important in terms of implementing effective interventions. Dietary and lifestyle behaviors are modifiable and have therefore been targets of obesity research and prevention [6,7]. Association of dietary behaviors, physical activity and sedentary lifestyle with childhood obesity has been extensively explored among school-aged children globally; however, most studies were conducted in the developed countries and literature in this regard is scarce in South Asian children. There is no data on diet- and activity-related behaviors associated with overweight and obesity among Pakistani school-aged children. Only one study conducted in Karachi, Pakistan reported physical activity levels in school-aged children and its inverse association with overweight and obesity [8]. The study aimed to explore dietary behaviors, physical activity and sedentary lifestyle associated with overweight and obesity, and their sociodemographic correlates, among Pakistani primary school children. http://www.ijbnpa.org/content/8/1/130

New Studies show Strong links between Diet, Behavior

Can the right diet make a child less hyperactive, alleviate an adult's depression, or even reduce aggression and antisocial acts? Recent research offers surprising evidence about the value of nutritional interventions for a wide range of behavioral and mood disorders. Diet and childhood behavior Researchers in the 1970s questioned the connection between diet and behavior. Newer, more sophisticated studies, however, reveal that for many children, the food/behavior link is real. J. Breakey reviewed studies on food and behavior conducted between 1985 and 1995, and concludes that the results "clearly show a relationship" between what children eat and how they act. "The most important finding," she says, "was that in almost all studies there was a statistically significant change in behavior with dietary intervention." In addition, the studies revealed a continuum of responses to dietary interventions, "rather than the all-or-nothing earlier expectation." Although diet changes reportedly can improve a wide range of behavior problems, including hyperactivity and sleep problems, Breakey says "an important unexpected finding is the number

of researchers who emphasize that the symptom most affected by diet is mood, especially irritability." Diet and aggression While most studies on diet and behavior have focused on reducing hyperactivity, there is evidence that diet also has a strong influence on aggression. Physician Melvyn Werbach cites some examples: -- One study found that 20 subjects with marginal deficiencies of thiamin were impulsive, highly irritable, aggressive, and sensitive to criticism. After their diets were supplemented with thiamin, the subjects' behavior improved significantly. -- Research shows that among adolescent males, iron deficiency is directly associated with aggressive behavior. Furthermore, one study found that iron deficiency was nearly twice as prevalent in a group of incarcerated adolescents as among their non- incarcerated peers. Werbach says animal studies indicate that iron deficiency may cause behavioral impairment by diminishing dopamine transmission. -Studies show that rats fed diets depleted in the amino acid tryptophan become more aggressive toward mice. In addition, research on vervet monkeys found that tryptophan-free diets increased aggression in males, while high-tryptophan food reduced aggression in both males and females. These findings are not surprising, according to Werbach, because tryptophan is the dietary building block of the brain chemical serotonin, and low levels of this neurotransmitter are strongly linked to behavior problems including impulsive aggression (See related article, Crime Times, 1995, Vol. 1, No. 1-2, Page 7). While noting that too little scientific research is available on the diet/aggression connection, Werbach concludes, "Epidemiological studies have repeatedly found associations between overaggressive behaviors and deficiencies of several essential nutrients: niacin, pantothenic acid, thiamin, vitamin B6, vitamin C, iron, magnesium and tryptophan." This evidence, he says, "argue[s] that a nutritional approach should be considered in the treatment of the aggressive behavioral syndrome." Diet and mood Depression, a serious problem in and of itself, is a risk factor for aggression and possibly even for criminal behavior (See related article, Crime Times, 1997, Vol. 3, No. 4, Page 6). Recent research points to a strong link between depression and dietary deficiencies, and in particular deficiencies of the B vitamin folate (folic acid). Beginning in the 1980s, study after study has shown that low levels of folic acid are correlated with depression. Jonathan E. Alpert and Maurizio Fava recently noted that "depressive symptoms are the most common neuropsychiatric manifestation of folate deficiency," and that as many as one third of adults diagnosed with depressive disorders have deficient or borderline

blood levels of folate. Studies by Alpert and Fava, as well as other researchers, also suggest that depressed patients with low folate levels respond poorly to antidepressant treatment, compared to subjects with normal folate levels. T. M. Ortega and colleagues say that the relationship between depression and low folate levels is easily explained, "because of the role of folates in [the] synthesis of neurotransmitters and elements of neuron structure." Another nutrient linked strongly to mood is selenium. British researchers David Benton and Richard Cook first reported, in 1991, that in normal subjects, higher selenium intake is "associated with a general elevation of mood and in particular, a decrease in anxiety." The lower the level of selenium in their subjects' diets, Benton and Cook reported, "the more reports of anxiety, depression, and tiredness," all of which decreased following five weeks of selenium supplementation. Wayne C. Hawkes and Linda Hornbostel recently conducted a similar experiment in the U.S., studying the effects of selenium supplementation or depletion on 11 healthy men. "Adding more selenium to the diets of our. volunteers had no effect on mood," they say, apparently because the U.S. subjects began with higher selenium levels than the British subjects. "However," the researchers say, "we did find that taking most of the selenium out of our volunteers' diets worsened the moods of those volunteers who had been consuming the lowest amounts of selenium prior to the beginning of our study. This was similar to the British study where they found that the moods of the people who ate the least selenium were improved most by giving them more selenium." Low levels of tryptophan also may lead to depression. In 1997, K. A. Smith et al. studied 15 women who had experienced major depression in the past but were no longer taking antidepressants. The subjects drank either an amino acid mixture containing tryptophan, or the same mixture without the tryptophan, and their depressive symptoms were measured before and seven hours after drinking the substances. "The tryptophan-free mixture produced a 75% reduction in plasma tryptophan concentration," the researchers report. "After drinking [this] mixture, ten of the 15 women experienced temporary but clinically significant depressive symptoms." No mood changes were seen when patients drank the mixture containing tryptophan.

Diet and criminality In addition to influencing mood, aggression, and symptoms of hyperactivity, diet appears to significantly improve the IQs of some children (See related article, Crime Times, 1996, Vol. 2, No. 2, Page 4). Since hyperactivity, hyperaggressiveness, depression, and IQ all are associated with criminality, some researchers are investigating whether or not diet may be useful in treating criminals (and, in particular, young delinquents). To date the research, while sparse, is encouraging.

During the early 1980s, Stephen Shoenthaler instituted dietary changes in a dozen juvenile correctional institutions. His data showed that following these dietary interventions, which involved 8076 delinquents, the institutions had a 47% reduction in antisocial behavior including assaults, insubordination, horseplay, suicide attempts, and general rule violations. Schoenthaler notes, additionally, that "the more violent the bad behavior [before dietary interventions began], the more the improvement." In a typical study, Schoenthaler supplemented the diets of 71 residents of a state juvenile treatment facility. During the treatment phase of the double-blind, placebo-controlled, crossover study, Schoenthaler reported, "overall violence fell 66 percent from 306 incidents to 104. Total AWOL and escape attempts fell 84 percent from 79 to 13 incidents and destruction or theft of state property dropped 51 percent from 49 to 24 incidents." He concludes that "the trial demonstrated, rather convincingly, that supplementation at dose levels which pose no risk whatsoever can produce a significant reduction in violence and antisocial behavior in incarcerated juveniles." Preliminary results from current studies by Schoenthaler corroborate these earlier findings. Needed: more data Researchers investigating dietary interventions for behavior- disordered children, troubled teens, and antisocial adults are excited about the accumulating evidence showing that these simple measures may have profound impact, but they are also frustrated by a lack of interest on the part of most clinicians. "Unfortunately, the idea that disturbed behavior and crime in particular are essentially the result of adverse social factors is so deeply embedded in human society that those seeking to conduct studies of non-social factors such as defective diets usually find that they face an uphill task," researcher Derek Bryce-Smith recently commented. "The demonstrated links between diet and behavior badly need to be extended as a matter of urgency, and their importance recognized." ----"The role of diet and behaviour in childhood," J. Breakey, Journal of Paediatr. Child Health, 33, 1997, pp. 190-194. Address: J. Breakey, P.O. Box 8, Beachmere, QLD 4510, Australia. ---and--"Nutritional influences on aggressive behavior," Melvyn Orthomolecular Medicine, Vol. 7, No. 1, 1995. Address not listed. ---and--"Nutrition and depression: the role of folate," Jonathan E. Alpert and Maurizio Fava, Nutrition Review,May 1997, Vol. 55, No. 5, pp. 145-149. Correspondence: Maurizio Fava, fax 1-617-7267541. R. Werbach, Journal of

---and--"The role of folates in the diverse biochemical processes that control mental function," T. M. Ortega, P. Andres, A. Lopez- Sobaler, A. Ortega, R. Redondo, A. Jimenez, and L. M. Jimenez, Nutr Hosp, Vol. 9, No. 4, July 1994, pp. 251-256. Address not listed. ---and--"Effects of dietary selenium on mood in healthy men living in a metabolic research unit," W. C. Hawkes and L. Hornbostel, Biological Psychiatry, Vol. 39, No. 2, January 15, 1996, pp. 121-128. Address not listed. ---and--"The impact of selenium supplementation on mood," David Benton and Richard Cook, Biological Psychiatry, Vol. 29, No. 11, June 1, 1991, pp. 1092-1098. Address not listed. ---and--"Relapse of depression after rapid depletion of tryptophan," K. A. Smith, C. G. Fairburn, and P.J. Cowen,The Lancet, Vol. 349, No. 9056, March 29, 1997, pp. 915-919. Address not listed. ---and--"Abstracts of early papers on the effects of vitamin and mineral supplementation on I.Q. and behaviour," Stephen J. Schoenthaler, Personal and Individual Differences, Vol. 12, No. 4, 1991, pp. 335-341. (Additional information from personal communication.) ---and--"Crime and nourishment," Derek Bryce-Smith, Perspectives, March 15, 1996. Address not listed.\ Body Image: Relationship to Attachment, Body Mass Index and Dietary Practices among College Students

Introduction There has been a tremendous amount of research on eating disorders among females. However, the difficulty of distinguishing eating disordered populations from normal controls has led to a growing literature that focuses on body image rather than eating behaviors of normal

adolescent females. Nevertheless, relatively little research has focused on factors that influence the body image among non-clinical adolescents, and almost no research has studied the relationship between body image and eating behaviors of males. This study examined body image and eating behavior among older adolescents of both genders. Body image is a multidimensional construct, that involves internal biological and psychological factors as well as external cultural and social factors (Cash & Pruzinsky, 1990; Geller, Srikameswaran, Cockell, & Zaitsoff, 2000; Petersen, Schulenberg, Abramovich, Offer, & Jarcho, 1984) and it has been established as an important aspect of self-worth and mental health across the life span (Harter, 1988; 1998; 1999). Several studies have demonstrated that body image as well as overall satisfaction with self undergoes change during adolescence years (Fabian & Thompson, 1989; Thompson, Heinberg, Altabe, & Tantleff-Dunn, 1999), partially in response to bodily changes associated with puberty. A negative self-evaluation during this time of developmental transition for young females often leads to body dissatisfaction and low selfesteem, as well as to increased incidents of depressive reactions and to eating-disordered behaviors (Ackard & Peterson, 2001; Button, Loan, Davies, & Sonuga-Barke, 1997; Davies & Furnham, 1986; Petersen, Sarigiani, & Kennedy, 1991).

Self-esteem and body esteem are terms that often used interchangeably to refer to evaluative perceptions of the self that are cognitively mediated and emotionally laden. Selfevaluation of physical appearance, or body esteem, is the only specific domain of self-esteem that has been studied extensively in overweight individuals, and findings of this research are consistent: overweight children, adolescents, and adults generally have lower body esteem than do their normal weight peers (Fabian & Thompson, 1989; Harter & Jackson, 1993; Mendelson, White, & Mendelson, 1996). Moreover, it is a well-known fact that if an adolescent fits into

the cultural ideal of the slim, well-proportioned physique, he/she probably will have a positive self-concept (Harter, 1988; 1998; 1999). In contrast, individuals who perceive their bodies negatively with regard to culturally valued features may have low self-esteem and feelings of inferiority, as well as risk factors for depression, anxiety or eating disorders. Findings from research aimed at explaining the transitional change in perception of self-worth during adolescence (Cauffman & Steinberg, 1996; Fabian & Thompson, 1989; Thompson et al., 1999) indicate that with maturation the self-esteem of females declines. In turn this leads to gender differences reflected in dramatically lower self-esteem in girls as compared to boys when esteem measures are based on their physical appearance (Harter, 1999; Mendelson et al., 1996; Smolak, Levine, & Gralen, 1993; Swarr & Richards, 1996). The prevalence of eating disorders in the United States has increased significantly over the past few decades (Grigg, Bowman, & Redman, 1996; Lemberg, 1999). However, the number of individuals with diagnosable eating disorders and associated body image disturbances represents only a small portion of the population for whom body image issues are problematic. A large part of the population experiences body image dissatisfaction; yet, many

of these individuals do not manifest an eating disorder. Some may be exercising or using dietary practices in order to achieve balance and satisfaction. The findings reported by Lemberg (1999) revealed that about 34% of males and 38% of the female population were dissatisfied with their overall appearance. Although most of respondents were content with their face and their height, body weight and shape were sources of discontent. Data further indicated that prevalence of dissatisfaction is on the rise, especially among women (Lemberg,

1999). However, body image distortions and concerns also affect males (Cash & Pruzinsky, 1990; Parks & Read, 1997). Unlike females, many adolescent males consider themselves underweight; therefore their body dissatisfaction is not likely to lead to eating disorder that focuses on reduction of weight (Kaplan, 1984). Cash and Pruzinsky (1990) reported that how the normal weight person classifies his/her weight affects the persons body image, eating behavior, and psychological well-being. It is becoming apparent that many non-disordered individuals have some level of appearancerelated, body image disturbance, such as dissatisfaction, specific size/weight dissatisfaction, or size perception inaccuracy, especially overestimation of body size (Cash & Pruzinsky, 1990). Among objectively normal weight individuals, those who proclaimed themselves overweight evaluated their bodies more negatively. Their personal dissatisfaction with body and appearance may have been intensified by societal norms to be thin and fit for females and to have masculine V-shape physique and tallness for males. Adolescence is referred to as a time of special body image instability as well as a time of adaptation to ones own body because of overall radical body transformation (Fisher, 1986). During this time of transitions, the challenges include puberty, the beginning of heterosexual 3relationships, time for change in parent-child relationships, and movement toward a career choice. One of the important indicators for successful adaptation through adolescence and for the development of healthy self-representation and self-concept is attachment to the caregiver (Harter, 1998; 1999). In the limited studies on the relationship between attachment and selfperception in adolescence, all (or almost all) have studied attachment to the mother figure. This study extended previous work by investigating the relationships between body image and attachment to mothers, fathers, and peers.

Cultural and societal standards regarding desirable body characteristics such as thinness have become unrealistic for young women within the past twenty years. Adolescent males are also vulnerable to the pressure to attain the ideal male body. Very often the ideal and actual body type will not or cannot coincide even with excessive exercising, and this leads to body image dissatisfaction for both males and females. Young adolescents are well aware of the cultural criteria for attractiveness through the news media, television and magazines. Media emphasis on possessing a muscular build for males and unrealistic thinness for females may have increased the percentage of young adolescents wishing to fit the ideals. It seems appropriate try to understand the developmental precursors and concomitant factors that are related to body image in order to comprehend the complexity of the self. It is also important to provide data on body image in non-clinical adolescents rather than promulgating studies within the narrow limits of the field of eating disorders. The purpose of this study was to explore, among older adolescent males and females, the relationships between Satisfaction with Physical Appearance as measured by the Physical 4Appearance Scale of Harters Self-Worth Scale for College Students and the following variables: a) attachment to the mother, father, and peers as measured by the Inventory of Parent and Peer Attachment Scale (Armsden & Greenberg, 1987), b) actual body proportion measured by Body Mass Index (BMI), obtained by dividing weight (in kilograms) by height ( in meters) squared, c) eating disturbances and attitudes as measured by EAT-26, (Garner, Olmsted, Bohr, & Garfinkel, 1982), d) peer influence and peer pressure in the Dieting Domain measured by the Peer

Influence and Peer Pressure Scale, (Mukai, 1993; 1996), and e) media influence measured by the Media Influence Scale developed by the researcher for the present study, By examining these factors, the researcher contributed to the research literature by providing data that deepens our understanding of the factors that influence satisfaction with physical appearance among older adolescents.

http://scholar.lib.vt.edu/theses/available/etd-05122003-121553/unrestricted/Diss.fin.pdf\

Definition of Terms: Body image The subjective concept of one's physical appearance based on self-observation and the reactions of others.

Preoccupation Preoccupation is a state of being focused on and engrossed in something, or the thing that you are engrossed in.