Prevalence of general and abdominal obesity in 2015–2016 and 8-year longitudinal weight and waist circumference changes in adults and elderly: the Tromsø Study

ObjectivesTo describe the prevalence of general (body mass index (BMI) ≥30 kg/m2) and abdominal (waist circumference women >88 cm, men >102 cm) obesity in Tromsø 7 (2015–2016), and the secular change from Tromsø 6 (2007–2008). Furthermore, to study longitudinal changes in body weight and waist circumference from Tromsø 6 to Tromsø 7.SettingA population study in Tromsø, Norway.ParticipantsThe cross-sectional analyses included 20 855 participants in Tromsø 7 (aged ≥40 years) and 12 868 in Tromsø 6 (aged ≥30 years). The longitudinal analyses included 8592 participants with repeated measurements, aged 35–79 in Tromsø 6.Outcome measuresMean age-specific and sex-specific BMI, waist circumference, prevalence of general and abdominal overweight and obesity, as well as longitudinal changes in body weight and waist circumference according to sex and birth cohort.ResultsOver 8 years, the age-adjusted prevalence of general obesity increased (p<0.0001) from 20.1% to 23.0% in women and from 20.7% to 25.2% in men. The age-adjusted prevalence of abdominal obesity did not increase in women (from 54.7% to 53.4%), and the increase in men was modest (from 36.8% to 38.6%, p=0.003). Longitudinal analyses showed an increase in body weight, by 1.1 kg (95% CI 0.9 to 1.2) in women and 0.7 kg (95% CI 0.6 to 0.9) in men, and also waist circumference, by 1.3 cm (95% CI 1.0 to 1.5) in women and 1.4 cm (95% CI 1.2 to 1.6) in men. There were inverse relationships (p<0.001) between age at baseline and change in weight and waist circumference.ConclusionsRepeated cross-sectional analyses showed that the prevalence of general obesity increased, whereas the increase in abdominal obesity was less marked. Longitudinal analyses showed increases in both body weight and waist circumference. The youngest age groups have the largest increase.

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Association between dietary diversity with overweight and obesity: A cross-sectional study conducted among pastoralists in Monduli District in Tanzania

PLoS ONE ◽

10.1371/journal.pone.0244813 ◽

2021 ◽

Vol 16 (1) ◽

pp. e0244813

Author(s):

Ahmed Gharib Khamis ◽

Julius Edward Ntwenya ◽

Mbazi Senkoro ◽

Sayoki Godfrey Mfinanga ◽

Katharina Kreppel ◽

...

Keyword(s):

Abdominal Obesity ◽

Dietary Diversity ◽

Cross Sectional Study ◽

Careful Consideration ◽

Overweight And Obesity ◽

Sectional Study ◽

General Obesity ◽

Cross Sectional ◽

Monduli District ◽

Arusha Region

Background The prevalence of overweight and obesity is rising at a rapid pace and is associated with negative health consequences like cardiovascular diseases, type 2 diabetes and cancer. Obesity is a multifactorial problem that develops mainly from lifestyle factors including physical inactivity and poor dietary intake. Dietary diversity is a simplified method for assessing the adequacy and quality of diet and is associated with nutritional need and overall health status. Therefore, we conducted this study to synthesize the associations between consumption of a diversified diet and overweight/ obesity among adults living in pastoral communities in Monduli district in Tanzania. Methods This was a cross-sectional study conducted among 510 adults aged ≥ 18 years old in the Monduli district, Arusha region in Tanzania. We conducted face-to-face interviews to collect information about socio-demographic characteristics, 24-hours dietary recall, and anthropometric measurements. The dietary diversity score (DDS) was constructed and used to determine the diversity of the diet consumed. We performed the multivariate Poisson regressions to determine the prevalence ratio (PR) with 95% confidence intervals (CI). The dependent variables were overweight and general obesity as measured by body mass index (BMI), abdominal obesity measured by waist-hip ratio (WHR) and waist circumference (WC). Results The prevalence of general obesity based on BMI was 20.2% (95%CI; 16.9–23.9), abdominal obesity based on WHR was 37.8% (95%CI; 33.7–42.1), and WC was 29.1% (95%CI; 25.2–33.1). More than half (54.3%) of the participants consumed an adequate dietary diversity (DDS ≥4). After adjustment for potential confounders, the prevalence of abdominal obesity by WHR decreased with higher DDS among male (APR = 0.42; 95% CI, 0.22–0.77) and female participants (APR = 0.63; 95% CI, 0.41–0.94). There were inconsistent positive associations between DDS and prevalence of overweight and general obesity among male and female. There was no association between DDS and abdominal obesity by WC. Conclusion More than half of the pastoralists have consumed an adequate diversified diet. Given the inconsistent findings on associations between dietary diversity and obesity measures, this study suggests that targeting dietary diversity as an overweight/obesity prevention strategy requires careful consideration.

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Are 24 h urinary sodium excretion and sodium:potassium independently associated with obesity in Chinese adults?

Public Health Nutrition ◽

10.1017/s136898001500230x ◽

2015 ◽

Vol 19 (6) ◽

pp. 1074-1080 ◽

Cited By ~ 8

Author(s):

Zeng Ge ◽

Jiyu Zhang ◽

Xiaorong Chen ◽

Liuxia Yan ◽

Xiaolei Guo ◽

...

Keyword(s):

Waist Circumference ◽

Abdominal Obesity ◽

Linear Trend ◽

Sampling Strategy ◽

Urinary Sodium Excretion ◽

Overweight And Obesity ◽

Chinese Adults ◽

Height Ratio ◽

Cross Sectional ◽

Waist To Height Ratio

AbstractObjectiveTo examine the association of 24 h urinary Na excretion and Na:K with obesity in Chinese adults.DesignPopulation-based cross-sectional study using a four-stage stratified sampling strategy.SettingShandong Province, China.SubjectsChinese adults (n 1906) aged 18–69 years who provided complete 24 h urine samples.ResultsOdds of obesity increased significantly across increasing quartiles of urinary Na excretion (1·00, 1·54, 1·69 and 2·52, respectively, for overweight; 1·00, 1·20, 1·50, and 2·03, respectively, for obesity; 1·00, 1·44, 1·85 and 2·53, respectively, for abdominal obesity (assessed by waist circumference); and 1·00, 1·28, 1·44 and 1·75, respectively, for abdominal obesity (assessed by waist-to-height ratio); P for linear trend <0·001 for all). In addition, odds of abdominal obesity, but not odds of overweight and obesity, increased significantly with successive Na:K quartiles. Additionally, for each increment in urinary Na excretion of 100 mmol, odds of overweight, obesity, abdominal obesity (by waist circumference) and abdominal obesity (by waist-to-height ratio) increased significantly by 46 %, 39 %, 55 % and 33 %, respectively. Similarly, with a 1 sd increase in Na:K, odds of abdominal obesity (by waist circumference) and abdominal obesity (by waist-to-height ratio) increased significantly by 12 % and 15 %, respectively.ConclusionsThese findings suggest that 24 h urinary Na excretion and Na:K might be important risk factors for obesity in Chinese adults.

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Dietary intake of branched-chain amino acids in relation to general and abdominal obesity

10.21203/rs.3.rs-327173/v1 ◽

2021 ◽

Author(s):

Farzaneh Asoudeh ◽

Asma Salari-Moghaddam ◽

Ammar Hassanzadeh Keshteli ◽

Ahmad Esmaillzadeh ◽

Peyman Adibi

Keyword(s):

Amino Acids ◽

Waist Circumference ◽

Dietary Intake ◽

Abdominal Obesity ◽

Cross Sectional Study ◽

Sectional Study ◽

General Obesity ◽

Level Of Evidence ◽

Cross Sectional ◽

Validated Questionnaire

Abstract Purpose: Despite the huge evidence on the link between dietary protein intake and obesity, limited studies have examined the role of individual amino acids in this regard. This study aimed to investigate the association between dietary total and individual BCAAs intake and odds of general and abdominal obesity in a large group of adults.Methods: This cross-sectional study was conducted among 8691 adults aged 18-55 years in Isfahan, Iran. Dietary BCAAs were assessed using a validated dish-based 106-item semi-quantitative food frequency questionnaire (DS-FFQ). Information about weight and waist circumference were collected through a self-reported validated questionnaire. General obesity was defined as body mass index (BMI) ≥30 kg/m2, and abdominal obesity was defined as waist circumference (WC) ≥88 cm for women and ≥102 cm for men.Results: Mean age of study participants was 36.8±8.1 years. Prevalence of general obesity was 9.2% in men and 9.7% in women and that of abdominal obesity was 13.3% and 36.2% in men and women, respectively. We found that participants in the top tertile of total BCAAs intake had higher odds of general obesity compared with those in the bottom tertile (OR: 1.42; 95% CI: 1.09-1.84). Such significant association was seen in men (OR: 1.57; 95% CI: 1.05-2.34), but not in women (OR: 1.33; 95% CI: 0.94-1.89) in our stratified analysis. We found no significant association between total BCAAs intake and odds of abdominal obesity. Stratified by sex, no significant association was observed between total BCAAs intake and odds of abdominal obesity [for men: (OR: 1.10; 95% CI: 0.74-1.65) and for women: (OR: 1.08; 95% CI: 0.84-1.38)]. Assessing the association with individual BCAAs, a significant positive association was observed between dietary intake of valine (OR: 1.42; 95% CI: 1.10-1.84), leucine (OR: 1.43; 95% CI: 1.10-1.86), and isoleucine (OR: 1.42; 95% CI: 1.09-1.84) with general obesity. We observed no significant association between dietary intake of individual BCAAs intake and odds of abdominal obesity.Conclusion: Dietary BCAAs intake was associated with an increased odds of general obesity, in particular among men. No significant association was observed between dietary BCAAs and abdominal obesity.Level of evidence: Level V, descriptive cross-sectional study.

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Association Between Body Mass Index, Waist Circumference and Gerd-Q Scores: A Cross-Sectional Study

Natural Sciences Engineering and Technology Journal ◽

10.37275/nasetjournal.v2i1.14 ◽

2021 ◽

Vol 2 (1) ◽

pp. 74-79

Author(s):

Aurel Feodora Tantoro ◽

Alwi Shahab ◽

Syarif Husin ◽

Ratna Maila Dewi Anggraini ◽

Liniyanti D. Oswari

Keyword(s):

Waist Circumference ◽

Abdominal Obesity ◽

Significant Relationship ◽

Adult Population ◽

Cross Sectional Study ◽

Overweight And Obesity ◽

Cross Sectional ◽

Cross Sectional Design ◽

The Relationship ◽

Gerd Symptoms

The prevalence of GERD has continued to increase in Asian countries in recent decades. The incidence of overweight and obesity continues to increase. Many studies have revealed that obesity in general or abdominal obesity causes a significant increase in the risk of GERD symptoms. The research objective was to determine the relationship between BMI and waist circumference with the incidence of GERD in the adult population of Palembang city.An analytic observational with a cross-sectional design. The population were all adults(≥20 years) of Palembang. The number of samples were 400 people. Data were taken from a self-completed questionnaire, distributed through various social media, then analyzed using logistic regression analysis.Among 400 subjects in the study, there were 81 subjects (20.3%) diagnosed with GERD, 43 subjects (10.8%) were overweight, 79 subjects (19.8%) were obese, and 160 subjects(40%) have had abdominal obesity. There was a significant relationship between obesity and diagnosis of GERD (p=0,001; OR =2,799; CI95% = 1,545-5,069). In contrast, there were no significant relationship between overweight and diagnosis of GERD. There were also no significant relationship between abdominal obesity and diagnosis of GERD. Obesity has a significant association with the diagnosis of GERD, but the absence of an association between overweight and diagnosis of GERD implies that increased BMI is not an independent risk factor in diagnosis of GERD.

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The Prevalence of Abdominal Obesity and Its Correlates among the Adults in Dodoma Region, Tanzania: A Community-Based Cross-Sectional Study

Advances in Medicine ◽

10.1155/2018/6123156 ◽

2018 ◽

Vol 2018 ◽

pp. 1-8 ◽

Cited By ~ 7

Author(s):

Mariam John Munyogwa ◽

Abdalla Hussein Mtumwa

Keyword(s):

Waist Circumference ◽

Abdominal Obesity ◽

Simple Random Sampling ◽

Cross Sectional Study ◽

Overweight And Obesity ◽

Noncommunicable Diseases ◽

Cross Sectional Survey ◽

Community Based ◽

Cross Sectional ◽

Logistic Regression Models

Introduction. Overweight and obesity are a threat to the public health following their association with noncommunicable diseases, such as type 2 diabetes mellitus, cardiovascular disease, and some cancers. Despite this fact, the information on overweight and obesity, particularly in most developing countries, is still scarce to address the problem. This article partly addresses the gap through the findings of a cross-sectional survey that was conducted in Dodoma Region, Central Tanzania, to determine the prevalence and correlates of abdominal obesity among adults. Methods. Using a community-based cross-sectional survey, data were generated from the participants who aged 18 years and above. Simple random sampling and Kish selection table techniques were used to get the sample who responded through a face-to-face-administered questionnaire. Waist circumference was measured using the guideline of the WHO protocol of measuring waist and hip circumference. Abdominal obesity is defined as a condition with waist circumference >102 cm for men and >88 cm for women. Prevalence was computed with a 95% confidence interval. Simple and multiple logistic regression models were fitted to identify the risk factors associated with abdominal obesity. Results. A total of 840 respondents took part in the study. The overall prevalence of abdominal obesity was found to be 24.88% (209/840). The prevalence of abdominal obesity was significantly higher among women than men (35.14% vs. 6.89%, p<0.0001) and higher among urban dwellers (33.56%) than their rural counterparts (15.56%). Correlates of abdominal obesity was found to be gender, marital status, place of residence, age, education level, and the time used in watching television. Conclusion. This study revealed a high prevalence of abdominal obesity among the people living in the Dodoma Region. Increased age, urban residence, more time spent on television, less walking per day, and being ever married were all associated with having abdominal obesity in this population.

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Evaluation of waist circumference to predict general obesity and arterial hypertension in women in Greater Metropolitan Belo Horizonte, Brazil

Cadernos de Saúde Pública ◽

10.1590/s0102-311x2002000300020 ◽

2002 ◽

Vol 18 (3) ◽

pp. 765-771 ◽

Cited By ~ 19

Author(s):

Gustavo Velásquez-Meléndez ◽

Gilberto Kac ◽

Joaquim Gonçalves Valente ◽

Roberta Tavares ◽

Cibele Queiroz da Silva ◽

...

Keyword(s):

Blood Pressure ◽

Multivariate Analysis ◽

Waist Circumference ◽

Abdominal Obesity ◽

Overweight And Obesity ◽

General Obesity ◽

Moderate Power ◽

Belo Horizonte ◽

Risk Predictor ◽

Good Risk

This study examined the capacity of waist circumference (WC) to identify subjects with overweight (BMI ³ 25) and obesity (BMI ³ 30), in agreement with internationally recommended levels of action. Data were obtained from 791 women, 15-59 years old. After identifying overweight and obesity according to WC values, sensitivity and specificity were calculated to verify whether WC could be a good risk predictor for hypertension. Associations were tested by linear regression and logistic regression, controlling for confounding. WC cut-off points of 80cm and 88cm correctly identified 89.8% and 88.5% of women with overweight and obesity, respectively. Abdominal obesity (WC ³ 88cm) was statistically associated with hypertension in the multivariate analysis (OR = 2.88; 95% CI: 1.77-4.67). Hypertension was identified with a sensitivity of 63.8% and 42.8%, and with a specificity of 68.0% and 83.3%, for WC ³ 80 and ³ 88, respectively. The proposed cut-off points for abdominal obesity can potentially distinguish individuals at risk for future obesity, but has only moderate power to predict individuals with high blood pressure.

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Anthropometry and Twin Epidemic of Malnutrition among Urban Population of Varanasi

The Indian Journal of Nutrition and Dietetics ◽

10.21048/ijnd.2017.54.4.15842 ◽

2017 ◽

Vol 54 (4) ◽

pp. 435

Author(s):

Shikha Singh ◽

Ravi Shankar

Keyword(s):

Waist Circumference ◽

Abdominal Obesity ◽

Urban Population ◽

Cross Sectional Study ◽

Overweight And Obesity ◽

Asia Pacific ◽

Related Factors ◽

Cross Sectional ◽

Energy Deficiency ◽

Male Subjects

As life expectancies increase the major causes of death shift to the chronic and non communicable diseases, Indian population is increasingly facing modern risks due to overweight and obesity and other diet-related factors. As a result, people are facing a growing burden from the modern risks to health, while still fighting an unfinished battle with the traditional risks that results in dual burden of risks and diseases. This study aims at estimating the prevalence of under nutrition and over nutrition based on anthropometric indices. A community based cross-sectional study with multi-stage sampling design was conducted among urban population of Varanasi aged 25-64 years living in the selected area. A pre designed and pre tested proforma was used to collect the basic characteristics of 640 study subjects. Anthropometric measurements (height, weight, waist circumference and hip circumference) were recorded by following standard procedures. WHO International and Asia pacific guidelines for BMI were used to define Chronic Energy Deficiency (CED), overweight and obesity. Waist circumference and WHR for identifying abdominal obesity were defined by Indian guidelines. Mean height and weight of male subjects (n=301) were 167.5 ± 7.5 cm and 66.8 ± 12.5 kg, respectively and height and weight of female subjects (n=339) were 153.5 ± 6.01 cm and 57.6 ± 10.2 kg, respectively. Mean BMI was higher among female (24.4 ± 3.92 kg/m2) than male subjects (23.8 ± 3.95 kg/m2). The prevalence of CED, overweight and obesity were 8.6, 22.8 and 38.3% respectively by Asian classification and 8.6, 29.1 and 9.3% respectively by Global classification. The prevalence of thinness was higher among males, whereas prevalence of overweight and obesity was higher among females. Prevalence of abdominal obesity was higher among females as compared to their male counterparts.

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Alarming Rates of Obesity and Diabetes in Urban Africa: A Case Study in Bamako, Mali

Current Developments in Nutrition ◽

10.1093/cdn/nzaa043_066 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 215-215

Author(s):

Yves Kameli ◽

Joseph Meunier ◽

Stephane BESANCON ◽

Mathilde Savy ◽

Yves Martin-Prevel

Keyword(s):

At Risk ◽

Waist Circumference ◽

Abdominal Obesity ◽

Task Force ◽

Overweight And Obesity ◽

Age Group ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Cut Points ◽

Obesity And Diabetes

Abstract Objectives Sahelian cities are growing very fast with changes in lifestyles and rise in obesity and associated chronic diseases. Reliable data on the nutritional situation in African cities is dreadfully missing. The aim of this study was to estimate overweight and obesity rates and the risk of pre-diabetes and diabetes in Bamako in order to trigger appropriate prevention measures. Methods From November 2019 to January 2020, a cross-sectional survey was conducted among a representative sample of 2040 households in Bamako, Mali. In each household, a random selection of individuals was stratified on age groups: 12–17 y, 18–29 y, 30–49 y, ≥50 y. Anthropometric measurements (weight, height, waist circumference) and plasma fasting glycemia (PFG) using Hemocue® devices were performed according to international procedures. The prevalence of overweight and obesity were defined by Body Mass Index (BMI) values using WHO cut-points for adults (25 kg/m2 ≤ BMI < 30 kg/m2 and BMI ≥ 30 kg/m2, respectively) and International Obesity Task Force cut-points for adolescents (IOTF-25 and IOTF-30, respectively). Abdominal obesity was defined by a waist circumference ≥88 cm for women and ≥102 cm for men. Risks of pre-diabetes and diabetes were defined by a PFG between 100 and 125 mg/dl and ≥126 mg/dl, respectively. Results All ages combined, the prevalence of overweight was 19.5% among men (n = 1933) and 24.4% among women (n = 2724) (P < 0.0001). The prevalence of obesity was 6.2% among men and 21.0% among women (P < 0.0001). We also found that 29.9% of women presented abdominal obesity vs 5.7% in men (P < 0.0001). Women older than 30 y (n = 1395) were the most affected, however women aged 12–17 y (n = 670) and 18–29 y (n = 881) presented alarming figures too (11.5% and 21.2% of them were overweight, respectively). Globally, 13.3% of individuals were at risk of pre-diabetes and 2.5% at risk of diabetes, with no significant gender differences. The risk of pre-diabetes ranged from 10.2% in the 12–17 y age-group to 17.8% in the ≥50 y age-group. Conclusions Our data calls for urgent actions to tackle the burden of overweight and obesity, especially among women, and to minimize the risk of diabetes and other associated non-communicable diseases in Bamako. Funding Sources French Embassy of Mali, French Institute of Research for sustainable Development (IRD).

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Media use and excess body weight among women in Nigeria: a cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2017-020802 ◽

2018 ◽

Vol 8 (7) ◽

pp. e020802 ◽

Cited By ~ 2

Author(s):

Bishwajit Ghose ◽

Sanni Yaya

Keyword(s):

Body Weight ◽

Weight Status ◽

Media Use ◽

Multivariable Analysis ◽

Overweight And Obesity ◽

Outcome Variable ◽

Excess Body Weight ◽

Demographic And Health Surveys ◽

Adult Women ◽

Cross Sectional

ObjectivesTo investigate the (1) time trends in body mass index (BMI) and (2) relationship between media use and body weight status among adult women in Nigeria. We hypothesise that higher frequency of media use is associated with higher likelihood of being overweight and obesity among adult women.Study designCross-sectional.SettingUrban and rural settings in Nigeria.ParticipantsAdult non-pregnant women aged between 15 and 49 years.MethodsData were derived from Nigeria Demographic and Health Surveys conducted in 2003, 2008 and 2013. The outcome variable was excess body weight (overweight and obesity), and main explanatory variables were frequency of reading newspaper, listening to radio and television (TV) viewing. Datasets were merged to perform pooled analysis, and were analysed using bivariate and multivariable regression techniques.ResultsOf the 69 401 participants, 16.2% had a BMI of 25.0–29.9 kg/m2(95% CI 15.8 to 16.6) and 6.6% had >30 kg/m2(95% CI 6.3 to 6.9). Between 2003 and 2013, the prevalence of overweight women increased by 4.1%, and that of obesity by 2.2%. Overall, radio was the most popular media followed by TV and newspaper. Respectively, 15.6% and 11.7% of the women reported using radio and TV almost every day and 30.6% and 25.1% at least once a week. In multivariable analysis, watching TV almost every day and at least once a week were associated with, respectively, 1.6 and 1.2 times higher odds of being overweight, and 2.7 and 1.5 times higher odds of being obese compared with those who never used radio. Similarly, significant associations were observed for newspaper and radio use as well.ConclusionThe prevalence of overweight and obesity is noticeably high among Nigerian women and has been increasing steadily over the past decade. A statistically significant association exists between BMI and the use of newspaper, radio and TV. Further studies are required to develop a better understanding of the mechanisms that underlie this relationship.

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Excessive body weight and its relationship to body image in teenagers aged 16–18 years old in South Jakarta

World Nutrition Journal ◽

10.25220/wnj.v04.s3.0033 ◽

2020 ◽

Vol 4 (1-3) ◽

pp. 45

Author(s):

Dania Mirza Ramadhanty ◽

Bernie Endyarni Medise

Keyword(s):

Body Image ◽

Body Weight ◽

Weight Status ◽

Overweight And Obesity ◽

Excess Body Weight ◽

Chi Square ◽

Cross Sectional ◽

Study Results ◽

Excessive Body Weight ◽

Chi Square Analysis

Objective. Overweight is one of the health problems that often occur in children and adolescents throughout the world, both in developed and developing countries. Study results in USA showed yearly increase of overweight prevalence in children aged 2–19 years old. In addition, based on the results by the National Health and Nutrition Examination Survey 2009–2010 in United States, the highest percentage of overweight and obesity by age group was found at 12–19 years old (33.6%). Basic Health Research/Riskesdas’s data in 2013 showed the prevalence of overweight in adolescents aged 16–18 years old in Indonesia reached the highest value of 11.5%. Moreover, most teenagers see their body images as a match between self’s and others’ ideal perception. Teenagers with positive body image tend to be more confident and also easier to get along with other people, especially their peers. In this study, researcher aimed to investigate the relationship between teenagers who have excess body weight with body image, whether it had positive or negative impact.Methods: This was a cross-sectional study. Data collection was done from December 2017 to January 2018. Data collected were anthropometric measurements (weight and height) and the King College London Body Image Questionnaire's filled by participants. From 400 subjects who filled the questionnaires, a total of 350 participants matched the inclusion criteria and were analyzed. Chi square test was done as data analysis.Results: Chi-square analysis for excess body weight status in relation to body image scores showed no relationship (p=1,000).Conclusions: There was no significant relationship between excessive body weight and body image.

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