Document Type

Theses, Ph.D


Available under a Creative Commons Attribution Non-Commercial Share Alike 4.0 International Licence


Health policy and services

Publication Details

Successfully submitted for the award of Doctor of Philosophy (Ph.D) to the Technological University Dublin, 2002.


OBJECTIVE: To establish the prevalence of fear of fatness (the desire to be thinner) and associated factors, including obesity, reported energy, iron and folate intakes. The difficulties in defining overweight among Irish children and an assessment of dietary and socio-economic factors related to dental caries and also reported in the group. METHODS: A one-year follow up study of 251 healthy schoolchildren at baseline (119 boys and 132 girls; mean age 11 years) attending 7 fee-paying (6 single- and 1-mixed sex) and 8 non-fee-paying (4 single- and 4 mixed-sex) schools in Dublin city center. Assessment of body image perceptions and satisfaction (using figure line drawings) and toothbrushing habits were reported in questionnaires specifically designed for this study. Nutrient intakes and the amount and frequency of cariogenic foods were estimated from two-day food diaries kept on two occasions over a three-week period. Weight, height, triceps and subscapular skinfolds were measured and used in several definitions of overweight, which include Body Mass Index and Actual Relative Weight cut-offs. RESULTS: Significantly more girls than boys (39% vs. 17%) and more overweight children were affected by fear of fatness. Girls were twice as likely as boys to report trying to lose weight (42% vs. 20% at baseline, and 41% vs. 21% at follow up). Overweight (BMI≥26kg/m2) has increased 5-fold among boys and 2.5-fold among girls over the last ten years. The prevalence of overweight differed by 9% at baseline and 8% as follow up depending upon which method of weight status was used. A high prevalence of under-reporting energy intake (39% at baseline and 50% at follow up) was found and associated with a desire to be thinner and with being overweight. Further, a substantial number of schoolchildren, especially girls, reported iron and folate intakes below the estimated average requirements but low tissue stores of iron (7% of boys and 8% of girls at baseline; 3% of boys and 15% of girls at follow up and folate (0% of boys and 1% of girls at baseline; nobody at follow up) did not relate to the reported low intakes. Social disadvantage emerged as a more important predictor than dietary factors of low iron stores among girls only and of high dental caries among all children. CONCLUSIONS: Fear of fatness was particularly prevalent among young Irish adolescent girls and was found to be associated with systematic under-reporting of energy intakes. The prevalence of overweight has increased dramatically over the past ten years and a standard method of assessment is urgently needed for evaluation of obesity prevention initiatives among Irish schoolchildren. The discrepancy between apparently low iron and folate intakes and sufficient actual tissue stores highlights the importance of including an independent measure of reported energy validity when assessing the reported diets of adolescents. Nonetheless, those children with low iron stores are likely to have reduced concentration levels adversely affecting academic progress. They are also at risk of iron deficiency anaemia, thus representing a serious public health concern.