| 摘要: | 青少年時期係指介於兒童期與成年期之間的快速成長期，亦是許多重要生理、心理、社會發展改變的過程，同時也是青少年對於自己的體重、相貌、體型及外表等的變化相當關注的時期，在此時期青少年對於自己身體的不滿意程度會比真實體重狀況及知覺體重狀態較與社會心理因素有關，且亦會影響到個人的健康相關行為。
過去不管是國外或國內的相關研究只考慮單因子(身體質量指數或身體意象)對於社會心理因素或特定的健康相關行為問題之間的關係，因此本研究除考慮學生身體質量指數(BMI)外(「正常」與「過重/肥胖」兩組)，再加入學生外表滿意度評價(「滿意」與「不滿意」兩組)，結合成為四組體重狀態，本研究目的即依性別進一步探討此體重狀態與社會心理因素(包括憂鬱傾向、自尊)、健康相關行為(包括睡眠時數、睡眠品質、吃早餐行為、久坐行為及減重行為)之關係。
本研究為橫斷性研究，依北市選舉之雙行政區之分布，隨機抽籤排序該雙行政區內社區型高中，依意願各選取一所，本研究共包括六所市立社區型高級中學，且於96年12月至97年3月執行84個班級1090名高一學生的自陳式團體問卷調查，並於96學年度下學期初，由每校健康中心人員測量每位學生身高及體重，並各別計算身體質量指數(BMI)值，再依不同性別以多變項線性迴歸及邏輯式迴歸進行分析。
結果顯示北市高中學生體重正常占56.3％(n=519)，體重過重及肥胖的學生分別為15.5％(n=169)、15.1％(n=165)；以身體質量指數而言，在控制基本人口學及其他變項後，男性體重肥胖比正常者有較多久坐行為(OR=2.04,95％CI=1.15,3.63)與較可能嘗試過減重行為(OR=5.38,95％CI=3.34,8.66)，而女性體重肥胖比正常者較可能會有天天吃早餐的行為(OR=0.29,95％CI=0.09,0.97)與較可能嘗試過減重行為(OR=3.96,95％CI=1.70,9.21)；以體重狀態而言，在控制基本人口學及其他變項後，男性體重正常的人當中，「不滿意外表」比「滿意外表」之高中生較可能具高憂鬱傾向(OR=3.93,95％CI=1.70,9.06)、低自尊(OR=3.08,95％CI=1.50,6.34)、較差的睡眠品質(OR=1.72,95％CI=1.01,2.94)、較多久坐行為(OR=5.07,95％CI=1.51,17.00)與較可能嘗試過減重行為(OR=1.93,95％CI=1.02,2.10)，女性並未發現相似結果。
本研究結果可應用於未來學校規劃青少年體重與社會心理因素及健康相關行為之預防介入計畫；其結果會依性別不同而有所差異，未來後續之相關研究可進一步探討此性別差異之原因或機制，建議未來相關研究除了考慮學生身體質量指數(BMI)外，還需更進一步探討學生對於自己的身體意象認知，以瞭解體重知覺對於社會心理因子或是健康相關行為之影響。
With a transition from childhood to adulthood, adolescence is marked by a rapid and dramatic growth in life. During the significant progression on physical, psychological, and social development, youths concern considerably on their own weight, body-shape, and appearance. Thus, dissatisfaction on one’s own body-shape and appearance, compared to his/her actual or perceived weight status, would be more significantly linked with the psychological well-being status and personal health-related behaviors.
Most of the previous literatures examined the effects of a single factor, either body mass index (BMI) or body image, on adolescents’ psychological status or health-related behaviors. In this study, in addition to the consideration of BMI (i.e., binary classification of “normal” and “overweight/obesity” groups) status, youths’ self-evaluation on appearance satisfaction (i.e., binary classification of “satisfied” and “unsatisfied” groups) was further combined to generate a “weight status” factor with four categories. This cross-sectional study was thus aimed to investigate the effects of the “weight status” on psychological factors (i.e., depression and self-esteem) and health-related behaviors (i.e., sleeping hours, sleeping quality, breakfast eating behaviors, sedentary lifestyle, and weight reduction behaviors). Boys and girls would be evaluated separately to assess specific gender effects.
For each of the bi-districts in Taipei city, one community high school was selected for participation. A total of six municipal high schools were recruited, with 84 classes or 1,090 students completing the in-class and self-reported questionnaires from December, 2007 to March, 2008. In the beginning of the second semester in the 2007 academic year, school nurses measured the height and weight of each student, with the BMI being further calculated. Multivariate linear and logistic regression models were carried out for analyses by gender.
It was observed that 56.3% (n=519) of the Taipei municipal high school students possessed a normal weight status, while 15.5％(n=169) and 15.1％(n=165) were overweight and obese, respectively. For the BMI status, after adjusting for sociodemographics and other listed variables, overweight and obese males were more likely to possess sedentary lifestyle (OR=2.04,95％CI=1.15,3.63) and to have tried to lose weight (OR=5.38,95％CI=3.34,8.66), compared to those with a normal weight status. On the other hand, females with overweight and obese BMI status were more likely to eat breakfast everyday (OR=0.29,95％CI=0.09,0.97) and to have tried to lose weight (OR=3.96,95％CI=1.70,9.21). For the “weight status” factor, after adjusting for sociodemographics and other listed variables, normal-weighted boys who were unsatisfied with their appearance, compared to those who were satisfied, were more likely to have higher levels of depression (OR=3.93,95％CI=1.70,9.06), lower levels of self-esteem (OR=3.08,95％CI=1.50,6.34), worse sleeping quality (OR=1.72,95％CI=1.01,2.94), more sedentary lifestyle (OR=5.07,95％CI=1.51,17.00) and more weight-reduction behaviors (OR=1.93,95％CI=1.02,2.10). Similar trends were not identified for girls.
The study results could be applied to the future design and implementation of a prevention-intervention program on youth’s psychological well-being and health-related behaviors. Because dissimilar trends were identified for boys and for girls, more studies should be administered to investigate the possible explanation or mechanism on the gender differences. Besides BMI status, future studies are suggested to investigate adolescents’ self perception on body image or body-shape in order to examine the effects of weight perception on both physical and psychological aspects in youth. |
