A cross-sectional study examining self-reported anthropometric measurements with adolescents' nutrition attitudes, obesity awareness and diet quality indices during the pandemic

Published:February 16, 2022DOI:


      • 37.7% of the adolescents had an overweight person in their family and 28.5% considered themselves overweight.
      • A negative relationship was found between adolescents’ measurements and their nutrition attitudes and obesity awareness
      • A negative relationship was found between adolescents’ measurements and their nutrition attitudes and obesity awareness.



      The purpose of this study is to evaluate the relationship between adolescents' nutritional attitudes, obesity awareness, and diet quality with their self-reported anthropometric measurements taken during the COVID-19 pandemic.

      Design and methods

      This cross-sectional type of study was conducted in a district in the south of Turkey. The research was carried out online with 907 adolescents who agreed to participate voluntarily.


      Among the adolescents, 28.5% considered themselves overweight, and 32.1% were currently trying to lose weight. According to BMI, 16.1% were affected by overweight/obesity. Adolescents' nutritional attitudes and obesity awareness levels were moderate, while their KIDMED nutritional habits were also moderate. In this study, a negative relationship was found between the adolescents' ASHN mean scores and their body weight, waist circumference, hip circumference, neck circumference, waist/hip ratio and waist/height ratio measurements; and between their OAS mean scores and their body weight, waist circumference, waist/hip ratio and waist/height ratio measurements; and between their KIDMED index scores and their waist/height ratio measurements (p < 0.001).


      The rate of adolescents who perceive themselves as overweight is higher than the results obtained from the measurement values. BMI levels and other anthropometric measurement values of adolescents with positive nutrition attitudes and physical activity behaviours are also positively affected.

      Practice implications

      This study may have a significant impact on the formulation and implementation of interventions to prevent obesity and increase physical activity for school health nurses. Since the pandemic is still continuing, healthcare providers must stress the risk of obesity in adolescence.


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        • Allen A.
        Effects of educational intervention on children's knowledge of obesity risk factors (Doctoral dissertation).
        (Retrieved from:)
        • Ammar A.
        • Brach M.
        • Trabelsi K.
        • Chtourou H.
        • Boukhris O.
        • Masmoudi L.
        • Hoekelmann A.
        Effects of COVID-19 home confinement on physical activity and eating behaviour preliminary results of the ECLB-COVID19 international online-survey.
        Nutrients. 2020; 12: 1583
        • Arouca A.
        • Moreno L.A.
        • Gonzalez-Gil E.M.
        • Marcos A.
        • Widhalm K.
        • Molnár D.
        • Michels N.
        Diet as moderator in the association of adiposity with inflammatory biomarkers among adolescents in the HELENA study.
        European Journal of Nutrition. 2019; 58: 1947-1960
        • Bacopoulou F.
        • Landis G.
        • Rentoumis A.
        • Tsitsika A.
        • Efthymiou V.
        Mediterranean diet decreases adolescent waist circumference.
        European Journal of Clinical Investigation. 2017; 47: 447-455
        • Baddou I.
        • El Hamdouchi A.
        • El Harchaoui I.
        • Benjeddou K.
        • Saeid N.
        • Elmzibri M.
        • Aguenaou H.
        Objectively measured physical activity and sedentary time among children and adolescents in Morocco: A cross-sectional study.
        BioMed Research International. 2018; 2018: 1-7
        • Banik R.
        • Naher S.
        • Pervez S.
        • Hossain M.M.
        Fast food consumption and obesity among urban college going adolescents in Bangladesh: A cross-sectional study.
        Obesity Medicine. 2020; 17: 100161
        • Banna M.H.A.
        • Brazendale K.
        • Hasan M.
        • Khan M.S.I.
        • Sayeed A.
        • Kundu S.
        Factors associated with overweight and obesity among Bangladeshi university students: A case–control study.
        Journal of American College Health. 2020; : 1-7
        • Baydemir C.
        • Ozgur E.G.
        • Balci S.
        Evaluation of adherence to Mediterranean diet in medical students at Kocaeli University, Turkey.
        Journal of International Medical Research. 2018; 46 ( 1585-1594
        • Bolton K.A.
        • Jacka F.
        • Allender S.
        • Kremer P.
        • Gibbs L.
        • Waters E.
        • de Silva A.
        The association between self-reported diet quality and health-related quality of life in rural and urban Australian adolescents.
        Australian Journal of Rural Health. 2016; 24: 317-325
        • Bujtor M.
        • Turner A.I.
        • Torres S.J.
        • Esteban-Gonzalo L.
        • Pariante C.M.
        • Borsini A.
        Associations of dietary intake on biological markers of inflammation in children and adolescents: A systematic review.
        Nutrients. 2021; 13: 356
        • Çağiran Y.F.
        • Çağiran D.
        • Özçelik A.Ö.
        Adolescent obesity and its association with diet quality and cardiovascular risk factors.
        Ecology of Food and Nutrition. 2019; 58: 207-218
        • Cardel M.I.
        • Atkinson M.A.
        • Taveras E.M.
        • Holm J.C.
        • Kelly A.S.
        Obesity treatment among adolescents: A review of current evidence and future directions.
        JAMA Pediatrics. 2020; 174: 609-617
        • Demir G.T.
        • Cicioğlu H.İ.
        Attitude scale for healthy nutrition (ASHN): Validity and reliability study.
        Gaziantep Üniversitesi Spor Bilimleri Dergisi. 2019; 4: 256-274
        • Esteban-Gonzalo L.
        • Turner A.I.
        • Torres S.J.
        • Esteban-Cornejo I.
        • Castro-Piñero J.
        • Delgado-Alfonso Á.
        • Veiga Ó.L.
        Diet quality and well-being in children and adolescents: The UP&DOWN longitudinal study.
        British Journal of Nutrition. 2019; 121: 221-231
        • Giménez-Legarre N.
        • Flores-Barrantes P.
        • Miguel-Berges M.L.
        • Moreno L.A.
        • Santaliestra-Pasías A.M.
        Breakfast characteristics and their association with energy, macronutrients, and food intake in children and adolescents: A systematic review and meta-analysis.
        Nutrients. 2020; 12: 2460
        • Gümüş A.B.
        • Yardımcı H.
        The evaluation of adherence to mediterranean diet among students by their habits of main meal consumption outside the home and anthropometric measurements.
        Sted/Sürekli Tıp Eğitimi Dergisi. 2019; 28: 397-403
        • Haines J.
        • Haycraft E.
        • Lytle L.
        • Nicklaus S.
        • Kok F.J.
        • Merdji M.
        • Hughes S.O.
        Nurturing Children’s healthy eating: Position statement.
        Appetite. 2019; 137: 124-133
        • Hamulka J.
        • Wadolowska L.
        • Hoffmann M.
        • Kowalkowska J.
        • Gutkowska K.
        Effect of an education program on nutrition knowledge, attitudes toward nutrition, diet quality, lifestyle, and body composition in polish teenagers. The ABC of healthy eating project: Design, protocol, and methodology.
        Nutrients. 2018; 10: 1439
        • Hossain M.M.
        • Sultana A.
        • Purohit N.
        Mental health outcomes of quarantine and isolation for infection prevention: A systematic umbrella review of the global evidence.
        Epidemiology and Health. 2020; 42 (Article e2020038)
        • Hu Z.
        • Lin X.
        • Kaminga A.C.
        • Xu H.
        Impact of the COVID-19 epidemic on lifestyle behaviors and their association with subjective well-being among the general population in mainland China: Cross-sectional study.
        Journal of Medical Internet Research. 2020; 22 (Article e21176)
        • Jiao W.Y.
        • Wang L.N.
        • Liu J.
        • Fang S.F.
        • Jiao F.Y.
        • Pettoello-Mantovani M.
        • Somekh E.
        Behavioral and emotional disorders in children during the COVID-19 epidemic.
        The Journal of Pediatrics. 2020; 221: 264-266.e1
        • Kabaran S.
        • Gezer C.
        Determination of the Mediterranean diet and the obesity status of children and adolescents in Turkish republic of northern Cyprus.
        Turkish Journal of Pediatric Disease. 2013; 1: 11-20
        • Kafkas M.
        • Özen G.
        The Turkish adaptation of the obesity awareness scale: A validity and reliability study.
        İnönü Üniversitesi Beden Eğitimi ve Spor Bilimleri Dergisi. 2014; 1: 1-15
        • Kartal F.T.
        • Burnaz N.A.
        • Yaşar B.
        • Sağlam S.
        • Kıymaz M.
        Investigation of the effect of nutrition knowledge levels of adolescents on their nutritional and exercising habits.
        CBÜ Beden Eğitimi ve Spor Bilimleri Dergisi. 2019; 14: 280-295
        • Keeley B.
        • Little C.
        • Zuehlke E.
        The state of the world’s children 2019. Children, food and nutrition: Growing well in a changing world.
        United Nations Children’s Fund, New York2019 (Retrieved from:)
        • Khan M.A.
        • Smith J.E.M.
        “Covibesity,” a new pandemic.
        Obesity Medicine. 2020; 19: 100282
        • Koca T.
        • Akcam M.
        • Serdaroglu F.
        • Dereci S.
        Breakfast habits, dairy product consumption, physical activity, and their associations with body mass index in children aged 6–18.
        European Journal of Pediatrics. 2017; 176: 1251-1257
        • Kutlu N.
        • Ekın M.M.
        • Aslıhan A.L.A.V.
        • Ceylan Z.
        • Meral R.
        A research on determining the change in the nutritional habit of ındividuals during the covid-19 pandemic period.
        International Journal of Social, Political and Economic Research. 2021; 8: 173-187
        • Lee J.
        Mental health effects of school closures during COVID-19.
        The Lancet Child & Adolescent Health. 2020; 4: 421
        • Marques A.
        • de Matos M.G.
        Trends in prevalence of overweight and obesity: Are Portuguese adolescents still increasing weight?.
        International Journal of Public Health. 2016; 61: 49-56
        • Mattioli A.V.
        • Pinti M.
        • Farinetti A.
        • Nasi M.
        Obesity risk during collective quarantine for the COVID-19 epidemic.
        Obesity Medicine. 2020; 20: 100263
        • Ministry of Health
        What is covid-19?.
        (Accessed May 24, 2020)
        • Moitra P.
        • Madan J.
        • Verma P.
        Impact of a behaviourally focused nutrition education intervention on attitudes and practices related to eating habits and activity levels in Indian adolescents.
        Public Health Nutrition. 2021; 24: 2715-2726
        • Naja F.
        • Hamadeh R.
        Nutrition amid the COVID-19 pandemic: A multi-level framework for action.
        European Journal of Clinical Nutrition. 2020; 74: 1117-1121
        • Ostachowska-Gasior A.
        • Piwowar M.
        • Kwiatkowski J.
        • Kasperczyk J.
        • Skop-Lewandowska A.
        Breakfast and other meal consumption in adolescents from southern Poland.
        International Journal of Environmental Research and Public Health. 2016; 13: 453
        • Özkan İ.
        • Adıbelli D.
        • İlaslan E.
        • Taylan S.
        Relationship between body mass ındex and obesity awareness of university students.
        Acıbadem Üniversitesi Sağlık Bilimleri Dergisi. 2020; 11: 120-126
        • Paakkari L.
        • Torppa M.
        • Mazur J.
        • Boberova Z.
        • Sudeck G.
        • Kalman M.
        • Paakkari O.
        A comparative study on adolescents’ health literacy in europe: Findings from the HBSC study.
        International Journal of Environmental Research and Public Health. 2020; 17: 3543
        • Qiu J.
        • Shen B.
        • Zhao M.
        • Wang Z.
        • Xie B.
        • Xu Y.
        A nationwide survey of psychological distress among Chinese people in the COVID-19 epidemic: Implications and policy recommendations.
        General Psychiatry. 2020; 33 (Article e100213)
        • Ribeiro K.D.D.S.
        • Garcia L.R.S.
        • Dametto J.F.D.S.
        • Assunção D.G.F.
        • Maciel B.L.L.
        COVID-19 and nutrition: The need for initiatives to promote healthy eating and prevent obesity in childhood.
        Childhood Obesity. 2020; 16: 235-237
        • Schneider B.C.
        • Dumith S.D.C.
        • Lopes C.
        • Severo M.
        • Assunção M.C.F.
        How do tracking and changes in dietary pattern during adolescence relate to the amount of body fat in early adulthood?.
        PLoS One. 2016; 11 (Article e0149299)
        • Serra-Majem L.
        • Ribas L.
        • Ngo J.
        • Ortega R.M.
        • García A.
        • Pérez-Rodrigo C.
        • Aranceta J.
        Food, youth and the Mediterranean diet in Spain. Development of KIDMED, Mediterranean diet quality index in children and adolescents.
        Public Health Nutrition. 2004; 7: 931-935
        • Silva F.A.
        • Candiá S.M.
        • Pequeno M.S.
        • Sartorelli D.S.
        • Mendes L.L.
        • Oliveira R.
        • Cândido A.P.C.
        Daily meal frequency and associated variables in children and adolescents.
        Jornal de Pediatria. 2017; 93: 79-86
        • Stavridou A.
        • Kapsali E.
        • Panagouli E.
        • Thirios A.
        • Polychronis K.
        • Bacopoulou F.
        • Tsitsika A.
        Obesity in children and adolescents during COVID-19 pandemic.
        Children. 2021; 8: 135
        • Todisco P.
        • Donini L.M.
        Eating disorders and obesity (ED&O) in the COVID-19 storm.
        Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity. 2021; 26: 747-750
        • Winpenny E.M.
        • van Sluijs E.M.
        • White M.
        • Klepp K.I.
        • Wold B.
        • Lien N.
        Changes in diet through adolescence and early adulthood: Longitudinal trajectories and association with key life transitions.
        International Journal of Behavioral Nutrition and Physical Activity. 2018; 15: 1-9
        • World Health Organization
        Stay physically active during self-quarantine.
        (Retrieved from:)
        • World Health Organization
        Coronavirus disease (COVID-19) pandemic.
        (Retrieved from:)
        • World Health Organization
        Obesity and overweight.
        (Retrieved from:)
        • Yuce G.E.
        • Muz G.
        Effect of COVID-19 pandemic on adults’ dietary behaviors, physical activity and stress levels.
        Cukurova Medical Journal. 2021; 46: 283-291
        • Zhu N.
        • Zhang D.
        • Wang W.
        • Li X.
        • Yang B.
        • Song J.
        • China Novel Coronavirus Investigating and Research Team
        A novel coronavirus from patients with pneumonia in China, 2019.
        New England Journal of Medicine. 2020; 382: 727-733