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HEALTH BEHAVIOUR IN SCHOOL-AGED CHILDREN: WHO COLLABORATIVE CROSS-NATIONAL STUDY (HBSC) 2014 SURVEY IN SCOTLAND NATIONAL REPORT BODY IMAGE AND BODY MASS INDEX INTRODUCTION Adolescence is a time of significant and rapid physical development, and an individual’s weight and body shape can change quite dramatically. It is also a time of heightened scrutiny and evaluation of these physical attributes – both by the individual themselves and by others 1 . The HBSC survey asks about both height and weight (from which age appropriate Body Mass Index (BMI) is derived as an indicator of fatness), and perceptions of body size and appearance. Perceived and actual body weights are associated: those with a higher BMI are more likely to report dissatisfaction with their body image 2 . Body weight dissatisfaction is more common in girls than boys with many normal-weight girls perceiving themselves to be overweight 3 , and is more common in older than younger adolescents 4,5 . Body image plays a strong role in young people’s mental well-being including their self-esteem. 6,7 Negative body image has also been linked to eating disturbances, depression, mood disorders and self-harming, as well as affecting general eating behaviour and physical activity 8,9 . In Scotland, the percentage of children with a BMI outside the healthy range has remained at around 30% since the turn of the century. It is consistently, but only slightly, lower for girls than boys and not strongly different among age groups 10 . A number of health policies, including Overweight and Obesity in Scotland: A Route Map Towards Healthy Weight (2010), are focussed on reducing childhood obesity 11 . Current Scottish Government initiatives include the Child Healthy Weight Intervention Programme (including HEAT targets set in conjunction with NHS Boards and schools 12 ), The Healthier Scotland Cooking Bus and Good Places, Better Health (2011) 13 . Because of the link between healthy body weight and positive body image, policy measures generally address both. HBSC FINDINGS The HBSC survey asks young people questions relating to perceived body size and looks, both of which have been collected since 1990. Data on self-reported good looks were collected from 13- and 15-year olds only, in 2014. Body mass index (BMI) is calculated based on self-reported height and weight (kg/m2). BODY SIZE Twenty-five percent (25%) of boys and 41% of girls report that they are ‘too fat’. There are large differences between 11 and 13-year olds, particularly among girls, with higher proportions of older adolescents describing themselves as too fat (Figure 9.1). At all ages, girls are more likely than boys to report that they are too fat. The prevalence of overweight perceptions among girls in 2014 (41%) is equivalent to that in 1990 (42%), following a peak in 1998 (48%). Boys have gradually become more likely to report that their body is overweight since 1990 (from 20% in 1990 to 25% in 2014) (Figure 9.2). REPORTING GOOD LOOKS Boys are approximately three times more likely than girls to report that they are ‘quite’ or ‘very’ good looking (32% and 33% of 13- and 15- year old boys, respectively, compared with 13% and 10% of girls at these ages; Figure 9.3). There is little difference between 13- and 15-year olds for either boys or girls. Across all seven surveys between 1990 and 2014, boys reported their looks more favourably than girls (Figure 9.4). Since 2006, the proportion of boys reporting good looks has remained consistent; however girls have become increasingly less likely to report good looks over this period. As such, the gender gap in perceived looks is now at its widest in the past 24 years. 54
HEALTH BEHAVIOUR IN SCHOOL-AGED CHILDREN: WHO COLLABORATIVE CROSS-NATIONAL STUDY (HBSC) 2014 SURVEY IN SCOTLAND NATIONAL REPORT Figure 9.1: REPORT BODY IS TOO FAT % who think their body is too fat 60% 50% 40% 30% 20% 10% 0% Figure 9.2: REPORT BODY IS TOO FAT 1990 – 2014 % who think their body is too fat 60% 40% 20% 0% Figure 9.3: REPORT GOOD LOOKS 40% 42 19 24 27 11 † 13 † 15 † Age (Years) 45 48 44 23 25 23 25 26 25 20 1990 † 1994 † 1998 † 2002 † 2006 † 2010 † 2014 † 45 40 40 28 Boys Boys Boys 55 HBSC Scotland 2014 Survey Girls HBSC Scotland 1990 – 2014 Surveys 41 Girls HBSC Scotland 2014 Survey Girls † Significant gender difference (p
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