Association between lifestyle-related, psychosocial factors and obesity among female adolescents in Taiwan

  • Pei-Ching Liu
    Corresponding author at: National Yang Ming Chiao Tung University, College of Nursing, Department of Nursing, No. 155, Sec. 2, Linong St., Beitou Dist., Taipei City 112304, Taiwan.
    Assistant Professor, Department of Nursing, College of Nursing, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St., Beitou Dist., Taipei City 112304, Taiwan
    Search for articles by this author
  • Yu-Cheng Lin
    MD, PhD, Department of Pediatrics, Far Eastern Memorial Hospital, No.21, Sec. 2, Nanya S. Rd., Banciao Dist., New Taipei City 220216, Taiwan

    Associate Professor, School of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St., Beitou Dist., Taipei City 112304, Taiwan
    Search for articles by this author
  • Bih-Shya Gau
    Associate Professor, School of Nursing, College of Medicine, National Taiwan University, No. 1, Sec. 1, Ren'ai Rd., Zhongzheng Dist., Taipei City 100233, Taiwan
    Search for articles by this author
  • Heng-Hsin Tung
    Professor, Department of Nursing, College of Nursing, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St., Beitou Dist., Taipei City 112304, Taiwan.
    Search for articles by this author
  • Sophia H. Hu
    Professor, Department of Nursing, College of Nursing, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St., Beitou Dist., Taipei City 112304, Taiwan.
    Search for articles by this author
  • Chi-Wen Chen
    Professor, Department of Nursing, College of Nursing, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St., Beitou Dist., Taipei City 112304, Taiwan.
    Search for articles by this author
Published:November 22, 2022DOI:


      • There is a dearth of research focused on overweight female adolescents and correlates contributing to their obesity.
      • This study depicted a wide spectrum of potential correlates associated with obesity exclusively among female adolescents.
      • Multicomponent interventions targeting female adolescents are encouraged to alleviate their obesity-related health burden.



      To examine a wide range of potential contributors to the risk of obesity in female adolescents.

      Design and methods

      Data for this study were collected using a cross-sectional design. A group of 175 female adolescents were recruited, and information on their demographic characteristics, lifestyle-related behaviors, and psychosocial factors was collected using a self-administered questionnaire during September 2018 to January 2019. Data were analyzed using SPSS 24.0.


      An overestimation of body weight was negatively correlated with overweight in the female adolescents. Age at menarche was negatively correlated with the arisk of overweight. Adolescents who slept for >7 h on weekend nights were less likely to be overweight. Eating more cheese, fish, seafood, and organ meats was negatively correlated with obesity risk. The female adolescents were more likely to become overweight if they ate dinners prepared by family and experienced more disturbances from parents and other family members.


      Female adolescents are a unique population affected by obesity. Although incorporating both lifestyle-related behavioral and psychosocial factors in future investigations and developing multicomponent interventions for obesity prevention are crucial, female adolescents should receive the utmost attention from researchers to alleviate the health burden of obesity.

      Practice implications

      The intertwined nature of obesity-related factors warrants future investigations to elaborate their roles interplaying with the risk of obesity. Multicomponent interventions should be developed, and nurses and health-care providers should target their efforts on obesity prevention for this specific population.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


        • Alberga A.S.
        • Sigal R.J.
        • Goldfield G.
        • Prud’homme D.
        • Kenny G.P.
        Overweight and obese teenagers: Why is adolescence a critical period?.
        Pediatric Obesity. 2012; 7: 261-273
        • Armstrong B.
        • Westen S.C.
        • Janicke D.M.
        The role of overweight perception and depressive symptoms in child and adolescent unhealthy weight control behaviors: A mediation model.
        Journal of Pediatric Psychology. 2013; 39: 340-348
        • Berge J.M.
        • Wall M.
        • Hsueh T.F.
        • Fulkerson J.A.
        • Larson N.
        • Neumark-Sztainer D.
        The protective role of family meals for youth obesity: 10-year longitudinal associations.
        The Journal of Pediatrics. 2015; 166: 296-301
        • Biehl A.
        • Hovengen R.
        • Grøholt E.K.
        • Hjelmesæth J.
        • Strand B.H.
        • Meyer H.E.
        Parental marital status and childhood overweight and obesity in Norway: A nationally representative cross-sectional study.
        BMJ Open. 2014; 4e004502
        • Bleich S.N.
        • Vercammen K.A.
        • Zatz L.Y.
        • Frelier J.M.
        • Ebbeling C.B.
        • Peeters A.
        Interventions to prevent global childhood overweight and obesity: A systematic review.
        The Lancet Diabetes & Endocrinology. 2018; 6: 332-346
        • Blodgett Salafia E.H.
        • Schaefer M.K.
        • Haugen E.C.
        Connections between marital conflict and adolescent girls’ disordered eating: Parent–adolescent relationship quality as a mediator.
        Journal of Child and Family Studies. 2014; 23: 1128-1138
        • Bronfenbrenner U.
        Basic concepts.
        in: The ecology of human development: Experiments by nature and design. Harvard University Press, 1979: 16-42
        • Costigan S.A.
        • Barnett L.
        • Plotnikoff R.C.
        • Lubans D.R.
        The health indicators associated with screen-based sedentary behavior among adolescent girls: A systematic review.
        Journal of Adolescent Health. 2013; 52: 382-392
        • Currie C.
        • Gabhainn S.
        • Godeau E.
        • Roberts C.
        • Smith R.
        • Currie D.
        Inequalities in children’s health: HBSC international report from the 2005/2006 survey World Health Organization.
        World Health Organization, Geneva2008
        • Cuypers K.
        • Kvaløy K.
        • Bratberg G.
        • Midthjell K.
        • Holmen J.
        • Holmen T.L.
        Being normal weight but feeling overweight in adolescence may affect weight development into young adulthood—An 11-year followup: The HUNT study, Norway.
        Journal of Obesity. 2012; 2012601872
        • Dalton 3rd, W.T.
        • Wang L.
        • Southerland J.L.
        • Schetzina K.E.
        • Slawson D.L.
        Self-reported versus actual weight and height data contribute to different weight misperception classifications.
        Southern Medical Journal. 2014; 107: 348-355
        • Darling K.E.
        • Ruzicka E.B.
        • Fahrenkamp A.J.
        • Sato A.F.
        Perceived stress and obesity-promoting eating behaviors in adolescence: The role of parent-adolescent conflict.
        Families, Systems & Health. 2019; 37: 62-67
        • Davison K.K.
        • Birch L.L.
        Childhood overweight: A contextual model and recommendations for future research.
        Obesity Reviews. 2001; 2: 159-171
        • De Vriendt T.
        • Clays E.
        • Maes L.
        • De Bourdeaudhuij I.
        • Vicente-Rodriguez G.
        • Moreno L.A.
        • Group, O. B. O. T. H. S
        European adolescents’ level of perceived stress and its relationship with body adiposity—The HELENA study.
        European Journal of Public Health. 2011; 22: 519-524
        • Dimitratos S.M.
        • Swartz J.R.
        • Laugero K.D.
        Pathways of parental influence on adolescent diet and obesity: A psychological stress-focused perspective.
        Nutrition Reviews. 2022; 80: 1800-1810
        • Duong H.T.
        • Roberts R.E.
        Perceived weight in youths and risk of overweight or obesity six years later.
        Journal of Psychosomatic Research. 2014; 76: 23-27
        • FAO
        Minimum dietary diversity for women.
        Food and Agriculture Organization of the United Nations, 2021
        • Fatima Y.
        • Doi S.A.R.
        • Mamun A.A.
        Longitudinal impact of sleep on overweight and obesity in children and adolescents: A systematic review and bias-adjusted meta-analysis.
        Obesity Reviews. 2015; 16: 137-149
        • Fredrickson J.
        • Kremer P.
        • Swinburn B.
        • de Silva A.
        • McCabe M.
        Weight perception in overweight adolescents: Associations with body change intentions, diet and physical activity.
        Journal of Health Psychology. 2015; 20: 774-784
        • Fulkerson J.A.
        • Larson N.
        • Horning M.
        • Neumark-Sztainer D.
        A review of associations between family or shared meal frequency and dietary and weight status outcomes across the lifespan.
        Journal of Nutrition Education and Behavior. 2014; 46: 2-19
        • Fulkerson J.A.
        • Story M.
        • Neumark-Sztainer D.
        • Rydell S.
        Family meals: Perceptions of benefits and challenges among parents of 8-to 10-year-old children.
        Journal of the American Dietetic Association. 2008; 108: 706-709
        • Gau B.S.L.
        • Liu P.C.H.
        Chronic conditions in childhood obesity subject: A mixed methods research approach.
        Ministry of Science and Technology, 2013
        • Gillman M.W.
        • Rifas-Shiman S.L.
        • Frazier A.L.
        • Rockett H.R.
        • Camargo Jr., C.A.
        • Field A.E.
        • Colditz G.A.
        Family dinner and diet quality among older children and adolescents.
        Archives of Family Medicine. 2000; 9: 235-240
        • Glanz K.
        • Metcalfe J.J.
        • Folta S.C.
        • Brown A.
        • Fiese B.
        Diet and health benefits associated with in-home eating and sharing meals at home: A systematic review.
        International Journal of Environmental Research and Public Health. 2021; 18: 1577
        • Goisis A.
        • Özcan B.
        • Van Kerm P.
        Do children carry the weight of divorce?.
        Demography. 2019; 56: 785-811
        • Goldhaber-Fiebert J.D.
        • Rubinfeld R.E.
        • Bhattacharya J.
        • Robinson T.N.
        • Wise P.H.
        The utility of childhood and adolescent obesity assessment in relation to adult health.
        Medical Decision Making. 2013; 33: 163-175
        • Gordon-Larsen P.
        • Nelson M.C.
        • Popkin B.M.
        Longitudinal physical activity and sedentary behavior trends: Adolescence to adulthood.
        American Journal of Preventive Medicine. 2004; 27: 277-283
        • Guthold R.
        • Stevens G.A.
        • Riley L.M.
        • Bull F.C.
        Global trends in insufficient physical activity among adolescents: A pooled analysis of 298 population-based surveys with 1·6 million participants.
        The Lancet Child & Adolescent Health. 2020; 4: 23-35
        • Hales C.M.
        • Fryar C.D.
        • Carroll M.D.
        • Freedman D.S.
        • Ogden C.L.
        Trends in obesity and severe obesity prevalence in US youth and adults by sex and age, 2007-2008 to 2015-2016.
        JAMA. 2018; 319: 1723-1725
        • Hallal P.C.
        • Andersen L.B.
        • Bull F.C.
        • Guthold R.
        • Haskell W.
        • Ekelund U.
        Global physical activity levels: Surveillance progress, pitfalls, and prospects.
        The Lancet. 2012; 380: 247-257
        • Haynes A.
        • Kersbergen I.
        • Sutin A.
        • Daly M.
        • Robinson E.
        A systematic review of the relationship between weight status perceptions and weight loss attempts, strategies, behaviours and outcomes.
        Obesity Reviews. 2018; 19: 347-363
        • Herva A.
        • Laitinen J.
        • Miettunen J.
        • Veijola J.
        • Karvonen J.T.
        • Läksy K.
        • Joukamaa M.
        Obesity and depression: Results from the longitudinal northern Finland 1966 birth cohort study.
        International Journal of Obesity (2005). 2006; 30: 520-527
        • Himes J.H.
        • Hannan P.
        • Wall M.
        • Neumark-Sztainer D.
        Factors associated with errors in self-reports of stature, weight, and body mass index in Minnesota adolescents.
        Annals of Epidemiology. 2005; 15: 272-278
        • Hirshkowitz M.
        • Whiton K.
        • Albert S.M.
        • Alessi C.
        • Bruni O.
        • DonCarlos L.
        • Ware J.C.
        National sleep foundation’s updated sleep duration recommendations: Final report.
        Sleep Health. 2015; 1: 233-243
        • Hsu Y.W.
        • Liou T.H.
        • Liou Y.M.
        • Chen H.J.
        • Chien L.Y.
        Measurements and profiles of body weight misperceptions among Taiwanese teenagers: A national survey.
        Asia Pacific Journal of Clinical Nutrition. 2016; 25: 108-117
        • Iannotti R.J.
        • Wang J.
        Patterns of physical activity, sedentary behavior, and diet in US adolescents.
        Journal of Adolescent Health. 2013; 53: 280-286
        • Jasik C.B.
        • Lustig R.H.
        Adolescent obesity and puberty: The “perfect storm”.
        Annals of the New York Academy of Sciences. 2008; 1135: 265-279
        • Khambalia A.
        • Hardy L.L.
        • Bauman A.
        Accuracy of weight perception, life-style behaviours and psychological distress among overweight and obese adolescents.
        Journal of Paediatrics and Child Health. 2012; 48: 220-227
        • Kim S.
        • So W.Y.
        Prevalence and sociodemographic trends of weight misperception in Korean adolescents.
        BMC Public Health. 2014; 14: 452
        • Klein E.G.
        • Lytle L.A.
        • Chen V.
        Social ecological predictors of the transition to overweight in youth: Results from the Teens eating for energy and nutrition at schools (TEENS) study.
        Journal of the American Dietetic Association. 2008; 108: 1163-1169
        • Kontostoli E.
        • Jones A.P.
        • Pearson N.
        • Foley L.
        • Biddle S.J.H.
        • Atkin A.J.
        Age-related change in sedentary behavior during childhood and adolescence: A systematic review and meta-analysis.
        Obesity Reviews. 2021; 22e13263
        • Koplan J.P.
        • Liverman C.T.
        • Kraak V.I.
        Preventing childhood obesity: Health in the balance: Executive summary.
        Journal of the American Dietetic Association. 2005; 105: 131-138
        • Leech R.M.
        • McNaughton S.A.
        • Timperio A.
        The clustering of diet, physical activity and sedentary behavior in children and adolescents: A review.
        International Journal of Behavioral Nutrition and Physical Activity. 2014; 11: 4
        • Leme A.C.B.
        • Thompson D.
        • Lenz Dunker K.L.
        • Nicklas T.
        • Tucunduva Philippi S.
        • Lopez T.
        • Baranowski T.
        Obesity and eating disorders in integrative prevention programmes for adolescents: Protocol for a systematic review and meta-analysis.
        BMJ Open. 2018; 8e020381
        • Liechty J.M.
        • Lee M.J.
        Body size estimation and other psychosocial risk factors for obesity onset among US adolescents: Findings from a longitudinal population level study.
        International Journal of Obesity. 2015; 39: 601-607
        • Mannan M.
        • Mamun A.
        • Doi S.
        • Clavarino A.
        Prospective associations between depression and obesity for adolescent males and females: A systematic review and meta-analysis of longitudinal studies.
        PLoS One. 2016; 11e0157240
        • Marmorstein N.R.
        • Iacono W.G.
        • Legrand L.
        Obesity and depression in adolescence and beyond: Reciprocal risks.
        International Journal of Obesity (2005). 2014, Jul; 38: 906-911
        • Mauskopf S.S.
        • O’Leary A.K.
        • Banihashemi A.
        • Weiner M.
        • Cookston J.T.
        Divorce and eating behaviors: A 5-day within-subject study of preadolescent obesity risk.
        Childhood Obesity. 2015; 11: 122-129
        • Moreno L.A.
        • Rodríguez G.
        • Fleta J.
        • Bueno-Lozano M.
        • Lázaro A.
        • Bueno G.
        Trends of dietary habits in adolescents.
        Critical Reviews in Food Science and Nutrition. 2010; 50: 106-112
        • Mozaffarian D.
        Dietary and policy priorities for cardiovascular disease, diabetes, and obesity.
        Circulation. 2016; 133: 187-225
        • NCD Risk Factor Collaboration
        Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: A pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults.
        Lancet (London, England). 2017; 390: 2627-2642
        • Nelson M.C.
        • Neumark-Stzainer D.
        • Hannan P.J.
        • Sirard J.R.
        • Story M.
        Longitudinal and secular trends in physical activity and sedentary behavior during adolescence.
        Pediatrics. 2006; 118: e1627-e1634
        • Neumark-Sztainer D.
        • Hannan P.J.
        • Story M.
        • Croll J.
        • Perry C.
        Family meal patterns: Associations with sociodemographic characteristics and improved dietary intake among adolescents.
        Journal of the American Dietetic Association. 2003; 103: 317-322
        • Neumark-Sztainer D.
        • MacLehose R.
        • Loth K.
        • Fulkerson J.A.
        • Eisenberg M.E.
        • Berge J.
        What’s for dinner? Types of food served at family dinner differ across parent and family characteristics.
        Public Health Nutrition. 2014; 17: 145-155
        • Ng M.
        • Fleming T.
        • Robinson M.
        • Thomson B.
        • Graetz N.
        • Margono C.
        • Abera S.F.
        Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: A systematic analysis for the global burden of disease study 2013.
        The Lancet. 2014; 384: 766-781
        • Ni Y.L.
        • Chang J.H.
        • Chen L.H.
        Investigating the relationship between district-level socioeconomic status and individual obesity in Taiwanese adolescents: A large-scale cross-sectional analysis.
        Scientific Reports. 2019; 9: 2928
        • Oken E.
        Maternal and child obesity: The causal link.
        Obstetrics and Gynecology Clinics. 2009; 36: 361-377
        • Park E.
        Overestimation and underestimation: Adolescents' weight perception in comparison to BMI-based weight status and how it varies across socio-demographic factors.
        Journal of School Health. 2011; 81: 57-64
        • Park E.
        Overestimation and underestimation: Adolescents' weight perception in comparison to BMI-based weight status and how it varies across socio-demographic factors.
        Journal of School Health. 2011; 81: 57-64
        • Pearson N.
        • Braithwaite R.E.
        • Biddle S.J.
        • van Sluijs E.M.
        • Atkin A.J.
        Associations between sedentary behaviour and physical activity in children and adolescents: A meta-analysis.
        Obesity Reviews. 2014; 15: 666-675
        • Pervanidou P.
        • Chrousos G.P.
        Stress and obesity/metabolic syndrome in childhood and adolescence.
        International Journal of Pediatric Obesity. 2011; 6: 21-28
        • Pursey K.
        • Burrows T.L.
        • Stanwell P.
        • Collins C.E.
        How accurate is web-based self-reported height, weight, and body mass index in young adults?.
        Journal of Medical Internet Research. 2014; 16e4
        • Rajan T.
        • Menon V.
        Psychiatric disorders and obesity: A review of association studies.
        Journal of Postgraduate Medicine. 2017; 63: 182-190
        • Reilly J.J.
        • Kelly J.
        Long-term impact of overweight and obesity in childhood and adolescence on morbidity and premature mortality in adulthood: Systematic review.
        International Journal of Obesity. 2011; 35: 891-898
        • Richmond T.K.
        • Thurston I.B.
        • Sonneville K.R.
        Weight-focused public health interventions—No benefit, some harm.
        JAMA Pediatrics. 2021; 175: 238-239
        • Rollins B.Y.
        • Belue R.Z.
        • Francis L.A.
        The beneficial effect of family meals on obesity differs by race, sex, and household education: The national survey of children’s health, 2003-2004.
        Journal of the American Dietetic Association. 2010; 110: 1335-1339
        • Rosi A.
        • Paolella G.
        • Biasini B.
        • Scazzina F.
        • Alicante P.
        • De Blasio F.
        • Strazzullo P.
        Dietary habits of adolescents living in North America, Europe or Oceania: A review on fruit, vegetable and legume consumption, sodium intake, and adherence to the Mediterranean diet.
        Nutrition, Metabolism, and Cardiovascular Diseases. 2019; 29: 544-560
        • Ruiz L.D.
        • Zuelch M.L.
        • Dimitratos S.M.
        • Scherr R.E.
        Adolescent obesity: Diet quality, psychosocial health, and cardiometabolic risk factors.
        Nutrients. 2020; 12: 43
        • Skinner A.C.
        • Ravanbakht S.N.
        • Skelton J.A.
        • Perrin E.M.
        • Armstrong S.C.
        Prevalence of obesity and severe obesity in US children, 1999-2016.
        Pediatrics. 2018; 141e20173459
        • Stierman B.
        • Afful J.
        • Carroll M.D.
        • Chen T.-C.
        • Davy O.
        • Fink S.
        • Hughes J.P.
        National Health and nutrition examination survey 2017–march 2020 Prepandemic data files development of files and prevalence estimates for selected health outcomes.
        • Sutin A.R.
        • Terracciano A.
        Body weight misperception in adolescence and incident obesity in young adulthood.
        Psychological Science. 2015; 26: 507-511
        • Todd A.S.
        • Street S.J.
        • Ziviani J.
        • Byrne N.M.
        • Hills A.P.
        Overweight and obese adolescent girls: The importance of promoting sensible eating and activity behaviors from the start of the adolescent period.
        International Journal of Environmental Research and Public Health. 2015; 12: 2306-2329
        • Trübswasser U.
        • Verstraeten R.
        • Salm L.
        • Holdsworth M.
        • Baye K.
        • Booth A.
        • Talsma E.F.
        Factors influencing obesogenic behaviours of adolescent girls and women in low- and middle-income countries: A qualitative evidence synthesis.
        Obesity Reviews. 2021; 22e13163
        • US Department of Agriculture and US Department of Health and Human Services
        Dietary guidelines for Americans, 2020–2025.
        9th ed. US Department of Agriculture and US Department of Health and Human Services, 2020
        • Valdés J.
        • Rodríguez-Artalejo F.
        • Aguilar L.
        • Jaen-Casquero M.
        • Royo-Bordonada M.
        Frequency of family meals and childhood overweight: A systematic review.
        Pediatric Obesity. 2013; 8: e1-e13
        • Vandewalle J.
        • Mabbe E.
        • Debeuf T.
        • Braet C.
        • Moens E.
        The daily relation between parental rejection and emotional eating in youngsters: A diary study.
        Frontiers in Psychology. 2017; 8: 691
        • Voelker D.K.
        • Reel J.J.
        • Greenleaf C.
        Weight status and body image perceptions in adolescents: Current perspectives.
        Adolescent Health, Medicine and Therapeutics. 2015; 6: 149-158
        • Wilson S.M.
        • Sato A.F.
        Stress and paediatric obesity: What we know and where to go.
        Stress and Health. 2014; 30: 91-102
        • World Health Organization
        Obesity and overweight.
        World Health Organization, 2020
        • World Health Organization
        World health statistics 2020: Monitoring health for the SDGs, sustainable development goals.
        World Health Organization, 2020
        • Yannakoulia M.
        • Papanikolaou K.
        • Hatzopoulou I.
        • Efstathiou E.
        • Papoutsakis C.
        • Dedoussis G.V.
        Association between family divorce and children’s BMI and meal patterns: The GENDAI study.
        Obesity. 2008; 16: 1382-1387
        • Zhen S.
        • Ma Y.
        • Zhao Z.
        • Yang X.
        • Wen D.
        Dietary pattern is associated with obesity in Chinese children and adolescents: Data from China health and nutrition survey (CHNS).
        Nutrition Journal. 2018; 17: 68