Environ Health Prev Med (2016) 21:430–438 DOI 10.1007/s12199-016-0543-1
REGULAR ARTICLE
Association between mass media and body weight concern among Jordanian adolescents’ residents of Amman: the role of gender and obesity Reema F. Tayyem1 • Hiba A. Bawadi2 • Suhad S. AbuMweis3 • Sabika Allehdan1 Lana Agraib1 • Hadeel A. Ghazzawi1 • Mariam A. Al-Mannai4 • AbdulRahman O. Musaiger5
•
Received: 5 April 2016 / Accepted: 1 June 2016 / Published online: 16 June 2016 Ó The Japanese Society for Hygiene 2016
Abstract Objectives Body image in the mass media promotes an unrealistic picture of body shape that leads to body dissatisfaction among adolescentsQuery. Therefore, the study presented in this paper aimed to assess the association between mass media and adolescents’ weight concerns and perceptions of body weight and shape. Methods A cross-sectional survey was conducted on school adolescents aged between 15 and 18 years during the academic year 2013–2014. Multistage stratified sampling method was used. The number of participants in the study was 795 students: 400 boys and 395 girls. & Reema F. Tayyem [email protected] Hiba A. Bawadi [email protected] Suhad S. AbuMweis [email protected] Sabika Allehdan [email protected] Mariam A. Al-Mannai [email protected] AbdulRahman O. Musaiger [email protected] 1
Department of Nutrition and Food Technology, Faculty of Agriculture, The University of Jordan, Amman 11942, Jordan
2
Human Nutrition Department, College of Health Sciences, Qatar University, P.O. Box 2713, Doha, Qatar
3
Department of Clinical Nutrition and Dietetics, Faculty of Allied Health, Science, Hashemite University, P.O. Box 150459, Zarqa 13115, Jordan
4
College of Science, University of Bahrain, Manama, Bahrain
5
Arab Center for Nutrition, Manama, Bahrain
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Results All participants have a common behavior in rarely reading magazines, but they spend more than 2 h in watching television or less than 3 h using the internet. However, most of obese/non-obese adolescents, boys or girls, have shown high influence (p \ 0.05) of reading magazines on the subject of dieting to lose weight. Conclusion While obese students read more magazines on dieting to lose weight, other mass media did not show the same results on weight concerns and body shape among Jordanian adolescents. Keywords Mass media Body weight concern Adolescents Jordan
Introduction Adolescence is a critical developmental period that occurs between the ages 10 and 19. It is characterized by physical, psychological, and social changes [1]. Additionally, the body undergoes many physical alterations in this age period as result of maturation process and growth acceleration in boys and girls. This is manifested in the increase of lean mass in boys and fat mass in girls [2, 3]. These morphological changes may directly affect the individual’s mental image, which may elicit concerns on body weight among boy and girl adolescents [4]. For instance, [5] revealed that 21.2 % of Jordanian girl adolescents aged between 10 and 16 experience body image dissatisfaction due to physical changes of puberty and this dissatisfaction led them to practicing negative eating behaviors [5]. Body image can be defined as a person’s perception, feelings and thoughts towards his or her body shape and size that are derived from biological, psychological, and social factors [6, 7]. Furthermore, there are other factors
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that can be associated with the construction of positive or negative body images among adolescents such as family environment [8, 9], peer pressure [9–11], socio-cultural and economic context [8, 12], media mass [9, 13], gender [14, 15], and age [15, 16]. Therefore, body dissatisfaction is part of the attitude related to body image and includes disregard for one’s own weight and appearance [10, 17]. Nowadays, adolescents grow up in a world submerged with the mass media (television, movies, magazines, music, advertising, fashion designers and the internet) [18]. They may spend a third to a half of their time indulging in some form of these mass media [19]. The media plays a significant role in contributing towards body shape, weight dissatisfaction and eating disorders in both boys and girl teenagers [20–22]. Several studies have indicated that both boy and girl adolescents frequently report body dissatisfaction; the girl adolescents have a higher concern for their body weight and a passion for thinness in comparison to their boy peers [4, 20, 23]. In general, adolescent girls are more influenced by television adverts and fashion magazines that represent slim, young and beautiful models and most of those young adolescents try to keep their body thin and/or exercise and diet to lose weight [20, 24, 25]. On the other hand, adolescent boys perceive more pressures from the media on muscularity [9, 26]. Even though, adolescent boys are more likely to become concerned with weight and diet in an attempt to appear like boy individuals celebrities in the media [20]. The pressure and concern stemming from the mass media for body weight of adolescents may lead them to practice unhealthy weight control diets and, consequently, eating disorders [27]. In Jordan, the pressure from mass media on the body weight concern of young girls has been studied [28, 29]. However, these studies have focused on adults. We are not aware of similar studies among both boy and girl adolescents in the Arab world in general and specifically in Jordan. Therefore, this study aimed to investigate the influence of mass media on adolescents’ weight concerns and perceptions of body weight and shape in Jordan.
Methods Design and participants This study is part of the ARABEAT-2 project, which aimed at evaluating the association between mass media and adolescents’ weight concerns and perceptions of body weight and shape in the Arab world including Amman, the capital of Jordan. A multistage stratified random sampling method was used to select the students. A sample of 795 (out of 818) adolescents (400 boys and 395 girls) was
431
obtained. The sample was obtained from students enrolled in both public and private schools in Amman. The response rate was about 97 %. First, schools were randomly selected and stratified according to gender, type of school (private and public), and location (West and East of the city of Amman). Four schools were selected from each location. Then, one classroom from each grade (10th, 11th, and 12th) was randomly chosen in each selected school. Hence, a total of 16 classrooms were surveyed. Sample size was calculated with a 5 % margin of error and with 95 % confidence of interval. In Amman, the total number of boy and girl students in the public and private secondary schools during the years 2013/2014 was about 80,000. The survey was conducted over 3 months from April to June 2013. Amman city was divided into four geographical areas, and then the secondary schools were selected proportionally to the student population in each area. Ethical permission The Ministry of Education and the selected schools in Jordan approved the study protocol. Consent forms were obtained from the students before starting data collection. The questionnaire A pre-tested questionnaire was used to measure the frequency of using mass media and the association of mass media with body weight concern [13, 30]. However, the reliability of the questionnaire was applied on a group of students before applying the questionnaire and tested again using the Cronbach’s alpha Coefficient. The questionnaire was applied twice on the same 30 students of the same age, before and after 1 week. The value of Cronbach’s alpha coefficient was calculated to be 0.721 and 0.733 for pre and after testing, respectively. This indicates an acceptable reliability of the questionnaire, and this reliability is very close to that in the previously tested questionnaire [30]. The questionnaire consisted of three sections: (1) frequency of using the media (magazines, TV and internet). (2) influence of media on dieting to lose weight and (3) influence of media on ideas of a perfect body shape. For the first section, the question was ‘‘how often you read magazines per week/watching TV per day/using Internet per day?’’. The second section aimed to measure the associations between media and dieting: ‘Does reading magazines/watching TV/using internet influence you to dieting to lose weight?’ (High influence/moderate influence/no influences). The third section measured the influence of media on idea of a perfect body shape: ‘Does reading magazines/watching TV/using internet influence what you consider the perfect body shape?’ (High influence/moderate influence/no influences) [13].
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432
Environ Health Prev Med (2016) 21:430–438
Anthropometric measurements
reading magazines on having diet to lose weight on obese adolescent, either boys or girls, was a high or moderate influence. Furthermore, the Internet had a high significant influence to having diet to lose weight in obese boys compared to non-obese boys (71.3 and 56.7 % for obese and non-obese, respectively; p = 0.023). The influence of mass media on idea of a perfect body shape among Jordanian adolescents based on either gender or weight status did not show any significant difference as shown in Tables 4 and 5. The results of Table 6 showed that as the influence of reading magazines on having diet to lose weight increased, the risk for obesity was found to be duplicated (OR 2.01; CI 1.23–3.29, P-Trend = 0.046) and specifically among girls (OR 2.55; CI 1.25–5.21, P-Trend = 0.017). The risk of mass media on having idea of a perfect body shape did not show any significant risk for being obese among obese or non-obese students as shown in Table 7.
Weight and height were measured by trained nutritionists, with minimum clothes and without shoes. For the purpose of analysis, the adolescents were divided into two groups: non-obese and obese. The obese group included both overweight and obese adolescents. Non-overweight, overweight and obesity were calculated for each age and sex using the International obesity task force standard (IOTF) for children aged between 15 and 18 years [31]. Statistical analysis The data were analyzed using SPSS statistical package version 20. Chi square tests were performed to find out the differences between gender and obesity with exposure to media and body weight concern. Multivariate analysis of covariance (MANCOVA) and liner logistic regression were used to calculate odds ratio (OR), CI, and P-Trend, and significance level was at \0.05.
Discussion The present study was targeted to explore the effect of three types of mass media on adolescents’ weight concerns and perceptions of body weight and shape in Jordan. The results shown in this study are similar to [32] who showed that most of Jordanian adolescents exceeded the current screen time (television and computer) recommendation and were spending more than 2 h a day watching TV and using computers [32]. Although this study suggests that watching television and using the internet are not associated with increased risk of obesity, [33] found that watching television for more than 2 hours per day was significantly linked with increased risk of obesity among 6–12-year-old Jordanian children [33].
Results The prevalence of overweight and obesity was 7.8 and 14.0 % for boy students and 3.0 and 20.0 % for girls, respectively. Table 1 demonstrates that there was no significant difference among obese and non-obese boy and girl students for the time and frequency of using mass media. Additionally, no significant effect of reading magazines, watching television or using the internet was detected on having diets to lose weight between boys and girls (Table 2). Table 3 shows the influence of types of mass media on having diet to lose weight among Jordanian adolescents by weight status. The influence of
Table 1 Frequency of using mass media among Jordanian adolescents by weight status Frequency of using the media
Boy
Girls
Non-obese
Obese
p value
No.
%
No.
%
Total
Non-obese
Obese
p value
No.
%
No.
%
Non-obese
Obese
No.
%
No.
p value %
Frequency of reading magazines/week Daily
53
16.9
16
18.4
0.350
35
11.5
17
18.7
0.317
88
14.5
33
18.5
0.230
2–4 5–6
68 17
21.7 5.4
25 2
28.7 2.3
– –
83 16
27.3 5.3
23 3
25.3 3.3
– –
15.1 33
24.5 5.3
48 5
27.0 2.8
– –
175
55.9
44
50.6
–
170
55.9
48
52.7
–
345
55.9
92
51.7
–
88
28.9
29
31.9
0.593
175
28.4
58
32.6
0.276
Rarely or none
Hours of watching television/day \2
87
27.8
29
33.3
0.315
2?
226
72.2
58
66.7
–
216
71.1
62
68.1
–
442
71.6
120
67.4
–
\3
174
55.6
46
52.9
0.650
159
52.3
48
52.7
0.948
333
54.0
94
52.8
0.784
3?
139
44.4
41
47.1
–
145
47.7
43
47.3
–
284
46.0
84
47.2
–
Hours of using internet/day
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Environ Health Prev Med (2016) 21:430–438 Table 2 Influence of mass media on dieting to lose weight among Jordanian adolescents by gender
433
Exposure to media and dieting to lose weight
Boy
Girls
No.
p value
%
No.
%
166
41.5
187
47.3
94
23.5
94
23.8
–
140
35.0
114
28.9
–
Influence of reading magazines to having diet to lose weight High influence Moderate influence Not influence
0.144
Influence of watching television to having diet to lose weight High influence
233
58.2
238
60.3
0.356
Moderate influence
75
18.8
82
20.8
–
Not influence
92
23.0
75
18.9
–
239
59.7
229
58.0
0.806
71 90
17.8 22.5
77 89
19.5 22.5
– –
Influence of using internet to having diet to lose weight High influence Moderate influence Not influence
Table 3 Influence of mass media on dieting to lose weight among Jordanian adolescents based on weight status Exposure to media and dieting to lose weight
Boy
Girls
Nonobese No.
Obese %
No.
p value
%
Total
Nonobese
Obese
No.
%
No.
%
p value
Nonobese
Obese
No.
%
No.
p value %
Influence of reading magazines to dieting to lose weight High influence Moderate influence Not influence
129
41.2
37
42.5
0.015
136
44.7
51
56.0
0.024
265
42.9
88
49.4
0.001
65
20.8
29
33.3
–
70
23.1
24
26.4
–
135
21.9
53
29.8
–
119
38.0
21
24.2
–
98
32.2
16
17.6
–
217
35.2
37
20.8
–
Influence of watching television to having diet to lose weight High influence
180
57.5
53
60.9
0.500
183
60.2
55
60.4
0.478
363
58.8
108
60.7
0.244
Moderate influence
57
18.2
18
20.7
–
60
19.7
22
24.2
–
117
19.0
40
22.4
–
Not influence
76
24.3
16
18.4
–
61
20.1
14
15.4
–
137
22.2
30
16.9
–
0.023
Influence of using internet to having diet to lose weight 177
56.7
62
71.3
176
57.9
53
58.2
0.270
353
57.3
115
64.6
0.204
Moderate influence
High influence
63
20.2
8
9.2
–
55
18.1
22
24.2
–
118
19.2
30
16.9
–
Not influence
73
23.1
17
19.5
–
73
24.0
16
17.6
–
146
23.5
33
18.5
–
0.05 [ Significance set at p
Moreover, our results revealed that some types of mass media can exert significant influences on having diet to lose weight among obese and non-obese boys, but not the idea of a perfect body shape. However, based on weight status, reading magazines had a significant influence on having diet to lose weight on obese than non-obese adolescents in both boys and girls. Being obese from dieting to lose weight due to the high influence of reading magazines increased the risk for obesity twice as compared to no influence of reading magazines in general and specifically among girls. These results are in agreement with [29] who studied the association between exposure to media and body weight concern among girl university students in five Arab countries (Bahrain, Egypt, Jordan, Oman and Syria) using cross-cultural design [29]. They demonstrated that the association of
exposure to magazines with having diets to lose weight was only significant among girls in Jordan (p \ 0.001). Exposure to magazines had a stronger association with body weight concerns of girls than exposure to television [29]. While the influence of using the internet on having a diet to lose weight was highly significant in obese boys (71.3 %) compared to non-obese boys (56.7 %). The influence of watching television to having a diet to lose weight among obese and non-obese in both sexes was high but insignificant. Nevertheless, the majority of our sample (all girl obese and non- obese as well as non-obese boys except obese boys) used television more frequently, followed by browsing the internet and reading magazines to having diet to lose weight. This could be attributed to the wide availability of television and higher cost of internet
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434 Table 4 Influence of mass media on idea of a perfect body shape among Jordanian adolescents based on gender
Environ Health Prev Med (2016) 21:430–438
Exposure to media and body shape concern
Boys No.
Girls %
No.
p value %
Influence of reading magazines on idea of a perfect body shape High influence
49
12.3
52
13.2
Moderate influence
181
45.2
191
48.4
0.514 –
Not influence
170
42.5
152
38.4
–
Influence of watching television on idea of a perfect body shape High influence
156
39.0
167
42.3
0.177
Moderate influence
169
42.3
173
43.8
–
75
18.7
55
13.9
–
Not influence
Influence of using internet on idea of a perfect body shape High influence
180
45.0
185
46.8
0.563
Moderate influence Not influence
135 85
33.7 21.3
138 72
34.9 18.3
– –
Table 5 Influence of mass media on idea of a perfect body shape among Jordanian adolescents based on weight status Exposure to media and body shape concern
Boys
Girls
Nonobese No.
Obese %
No.
p value
%
Total
Nonobese No.
Obese %
No.
%
p value
Nonobese
Obese
No.
%
No.
%
p value
Influence of reading magazines on idea of a perfect body shape High influence
35
11.2
14
16.1
39
12.8
13
14.3
0.875
74
12.0
27
15.2
0.501
Moderate influence
144
46.0
37
42.5
0.459
149
49.0
42
46.2
–
293
47.5
79
44.4
–
Not influence
134
42.8
36
41.4
116
38.2
36
39.5
–
250
40.5
72
40.4
–
Influence of watching television on idea of a perfect body shape High influence
120
38.3
36
41.4
0.793
127
41.8
40
44.0
0.983
247
40.0
76
42.7
0.730
Moderate influence
135
43.1
34
39.1
–
135
44.4
38
41.8
–
270
43.8
72
40.4
–
58
18.6
17
19.5
–
42
13.8
13
14.2
–
100
16.2
30
16.9
–
Not influence
Influence of using internet on idea of a perfect body shape High influence
143
45.8
37
42.5
0.589
142
46.7
43
47.2
0.984
285
46.2
80
44.9
0.835
Moderate influence
106
34.0
28
32.2
–
106
34.9
32
35.2
–
212
34.4
60
33.7
–
64
20.2
22
25.3
–
56
18.4
16
17.6
–
120
19.4
38
21.4
–
Not influence
connectivity/usage rate in Jordan. Furthermore, the print media, like books and magazines, is less attractive to adolescents nowadays, who prefer to spend their time on television and online. When comparing our results to the findings of a recent study conducted in United Arab Emirates, the internet was the most influential method on body image 47.3 and 42 % of boys and girls, respectively, followed by television (31 % boys and 37 % girls) [34]. The impact of the media on body weight perceptions among adolescents has been examined by numerous studies from western countries [12, 35–37]. Achtenberg [36] reported that magazine and printed media had very strong and consequential effect on body image among American adolescent girls [36]. Findings from a survey of adolescent girls conducted in the United States showed that 69 % of
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the participants reported that images of girls displayed in magazines influence their concerns of the perfect body shape and 47 % reported that the images forced them to lose weight [37]. Some researchers illustrated that girls who read fashion magazines often compared themselves with the models that appear in the television advertisements and the magazine articles, resulting in more negative feelings about their own body figure [12, 35, 37]. On the one hand, [20, 37] showed that adolescent boys also were making a lot of effort to look like boy models in the media [37]. Field et al. [37] also found boys who read men, teen, fashion, health or fitness magazines were twice more likely than their peers who did not read magazines to use products to enhance their appearance, muscle mass, or strength. On the other hand, [38] revealed that half of the boys reported
Environ Health Prev Med (2016) 21:430–438 Table 6 OR and 95 % CI for Influence of mass media on having diet to lose weight and risk of obesity
Frequency
435 No influencea
Moderate influence
High influence
p value
0.046
Reading magazines (per week) Total No. of non-obese
217
125
265
37
53
88
2.41 (1.43–4.04)
2.01 (1.23–3.29)
No. of obese OR (95 % CI)
1
Boys No. of non-obese
119
65
129
21
29
37
2.64 (1.29–5.41)
1.66 (0.82–3.33)
No. of obese OR (95 % CI)
1
0.659
Female No. of non-obese
98
70
136
No. of obese
16
24
51
2.19 (1.02–4.73)
2.55 (1.25–5.21)
137
117
363
30
40
108
1.16 (0.68–2.07)
0.84 (0.48–1.46)
OR (95 % CI)
1
0.017
Watching television (h/day) Total No. of non-obese No. of obese OR (95 % CI)
1
0.513
Boys No. of non-obese
76
57
180
No. of obese
16
18
53
1.17 (0.50–2.69)
0.81 (0.37–1.81)
OR (95 % CI)
1
0.651
Girls No. of non-obese
61
60
183
No. of obese
14
22
55
1.08 (0.47–2.46)
0.80 (0.37–1.75)
OR (95 % CI)
1
0.665
Using internet (h/day) Total No. of non-obese
145
118
353
No. of obese
33
30
115
OR (95 % CI) Boys
1
0.88 (0.49–1.60)
1.13 (0.68–1.88)
No. of non-obese
72
63
177
No. of obese
17
8
62
0.44 (0.17–1.15)
1.24 (0.60–2.65)
OR (95 % CI)
1
0.242
0.061
Girls No. of non-obese
73
55
176
No. of obese
16
22
53
1.47 (0.66–3.26)
1.03 (0.45–2.13)
OR (95 % CI)
1
0.785
0.05 [ Significance set at p a
Reference category
that the media had no effect on their body image or eating behaviors [38]. There is one limitation of this study that should be considered in future studies. It is the challenge of selfmeasuring influence of media rather than establishing criteria for frequency of exposure. Despite this difficulty, this study showed a trend in exposure to media and level of
influence of media in weight concern. We did crosstab between frequency of media used and level of influence of media and findings suggested that the participants’ estimation of media influence was positively related to frequency of media used. In conclusion, this study indicated that the mass media did not show the significant effect on the idea of a
123
436 Table 7 OR and 95 % CI for influence of mass media on idea of a perfect body shape and risk of obesity
Environ Health Prev Med (2016) 21:430–438
Frequency
No influencea
Moderate influence
High influence
p value
0.572
Reading magazines (per week) Total No. of non-obese No. of obese OR (95 % CI)
250
293
74
72
79
27
0.94 (0.65–1.34)
1.27 (0.76–2.12)
1
Boys No. of non-obese No. of obese OR (95 % CI)
134
144
35
36
37
14
0.99 (0.57–1.76)
1.50 (0.71–3.19)
1
0.149
Girls No. of non-obese No. of obese OR (95 % CI)
116
149
39
36
42
13
0.88 (0.52–1.49)
1.08 (0.51–2.26)
100
270
247
30
72
76
0.89 (0.55–1.44)
1.03 (0.63–1.66)
1
0.972
Watching television Total No. of non-obese No. of obese OR (95 % CI)
0.740
1
Boys No. of non-obese
58
135
120
No. of Obese
17
34
36
OR (95 % CI)
1
1.02 (0.487–2.13)
1.19 (0.54–2.61)
0.702
Girls No. of non-obese
42
135
127
No. of obese
13
38
40
0.89 (0.42–1.89)
1.02 (0.47–2.20)
OR (95 % CI)
1
0.863
Using internet Total No. of non-obese
119
212
285
No. of obese
38
60
80
OR (95 % CI) Boys
1
0.89 (0.56–1.41)
0.88 (0.56–1.37)
No. of non-obese
63
106
143
No. of obese
22
28
37
0.72 (0.36–1.44)
0.68 (0.34–1.35)
OR (95 % CI)
1
0.608
0.267
Girls No. of non-obese
56
106
142
No. of obese
16
32
43
1.0 (0.54–2.23)
1.11 (0.55–2.24)
OR (95 % CI) a
1
Reference category
perfect body shape among boys and girls as well as obese and non-obese Jordanian adolescents. However, the influence of reading magazines was significant on undertaking diets to lose weight among both obese and non-obese adolescents and also among both boys and
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0.918
girls. Using the Internet had a high significant influence in obese boys. Acknowledgments This study was funded by Arab Center for Nutrition, Bahrain, Project ARABEAT-2.
Environ Health Prev Med (2016) 21:430–438 Compliance with ethical standards Conflict of interest The authors declare that they have no conflict of interest.
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437 19. Bergsma LJ, Carney ME. Effectiveness of health promoting media literacy education: a systematic review. Health Educ Res. 2008;23:522–42. 20. Field AE, Camargo CAJ, Taylor B, Berkey CS, Roberts SB, Colditz GA. Peer, parent, and media influences on the development of weight concerns and frequent dieting among preadolescent and adolescent girls and boys. Pediatrics. 2001;107:54–60. 21. Nishina A, Ammon NY, Bellmore AD, Graham S. Body dissatisfaction and physical development among ethnic minority adolescents. J Youth Adolesc. 2006;35:179–91. 22. Ata RN, Ludden AB, Lally MM. The effects of gender and family, friend, and media influences on eating behaviors and body image during adolescence. J Youth Adolesc. 2007;36:1024–37. 23. Neumark-Sztainer D, Story M, Hannan PJ, Perry CL, Irving LM. Weight-related concerns and behaviors among overweight and non-overweight adolescents: implications for preventing weightrelated disorders. Arch Pediatr Adolesc Med. 2002;156:171–8. 24. Tiggemann M, Pickering AS. Role of television in adolescent women’s body dissatisfaction and drive for thinness. Int J Eat Disord. 1996;20:199–203. 25. Harrison K. Ourselves, our bodies: thin-ideal media, self-discrepancies, and eating disorder symptomatology in adolescents. J Soc Clin Psychol. 2001;20:289–323. 26. Labre MP. Adolescent boys and the muscular male body ideal. J Adolesc Health. 2002;30:233–42. 27. Musaiger AO, Al-Mannai M, Tayyem R, Al-Lalla O, Ali EYA, Kalam F, et al. Risk of eating disorders among adolescents in seven Arab countries by gender and obesity: a cross-cultural study. Appetite. 2013;60:162–7. 28. Madanat H, Hawks SR, Angeles HN. Obesity and body size preferences of Jordanian Women. Health Educ Behav. 2011;38:91–8. 29. Musaiger AO, Al-Mannai M. Association between exposure to media and body weight concern among female university students in five Arab Countries: a preliminary cross-cultural study. J Biosoc Sci. 2014;46:240–7. 30. Field AE, Camargo CA, Taylor CB Jr, Berkey CS, Colditz GA. Relation of peer and media influences to the development of purging behaviors among preadolescent and adolescent girls. Arch Pediatr Adolesc Med. 1999;153:1184–9. 31. Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ. 2000;320(7244):1240–3. 32. Tayyem RF, Al-Hazzaa HM, Abu-Mweis SS, Bawadi HA, Hammad SS, Musaiger AO. Dietary habits and physical activity levels in Jordanian adolescents attending private versus public schools. East Mediterr Health J. 2014;20:411–8. 33. Khader Y, Irshaidat O, Khasawneh M, Amarin Z, Alomari M, Batieha A. Overweight and obesity among school children in Jordan: prevalence and associated factors. Matern Child Health J. 2009;13(3):424–31. 34. Sreedharan J, Antony A, Qureshi S, Fazal S, Siddiqui H, Choudhury J, et al. Media influence on the body image among students in UAE. Community Med Health Educ. 2012;2:4. doi:10.4172/2161-0711.1000182. 35. Jones DC, Vigfusdottir TH, Lee Y. Body image and the appearance culture among adolescent girls and boys: an examination of friend conversations, peer criticism, appearance magazines, and the internalization of appearance ideals. J Adolesc Res. 2004;19:323–39. 36. Achtenberg, B. Mass media and its influence on the adolescent mind: a study of student perceptions of body image and magazine advertisements. 2006. Macalester College. https://
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REGULAR ARTICLE
Association between mass media and body weight concern among Jordanian adolescents’ residents of Amman: the role of gender and obesity Reema F. Tayyem1 • Hiba A. Bawadi2 • Suhad S. AbuMweis3 • Sabika Allehdan1 Lana Agraib1 • Hadeel A. Ghazzawi1 • Mariam A. Al-Mannai4 • AbdulRahman O. Musaiger5
•
Received: 5 April 2016 / Accepted: 1 June 2016 / Published online: 16 June 2016 Ó The Japanese Society for Hygiene 2016
Abstract Objectives Body image in the mass media promotes an unrealistic picture of body shape that leads to body dissatisfaction among adolescentsQuery. Therefore, the study presented in this paper aimed to assess the association between mass media and adolescents’ weight concerns and perceptions of body weight and shape. Methods A cross-sectional survey was conducted on school adolescents aged between 15 and 18 years during the academic year 2013–2014. Multistage stratified sampling method was used. The number of participants in the study was 795 students: 400 boys and 395 girls. & Reema F. Tayyem [email protected] Hiba A. Bawadi [email protected] Suhad S. AbuMweis [email protected] Sabika Allehdan [email protected] Mariam A. Al-Mannai [email protected] AbdulRahman O. Musaiger [email protected] 1
Department of Nutrition and Food Technology, Faculty of Agriculture, The University of Jordan, Amman 11942, Jordan
2
Human Nutrition Department, College of Health Sciences, Qatar University, P.O. Box 2713, Doha, Qatar
3
Department of Clinical Nutrition and Dietetics, Faculty of Allied Health, Science, Hashemite University, P.O. Box 150459, Zarqa 13115, Jordan
4
College of Science, University of Bahrain, Manama, Bahrain
5
Arab Center for Nutrition, Manama, Bahrain
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Results All participants have a common behavior in rarely reading magazines, but they spend more than 2 h in watching television or less than 3 h using the internet. However, most of obese/non-obese adolescents, boys or girls, have shown high influence (p \ 0.05) of reading magazines on the subject of dieting to lose weight. Conclusion While obese students read more magazines on dieting to lose weight, other mass media did not show the same results on weight concerns and body shape among Jordanian adolescents. Keywords Mass media Body weight concern Adolescents Jordan
Introduction Adolescence is a critical developmental period that occurs between the ages 10 and 19. It is characterized by physical, psychological, and social changes [1]. Additionally, the body undergoes many physical alterations in this age period as result of maturation process and growth acceleration in boys and girls. This is manifested in the increase of lean mass in boys and fat mass in girls [2, 3]. These morphological changes may directly affect the individual’s mental image, which may elicit concerns on body weight among boy and girl adolescents [4]. For instance, [5] revealed that 21.2 % of Jordanian girl adolescents aged between 10 and 16 experience body image dissatisfaction due to physical changes of puberty and this dissatisfaction led them to practicing negative eating behaviors [5]. Body image can be defined as a person’s perception, feelings and thoughts towards his or her body shape and size that are derived from biological, psychological, and social factors [6, 7]. Furthermore, there are other factors
Environ Health Prev Med (2016) 21:430–438
that can be associated with the construction of positive or negative body images among adolescents such as family environment [8, 9], peer pressure [9–11], socio-cultural and economic context [8, 12], media mass [9, 13], gender [14, 15], and age [15, 16]. Therefore, body dissatisfaction is part of the attitude related to body image and includes disregard for one’s own weight and appearance [10, 17]. Nowadays, adolescents grow up in a world submerged with the mass media (television, movies, magazines, music, advertising, fashion designers and the internet) [18]. They may spend a third to a half of their time indulging in some form of these mass media [19]. The media plays a significant role in contributing towards body shape, weight dissatisfaction and eating disorders in both boys and girl teenagers [20–22]. Several studies have indicated that both boy and girl adolescents frequently report body dissatisfaction; the girl adolescents have a higher concern for their body weight and a passion for thinness in comparison to their boy peers [4, 20, 23]. In general, adolescent girls are more influenced by television adverts and fashion magazines that represent slim, young and beautiful models and most of those young adolescents try to keep their body thin and/or exercise and diet to lose weight [20, 24, 25]. On the other hand, adolescent boys perceive more pressures from the media on muscularity [9, 26]. Even though, adolescent boys are more likely to become concerned with weight and diet in an attempt to appear like boy individuals celebrities in the media [20]. The pressure and concern stemming from the mass media for body weight of adolescents may lead them to practice unhealthy weight control diets and, consequently, eating disorders [27]. In Jordan, the pressure from mass media on the body weight concern of young girls has been studied [28, 29]. However, these studies have focused on adults. We are not aware of similar studies among both boy and girl adolescents in the Arab world in general and specifically in Jordan. Therefore, this study aimed to investigate the influence of mass media on adolescents’ weight concerns and perceptions of body weight and shape in Jordan.
Methods Design and participants This study is part of the ARABEAT-2 project, which aimed at evaluating the association between mass media and adolescents’ weight concerns and perceptions of body weight and shape in the Arab world including Amman, the capital of Jordan. A multistage stratified random sampling method was used to select the students. A sample of 795 (out of 818) adolescents (400 boys and 395 girls) was
431
obtained. The sample was obtained from students enrolled in both public and private schools in Amman. The response rate was about 97 %. First, schools were randomly selected and stratified according to gender, type of school (private and public), and location (West and East of the city of Amman). Four schools were selected from each location. Then, one classroom from each grade (10th, 11th, and 12th) was randomly chosen in each selected school. Hence, a total of 16 classrooms were surveyed. Sample size was calculated with a 5 % margin of error and with 95 % confidence of interval. In Amman, the total number of boy and girl students in the public and private secondary schools during the years 2013/2014 was about 80,000. The survey was conducted over 3 months from April to June 2013. Amman city was divided into four geographical areas, and then the secondary schools were selected proportionally to the student population in each area. Ethical permission The Ministry of Education and the selected schools in Jordan approved the study protocol. Consent forms were obtained from the students before starting data collection. The questionnaire A pre-tested questionnaire was used to measure the frequency of using mass media and the association of mass media with body weight concern [13, 30]. However, the reliability of the questionnaire was applied on a group of students before applying the questionnaire and tested again using the Cronbach’s alpha Coefficient. The questionnaire was applied twice on the same 30 students of the same age, before and after 1 week. The value of Cronbach’s alpha coefficient was calculated to be 0.721 and 0.733 for pre and after testing, respectively. This indicates an acceptable reliability of the questionnaire, and this reliability is very close to that in the previously tested questionnaire [30]. The questionnaire consisted of three sections: (1) frequency of using the media (magazines, TV and internet). (2) influence of media on dieting to lose weight and (3) influence of media on ideas of a perfect body shape. For the first section, the question was ‘‘how often you read magazines per week/watching TV per day/using Internet per day?’’. The second section aimed to measure the associations between media and dieting: ‘Does reading magazines/watching TV/using internet influence you to dieting to lose weight?’ (High influence/moderate influence/no influences). The third section measured the influence of media on idea of a perfect body shape: ‘Does reading magazines/watching TV/using internet influence what you consider the perfect body shape?’ (High influence/moderate influence/no influences) [13].
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432
Environ Health Prev Med (2016) 21:430–438
Anthropometric measurements
reading magazines on having diet to lose weight on obese adolescent, either boys or girls, was a high or moderate influence. Furthermore, the Internet had a high significant influence to having diet to lose weight in obese boys compared to non-obese boys (71.3 and 56.7 % for obese and non-obese, respectively; p = 0.023). The influence of mass media on idea of a perfect body shape among Jordanian adolescents based on either gender or weight status did not show any significant difference as shown in Tables 4 and 5. The results of Table 6 showed that as the influence of reading magazines on having diet to lose weight increased, the risk for obesity was found to be duplicated (OR 2.01; CI 1.23–3.29, P-Trend = 0.046) and specifically among girls (OR 2.55; CI 1.25–5.21, P-Trend = 0.017). The risk of mass media on having idea of a perfect body shape did not show any significant risk for being obese among obese or non-obese students as shown in Table 7.
Weight and height were measured by trained nutritionists, with minimum clothes and without shoes. For the purpose of analysis, the adolescents were divided into two groups: non-obese and obese. The obese group included both overweight and obese adolescents. Non-overweight, overweight and obesity were calculated for each age and sex using the International obesity task force standard (IOTF) for children aged between 15 and 18 years [31]. Statistical analysis The data were analyzed using SPSS statistical package version 20. Chi square tests were performed to find out the differences between gender and obesity with exposure to media and body weight concern. Multivariate analysis of covariance (MANCOVA) and liner logistic regression were used to calculate odds ratio (OR), CI, and P-Trend, and significance level was at \0.05.
Discussion The present study was targeted to explore the effect of three types of mass media on adolescents’ weight concerns and perceptions of body weight and shape in Jordan. The results shown in this study are similar to [32] who showed that most of Jordanian adolescents exceeded the current screen time (television and computer) recommendation and were spending more than 2 h a day watching TV and using computers [32]. Although this study suggests that watching television and using the internet are not associated with increased risk of obesity, [33] found that watching television for more than 2 hours per day was significantly linked with increased risk of obesity among 6–12-year-old Jordanian children [33].
Results The prevalence of overweight and obesity was 7.8 and 14.0 % for boy students and 3.0 and 20.0 % for girls, respectively. Table 1 demonstrates that there was no significant difference among obese and non-obese boy and girl students for the time and frequency of using mass media. Additionally, no significant effect of reading magazines, watching television or using the internet was detected on having diets to lose weight between boys and girls (Table 2). Table 3 shows the influence of types of mass media on having diet to lose weight among Jordanian adolescents by weight status. The influence of
Table 1 Frequency of using mass media among Jordanian adolescents by weight status Frequency of using the media
Boy
Girls
Non-obese
Obese
p value
No.
%
No.
%
Total
Non-obese
Obese
p value
No.
%
No.
%
Non-obese
Obese
No.
%
No.
p value %
Frequency of reading magazines/week Daily
53
16.9
16
18.4
0.350
35
11.5
17
18.7
0.317
88
14.5
33
18.5
0.230
2–4 5–6
68 17
21.7 5.4
25 2
28.7 2.3
– –
83 16
27.3 5.3
23 3
25.3 3.3
– –
15.1 33
24.5 5.3
48 5
27.0 2.8
– –
175
55.9
44
50.6
–
170
55.9
48
52.7
–
345
55.9
92
51.7
–
88
28.9
29
31.9
0.593
175
28.4
58
32.6
0.276
Rarely or none
Hours of watching television/day \2
87
27.8
29
33.3
0.315
2?
226
72.2
58
66.7
–
216
71.1
62
68.1
–
442
71.6
120
67.4
–
\3
174
55.6
46
52.9
0.650
159
52.3
48
52.7
0.948
333
54.0
94
52.8
0.784
3?
139
44.4
41
47.1
–
145
47.7
43
47.3
–
284
46.0
84
47.2
–
Hours of using internet/day
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Environ Health Prev Med (2016) 21:430–438 Table 2 Influence of mass media on dieting to lose weight among Jordanian adolescents by gender
433
Exposure to media and dieting to lose weight
Boy
Girls
No.
p value
%
No.
%
166
41.5
187
47.3
94
23.5
94
23.8
–
140
35.0
114
28.9
–
Influence of reading magazines to having diet to lose weight High influence Moderate influence Not influence
0.144
Influence of watching television to having diet to lose weight High influence
233
58.2
238
60.3
0.356
Moderate influence
75
18.8
82
20.8
–
Not influence
92
23.0
75
18.9
–
239
59.7
229
58.0
0.806
71 90
17.8 22.5
77 89
19.5 22.5
– –
Influence of using internet to having diet to lose weight High influence Moderate influence Not influence
Table 3 Influence of mass media on dieting to lose weight among Jordanian adolescents based on weight status Exposure to media and dieting to lose weight
Boy
Girls
Nonobese No.
Obese %
No.
p value
%
Total
Nonobese
Obese
No.
%
No.
%
p value
Nonobese
Obese
No.
%
No.
p value %
Influence of reading magazines to dieting to lose weight High influence Moderate influence Not influence
129
41.2
37
42.5
0.015
136
44.7
51
56.0
0.024
265
42.9
88
49.4
0.001
65
20.8
29
33.3
–
70
23.1
24
26.4
–
135
21.9
53
29.8
–
119
38.0
21
24.2
–
98
32.2
16
17.6
–
217
35.2
37
20.8
–
Influence of watching television to having diet to lose weight High influence
180
57.5
53
60.9
0.500
183
60.2
55
60.4
0.478
363
58.8
108
60.7
0.244
Moderate influence
57
18.2
18
20.7
–
60
19.7
22
24.2
–
117
19.0
40
22.4
–
Not influence
76
24.3
16
18.4
–
61
20.1
14
15.4
–
137
22.2
30
16.9
–
0.023
Influence of using internet to having diet to lose weight 177
56.7
62
71.3
176
57.9
53
58.2
0.270
353
57.3
115
64.6
0.204
Moderate influence
High influence
63
20.2
8
9.2
–
55
18.1
22
24.2
–
118
19.2
30
16.9
–
Not influence
73
23.1
17
19.5
–
73
24.0
16
17.6
–
146
23.5
33
18.5
–
0.05 [ Significance set at p
Moreover, our results revealed that some types of mass media can exert significant influences on having diet to lose weight among obese and non-obese boys, but not the idea of a perfect body shape. However, based on weight status, reading magazines had a significant influence on having diet to lose weight on obese than non-obese adolescents in both boys and girls. Being obese from dieting to lose weight due to the high influence of reading magazines increased the risk for obesity twice as compared to no influence of reading magazines in general and specifically among girls. These results are in agreement with [29] who studied the association between exposure to media and body weight concern among girl university students in five Arab countries (Bahrain, Egypt, Jordan, Oman and Syria) using cross-cultural design [29]. They demonstrated that the association of
exposure to magazines with having diets to lose weight was only significant among girls in Jordan (p \ 0.001). Exposure to magazines had a stronger association with body weight concerns of girls than exposure to television [29]. While the influence of using the internet on having a diet to lose weight was highly significant in obese boys (71.3 %) compared to non-obese boys (56.7 %). The influence of watching television to having a diet to lose weight among obese and non-obese in both sexes was high but insignificant. Nevertheless, the majority of our sample (all girl obese and non- obese as well as non-obese boys except obese boys) used television more frequently, followed by browsing the internet and reading magazines to having diet to lose weight. This could be attributed to the wide availability of television and higher cost of internet
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434 Table 4 Influence of mass media on idea of a perfect body shape among Jordanian adolescents based on gender
Environ Health Prev Med (2016) 21:430–438
Exposure to media and body shape concern
Boys No.
Girls %
No.
p value %
Influence of reading magazines on idea of a perfect body shape High influence
49
12.3
52
13.2
Moderate influence
181
45.2
191
48.4
0.514 –
Not influence
170
42.5
152
38.4
–
Influence of watching television on idea of a perfect body shape High influence
156
39.0
167
42.3
0.177
Moderate influence
169
42.3
173
43.8
–
75
18.7
55
13.9
–
Not influence
Influence of using internet on idea of a perfect body shape High influence
180
45.0
185
46.8
0.563
Moderate influence Not influence
135 85
33.7 21.3
138 72
34.9 18.3
– –
Table 5 Influence of mass media on idea of a perfect body shape among Jordanian adolescents based on weight status Exposure to media and body shape concern
Boys
Girls
Nonobese No.
Obese %
No.
p value
%
Total
Nonobese No.
Obese %
No.
%
p value
Nonobese
Obese
No.
%
No.
%
p value
Influence of reading magazines on idea of a perfect body shape High influence
35
11.2
14
16.1
39
12.8
13
14.3
0.875
74
12.0
27
15.2
0.501
Moderate influence
144
46.0
37
42.5
0.459
149
49.0
42
46.2
–
293
47.5
79
44.4
–
Not influence
134
42.8
36
41.4
116
38.2
36
39.5
–
250
40.5
72
40.4
–
Influence of watching television on idea of a perfect body shape High influence
120
38.3
36
41.4
0.793
127
41.8
40
44.0
0.983
247
40.0
76
42.7
0.730
Moderate influence
135
43.1
34
39.1
–
135
44.4
38
41.8
–
270
43.8
72
40.4
–
58
18.6
17
19.5
–
42
13.8
13
14.2
–
100
16.2
30
16.9
–
Not influence
Influence of using internet on idea of a perfect body shape High influence
143
45.8
37
42.5
0.589
142
46.7
43
47.2
0.984
285
46.2
80
44.9
0.835
Moderate influence
106
34.0
28
32.2
–
106
34.9
32
35.2
–
212
34.4
60
33.7
–
64
20.2
22
25.3
–
56
18.4
16
17.6
–
120
19.4
38
21.4
–
Not influence
connectivity/usage rate in Jordan. Furthermore, the print media, like books and magazines, is less attractive to adolescents nowadays, who prefer to spend their time on television and online. When comparing our results to the findings of a recent study conducted in United Arab Emirates, the internet was the most influential method on body image 47.3 and 42 % of boys and girls, respectively, followed by television (31 % boys and 37 % girls) [34]. The impact of the media on body weight perceptions among adolescents has been examined by numerous studies from western countries [12, 35–37]. Achtenberg [36] reported that magazine and printed media had very strong and consequential effect on body image among American adolescent girls [36]. Findings from a survey of adolescent girls conducted in the United States showed that 69 % of
123
the participants reported that images of girls displayed in magazines influence their concerns of the perfect body shape and 47 % reported that the images forced them to lose weight [37]. Some researchers illustrated that girls who read fashion magazines often compared themselves with the models that appear in the television advertisements and the magazine articles, resulting in more negative feelings about their own body figure [12, 35, 37]. On the one hand, [20, 37] showed that adolescent boys also were making a lot of effort to look like boy models in the media [37]. Field et al. [37] also found boys who read men, teen, fashion, health or fitness magazines were twice more likely than their peers who did not read magazines to use products to enhance their appearance, muscle mass, or strength. On the other hand, [38] revealed that half of the boys reported
Environ Health Prev Med (2016) 21:430–438 Table 6 OR and 95 % CI for Influence of mass media on having diet to lose weight and risk of obesity
Frequency
435 No influencea
Moderate influence
High influence
p value
0.046
Reading magazines (per week) Total No. of non-obese
217
125
265
37
53
88
2.41 (1.43–4.04)
2.01 (1.23–3.29)
No. of obese OR (95 % CI)
1
Boys No. of non-obese
119
65
129
21
29
37
2.64 (1.29–5.41)
1.66 (0.82–3.33)
No. of obese OR (95 % CI)
1
0.659
Female No. of non-obese
98
70
136
No. of obese
16
24
51
2.19 (1.02–4.73)
2.55 (1.25–5.21)
137
117
363
30
40
108
1.16 (0.68–2.07)
0.84 (0.48–1.46)
OR (95 % CI)
1
0.017
Watching television (h/day) Total No. of non-obese No. of obese OR (95 % CI)
1
0.513
Boys No. of non-obese
76
57
180
No. of obese
16
18
53
1.17 (0.50–2.69)
0.81 (0.37–1.81)
OR (95 % CI)
1
0.651
Girls No. of non-obese
61
60
183
No. of obese
14
22
55
1.08 (0.47–2.46)
0.80 (0.37–1.75)
OR (95 % CI)
1
0.665
Using internet (h/day) Total No. of non-obese
145
118
353
No. of obese
33
30
115
OR (95 % CI) Boys
1
0.88 (0.49–1.60)
1.13 (0.68–1.88)
No. of non-obese
72
63
177
No. of obese
17
8
62
0.44 (0.17–1.15)
1.24 (0.60–2.65)
OR (95 % CI)
1
0.242
0.061
Girls No. of non-obese
73
55
176
No. of obese
16
22
53
1.47 (0.66–3.26)
1.03 (0.45–2.13)
OR (95 % CI)
1
0.785
0.05 [ Significance set at p a
Reference category
that the media had no effect on their body image or eating behaviors [38]. There is one limitation of this study that should be considered in future studies. It is the challenge of selfmeasuring influence of media rather than establishing criteria for frequency of exposure. Despite this difficulty, this study showed a trend in exposure to media and level of
influence of media in weight concern. We did crosstab between frequency of media used and level of influence of media and findings suggested that the participants’ estimation of media influence was positively related to frequency of media used. In conclusion, this study indicated that the mass media did not show the significant effect on the idea of a
123
436 Table 7 OR and 95 % CI for influence of mass media on idea of a perfect body shape and risk of obesity
Environ Health Prev Med (2016) 21:430–438
Frequency
No influencea
Moderate influence
High influence
p value
0.572
Reading magazines (per week) Total No. of non-obese No. of obese OR (95 % CI)
250
293
74
72
79
27
0.94 (0.65–1.34)
1.27 (0.76–2.12)
1
Boys No. of non-obese No. of obese OR (95 % CI)
134
144
35
36
37
14
0.99 (0.57–1.76)
1.50 (0.71–3.19)
1
0.149
Girls No. of non-obese No. of obese OR (95 % CI)
116
149
39
36
42
13
0.88 (0.52–1.49)
1.08 (0.51–2.26)
100
270
247
30
72
76
0.89 (0.55–1.44)
1.03 (0.63–1.66)
1
0.972
Watching television Total No. of non-obese No. of obese OR (95 % CI)
0.740
1
Boys No. of non-obese
58
135
120
No. of Obese
17
34
36
OR (95 % CI)
1
1.02 (0.487–2.13)
1.19 (0.54–2.61)
0.702
Girls No. of non-obese
42
135
127
No. of obese
13
38
40
0.89 (0.42–1.89)
1.02 (0.47–2.20)
OR (95 % CI)
1
0.863
Using internet Total No. of non-obese
119
212
285
No. of obese
38
60
80
OR (95 % CI) Boys
1
0.89 (0.56–1.41)
0.88 (0.56–1.37)
No. of non-obese
63
106
143
No. of obese
22
28
37
0.72 (0.36–1.44)
0.68 (0.34–1.35)
OR (95 % CI)
1
0.608
0.267
Girls No. of non-obese
56
106
142
No. of obese
16
32
43
1.0 (0.54–2.23)
1.11 (0.55–2.24)
OR (95 % CI) a
1
Reference category
perfect body shape among boys and girls as well as obese and non-obese Jordanian adolescents. However, the influence of reading magazines was significant on undertaking diets to lose weight among both obese and non-obese adolescents and also among both boys and
123
0.918
girls. Using the Internet had a high significant influence in obese boys. Acknowledgments This study was funded by Arab Center for Nutrition, Bahrain, Project ARABEAT-2.
Environ Health Prev Med (2016) 21:430–438 Compliance with ethical standards Conflict of interest The authors declare that they have no conflict of interest.
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