1. Introduction
obesity, weight loss, adiposity, eating disorder
OBESITY, CHILDHOOD OBESITY, OBESE, CHILDHOOD OBESITY, ADIPOSITY
Besides genetic factors and energy-related behaviors, psycho-cultural factors are also important in obesity etiology. Previous studies have suggested that improving body image might be an effective method for managing body weight. Thus, this study aimed to evaluate the effects of a multifaceted intervention on the body image of children and explore whether body image played a mediating role in changes in adiposity indicators. This study was embedded in a cluster randomized controlled trial, involving 1287 children from 24 primary schools in three cities in China (Beijing, Changzhi and Urumqi). The 9-month multifaceted intervention on childhood obesity included five components (three targeted children and two targeted environments), and randomization was performed by an independent person who was blinded to the schools. Two indicators (body size perception and body size expectation) were chosen to characterize body image and were measured by Ma figural stimuli at baseline and the end of the trial. Changes in body image indicators were classified as conducive to weight loss or not. Other anthropometric measures and self-reported behaviors were also collected at both time points. Generalized linear mixed models were used in the analyses. Compared to the controls (Childhood obesity is a global health problem. The number of obese children and adolescents around the world has increased ten-fold in the past four decades from 1975 to 2016 [Besides genetic factors and energy-related behaviors (like diet, sedentary time and physical exercise), psycho-cultural factors are also important in obesity etiology [Previous studies have shown that the negative subjective evaluations or experiences of one’s physical appearance may increase the risk of unhealthy behaviors, such as a sedentary lifestyle and eating disorder [The Diet, Exercise and Cardiovascular Health—Children (DECIDE-Children) program was a cluster randomized clinical trial for a multifaceted intervention, including five components targeting three levels of children, school and family. A total of 1392 children from 24 primary schools across three socioeconomically distinct regions in China participated in the intervention. During the intervention, children were helped to establish a positive body image using health education activities, regular weight monitoring and receiving feedback. Our primary study showed that the DECIDE-Children program was effective in reducing BMI and the prevalence of obesity [Based on the data from DECIDE-Children program, this study mainly had two objectives. Firstly, we evaluated the effect of an intervention on the improvement in children’s body image. And then we analyzed the mediating role of the changes in body image between the intervention and the changes in adiposity indicators, in order to provide scientific evidence for incorporating body image in a multifaceted intervention in the future.