Body image and health_Final_Handout

20 November, 2019 Images on Physique,
College of Medicine, Rajvithi Hospital, Proportion or on particular
Rangsit University, Bangkok, Thailand
part of body
Body image and Health

Masa Kagawa http://pic.prepics‐cdn.com/chonchan/16665114.jpeg
Associate Professor, Deputy Director http://blogimg.goo.ne.jp/user_image/59/02/053a8ebb50b06306d3a68c4c4c14c902.jpg
http://thegrandnarrative.files.wordpress.com/2009/01/girls‐generation‐breasts‐ec868ceb8580ec8b9ceb8c80‐eab080ec8ab4.jpg
Institute of Nutrition Sciences
Kagawa Nutrition University 2

[email protected]

1

What is “Body image” Typical body
image today
Any image and values on body of
oneself and others

(e.g. Perception, Satisfaction, Concern)

Body image varies between ethnicity, 4
gender, age, the Era and social

backgrounds and also keeps changing

3

Differences by culture Change in ideal physique
over time

http://www.mekong.ne.jp/photo/IzumiYu/izumi10‐11.jpg https://www.youtube.com/watch?v=Xrp
0zJZu0a4
Bound feet
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Body modification as an
expression of “Beauty”, and
“Strong mind”

http://yaplog.jp/cv/konohanasaku/img/1069/t06_p.jpg http://blog.hicbc.com/blog/sekidou/images/murusi.jpg
http://bayofislands‐nz.up.seesaa.net/image/maoritattoo1‐thumbnail2.jpg

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1

Body image often influenced by Attractiveness of plump figure
food accessibility

http://blog‐imgs‐29.fc2.com/y/o/g/yogakutir/200px‐Starved_girl.jpg http://blogimg.goo.ne.jp/user_image/20/5e/2bdd5f7e5e8391db2684ca7e230a4421.jpg http://blog‐imgs‐32.fc2.com/a/r/t/artmeigakan/ingres1.jpg http://www.artistyle.jp/images2/venus.jpg
http://image.rakuten.co.jp/art‐meigakan/cabinet/renoir/renoir5.jpg
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The Era of self-control Western culture and media influence

9 • Twiggy in 1960’s

• Mode of fashion

• Idealizing
slim/slender/thin
physique through
media

• Treating plump
figure as non-
attractive

http://geniusbeauty.com/wp‐content/uploads/2009/06/pucci‐peach‐corset‐and‐mini‐skirt.jpg
http://3.bp.blogspot.com/‐80sagRcN1Kk/TVuUx870UrI/AAAAAAAAAFw/XWVKvSvkaEQ/s1600/Twiggy_promo.jpg

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Associations with the physique Hourglass to tubular body shape

• Both genders consider images of slender  BMI of playboy models declines from 1950
females with small WHR and large breast to 2000 however WHR and the Androgyny
attractive and healthy (Singh, 1994; 1995) index (waist/(hip x bust)0.5) increased

• BMI is a stronger index associated with body Physique of the model has become more
image than WHR (Tovee et al. 1999; 2002)
tube type (Voracek and Fisher BMJ 2002)
• Correlations between body dissatisfaction
and: 12

– Lower body girths (waist and hip) (Bailey, et al.

1990)

– Breadths and body fat (Davis et al., 1994)

11

2

Proportion of Miss Japan 2008 and Influence of SNPs on fat accumulation
Miss Astro 2008 contestants

Agras and Kirkley index of “Androgyny”

Height/(Bust – Waist) + (Hips – Waist) n = 74. Kagawa et al. Ann Inst Nutr Sci KNU, 2013

Greater the values, more tubular shape • Possibility

Age Height Body BMI Bust Waist Hip Androgynous – The G/G genotype of UCP1 gene may accumulate fat on
mass abdominal and upper body

2008 Miss 21 167.5 49.5 17.6 81.2 59.1 86.3 3.4 – The T/T genotype of angiotensinogen gene may accumulate
Japan 22 164.4 fat on the trunk
49.2 18.2 78.6 62.7 90.3 3.8
2008 Miss 14
Astro http://www.sponichi.co.jp/miss_nippon/special/08eve/31.html

13

Japanese Ideal Large proportion of “underweight” females

• A mixture of global trend and Underwt
Japanese-specific cultural Among
value females in
20’s
• The Heian Era⇒Plumpness
2000 2010
– Fair and fine skin
– Rounded face “Healthy Japan 21” period
– Thin eyes
National Nutrition Survey in Japan, 2017
• The Edo Era⇒Slenderness
16
– Fair and fine skin
– Thin surface
– Long limbs and thin waist

http://3.bp.blogspot.com/_qIYzfooSGew/SkQY-T4HD_I/AAAAAAAAENA/hiZfw3BPKpE/s320/R127-2.JPG

15

Characteristics of Japanese females Same Body parts Japanese Malaysian Chinese
results (n = 197) (n = 291)
• Increase in dissatisfaction of abdominal and Head
limbs as increase in BMI (Ishigaki et al. 2009) with Face 3.9±1.3** 2.5±1.4
Asians Jaw 4.6±1.2** 3.1±1.5
• Decide plumpness by weight and BMI (Tanaka Teeth 4.3±1.3** 3.0±1.5
** p < 0.01 Nose 4.4±1.6** 3.1±1.7
et al. 2002) Mouth 4.5±1.4** 3.2±1.6
Kagawa et al. Eyes 4.1±1.3** 2.7±1.3
• Self-report accurately but have a distorted APACPH 2018 Ears 4.2±1.6** 2.7±1.6
perception (Kagawa et al. 2007) Shoulders 3.3±1.2** 2.3±1.3
18 Neck 4.0±1.3** 2.6±1.4
Agreement 0.7 %BF vs Fatness Chest 3.7±1.3** 2.7±1.4
BMI vs Heaviness Tummy 4.8±1.3** 3.1±1.5
0.6 Japanese males Japanese females Arms 5.1±1.4** 4.1±1.8
0.5 Study groups * Kappa values： 0.21-0.40 = Fair, Hands 4.5±1.5** 3.6±1.7
0.41-0.60 = Moderate agreement Legs 4.1±1.5** 2.8±1.5
0.4 Feet 5.4±1.3** 3.9±1.8
4.5±1.4** 3.0±1.7
0.3

0.2

0.1
Australian Caucasian
males

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3

Sources of influences Factors influence body concern

** p < 0.01, * p < 0.05 between ethnic groups. Number of responses vary between ** p < 0.01, * p < 0.05 between ethnic groups. Number of responses vary between
questions. questions. Japanese females = 197, Malaysian Chinese females = 291
Japanese females = 197, Malaysian Chinese females = 291
Kagawa et al. APACPH 2018
Kagawa et al. APACPH 2018
20
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Influence of fashion Ethnic differences in social values

• Attractive outfits tend to have smRinatallal arnad nMgusetajoikni, BsMizJ. e1992 Japanese Malaysian Chinese
• Change in body size of mannequins over time (Rintala
Thin Just right Fat Thin Just right Fat
and Mustajoki, BMJ. 1992)
Important for finding 93.3 98.2** 97.5** 80.0 81.4 78.5
– Estimation of %BF from girth measurements of mannequins
used in ’20s, ’30s, ’50s, ’60s partner (% Yes)

– Mannequins after 1950s were found to have extremely Important for finding 100.0 82.5 83.2 80.0 87.2 84.7
low %BF job (% Yes)

21 Important for marriage 80.0 91.2** 89.9** 56.0 67.4 64.8
(% Yes)

Compare with media 80.0 94.7 93.3 88.0 84.9 88.1
(% Yes)

Compare with family or 80.0 93.0 96.6* 84.0 81.4 94.4

friends (% Yes)

Compare with people 80.0 91.2 96.6* 84.0 77.9 86.4

on the street (% Yes)

Compare with cartoon 26.7 12.3 20.2 20.0 20.9 24.9
or games (% Yes)

** p < 0.01, * p < 0.05 between ethnic groups of the same body perception. Number

of responses vary between questions. Kagawa et al. APACPH 2018

22

Weight loss without exercise

https://cdn2.omidoo.com/sites/default/files/imagecache/full_width/images/bydate/may_3_2012_-_235pm/shutterstock_64072843.jpg Weight loss behaviours without exercise
http://www.a2magazine.co.za/wp-content/uploads/2013/03/plastic-surgery-1.jpg ⇒Reduction of muscle and bone mass
http://nursing-resource.com/wp-content/uploads/2010/02/anorexia-nervosa.jpg ⇒Increase in %BF and decline cardiorespiratory
https://s-media-cache-ak0.pinimg.com/564x/b9/de/55/b9de553718bc48e765bf451396ec2e07.jpg http://www.dietacademy.jp/img/t01/1_4.gif fitness⇒Future health risks

23 http://blogs.glam.com/glamspirit/files/2009/12/exercise.jpg http://peakperformancefoxvalley.com/wp-content/uploads/2016/09/fadfad.png

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4

Ethnic differences in lifestyle behaviours Stop exercise to reduce weight?

Japanese Malaysian Chinese • PE individuals University students enrolled
who wish to lose in Nutrition Sciences (NS)
Thin Just Fat Thin Just Fat 4 kg or more: and Physical Education (PE)

right right 1.Tend to skip
breakfast (33.3 %
Health status 66.7* 78.9* 74.8** 29.2 59.3 39.5
(% Good) vs 50.9 %; p<0.05)

Effort to maintain or 60.0 50.9 56.3* 52.0 54.7 70.1 2.Less physically
achieve wt (% Yes) active (78.7 % vs

Aware of food 80.0** 86.0** 82.4** 32.0 51.2 57.1 94.7 %; p<0.01)
content (% Yes)
* p<0.05, ** p<0.01 NS (n) = 232, PE (n) = 189
Eat fast 26.7 22.8** 43.7 16.0 29.1 42.4 Kagawa et al. ICO Satellite meeting, 2014
(% Yes)
26
Check food label 26.7 96.5** 38.7** 20.0 80.3 23.7
(% Yes)

Exercise/week 60.0 49.1 60.5** 36.0 31.4 19.2
(% Not at all)

** p < 0.01, * p < 0.05 between ethnic groups of the same body perception. Number

of responses vary between questions. Kagawa et al. APACPH 2018

25

Physical inactivity and poor diet Sarcopenia, locomotive syndrome,
increase risk of osteoporosis frailty

https://images.squarespace-cdn.com/content/5408e9b3e4b0e5142540c5d3/1443441314428-MPO57E1JMO4R2EXXZHRA/?content- EWGS, 2014
type=image%2Fjpeg
http://img.webmd.com/dtmcms/live/webmd/consumer_assets/site_images/articles/health_tools/osteoporosis_overview_slideshow/webmd_rm_photo • Sarcopenia: Reduction of muscle mass and
_of_porous_bones.jpg strength due to aging

27 • Frailty: Increasing vulnerability to health
problems due to reduced functional ability

https://d1vzuwdl7rxiz0.cloudfront.net/content/ehj/35/26/1726/F1.large.jpg

28

About 40% of the pop’n will be 65+y in 2060 Healthy life expectancy is not long
Life expectancy for females may exceed 90
Males
ten thousands Observed Estimated

Total pop’n

Aging rate

Females

Report of the Aging Life expectancy
Society 2018 Healthy life expectancy

Difference

29 30

5

Mothers have strong influence on 20 million diabetes patients in Japan
nutritional status of their children
(10 thousands) Medical cost for diabetes
• Developmental Origins of Health and Diseases in 2018: ~1.2 trillion yen
(DOHaD)

• Influence across a generation

Likely to be Those unable to Total of those likely and
diabetes reject likelihood unable to reject likelihood

• No of death (2015): 13,327 per 100,000 (Vital statistics, 2016)
• Dialysis patients from diabetes in 2016: 123,657 (38.8% of all

patients [i.e. 319,109]) (Japan Society for Dialysis Therapy, 2017)

Skinner, Reprod Toxicol. 2008 http://www.dm-net.co.jp/calendar/2017/027369.php

31 32

Medical cost is keep rising Mother’s responsibility with
childhood obesity
• Medical cost in 2016:
42.2 trillion yen Acta Obestric Gynaecol Japon、2008

• It was 32 trillion in • Average energy consumption is declining
2004
Overview of National Medical cost 2016, Ministry of • Increasing LBW infant birth rate
Health, Labour and Welfare, 2018 ⇒Increase of 1+ trillion
yen/year 饗場、「近年における子どもたちの食生活の変化」

⇒10.76% of national
income in 2016

• About 30% of medical
cost was related to
vascular diseases
and cancer in 2012

http://www.shaho‐net.co.jp/zuiso/2009/images/12.gif

33 34

Presence of “Hidden” Hunger Increase of dieting among children

Variables Dietary Reference NNS-J 2016 ＋5.4%
Energy (kcal) Intake 2015 20’s (n = 779) ＋8.7%

- 1,631±452.9 Benesse Second children lifestyle survey, 2009

Vitamin A (μg RE) 650~700 μg RAE1 459±528 36

Folate (μg) 240 μg 229±108

Calcium (mg) 660 mg 396±202

Iron (mg) 10.5 mg2 6.5±2.6

Zinc (mg) 8 mg 7.1±2.3

Dietary fibre (g)3 18.0 g ≤ 11.9±6.1

1 The unit has changed from retinol equivalent (RE) to retinol activation equivalent (RAE) in the
Dietary Reference Intake for Japanese 2015
2 RDA for 18-29 yo was calculated from ([Age-specific basic iron loss + loss from menstrual blood
(0.55 mg)]/absorption rate (0.15))x1.2
3 Value for dietary fibre was as a tentative dietary goal for preventing lifestyle-related diseases (DG)

35

6

Dieting is more common among Positive body image
girls above 10 years old
• Know current physique and appropriate behaviours
Girls 15.5% • Survey (Knowledge)
Boys 11.1% conducted in
8.5% 1998－2008 • Understand oneself (Objectivity)
– Physique
4.3% 2.4% (n = 46, 782) – Lifestyle
• Although having
Primary Primary Primary Secondary High • Put knowledge on healthy lifestyle into an action
a BMI below the (Action)
1 & 2 3 & 4 5 & 6 school school average, a large
proportion of Confidence, Self-esteem, Satisfaction,
grades grades grades girls undergo Perceived health status
dieting
38
Shimoda & Sakae, 2012

37

Importance of media literacy Importance of balanced diet

• Editing using Adobe http://lib3.store.yahoo.co.jp/lib/kamakurayamanatto/m26.jpg http://www.insideyork.co.uk/assets/images/Restaraunts/fishandchips.jpg
photoshop http://thumbnail.image.rakuten.co.jp/@0_mall/harikai/cabinet/set/set‐b.jpg http://tabe‐aruki.up.seesaa.net/image/A4B4A4CFA4F3.jpg

• Unrealistically thin 40 http://pasadenanow.com/main/wp‐content/uploads/2009/04/nutrition.jpg
mannequins

• Regulations to fashion
models in France

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・・・and physical activity Actions for next generations

• Nutrition during a period
from conception until
about two years of age
is critical

https://www.cookinglight.com/healthy-living/fitness/winter-exercise-guide • Dietary Guidelines
https://wamu-gr.co.jp/blog/wp-content/uploads/2017/06/0611082643.jpg

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