Serviços customizados
Inglês (pdf)
Artigo em XML
Referências do artigo
Tradução automática
Enviar este artigo por email
Citado por SciELO 
Citado por Google 
Similares em
SciELO 
Similares em Google 
Permalink
Key messages
Body Cathexis Scale (BCS) points of thin students are significantly lower than slightly overweight and obese students.
There was a significant difference between the adolescent girls actual BMIs (Body Mass Index) and their body perceptions in the menstrual period.
There was a positive weak correlation between BMI and BCS score, a positive moderate correlation with the body image in the menstrual period, and a positive strong correlation with the body image in the non-menstrual time periods.
Introduction
Adolescence is the phase of life between childhood and adulthood1. According to Turkey Demographic and Health Survey 2018, 16.4% of Turkey's population are adolescents2. Adolescence is a period in which nutritional habits and food preferences change, as well as unhealthy eating behaviors. Adolescents continue the nutritional behaviors which have acquired in this period in their later stages of life1.
Body image is defined as the degree of satisfaction of people reports about their body3. Body image problems involve misperceptions, those who suffer tend to over or underestimate the size of body parts or entire bodies4. Although the differences in body perception continues throughout life, increments in dissatisfaction with appearance and body shape causes nutritional problems5,6.
The menstrual cycle is an important source of physical and psychological variation experienced by women from menarche to menopause due to edema, pain, negative mood, and increased appetite, and the beginning of the menstrual cycle is associated with increased body dissatisfaction7. Also body image concepts have been linked with various psychological illnesses, such as depression and eating disorders8. Therefore, body dissatisfaction is higher in adolescent girls with the onset of the menstrual period9,10. In this time period, body dissatisfaction, body image anxiety and changes in eating habits are observed as a result6.
Girls usually start dieting at the age of 13-1411. It has been reported that dieting is applied among thin and normal individuals as well as those with body dissatisfaction with overweight. Hence they attach great importance to the benefits of appearance and maintaining ideal body weight10. In a study conducted with 14-18 years old girls, it was found that while 62% of the individuals had a normal body mass index (BMI), 83% of them had body dissatisfaction and wanted to lose weight12.
Recent studies mostly focus on non-menstrual time periods of adolescents. This study aimed to evaluate the relationship between and body perceptions during menstrual and non-menstrual time periods.
Methodology
Participants and type of study
This cross sectional study was carried out with 291 girls aged 14-18, who were studying at a private high school between September-November 2021 and voluntarily agreed to participate.
Ethical aspects
The study was approved by Baskent University Institutional Review Board and Ethics Committee (Project no: KA20/420). The students were included after obtaining permissions (themselves and caregiver), “Informed Voluntary Consent Form for Research in Children” was read and signed. Data were obtained from students in the sampled schools. All data included in this study obtained face to face interview by paying attention to the pandemic conditions.
Data collection
A questionnaire form was applied to students, in which descriptive information about general characteristics, information about menstruation period, and mood during the menstruation period were questioned. Height (cm) and waist circumference (cm) measurements were taken with a non-stretchable tape measure. Body weight (kg) was determined with a portable scale. For waist circumference, the midpoint between the lowest rib bone and the crista iliac was found, the circumference was measured13. BMI values for age were evaluated according to the criteria of the World Health Organization Multicenter Growth Reference Study (WHO-MGRS)14. According to this classification, standard deviation score was considered <-2 as “underweight”, ≥-2 - <+1 as “normal”, ≥+1 - <+2 as “overweight” and ≥+2 as “obese”14. Waist circumference values was evaluated by Hatipoğlu et al.15 waist circumference percentile values for Turkish children.
The Body Cathexis Scale (BCS) consists of 40 items was developed by Secord and Jourard in 195316. The Turkish validity and reliability study of this scale was conducted by Hovardaoğlu17. The participant is asked to choose the most suitable option for different parts of body, such as “I don't like it at all” (5 points), “I don't like it very much” (4 points), “I am undecided” (3 points), “I like it quite a bit” (2 points), “I like it very much” (1 point). High total score indicates low body image satisfaction16,17.
Students were asked to mark how they perceived themselves during menstruation and non-menstruation periods with the Stunkard Figure Rating Scale. The figure rating scale was developed by Stunkard et al.18 as an easy-to-apply self-report scale for body image perception. This scale consists of nine figures ranges from underweight (value 1) to obese (value 9). Figures are classified according to BMI status. Figure 1 means thin, Figures 2, 3 and 4 are normal, Figures 5, 6, 7, 8 and 9 are obese18 (see Supplementary Material).
Statistical analysis
Statistical analyses were performed using Statistical Package for the Social Sciences Version 20. Qualitative variables are given as numbers and percentages. Continuous variables are given with mean and standard deviation (SD) values. Chi-square (χ2) tests were used to evaluate categorical variables. One way Anova and independent sample T-test were used to evaluate the independent variables. Kendall Tau-b test was used to determine the relationships between binary and ordinal scaled variables. Statistical analyses included Cohen's Kappa test (K). Alpha level of <0.05 was used to determine statistical significance.
Results
A total of 291 students were involved in the study with a mean age of 15.9(1.13) years. The mean BMI of the students was 21.13(3.33) kg/m2,and the waist circumference was 70.48(8.87) cm. BCS was found to be 97.39(24.59) (Data not shown).
BCS scores of the students were compared according to sociodemographic characteristics and knowledge about the menstrual period. During the menstrual period, while there was no change in body weight in 56.3% of the students, an increase in 36.1%. The students felt aggression (39.9%) and fatigue (29.2%). The mean body perception score was found to be higher in those who felt sad and aggressive during the menstrual period (102.78(23.43), 100.59(24.14), respectively) (Table 1).
Table 1. Body Cathexis Scale scores averages of the participants according to their knowledge about sociodemographic characteristics and menstrual periods.
| n | % | Body Cathexis score/Mean(SD) | p | |
|---|---|---|---|---|
| Grade | ||||
| 9th | 90 | 30.9 | 90.90(27.44) | 0.163¤ |
| 10th | 48 | 16.5 | 98.38(18.44) | |
| 11th | 110 | 37.8 | 97.54(21.69) | |
| 12th | 43 | 14.8 | 93.15(28.20) | |
| Menstruation Frequency | ||||
| <Every 21 days | 45 | 15.5 | 90.97(27.44) | 0.781¤ |
| Every 21-27 days | 130 | 44.7 | 94.98(22.33) | |
| Every 28-35 days | 91 | 31.2 | 96.60(24.97) | |
| >Every 35 days | 25 | 8.6 | 96.55(24.01) | |
| Menstruation Period | ||||
| 2-6 days | 171 | 58.8 | 93.21(24.01) | 0.110¥ |
| ≥7 days | 120 | 41.2 | 98.02(24.07) | |
| Changes in Body Weight | ||||
| My body weight increases | 105 | 36.1 | 97.26(25.99) | 0.556¤ |
| My body weight decreases | 22 | 7.6 | 91.62(25.82) | |
| There is no change in my body weight | 164 | 56.3 | 96.38(21.92) | |
| Mood in Menstrual PeriodΩ | ||||
| Sad | 49 | 16.8 | 102.78(23.43) | 0.047¤* |
| Tired | 85 | 29.2 | 93.53(24.92) | |
| Joyful | 10 | 3.4 | 93.60(28.10) | |
| Aggressive | 116 | 39.9 | 100.59(24.14) | |
| Painful | 13 | 4.5 | 90.77(28.28) | |
*p<0.05;
¤One way ANOVA;
¥Student T-test;
ΩMultiple answers marked.
The anthropometric measurements of the students are given in Table 2. BCS points of thin students are significantly lower than slightly overweight and obese students.
Table 2. Mean Body Cathexis Scale scores according to the anthropometric measurements.
| Body Cathexis Scale | |||||
|---|---|---|---|---|---|
| n | Mean(SD) | Minimum | Maximum | p | |
| BMI groups | |||||
| Underweight | 7 | 80.57(31.04)a | 50.0 | 143.0 | p=0.001* |
| Normal | 232 | 95.42(24.52)ac | 40.0 | 170.0 | |
| Overweight | 43 | 107.60(20.22)bc | 56.0 | 149.0 | |
| Obese | 8 | 114.38(21.35)c | 88.0 | 148.0 | |
| Waist Circumference (Percentiles) | |||||
| <10 | 10 | 88.89(27.00)ab | 48.0 | 137.0 | p=0.014*¤ |
| ≥10 - <25 | 32 | 87.72(20.29)a | 50.0 | 143.0 | |
| ≥25 - <75 | 121 | 96.77(26.40)ab | 40.0 | 170.0 | |
| ≥75 - <90 | 45 | 95.60(24.74)ab | 43.0 | 137.0 | |
| ≥90 | 83 | 104.05(21.68)b | 56.0 | 151.0 | |
Different letters indicate significant differences (p<0.05) according to the Tukey Kramer-post-hoc test.
*p<0.05;
¤One way ANOVA;
SD:Standard deviation.
The relationship between the students' BMI and body image perceptions during menstrual and non-menstrual periods according to the Stunkard Figure Rating Scale is given in Table 3. There was a significant difference between the actual BMIs and their perceptions in the menstrual period (p=0.000), and it was determined that the agreement with each other was slight (K=0.172). While 39.6% of students with normal BMI perceived themselves slightly overweight and obese during menstrual period, 50% of slightly overweight students perceived themselves as obese. There was a significant difference (p<0.001) between actual BMIs non-menstrual periods and body image, their agreement with each other was moderate (K=0.474).
Table 3. The relationship between the actual Body Mass Indexes and body image perceptions during menstrual and non-menstrual periods according to the Stunkard Figure Rating Scale.
| Stunkard Figure Rating Scale Groups | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Actual BMI Groups | Underweight | Normal | Overweight | Obese | x2 | p¤ | K | ||||
| n | % | n | % | n | % | n | % | ||||
| Which silhouette is closest to your appearance in menstrual period? | |||||||||||
| Underweight | 3 | 42.9 | 4 | 57.1 | - | - | - | - | 71.712 | <0,001 | 0.172 |
| Normal | 12 | 5.2 | 128 | 55.2 | 68 | 29.3 | 24 | 10.3 | |||
| Overweight | - | - | 5 | 11.4 | 17 | 38.6 | 22 | 50.0 | |||
| Obese | - | - | - | - | 3 | 37.5 | 5 | 62.5 | |||
| Which silhouette is closest to your appearance in non-menstrual period? | |||||||||||
| Underweight | 5 | 71.4 | 2 | 28.6 | - | - | - | - | 137.052 | <0,001 | 0.474 |
| Normal | 16 | 6.9 | 185 | 79.7 | 30 | 12.9 | 1 | 0.5 | |||
| Overweight | - | - | 6 | 13.6 | 31 | 70.5 | 7 | 15.9 | |||
| Obese | - | - | - | - | 5 | 62.5 | 3 | 37.5 | |||
¤Chi-square.
The relationship between students' BMI and BCS scores and their body image perceptions in the menstrual and non-menstrual period was given in Table 4. There was a positive weak correlation between BMI and BCS score (r=0.208), a positive moderate correlation with the body image in the menstrual period (r=0.447), and a positive strong correlation with the body image in the non-menstrual time periods (r=0.631).
Table 4. The relationship between Body Mass Index and Body Cathexis Scale score during menstrual and non-menstrual periods and body image perceptions according to Stunkard Figure Rating Scale.
| Body Cathexis - Scale | Body image - menstrual period | Body image - non-menstrual period | ||||
|---|---|---|---|---|---|---|
| R* | 95% CI | ra | 95% CI | ra | 95% CI | |
| BMI | 0.208 | 0.18-0.25 | 0.447 | 0.38-0.46 | 0.631 | 0.62-0.75 |
*Kendall's Tau-b correlation coefficient;
BMI: Body mass index.
Discussion
Decreased body image, body dissatisfaction and body misperception are frequently encountered in adolescence girls especially with menarche. However, no study has been found about the effect of the menstrual period on body perception and body image in adolescents. In this study, there was a significant difference between the actual BMIs and perceptions of participants in the menstrual period. The mean body perception score which was 97.39(24.59) found lower than the other similar studies. In a study conducted with girls aged 12-14, body perception score was 153.95(24.77)19.
According to Turkey Nutrition and Health Survey 2017,18.6% of girls aged 15-18 were overweight, while 4.8% were obese20. In this study, 15.1% of students were overweight, while 2.8% were obese.
In this study, BCS scores of underweight students were found to be lower than those of overweight and obese students. Contrary to this study, in a study conducted with adolescents, no significant relationship was found between BMI and Body Image Scale score21.
Body image plays an important role in the management of body weight, especially among female adolescents22. Many adolescents with normal weight compare themselves to images of very thin people presented by the media and perceive themselves as being fat and overweight. The ideal beauty standard, defined as having a slim and/or muscular body, makes individuals vulnerable to developing body image dissatisfaction23. In this study, it was determined that the agreement between the actual BMIs of the students and their body image in the menstrual period was slight (K=0.172), while the agreement between the body image in the non-menstrual period was moderate (K=0.474). In a study conducted with adolescents, 66% of adolescents rightly matched their BMI-for-age category with theirself-perceived body image (K=0.37)24.
In this study, approximately 47% of the students in the menstrual period and 23% of the student in the non-menstrual period evaluate themselves differently from their actual BMI. About 30% of children and adolescents aged 8-15 years in the United States misperceive their weight status25.
According to this study, 40% of the adolescents in the menstrual period and 13.75% in the non-menstrual period were overestimated their actual weight and 6.87% in the menstrual period and 9.28% in the non-menstrual period were underestimated their actual weight. In a study of Polish adolescent girls shown that the probability of body dissatisfaction among subjects differing by phases of the menstrual cycle was 2.4 times higher for subjects at their premenstrual cycle phase than menstrual phase26. In a study of college students, participants judged highest body size and body dissatisfaction during the menstrual phase27.
Since the effect of BMI on body image is long-term, having a high BMI in adolescence strongly predicts body dissatisfaction in young adulthood28.
There are various limitations of this study. Due to time constraints, collecting data from a single private school in sample selection is one of the limitations of the study and may not reflect the universe. Another limitation of the study is that it was conducted with students studying in private schools, which is low in generalizability due to the fact that they have children from families with middle-high socioeconomic status. Although it is thought that the use of BMI as an anthropometric measurement is not sufficient, especially in adolescents, it was used due to the difficulty of skinfold thickness measurement, time limitation, and the absence of a body analyzer, but both BMI and waist circumferences evaluated according to the standard deviations of the World Health Organization as recommended. Therefore, more studies can be conducted with similar variables in different settlements and different sample groups. Food records could not be obtained due to the fact that they could not be interviewed for a long time under pandemic conditions and extra time was required for the accuracy of the records in adolescents. Despite this, the high number of participants and face to face interview were conducted to rule out peer effectiveness while collecting questionnaires are the strengths of the study. The quality and quantity of the food groups preferred by the participants who overestimated their weight in the menstrual period may be important for the result of the study, so it is recommended to evaluate them in future studies.
Since menstruation is a period in which body image is perceived differently, it should be encouraged to evaluate especially adolescent girls in terms of eating disorders. Adolescent nutrition is crucial for proper growth and development and a prerequisite for achieving full developmental potential. In this context, it is thought that dietitian support is important to prevent the development of malnutrition or obesity. Both malnutrition and obesity in adolescence are effective factors that can be determinants of health in adulthood. In terms of public health, body image affirmation is important for healthy generations, especially for female adolescents.
Conclusions
As a result, the menstruation period negatively affects body image satisfaction. It affects especially adolescent girls more, as it is determined that they feel heavier than they are even in non-menstrual periods. Since menstruation is a period in which body image is perceived differently than it is, it should be encouraged to specifically evaluate adolescent girls in terms of eating disorders in the early period.
