北市高中學生身體質量指數之改變對其生理及心理指標之影響

Impacts of changes of body mass index on psychological and physical condition -- Investigation on overweight high school students in Taipei

廖盈婷(Ying-Ting Liao)

指導教授 ： 陳怡樺

臺北醫學大學/公共衛生暨營養學院/公共衛生學研究所/碩士(2010年)

https://doi.org/10.6831/TMU.2010.00209

摘要

世界衛生組織(WHO)指出，從1980年代開始，許多歐洲國家的肥胖盛行率已增加三倍之多，WHO也提出警告：肥胖是一種疾病，且全球肥胖人口急遽增加，已經成為一種新的流行病，台灣同樣也面臨肥胖的威脅，不論是成人、青少年及兒童均有極高的肥胖盛行率，讓我們不能忽視的是其背後帶來可能的心理及生理上的疾病。
特別需要關注的就是青少年時期，因為肥胖兒童變成肥胖成人的機率有二分之一，但肥胖青少年變成肥胖成人的機率卻佔了四分之三，且台灣十大死因中，與肥胖相關之疾病就佔了六項，顯見青少年肥胖問題若不及時控制極可能在未來成為國家嚴重的醫療負擔。
本研究研究目的(一)了解北市過重肥胖高中生之前測、後測與後後測的體重狀態、心理行為及生理之分布。(二) 探討台北市肥胖及過重高中生身體質量指數變化後，其心理指標(如憂鬱、自尊等)在後測及後後測之改變。(三) 探討台北市肥胖及過重高中生身體質量指數變化後，其生理指標(如血壓、血糖等)在後測之改變。在台灣，相關研究多數為橫斷式研究，本研究利用前、後測以及後後測來看過重或肥胖之高中生，其BMI下降後，是否進一步影響到其生理以及心理行為指標。
本研究以臺北市政府衛生局98年度研究計畫「台北市立高中學生體重控制介入成效及其相關生理心理指標改變與影響」資料進行分析。該計畫針對六所社區高中，依學校意願選擇過重與肥胖組學生共100名於2009年4月參與為期12週的整合型介入方案，本研究選取這100名過重與肥胖學生，進行前測與短期三個月後測之體檢資料(含體重、血壓及抽10c.c.的血液進行血脂、血糖測定)測量。另外，上述兩個時間點，同樣也進行結構式問卷(含生活型態、憂鬱、身體意象等)測量，並於中期八個月後後測增加一次結構式問卷測量，以比較三次之差異。
本研究短期以身體質量指數(BMI)下降2%作為切點，中期則以BMI下降3%為切點，短期分(1) 「ΔBMI21＜-2%」組 ，(2) 0%＞ΔBMI21≧-2%組 ，(3) 「ΔBMI21≧0%」組；中期則分(4) 「ΔBMI31＜-3%」組，(5) 0%＞ΔBMI31≧-3%組 ，(6) 「ΔBMI31≧0%」組，各三組，針對身體質量指數下降不同之幅度之各組別，探討其在生理與心理各項指標之改變情形。本研究利用配對T檢定進行各組內研究分析，探討各變項在三次測量時間之差異；另外，透過one way ANOVA探討各組間之差異。
在身體質量指數(Body Mass index，BMI)下降之後，本研究發現短期三個月，憂鬱、自尊與身體意象各組間並沒有顯著差異，但男高中生中減重效果較好的「ΔBMI21＜-2%」組(53.31±11.989 mg/dL)相較於減重沒成效的「ΔBMI21≧0%」組(44.24±6.53 mg/dL)，其高密度脂蛋白膽固醇顯著較高(P＝0.024);而在中期八個月內，本研究發現，「ΔBMI31≧0%」組自尊顯著下降(P＜0.05)、 女高中生「ΔBMI31＜-3%」組之憂鬱顯著較「0%＞ΔBMI31≧-3%」組低且也顯著較「ΔBMI31≧0%」組低(P＝0.009)。
本研究發現對男高中生短期體重介入，可改善其部分生化值，中期透過減重介入可改善女高中生之憂鬱傾向，未來研究建議在觀察時間上可拉長，並酌加質性調查，更能看出當中對青少年影響之脈絡，有鑒於部份過重、肥胖青少年生化值已出現異常，本研究建議對於青少年肥胖問題必須持續關注。

關鍵字

青少年 ； 肥胖 ； 過重 ； 憂鬱 ； 自尊 ； 血壓 ； 減重

並列摘要

The World Health Organization (WHO) indicated that the prevalence of obesity has tripled in many European countries since 1980s. As the world's obese population has increased drastically, the WHO warns that obesity is a disease and has become a new epidemic illness worldwide. In Taiwan, the threats of obesity expand across lifespan, including childhood, adolescence, and adulthood.
Childhood obesity frequently persists into adulthood, with up to 42-63% of obese children and 80% of obese adolescents being reported to become obese adults. This is of great concern, given that many adverse effects on health are already found in obese adolescents, including physical (e.g., hypertension, type 2 diabetes) and psychosocial (e.g., depression) problems. As obesity has contributed to substantial medical burden and to many of the top ten causes of death, there is an imperative need to address the problem on adolescent obesity.
The purpose of this study was (1) to explore the distributions of weight status and psychological and physical conditions among overweight and obese high school students in Taipei across three different time points (i.e., Wave I (baseline), Wave II (3 months later), and Wave III (8 months later)); (2) to explore the effects of weight loss on the consequent change of psychological conditions in Wave II and Wave III; (3) to explore the effects of weight loss on the consequent change of physical conditions in Wave II. To the best of our knowledge, most of the previous reserches on adolescent weight loss in Taiwan were cross-sectional. Our study was designed to collect information on three time points to investigate if weight loss could improve both psychological and physical conditions on adolescents.
A total of 100 overweight and obese students who participated in the research project of “the Effectiveness of an Integrated Weight Management Intervention and its Consequences on Related Physical and Mental Indices for Taipei Municipal High School Students” starting from April, 2009 (Wave I) were recruited in our study. These students were selected among six municipal senior high schools in Taipei.
Three assessments of structured questionnaires (e.g., lifestyle, depression, and body image) and two measures of physical and laboratory examinations (e.g., weight, blood pressure, and 10c.c. blood for blood lipid and blood sugar measurements) were implemented at different time points. In addition, the change of body mass index (ΔBMI), the independent variable, was calculated. For the comparison between Wave I and Wave II status, we used 2% as a cut-off point (i.e., categorized into three groups of ΔBMI21＜-2%, 0%＞ΔBMI21≧-2%, and ΔBMI21≧0%), while for the comparison between Wave I and Wave III status, we used 3% as a cut-off point (i.e., categorized into three groups of ΔBMI31＜-3%, 0%＞ΔBMI31≧-3%, and ΔBMI31≧0%). The pair-T test ,one-way ANOVA and χ2 were adopted for analysis.
For the comparison between Wave I and Wave II status, we found that (1) there was no significant difference on psychological conditions within and between groups; (2) there was significant improvement on high density lipoprotein cholesterol (HDL-C) among male students. Specifically, the group of “ΔBMI21＜-2% (53.31±11.989 mg/dL)” is better than the group of ΔBMI21≧0% (44.24±6.53 mg/dL; P＝0.024).
For the comparison between Wave I and Wave III status, we found that (1) the group of “ΔBMI31≧0%” displayed significantly lower self-esteem. (P＜0.05); (2) among female students, students in the group of “ΔBMI31＜-3%” reported significantly lower scores on depression, compared to those in the group of “0%＞ΔBMI31≧-3%” and “ΔBMI31≧0%” (P＝0.009).
In conclusion, for male students with weight loss in about 3 months, the HDL-C might be improved accordingly. On the other hand, for female students with weight loss in about 8 months, depressive scores might be improved. It might be helpful to conduct longer-term intervention and qualitative researches in the future to further address the effects of change of weight status on the consequent modification of physical and psychological conditions among adolescents. Because abnormal biochemical values were observed on some of these obese students, the design and administration of the prevention and intervention programs on adolescent obesity have remained a major public health issue to concern for.

並列關鍵字

adolescent ； obesity ； overweight ； depression ； self-esteem ； blood pressure ； weight loss

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