Body dissatisfaction and body mass in girls and boys transitioning from early to mid-adolescence: additional role of self-esteem and eating habits
© Mäkinen et al.; licensee BioMed Central Ltd 2012
Received: 19 August 2011
Accepted: 27 April 2012
Published: 8 June 2012
In the transition from early to mid-adolescence, gender differences in pubertal development become significant. Body dissatisfaction is often associated with body mass, low self-esteem and abnormal eating habits. The majority of studies investigating body dissatisfaction and its associations have been conducted on female populations. However, some evidence suggests that males also suffer from these problems and that gender differences might already be observed in adolescence.
To examine body dissatisfaction and its relationship with body mass, as well as self-esteem and eating habits, in girls and boys in transition from early to mid-adolescence.
School nurses recorded the heights and weights of 659 girls and 711 boys with a mean age of 14.5 years. The Rosenberg Self-Esteem Scale and the Body Dissatisfaction subscale of the Eating Disorder Inventory were used as self-appraisal scales. Eating data were self-reported.
The girls were less satisfied with their bodies than boys were with theirs (mean score (SD): 30.6 (SD 12.2) vs. 18.9 (SD 9.5); p < 0.001). The girls expressed most satisfaction with their bodies when they were underweight, more dissatisfaction when they were of normal weight and most dissatisfaction when they had excess body weight. The boys also expressed most satisfaction when they were underweight and most dissatisfaction when they had excess body weight. The boys reported higher levels of self-esteem than did the girls (mean (SD): 31.3 (4.8) vs. 28.0 (5.9); p < 0.001). The adolescents self-reporting abnormal eating habits were less satisfied with their bodies than those describing normal eating habits (mean (SD): 33.0 (12.9) vs. 21.2 (10.2); p < 0.001).
Body mass, self-esteem and eating habits revealed a significant relationship with body dissatisfaction in the transitional phase from early to mid-adolescence in girls and boys, but significant gender differences were also found.
Adolescence is a period of life when individuals transfer from childhood and their biological, cognitive, psychological and social characteristics rapidly change as they become more adult-like. This challenging developmental stage is initiated by pubertal onset and can be divided into three periods: early (ages 12 to 14 years), middle (ages 15 to 16 years) and late adolescence (ages 17 to 19 years and beyond) . In the transition from early to mid-adolescence, gender differences in pubertal maturation are significant. Girls are already post-pubertal, having reached their final height as well as accumulated adipose tissue at specific sites. Boys, however, represent the full scale of pubertal development from early to post-puberty, most of them having their lifetime lowest body fat content due to the simultaneous growth spurt in height .
Body dissatisfaction, the subjective evaluation of one’s figure or body part, has been conceptualized to be an important part of body image disturbance [3, 4]. In three recent large community-based studies, the proportion of adolescent girls reporting body dissatisfaction varied between 24 % and 46 %, whereas the respective proportions of boys ranged from 12 % to 26 % [4–6]. Body dissatisfaction appears to either remain stable or increase during adolescence among girls [7, 8]. It has been speculated that puberty precipitates body dissatisfaction in girls, who accrete more adipose tissue, which in turn moves them away from the current thin beauty ideal [4, 9]. Among boys, body dissatisfaction has been reported to either decrease or remain stable as they move towards adulthood [7, 8]. However, boys are nowadays known to be under increasing pressure to meet their unrealistic lean and muscular body ideal [10–12].
Body mass is the most consistent biological factor correlated with body dissatisfaction, although the relation seems to differ between genders [4, 12, 13]. Boys have been reported to feel dissatisfaction with their bodies when either below or above average weight, and to be most satisfied when they are of average weight [4, 10, 14]. In contrast, girls showed a positive linear relationship, such that their body dissatisfaction increased as a function of body weight [4, 14]. Dissatisfaction with one’s body tends to manifest in attempts at weight loss in girls, whereas dissatisfaction in boys can either appear as weight gain or weight loss .
Self-esteem can be described as a favourable or unfavourable attitude towards oneself . Low self-esteem is a lack of respect for oneself, with feelings of unworthiness, inadequacies and deficiencies . Self-esteem is more strongly associated with age among boys than girls, and self-esteem has been reported to be higher among boys than girls during adolescence [17, 18]. The extent of being overweight has been described to be inversely correlated with self-esteem, although the magnitude of the relationship has been found to be only modest, with self-esteem scores of overweight adolescents within the normal range [19, 20]. Apart from perceived overweight, body dissatisfaction is also often associated with low self-esteem, especially in girls [21–23]. In fact, body dissatisfaction has been reported to be a risk factor for low self-esteem in girls in early adolescence and in boys in mid-adolescence .
Abnormal eating habits may be associated with body dissatisfaction . Dissatisfaction is thought to increase the risk of eating pathology through two central mechanisms . The first suggested pathway is that body dissatisfaction leads to increased dietary restraint, which subsequently leads to an increased likelihood of anorexic and bulimic behaviour. The another suggested pathway is that body dissatisfaction leads to increases in negative emotional feelings, which in turn increase the risk of binge eating, as some individuals overeat to ameliorate such adverse emotions. However, it has been reported that men who are dissatisfied with their bodies appear to be less likely to diet or attempt to lose weight than women .
The aim of the present study was to examine body dissatisfaction and its relationship with body mass, as well as self-esteem and eating habits, in girls and boys in transition from early to mid-adolescence. The differences in pubertal maturation in this age group indicate that gender differences might exist. Our hypotheses were that: 1. girls would be more dissatisfied with their bodies than boys, and the relationship between body dissatisfaction and body mass would differ between genders; 2. body dissatisfaction would be related to self-esteem and the relationship would be gender-specific; and 3. eating habits would be associated with body dissatisfaction, especially in girls.
Material and Methods
This cross-sectional study was performed on adolescent girls and boys attending the 8th grade at 24 secondary schools in the city of Helsinki, Finland, in 2003 and 2004. The mean age of the participants was 14.5 (SD 0.3) years. Although the general population is relatively homogeneous in Helsinki, the schools were selected in order to cover all the representative socio-economic groups across the city districts. The sample included state, municipal and private schools. All participants attended ordinary education programmes and they spoke Finnish as their mother tongue. Of the 2 286 students, 1 370 participated in the study (659 girls and 711 boys). The overall participation rate was 61.4 % for girls and 58.6 % for boys. Single missing values were imputed. However, in 27 (2.0 %) cases for which there were systematic missing values, their data were excluded from the study. Accordingly, the final sample consisted of 650 girls and 693 boys.
Teachers of the selected schools received written information about the study and were present during the 60-minute data collection visit when the participants completed the questionnaires. The questionnaire covered details of the participants’ health- and food-related habits in addition to recording the measurements described below. The questionnaire also contained numerical codes to match and identify the participants.
The Body Dissatisfaction subscale of the Eating Disorder Inventory (EDI) [3, 28] was used to measure body dissatisfaction. The subscale consists of 9 items that are all rated on a 6-point Likert-scale, with response options ranging from “always” to “never”. Higher scores on the scale indicate a greater dissatisfaction with one’s body. The EDI was initially developed for women and is well validated in female populations [3, 28–30]. However, its validity with respect to studying body dissatisfaction in adolescent boys has only recently been reported . In the present study, the internal consistency of the EDI was found to be acceptable for both sexes (Cronbach’s alpha 0.94 for girls and 0.89 for boys).
BMI cut-off points and weight status among 1343 adolescent girls and boys
BMI cut-off points
Self-esteem was measured using the Rosenberg Self-Esteem Scale . The scale comprised 10 self-appraisal statements, each rated as positive or negative. Each statement has four separate response options (from 1 = “not at all true of me” to 4 = “very true of me”), and higher scores reflect a greater level of self-esteem. The Rosenberg Self-Esteem Scale has been widely used in measuring self-esteem among adolescents [16, 24, 35, 36]. Its reliability and validity are well documented . In the present study, internal consistency was acceptable (Cronbach’s alpha 0.86 for girls and 0.79 for boys).
Eating habits were assessed from answers to the following question: “Which of following best describes you?” with four options: “It’s easy for me to eat approximately the amount I need” (normal eating); “I quite often eat more than I actually need “(overeating); “I often try to restrict my eating” (restrictive eating); and “Occasionally, I’m on a strict diet or I overeat” (alternating restrictive eating/overeating. The last three response options were considered as being indicative of abnormal eating habits.
The analyses were performed on girls and boys as separate groups. Missing value analysis and imputation were carried out using the expectation maximization method. An independent-samples t-test and one-way ANOVA were used to compare the means. The chi-squared (χ2) test was used to compare frequencies. The differences in the correlations were estimated using an interaction term between gender and the explanatory variable. Eating habits were dichotomized (normal eating/abnormal eating) for regression analysis. Cohen’s d effect sizes obtained from the t-tests were calculated to describe practical significance values. The Cohen effect sizes classes of 0.2 as small, 0.5 medium and 0.8 large were used . Linear regression analysis was performed to measure the associations between body dissatisfaction and other variables, despite the fact that some distributions were skewed and some relationships departed from a linear relationship. Neither stepwise nor hierarchical models were used. The distribution free method CATREG produced very similar results to linear regression analysis . Linear regression analysis was also used when 5 % of the lowest and highest scores were eliminated, but the elimination did not influence the results. BMI squared and LOWESS (locally weighted scatterplot smoothing) regression were compared and used to describe the nonlinearity between variables . The data were analyzed using SPSS for Windows, version 18.0 . P-values < 0.05 indicated statistical significance in all tests.
The Ethics Committee of the Hospital for Children and Adolescents at Helsinki University Central Hospital, Helsinki, Finland approved the study. Letters outlining the nature of the study were sent to the parents or guardians of the under-aged participants. Either the active or passive consent of parents or guardians was obtained. The participants were also requested to provide their own written permission when completing the questionnaires in the study session.
Gender-specific differences in body dissatisfaction and self-esteem scores and body mass index among 1343 adolescent girls and boys
Girls (N = 650)
Boys (N = 693)
BD of EDI
BMI (kg/m 2 )
Linear regression analysis, coefficients, with the Body Dissatisfaction subscale of the Eating Disorder Inventory as the dependent variable among 1343 adolescent girls and boys
Unique proportion of the variance
Girls (N = 650)
Boys (N = 693)
Self-reported eating habits among 1343 adolescent girls and boys
As hypothesized and consistently with previous studies, the girls were less satisfied with their bodies than boys were with theirs [4, 7, 8]. On closer examination, the girls expressed the greatest satisfaction with their bodies when they were underweight. The girls who were overweight or of normal weight expressed lower body satisfaction. This finding is in line with previous research documenting the impact of a greater body mass on body dissatisfaction in adolescent girls [6, 8, 24]. Interestingly, a recent study indicated that body satisfaction was protective against increased body mass, even among girls who were overweight. Findings such as this point to the importance of helping adolescent girls, regardless of their size, to develop a positive sense of their bodies .
In some previous studies among adolescent boys, the relationship between body dissatisfaction and body mass has been described to be quadratic, which indicates that boys express most dissatisfaction with their bodies when they are either below or above average weight and most satisfaction when they are of average weight [4, 14]. We also found a significant quadratic component, but LOWESS regression described the nonlinearity better. In fact, the curve had an inverse L-shape, indicating that body dissatisfaction was related to being overweight or obese, but not to being underweight. Age does not explain the difference, since a quadratic component has been described in both younger and older boys than those of our sample [4, 14]. However, cultural norms might give an explanation for this difference: a muscular male body ideal may not be strong enough to cause body dissatisfaction in Finnish underweight boys in transition from early to mid-adolescence. This hypothesis should, however, be tested in future studies.
As hypothesized, self-esteem and body dissatisfaction were negatively correlated in both genders, but the correlation was stronger among the girls. From the perspective of clinical work, the findings highlight the importance of strengthening the self-esteem of adolescents expressing abnormal eating, which in turn may reduce their body dissatisfaction and consequently lower the risk of developing clinical eating disorders .
A normal eating pattern was significantly more prevalent among the boys than the girls in our study, which is in line with the fact that both clinical eating disorders and subclinical eating pathology are typically problems of young females [44, 45]. The relationship between eating habits and body dissatisfaction was found in both genders, but, as hypothesized, it was stronger among the girls. In line with two previous studies, the adolescents self-reporting abnormal eating habits were less satisfied with their bodies than those describing normal eating habits [25, 26]. We found that the girls and boys reporting abnormal eating showed higher BMI values than adolescents self-reporting normal eating. According to a previous follow-up study among adolescents, dieting and unhealthy weight control behaviours predicted greater body mass increases in females and males, as compared with cases with no such behaviour. Associations were found in both overweight and non-overweight participants . Research is needed to assess whether helping adolescents substitute dieting and unhealthy weight control behaviours with healthier behavioural patterns results in long-term improvements in weight status .
The prevalence of overweight and obesity in adolescence has been reported to vary between 10 % and 20 % in most European countries, and consistently with this was approximately 11 % among the girls and 15 % among the boys in the present study [47, 48]. Our results were also in accordance with the findings of a study on a nationally representative sample of Finnish 14-year-old girls and boys . In both the national study and the present investigation, overweight and obesity appeared to be more prevalent among boys than girls.
The strength of the present study was its scale covering 24 secondary schools in the city of Helsinki. The overall participation rate of the present study was approximately 60 %. A traditional nationwide school survey carried out biannually in Finnish comprehensive schools (grades 8th and 9th) with the same data collection method has repeatedly reported a participation rate of approximately 80 % . Consequently, the participation rate of the present study cannot be regarded as excellent or good, but we consider it acceptable. Unfortunately, we were unable to specify any attributes of the dropout group. Nonetheless, it is possible that the adolescents with the most marked eating problems might have refused to participate in the study because the study methodology included weight measurements performed by school nurses. The BMI values used in the present study were calculated from measurements taken by professional school nurses rather than self-reported values, as self-reported data are known to underestimate the prevalence of being overweight .
The body dissatisfaction subscale of the EDI was used to measure body dissatisfaction in this study. It is a widely used questionnaire for both girls and boys. However, it does not contain questions about the desire to be bigger, which is a factor relevant to some adolescent boys [12, 15]. For this reason, it has been speculated that the EDI is perhaps not an ideal measure to examine the correlates of the desire to gain weight . Nevertheless, there is evidence of its usefulness in scoring body dissatisfaction in boys [31, 52, 53]. One must bear in mind that the assessment of the eating habits was self-reported and limited to one question. Consequently, such data do not necessarily reflect actual eating behaviours but subjective ideas or memories of eating habits. However, Keski-Rahkonen et al. have previously used the same question with same response options in their large study on Finnish twins . Also, the number of underweight boys was small and the results must be interpreted with caution.
Body mass, self-esteem and eating habits revealed a significant relationship with body dissatisfaction in the transitional phase from early to mid-adolescence in girls and boys, but significant gender differences were also found.
The authors thank Erkki Komulainen, M.A., Ph.D., for statistical advice. This study was supported by the Foundation of Pediatric Research, the Gyllenberg Foundation, the Children’s Castle Foundation, the Finnish Association of Adolescent Psychiatry, and the Finnish Psychiatric Association.
- Richter SK: Overview of normal adolescent development. Handbook of child and adolescent psychiatry, Volume 3. Adolescence: development and syndromes. Edited by: Noshpitz JD (editor-in-chief), Flaherty LT, Sarles RM. 1997, John Wiley & Sons, New York, 15-25.Google Scholar
- Sarles RM: Encounter with new body changes. Handbook of child and adolescent psychiatry, Volume 3. Adolescence: development and syndromes. Edited by: Noshpitz JD (editor-in-chief), Flaherty LT, Sarles RM. 1997, John Wiley & Sons, New York, 43-51.Google Scholar
- Garner DM: Eating Disorder Inventory-2. Professional Manual. 1991, Psychological Assessment Resources, Odessa, FloridaGoogle Scholar
- Presnell K, Bearman SK, Stice E: Risk factors for body dissatisfaction in adolescent boys and girls: a prospective study. Int J Eat Disord. 2004, 36: 389-401.View ArticlePubMedGoogle Scholar
- Neumark-Sztainer D, Story M, Hannan PJ, Perry C, Irving LM: Weight-related concerns and behaviors among overweight and nonoverweight adolescents. Implications for preventing weight-related disorders. Arch Ped Adolesc Med. 2002, 156: 171-178.View ArticleGoogle Scholar
- Stice E, Whitenton K: Risk factors for body dissatisfaction in adolescent girls: a longitudinal investigation. Dev Psychol. 2002, 38: 669-678.View ArticlePubMedGoogle Scholar
- Rosenblum GD, Lewis M: The relations among body image, physical attractiveness, and body mass in adolescence. Child Dev. 1999, 70: 50-64.View ArticlePubMedGoogle Scholar
- Jones DC: Body image among adolescent girls and boys: a longitudinal study. Dev Psychol. 2004, 40: 823-835.View ArticleGoogle Scholar
- Graber JA, Brooks-Gunn J, Paikoff RL, Warren MP: Prediction of eating problems: an 8- year study of adolescent girls. Dev Psychol. 1994, 30: 823-834.View ArticleGoogle Scholar
- Cohane GH, Pope HG: Body image in boys: a review of the literature. Int J Eat Disord. 2001, 29: 373-379.View ArticlePubMedGoogle Scholar
- McCabe MP, Ricciardelli LA: Body image dissatisfaction among males across the lifespan: a review of past literature. J Psychosom Res. 2004, 56: 675-685.View ArticlePubMedGoogle Scholar
- Labre MP: Adolescent boys and the muscular male body ideal. J Adolesc Health. 2002, 30: 233-242.View ArticlePubMedGoogle Scholar
- Lawler M, Nixon E: Body dissatisfaction among adolescent boys and girls: the effects of body mass, peer appearance culture and internalization of appearance ideals. J Youth Adolescence. 2011, 40: 59-71.View ArticleGoogle Scholar
- Austin SB, Haines J, Veugelers PJ: Body satisfaction and body weight: gender differences and sociodemographic determinants. BMC Publ Health. 2009, 9: 313-View ArticleGoogle Scholar
- Furnham A, Calnan A: Eating disturbance, self-esteem, reasons for exercising and body weight dissatisfaction in adolescent males. Eur Eat Disorders Rev. 1998, 6: 58-72.View ArticleGoogle Scholar
- Rosenberg M: Society and adolescent self-image. 1965, Princeton University Press, PrincetonView ArticleGoogle Scholar
- Frost J, McKelvie S: Self-esteem and body satisfaction in male and female elementary school, high school, and university students. Sex Roles. 2004, 51: 45-54.View ArticleGoogle Scholar
- Sahlstein E, Allen M: Sex differences in self-esteem: a meta-analytic assessment. Interpersonal communication research: advances through meta-analysis. Edited by: Allen M, Preiss RW, Gayle BM, Burrell NA. 2002, Lawrence Erlbaum Associates, Mahwah, 59-72.Google Scholar
- French SA, Story M, Perry CL: Self-esteem and obesity in children and adolescents: a literature review. Obes Res. 1995, 3: 479-490.View ArticlePubMedGoogle Scholar
- Wardle J, Cooke L: The impact of obesity on psychological well-being. Best Pract Res Clin Endoc Metab. 2005, 19: 421-440.View ArticleGoogle Scholar
- Tiggemann M: Body dissatisfaction and adolescent self-esteem: prospective findings. Body Image. 2005, 2: 129-135.View ArticlePubMedGoogle Scholar
- Pesa JA, Syre TR, Jones E: Psychosocial differences associated with body weight among female adolescents: the importance of body image. J Adolesc Health. 2000, 26: 330-337.View ArticlePubMedGoogle Scholar
- van den Berg PA, Mond J, Eisenberg M, Ackard D, Neumark-Sztainer D: The link between body dissatisfaction and self-esteem in adolescents: similarities across gender, age, weight status, race/ethnicity, and socioeconomic status. J Adolesc Health. 2010, 47: 290-296.View ArticlePubMedPubMed CentralGoogle Scholar
- Paxton SJ, Eisenberg ME, Neumark-Sztainer D: Prospective predictors of body dissatisfaction in adolescent girls and boys: a five-year longitudinal study. Dev Psychol. 2006, 42: 888-899.View ArticlePubMedGoogle Scholar
- Johnson F, Wardle J: Dietary restraint, body dissatisfaction, and psychological distress: a prospective analysis. J Abnorm Psychol. 2005, 114: 119-125.View ArticlePubMedGoogle Scholar
- Stice E, Shaw HE: Role of body dissatisfaction in the onset and maintenance of eating pathology, A synthesis of research findings. J Psychosom Res. 2002, 53: 985-993.View ArticlePubMedGoogle Scholar
- Carlat DJ, Camargo CA: Review of bulimia nervosa in males. Am J Psychiatry. 1991, 148: 831-843.View ArticlePubMedGoogle Scholar
- Garner DM, Olmstead MP, Polivy J: Development and validation of a multidimensional eating disorder inventory for anorexia nervosa and bulimia. Int J Eat Disord. 1983, 2: 15-34.View ArticleGoogle Scholar
- Crowther JH, Lilly RS, Crawford PA, Shepherd KL: The stability of the Eating Disorder Inventory. Int J Eat Disord. 1992, 12: 97-101.View ArticleGoogle Scholar
- Leung F, Wang J, Tang CW: Psychometric properties and normative data of the Eating Disorder Inventory among 12 to 18 year old Chinese girls in Hong Kong. J Psychosom Res. 2004, 57: 59-66.View ArticlePubMedGoogle Scholar
- Spillane NS, Boerner LM, Anderson KG, Smith GT: Comparability of the Eating Disorder Inventory-2 between women and men. Assessment. 2004, 11: 85-93.View ArticlePubMedGoogle Scholar
- Pietrobelli A, Faith MS, Allison DB, Gallagher D, Chiumello G, Heymsfield SB: Body mass index as a measure of adiposity among children and adolescents: a validation study. J Pediatr. 1998, 132: 204-210.View ArticlePubMedGoogle Scholar
- Cole TJ, Bellizzi MC, Flegal KM, Dietz WH: Establishing a standard definition for child overweight and obesity worldwide: international survey. Br Med J. 2000, 320: 1240-1243.View ArticleGoogle Scholar
- Wei Y, Pere A, Koenker R: Body mass index reference curves for Finnish girls and boys.Childhood obesity. Current care guideline. 2005, http://www.kaypahoito.fi/xmedia/extra/hoi/hoi50034a.pdf, http://www.kaypahoito.fi/xmedia/extra/hoi/hoi50034b.pdf Google Scholar
- Schmitt DP, Allik J: Simultaneous administration of the Rosenberg Self-Esteem Scale in 53 nations: exploring the universal and culture-specific features of global self-esteem. J Pers Soc Psychol. 2005, 89: 623-642.View ArticlePubMedGoogle Scholar
- Abell SC, Richards MH: The relationship between body shape satisfaction and self- esteem: an investigation of gender and class differences. J Youth Adolesc. 1996, 25: 691-703.View ArticleGoogle Scholar
- Fleming JS, Courtney BE: The dimensionality of self-esteem: II. Hierarchical facet model for revised measurement scales. J Pers Soc Psychol. 1984, 46: 404-421.View ArticleGoogle Scholar
- Cohen J: A power primer. Psychol Bul. 1992, 112: 155-159.View ArticleGoogle Scholar
- van der Kooij AJ: Prediction accuracy and stability of regression with optimal scaling transformations. Doctoral thesis. Leiden, Leiden University: Child & Family Studies and Data Theory (AGP-D), Department of Education and Child Studies, Faculty of Social and Behavioral Sciences. 2007Google Scholar
- Cleveland WS, Devlin SJ: Locally weighted regression: an approach to regression analysis by local fitting. J Am Stat Ass. 1988, 83: 596-610.View ArticleGoogle Scholar
- Pallant J: SPSS Survival manual. A step by step guide to data analysis using SPSS program. 2010, Open University Press, Maidenhead, 4Google Scholar
- van den Berg P, Neumark-Sztainer D: Fat´n happy 5 years later: is it bad for overweight girls to like their bodies?. J Adolesc Health. 2007, 41: 415-417.View ArticlePubMedGoogle Scholar
- O’Dea JA: Evidence for a self-esteem approach in the prevention of body image and eating problems among children and adolescents. Eat Dis. 2004, 12: 225-239.View ArticleGoogle Scholar
- Neumark-Sztainer D: Weight-related behaviors among adolescent girls and boys, Results from a national survey. Arch Pediatr Adolesc Med. 2000, 154: 569-577.View ArticlePubMedGoogle Scholar
- Chamay-Weber C, Narring F, Michaud P-A: Partial eating disorders among adolescents: a review. J Adolesc Health. 2005, 37: 417-427.View ArticlePubMedGoogle Scholar
- Neumark-Sztainer D, Wall M, Story M, Standish AR: Dieting and unhealthy weight control behaviors during adolescence: associations with 10-year changes in body mass index. J Adolesc Health. 2012, 50: 80-86.View ArticlePubMedGoogle Scholar
- Lissau I, Overpeck MD, Ruan WJ, Due P, Holstein BE, Hediger ML, the Health Behaviour in School-aged Children Obesity Working Group, the Health Behaviour in School-aged Children Obesity Working Group: Body mass index and overweight in adolescents in 13 European countries, Israel, and the United States. Arch Pediatr Adolesc Med. 2004, 158: 27-33.View ArticlePubMedGoogle Scholar
- Lobstein T, Frelut M-L: Prevalence of overweight among children in Europe. Obes Rev. 2003, 4: 195-200.View ArticlePubMedGoogle Scholar
- Kautiainen S, Rimpelä A, Vikat A, Virtanen SM: Secular trends in overweight and obesity among Finnish adolescents in 1977–1999. Int J Obes. 2002, 26: 544-552.View ArticleGoogle Scholar
- School health promotion study (in Finnish). [http://www.info.stakes.fi/kouluterveyskysely]
- Sherry B, Jefferds ME, Grummer-Strawn LM: Accuracy of adolescent self-report of height and weight in assessing overweight status. A literature review. Arch Pediatr Adolesc Med. 2007, 161: 1154-View ArticlePubMedGoogle Scholar
- Shore RA, Porter JE: Normative and reliability data for 11 to 18 year olds on the Eating Disorder Inventory. Int J Eat Disord. 1990, 9: 201-207.View ArticleGoogle Scholar
- Machado PP, Gonçalves S, Martins C, Soares IS: The Portuguese version of Eating Disorder Inventory: evaluation of its psychometric properties. Eur Eat Disorders Rev. 2001, 9: 43-52.View ArticleGoogle Scholar
- Keski-Rahkonen A, Bulik CM, Neale BM, Rose RJ, Rissanen A, Kaprio J: Body dissatisfaction and drive for thinness in young adult twins. Int J Eat Disord. 2005, 37: 188-199.View ArticlePubMedGoogle Scholar
- The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-244X/12/35/prepub