OBJECTIVETo analyze the influence factors of body image dissatisfaction among children and adolescents with normal weight.

METHODSThe primary and middle school students who were selected from Changping district of Bejing city using the stratified cluster sampling method were measured body height, weight, and waist circumference. Body image cognitive attitude of students or their parents was surveyed using 'Ma figural shape'. The cognitive attitude of obesity risk factors was surveyed by self-designed questionnaires. The students with normal weight were selected according to 'reference norm for screening overweight and obesity in Chinese children and adolescents (WGOC) in 2005' and 'reference norm for screening underweight in Chinese children and adolescents aged 6-19 years'. The association between body image dissatisfaction and cognitive attitude of obesity risk factors was analyzed for each gender.

RESULTSThe study validly surveyed and measured 680 students, and there were 36.6% (249/680) students with overweight or obesity, 4.0% (27/680) students with underweight, and 59.4% (404/680) students with normal weight. Prevalence of body image satisfaction, expecting to be thinner, and to be fatter in students with normal weight was 32.7% (132/404), 35.1% (142/404), and 32.2% (130/404), respectively. The prevalence of expecting to be thinner in females and middle students was higher than that in males and primary students (46.4% (102/220) vs 21.8% (40/184)), (39.8% (88/221) vs 29.5% (54/183)), respectively; χ² values were 26.65 and 4.67 respectively (P < 0.05). The prevalence of expecting to be fatter in males was higher than that in females ((42.9% (79/184) vs 23.2% (51/220)) (χ² = 17.91, P < 0.001). The concordance ratio on body image cognitive attitude between students and their parent was 60.4% (244/404), and the consistency coefficient was 0.41 (P < 0.001). The factors including parents expecting their children to be thinner, the negative attitude on less drinking sugary beverages and having breakfast per day might increase the risks of children expecting to be thinner in males, the OR (95% CI) value were 5.20 (1.51-17.89), 3.43 (1.11-10.59), and 6.53(1.14-37.58), respectively. The parents expecting their children to be fatter might increase the risk of children expecting to be fatter in males, the OR (95% CI) value were 7.57 (3.47-16.52). The factors including parents expecting their children to be thinner, and the positive attitude on less eating high calorie snacks might increase the risk of children expecting to be thinner in females, the OR (95% CI) value were 65.74 (8.45-511.21) and 3.03 (1.01-9.09), respectively. The parents expecting their children to be thinner or fatter might increase the risk of children expecting to be fatter in females, the OR (95% CI) value were 17.38 (1.53-197.74) and 9.64 (3.98-23.35), respectively.

CONCLUSIONThe prevalence of body image dissatisfaction among students with normal weight was high, and the concordance ratio on body image cognitive attitude between themselves and their parents was low. Guiding students to have the correct cognitive attitude on less drinking sugary beverages, having breakfast per day, and less eating high calorie snacks may be conducive to prevent body image dissatisfaction.