Body image and physical activity among overweight and obese girls in Taiwan

This study examined the physical activity, attitudes toward obesity and ideal body images of overweight/obese girls from Taiwan. Thirteen overweight/obese girls aged 13 to 16 were interviewed. The method of data interpretation was based on the Consensual Qualitative Research approach. Data were classified into 6 domains (12 sub-domains) and 31 categories. The main domains included experience of physical activity, experience of their body, ideal body image, attitude toward obesity, popularity of thinness, and weight loss behavior. Results indicated that body image plays a dominant role in the development of overweight/obese girls' motives and barriers toward physical activity engagement. Weight-related teasing is evidenced and fosters idealisation of thinness and a desire to lose weight.

Introduction

The issue of body image and perceptions of fatness and slenderness have become increasingly central to western culture and values. As a reflection of overall society, they also have prominence in the adolescent sub-culture. Adolescent girls in particular exhibit concerns about becoming overweight/obese (Levine and Smolak, 2002, Presnell et al., 2004); research, for example, carried out in 24 countries and regions across Europe, Canada, and the USA has shown a high prevalence of body dissatisfaction among adolescent girls (Canada: 43.1%; Germany: 46.0%; France: 50.5%; and USA:51%, etc.) (Sabbah et al., 2009) (p4). Although many studies have examined preoccupation with slimness among adolescent girls, these have mainly focused on white populations living in Western societies (Lee, 1993, Wildes et al., 2001). Body image, however, is culturally determined. Levels of body dissatisfaction differ by sub-cultures and ethnicity since socio-cultural factors play an important role in the development and prevalence of body dissatisfaction (Smolak, 2004). A meta-analysis, involving 35 studies from over 17,000 participants, revealed that white women experience greater body dissatisfaction than non-white women in western countries (Wildes et al., 2001). Therefore, even within the same country, different ethnic groups reflect differences in the perception of body weight and dissatisfaction. Research suggests that Black American women seem to be better ‘protected’ from body image distortions than White American women (Crago et al., 1996, Padgett and Biro, 2003).

There is a paucity of research on body image with Chinese populations in Asia (Chen et al., 2008, Kennedy et al., 2004) and results from research conducted in western countries cannot be assumed to be generalizable to those who live in Asian countries. For instance, there have been periods in Chinese history that fatness has been appreciated by the Chinese as it was seen to represent wealth fertility and health (Kawamura, 2002, Lai, 2000, Lee, 1999, Wong et al., 2000) although the plump figure was valued within relatively short time periods (Liu & Chang, 2003). In contrast, ‘Xi-Shi’ and ‘Zhao, FeiYen’, two great beauties, are examples of the dominant image of the frail, delicate and slender female beauty in Chinese history (Xu, 2000, Zhao & Hu, 2000).

Taiwan has mixed cultural influences. Although it is ‘a stronghold of traditional Chinese culture’ (Offer et al., 1988), it is also becoming more westernised and adopting western values and norms (Lam et al., 2002, Lee et al., 1996, Sands and Wardle, 2003, Shih and Kubo, 2002). The traditional frail and delicate image and western values of thinness are both influential for Taiwanese. Rieger et al. (2001) illustrated that ‘the processes of adopting Western attitudes toward the body is likely to be facilitated if the new values system is compatible with existing cultural values’(pp 211–212). Thus, both traditional Chinese and Western values might combine to produce pressures for extremely thin ideals and this might result in high body dissatisfaction for Taiwanese girls. Therefore, for an understanding of how young Taiwanese females perceive and behave in relation to their bodies, it is essential that it is studied within social, cultural and historical contexts.

The desire for thinness also exists at a time when there are global increases in the prevalence of overweightness and obesity (Chen et al., 2006, Lobstein et al., 2004). Dieting and physical activity for weight management are increasingly prominent, even in Asian communities (Chen et al., 2007, Chen et al., 2007, Lee and Lee, 2000). Researchers have suggested that a focus on physical activity rather than diet might be a more appropriate strategy, since reduced intake might endanger nutritional health and growth. Furthermore, raising public awareness of weight gain and dietary strategies might increase the incidence of body dissatisfaction and eating disorders (Goran et al., 1999, Neumark-Sztainer et al., 2006). Page and Fox (1997) have pointed out that adolescent girls generally view desirable body shape as something to be achieved through dietary restriction, with increased physical activity rarely mentioned. This is reflected in Taiwan, where low physical activity engagement has been reported among girls (Chen et al., 2007, Chen et al., 2007, Taiwan Bureau of Health Promotion, 2006) where sport tends to be male dominated (Chen et al., 2007, Chen et al., 2007).

Studies investigating body image, physical activity and weight-related issues in Taiwan have been restricted to cross-sectional designs with correlational analyses. Although this has helped identify important relationships across populations, it is not possible to disentangle the complex inter-relationships between key variables within individuals (Chen et al., 2007, Chen et al., 2007, Chen et al., 2006, Chen et al., 2008, Wong et al., 2000). Qualitative research provides an opportunity to gain a more comprehensive and richer picture of individual experiences and a more complete description of the phenomenon under study (Hill et al., 1997, Miles and Huberman, 1994).

This study adopted such an approach to provide a deeper understanding of how young Taiwanese females who are already assessed as overweight or obese are perceiving and reacting to their bodies. Particular attention is paid to their body ideal, their view of overweight and obesity and the role of dieting and physical activity in weight management. Such information is required to develop sensitive and meaningful interventions to help adolescent females develop healthy perceptions and strategies regarding their physical selves.