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Abstract

BACKGROUND:

In recent years, plant-based diets and their effects on health have gained attention. This diet has become a preferred dietary style for managing obesity. Weight gain is influenced by various factors, such as low body image perception and obesity prejudice.

OBJECTIVE:

The purpose of the study is to evaluate the prevalence of plant-based diets among female students and their associations with obesity prejudice and body self-perception.

METHODS:

The research was conducted with 450 female university students. The anthropometric measurements were obtained based on self-reporting. the GAMS-27 Obesity Prejudice Scale and the Multidimensional Body-Self Relationship Questionnaire (MBSRQ) were applied to evaluate obesity prejudice and body self-perception, respectively.

RESULTS:

The study found no significant differences in anthropometric measurements between omnivores and vegetarians (p > 0.05). However, 78.6% of the students showed some level of tendency toward prejudice or prejudice against obesity. There was no significant relationship between body weight, BMI, and obesity prejudice in both dietary groups (p > 0.05). Yet, vegetarians had significantly lower mean scores on the MBRSQ, indicating body image dissatisfaction (p < 0.05).

CONCLUSIONS:

While the anthropometric measurement and prejudice against obesity did not yield notable results, significantly lower scores on the MBSRQ indicated greater dissatisfaction with body image in vegetarians.

Keywords

Vegetarianism anthropometric measurements GAMS-27 obesity prejudice scale obesity prejudice Multidimensional Body-Self Relationship Questionnaire (MBSRQ)body self-perception

1 Background

In recent years, attention has been drawn to the impact of plant-based diets on health. In a vegetarian diet, animal-based foods, especially red meat, poultry, and fish, are replaced by grains, legumes, soy, and other plant-based sources [1].

Various forms of vegetarianism have gained popularity recently, each of which can be identified by the specific foods they exclude from their diet [2 –5]. The term ‘vegetarianism’ has been broadened in recent research to encompass subcategories that allow varying amounts of animal product intake. These subcategories include pescovegetarianism [6] (limiting meat consumption to fish and seafood), lacto-ovo-vegetarianism [7] (excluding meat and fish but including eggs and dairy), ovo-vegetarianism [8] (excluding meat, fish, and dairy but permitting eggs), and the flexitarian or semi-vegetarian [9] approach, which is primarily plant-based with occasional inclusion of animal products like meat or fish. This movement also encompasses veganism, which extends its principles beyond food to encompass the avoidance of commercial products like apparel and cosmetics containing animal products. The nutritional diversity of vegan diets comprises grains, legumes (including soy and its variations), vegetables, fruits, nuts, and seeds, as well as plant-based fats [10].

It can be said that India, which is the only country in the world with the highest prevalence (almost 40% of the population) of vegetarianism, contributes to the results of the Asian continent. While the prevalence in Africa and the Middle East is around 16%, it is determined to be 8% in Central and South America. The places where vegetarianism is least seen are North America (about 6% of the population is vegetarian) and Europe (only 5% of the population is vegetarian). According to the literature, the total rate of vegetarians and vegans in Turkey is less than 5%, and the number of vegans is around 80,000 [11]. The prevalence of vegetarian diets is estimated to be around 18% (one and a half billion people) of individuals worldwide, although it is not definitive according to the literature. Of these individuals, 75 million choose to follow a vegetarian diet, while 1,450 million are considered forced vegetarians due to reasons such as health issues [12]. Recent studies have found that the population of vegetarians is approximately 5% in the United States [13] 8% in Canada [14], and 4.3% in Germany [15]. The highest prevalance of vegetarians is found in India, where they make up 30% of the population [16, 17]. 0.7% of the population in Turkey (0.2% male and 1.2% female) prefer a vegetarian diet. Flexitarian, which is preferred by 45% of vegetarians, is the most popular type of vegetarianism.

It has been reported that individuals who follow a vegetarian diet have lower rates of overweight and obesity as well as lower risk of chronic diseases such as heart disease, cancer, and diabetes [18 –21]. These effects could be related to the fact that vegetarian individuals consume more complex carbohydrates, legumes, fruits, and vegetables, all of which are rich in fiber. In addition, it has been reported that high fiber intake is inversely related to feelings of satiety and leads to weight loss [22].

The global prevalence of obesity has increased approximately threefold since 1975. According to data from the World Organization [23], as of 2016, there were at least 1.9 billion overweight individuals aged 18 and over worldwide, and 650 million of them were reported to be obese. According to the latest estimates in European Union countries, between 30% to 70% of adults are affected by overweight, and between 10% to 30% are affected by obesity. The prevalence of obesity in Turkey is 20.5% in males, 41.0% in females, and 30.3% in total [24].

According to research, a relationship has been found between BMI and body image among university students, and this situation has been found to particularly affect eating behaviors and diet choices, especially among female students. Considering that university students, especially girls, frequently follow diets, being vegetarian can be seen as an attempt to control body weight, although it may not be the primary reason for adopting a vegetarian diet [25].

Stigmatization is characterized by assigning an unfavorable label to a situation that an individual might feel ashamed of. This labeling process entails conveying this adverse situation to individuals, leading to their segregation or detachment from society. Stigma encompasses stereotypes, biases, and unjust treatment. In literary contexts, stigmatization and prejudice are often used interchangeably. Prejudice involves forming stereotypes and unfavorable opinions about an individual, while stigmatization involves subjecting an individual to mistreatment and bias due to their actions. Conversely, individuals who experience stigmatization are ostracized or pushed to the fringes of society due to various negative traits [26 –29].

Stigmatization of obese individuals is a prevalent socio-cultural problem. Additionally, obese individuals are often stereotyped as lazy, careless, and low in self-discipline and motivation. In recent years, the frequency of weight-related stigma has increased [30]. Individuals who are overweight or obese also experience the impact of these social stigmas. In such circumstances, psychological shifts can have adverse effects on nutrition treatments. The pervasive influence of social media has notably contributed to the perpetuation of societal prejudice against obesity, thereby exacerbating the stigmatization of overweight individuals. [28].

It has been found that stigma against obesity or negative reactions to overweight and obese individuals have social, psychological, and economic negative effects in many areas of their lives (e.g., workplace, school, family, social environments, and healthcare services). These include negative social outcomes (physical violence and victimization), negative psychological outcomes (body image dissatisfaction and increased risk of depression, etc.), and negative economic outcomes (reduced likelihood of attending university and increased likelihood of being overlooked for employment promotions) [31].

The present study aims to assess vegetarian diet prevalence among young female adults and their relations with obesity prejudice and body self-perception.

2 Material and methods

2.1 Study population

This study was conducted between September 2020 and November 2021 at Başkent University, Turkey, included 450 female university students in the age group 18–32 years (mean age of 22.1±2.88 years) who volunteered to participate in the study. In this research, individuals adhering to a plant-based diet are categorized as the “vegetarians”, while on the other hand, individuals are designated as “omnivores”. This study was approved by Başkent University Institutional Review Board and Ethics Committee.

2.2 Data collection

2.2.1 Questionnaire

The self-reported questionnaire form was designed to assess the students’ general information and anthropometric measurements (gender, age, weight, height, etc.), dietary habits (food and beverage preferences, frequency of nutrient intake, etc.), and obesity prejudice tendencies. Because of the Covid-19 pandemic, the survey was distributed to students online and incompleted ones were excluded.

2.2.2 Anthropometric Measurements

BMI was calculated as body weight divided by height squared (m²); and evaluated according to the classification of the World Health Organization, in which less than 18.49, 18.5 –24.9, 25 –29.9, 30 –34.9, and more than 35.0 kg/m² are considered as underweight, normal weight, overweight and obese respectively [32].

2.2.3 Obesity Prejudice Scale (GAMS-27)

The Obesity Prejudice Scale (GAMS-27), developed and validated by Ercan et al. [33], was used to assess students’ prejudice against obesity. This scale consists of 27 questions and is scored from 1 to 5, ranging from “strongly agree” to “strongly disagree.” The lowest possible score on this scale is 27, and the highest is 135. Based on the total score, individuals can be categorized as having no obesity prejudice (score of 68 or below), having a tendency towards prejudice (score of 68.01–84.99), or being prejudiced (score of 85 or above).

2.2.4 Multidimensional Body-Self Relations Questionnaire (MBSRQ)

In this study, the Multidimensional Body-Self Relations Questionnaire (MBSRQ) was utilized to assess the self-attudinal components of body image perception. Winstead and Cash [34] created the initial scale, which included 140 components. Hovardaoğlu [35] conducted a validity and reliability assessment on the scale utilized in this study in 1993, and the short form with 57 items was employed. The total scale score is the sum of an individual’s scores on the scale’s items. The total score gained from the scale is divided by the total number of items on the scale to yield the item mean score, which is set to range from 1 to 5. A low item mean score implies “body image dissatisfaction".

2.3 Statistical analysis

Statistical analysis was performed using IBM SPSS Statistics (version 19.0 of the SPSS statistical package). Participant numbers (S), percentages (%), the mean and standard deviation ( $\bar{x}$ ±SD) were calculated. Statistical comparisons among groups were conducted using Chi-square, independent sample t-test, and ANOVA, where suitable. Statistically significant results were defined as those with p-values below 0.05 (<0.05) [36].

3 Results

It was found that 13.3% of students were vegetarian, of which % were ovovegetarian, % 0.9 lactovegetarian, % 3.3 lactoovovegatarien, % 0.2 pescovegetarian, % 5.6 vegan, and % 2.2 semi-vegetarian. The mean anthropometric measurements of omnivores and vegatarians were shown in Table 1. The mean body weight was found to be 58.4±9.78 kg for omnivores, 56.3±11.13 kg for vegetarians. The mean height for omnivores and vegetarians were 1.64±0.05 m and 1.63±0.05 m, respectively. The mean BMI for omnivores was 21.6±3.31 kg/m², 20.9±3.32 kg/m² for vegetarians. There was no statistically significant difference in anthropometric measurements between groups (p > 0.05).

Table 1
The mean anthropometric measurements and the distribution of BMI of omnivore and vegetarian females

Omnivores (n: 390) Vegetarians (n: 60)

$\bar{x}$ ±SD $\bar{x}$ ±SD p-value

Weight (kg) 58.4±9.78 56.3±11.13 0.985

Height (m) 1.64±0.05 1.63±0.05 0.823

BMI (kg/m²) 21.6±3.31 20.9±3.32 0.826

BMI Classification S (%) S (%)

Underweight 63(16.1) 14 (23.3) 0.552

Normal weight 268 (68.7) 39 (65.0)

Overweight 50 (12.9) 6 (10.0)

Obese 9 (2.3) 1 (1.0)

	Omnivores (n: 390)	Vegetarians (n: 60)
Weight (kg)	58.4±9.78	56.3±11.13	0.985
Height (m)	1.64±0.05	1.63±0.05	0.823
BMI (kg/m²)	21.6±3.31	20.9±3.32	0.826
BMI Classification	S (%)	S (%)
Underweight	63(16.1)	14 (23.3)	0.552
Normal weight	268 (68.7)	39 (65.0)
Overweight	50 (12.9)	6 (10.0)
Obese	9 (2.3)	1 (1.0)

The mean values and distribution of female’s Obesity Prejudice Scale scores by BMI categories and their diet types were shown in Table 2. According to Obesity Prejudice Scale scores, 22.4% of females were unprejudiced, 56.6% had a tendency towards prejudice and 12.0% were prejudiced. The mean body weights were 59.4±12.13, 57.2±9.08 and 60.6±9.7 7 kg for unprejudiced, tendency toward prejudice, and prejudiced students respectively. The mean heights were 1.64±0.05, 1.63±0.06 and 1.65±0.04 cm for unprejudiced, tendency toward prejudice, and prejudiced students respectively. Additionaly, the mean BMIs for unprejudiced, tendency toward prejudice, and prejudiced students were 21.9±3.96, 21.2±3.05 and 22.1±3.27 kg/m², respectively.

Table 2

Mean anthropometric measurements, BMI and frequency of BMI classifications, diet type according to Obesity Prejudice Scale subgroups

	Obesity Prejudice Scale Subgroups
	Unprejudiced	Tendency	Prejudiced	Total
	(n:101)	Towards	(n:54)	(n:450)	p-value
		Prejudice
		(n:295)
	$\bar{x}$ ±SD	$\bar{x}$ ±SD	$\bar{x}$ ±SD
Weight (kg)	59.4±12.13	57.2±9.08	60.6±9.7 7	58.1±9.99	0.067
Height (m)	1.64±0.05	1.63±0.06	1.65±0.04	1.64±0.05	0.152
BMI (kg/m²)	21.9±3.96	21.2±3.05	22.1±3.27	21.5±3.31	0.177
BMI Classifications	S (%)	S (%)	S (%)	S (%)
Underweight	19 (18.8)	55 (18.6)	3 (5.5)	77 (17.2)	0.092
Normal weight	62 (61.4)	203 (68.8)	42 (77.8)	307 (68.2)
Overweight	15 (14.9)	34 (11.6)	7 (12.9)	56 (12.4)
Obese	5 (4.9)	3 (1.0)	2 (3.8)	10 (2.2)
Diet Type
Omnivore	93 (92.1)	261 (88.5)	36 (66.7)	390 (86.7)	0.424
Vegetarian	8 (7.9)	34 (11.5)	18 (33.3)	60 (13.3)

According to WHO, BMI classification, among unprejudiced students 18.8 % were underweight, 61.4 % were normal weight, 14.9 % were overweight and 4.9 % were obese. On the other hand, among the tended towards prejudice female students, 18.6 % were underweight, 68.8 % were normal, 11.6 % were overweight and 1.0 % were obese. Additionally, 5.5 % of the prejudiced students were underweight, 77.8 % were normal, 12.9 % were overweight and 3.8 % were obese. There were no statistically significant differences in the distribution of BMI categories and the Obesity Prejudice Scale scores (p > 0.05).

Among omnivores females, 20.7 % were unprejudiced, 58.0 % had a tendency towards prejudice, and 8.0 % were prejudiced. Among vegetarian students, 1.7% were unprejudiced, 7.6 % were had a tendency towards prejudice, and 4.0% were prejudiced. There were no significant differences between omnivor and vegetarian students (p > 0.05).

In Table 3 mean MBSRQ scores by diet type of females were shown. The mean MBSRQ score was 3.4±0.40 in total. The mean scores for omnivores and vegetarians were determined as 3.4±0.39 and 3.3±0.46, respectively, with a statistically significant difference between them (p < 0.05).

Table 3

Mean MBSRQ scores according to diet type

	MBSRQ scores		p-value
	$\bar{x}$ ±SD	Min-Max
Diet Type
Omnivores (n: 390)	3.4±0.39	2.18–4.63	0.037 *
Vegetarians (n: 60)	3.3±0.46	1.88–4.49
Total (n: 450)	3.4±0.40	1.88–4.63

* p < 0.05.

The correlation between students’ MBSRQ scores and anthropometric measurements was shown in Table 4. There were statistically significant negative correlations between body weight, BMI and MBSRQ scores (p < 0.05).

Table 4

The correlation between students’ MBSRQ scores and anthropometric measurements

	MBSRQ scores (n: 450)
	r	p-value
Weight (kg)	–0.196	0.000*
Height (m)	0.054	0.252
BMI (kg/m²)	–0.244	0.000*

* p < 0.05.

Findings from the regression analysis shown in Table 5. indicated that vegetarians were 1.19 times more likely to prejudice against obesity than omnivores (p < 0.05). The analysis reveals that being vegetarian has no significant effect on MBSRQ mean scores (p > 0.05).

Table 5

Regression analysis between dietary preferences’ and the Obesity Prejudice Scale and MBSRQ scores

	β	SE	Wald	p	Exp (β)	95% CI
Obesity Prejudice Scale scores	0,177	0,027	41,973	0,000 *	1,193	1,131	1,259
MBSRQ scores	–0,14	0,009	2,544	0,111	0,963	0,969	1,003

* p < 0.05.

4 Discussion

Recently, there has been increasing interest in vegetarianism and its impact on health, both positively and negatively. The primary reasons people choose a vegetarian diet are concern for animals and their rights, individual health, and environmental concerns. This dietary approach is often recommended for weight loss due to its high fiber, low glycemic index and low saturated fatty acid content [1 , 37–41]. Diverse cultures can result in varied perspectives on meat consumption among men and women. Traditional gender roles might influence men to lean towards higher meat intake, while women might be encouraged to reduce their meat consumption. As a result, this could promote a higher inclination among women to adopt plant-based and vegetarian diets [42]. In this study, 13.3 % of the students followed a vegetarian diet. According to TBSA-2017 (Turkey Nutrition and Health Survey-2017), only 0.7% of individuals aged 15 and over preferred a vegetarian diet. Semi-vegetarians account for 45% of vegetarians, while lacto-ovo vegetarians make up 33.4% . Ovo-vegetarians constitute 11.7%, followed by pescetarians at 7.1%, and lacto-vegetarians at 2.8% . When asked about their reasons for adopting a vegetarian lifestyle, 65.7% mention a dislike for meat, 9.5% prioritize animal ethics, 5% consider ecological and environmental factors, 3.1% mention the influence of vegetarian friends or family, and 2.3% cite a desire for improved health and healthier eating habits. In another study, 24.5% of individuals were found to follow a vegetarian diet [43]. The reason why the prevalence of vegetarianism was found to be higher in this study compared to the TBSA-2017 data could be due to the fact that this study was limited to a younger age group.

In this study, the mean BMI of the students was found as 21.5±3.31 kg/m². In the study conducted by Güneş et al. [44], similar to this study, the mean BMI values were found to be 20.2±2.7 kg/m² for female students. In another study, the mean BMI values for female students were 20.9±2.8 kg/m² [45]. Evaluating the anthropometric measurements of the students, weight and BMI were not statistically different between omnivore and vegetarian students. Although there was no statistically significant difference in the body weights of students, it was found to be higher in omnivores. In a study conducted by Karavasiloglou et al. [46], BMI was found to be similar among individuals with different dietary habits, which is similar to the findings in this study.

It has been shown that stigmatization towards obesity has increased in parallel with the increase in obesity prevalence, and simultaneously, prejudice against obesity has been increased among university students. However, it has been observed that obesity prejudice is lower among students with a history of obesity or overweight. In addition, many people may not be aware that they are prejudiced against obesity and describe themselves as unprejudiced [47 –49]. Obesity prejudice is defined as negative stereotypes and attitudes toward an individual manifested through words and/or behaviors [27]. In this study, 65.6 % of the students were found to have a “tendency towards obesity prejudice” and 12.0 % were found to be “prejudiced” against obesity. Obese individuals are exposed to obesity prejudice by society, family, friends, and other individuals throughout their lives, and this situation affects their lives.

The discrimination faced by individuals who are obese or overweight, as well as the negative attitudes towards them, have been shown to impact their lives in several ways. These effects extend to different areas, including their workplaces, schools, families, social circles, and access to healthcare services. The consequences of this stigmatization can be observed in social, psychological, and economic aspects. Socially, individuals may experience physical abuse and victimization. Psychologically, they may develop distorted body image and face an increased risk of depression. Economically, their chances of attending college may decrease, and they may also be more likely to be overlooked for promotions in employment [31]. Although studies have demonstrated the impact of stigma-induced eating disorders on dietary preferences, there is a lack of available studies examining the connection between plant-based diets and prejudice towards obesity and body self-perception. Conversely, although there is no specific research investigating the prejudice against obesity based on body weight and BMI among individuals who follow a vegetarian diet, it has been observed that prejudice against obesity tends to be more pronounced in individuals with lower body weight and BMIs [47 –49]. This finding may be attributed to the inclination or predisposition of vegetarian students to hold prejudices against obesity.

According to this study, the students’ mean MBSRQ scores were considerably lower, indicating body image dissatisfaction. Other research has found that male students have more positive body perceptions than females [50 –54]. In this study, a significant relationship was found between the mean MBSRQ scores and anthropometric measurements. In previous research, significant correlations were found between MBSRQ scores and body weight and BMI values. It was reported that female students were more satisfied with their appearance if they had a thin or normal body weight [55 –57]. In this study, although the mean of BMI was normal, due to the influence of social media and society, students want to be thinner and have more concerns about their appearance. The mean MBRSQ scores were found to be significantly lower in vegetarians compared to omnivores students, indicating the presence of body image dissatisfaction in these students. Despite some research finding no substantial link between a vegetarian diet and body image dissatisfaction or eating disorders [58, 59], vegetarians have a higher risk of body image dissatisfaction [60, 61]. In a similar study conducted in Spain, it was shown that vegetarian students have a higher risk of body image dissatisfaction and eating disorders such as orthorexia nervosa [55]. According to Brytek-Matera [62] study, there was a link between vegetarian diets and having orthorexia. This study, similar to the literature, has demonstrated that those who choose a vegetarian diet have a higher risk of body image dissatisfaction, which could be considered one of the reasons they choose this diet.

As a result of this research, it was found that obesity prejudice is 1.19 times higher among vegetarian students. Furthermore, omnivores were found to have greater body weights despite the fact that there was no statistically significant difference in student body weights. However, as was already indicated, the literature shows that individuals with lower body weight and BMI values have a higher tendency towards obesity prejudice [47 –49]. This can explain why vegetarian students are more prone to or prejudiced against obesity.

Applying a regression analysis might result in a better conclusion by conducting many factors, despite the fact that correlations have varying findings and may seem confusing.

5 Conclusion

In conclusion, the recent surge in interest surrounding vegetarianism has sparked debates regarding its impact on health. People choose plant-based diets for various reasons, including animal welfare, personal health, and environmental concerns. This dietary approach is often recommended for weight loss due to its high fiber, low glycemic index, and low saturated fat content. In this study, although weight and BMI did not significantly differ between omnivore and vegetarian students, the prevalence of prejudice against obesity was high among the participants, affecting their lives and interactions. The study also highlighted body image dissatisfaction among students, with vegetarians displaying a higher risk compared to omnivores. Other research has found similar associations between vegetarianism and body image dissatisfaction or eating disorders. Furthermore, a significant link was found between vegetarian diets and orthorexia in a separate study. The findings suggest that individuals who choose a vegetarian diet may have an increased risk of body image dissatisfaction, which may be a contributing factor to their dietary choice. Interestingly, this study revealed that vegetarian students exhibited a higher tendency towards obesity prejudice, while individuals with a lower body weight and BMI were also more inclined towards such prejudice. This displays the complex relationship between dietary habits, body image, and prejudice against obesity.

So, the study highlights a connection between plant-based diets and obesity prejudice. While there may be some limitations in the research, it provides a solid foundation for future studies in this field. Overall, the findings suggest that further investigation is needed to fully understand the relationship between plant-based diets and obesity prejudice.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Conflict of interest

The authors have no conflict of interest to report.

Ethical consideration

Protocol number is ‘KA20/272’ and the date for Ethical permission is 06/07/2020.

Author Contributions

Aylar Kargar: conceptualisation, formal analysis, writing - review & editing.

Gül Kızıltan: formal analysis, writing - review & editing, supervision.

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Plant-based diets: obesity prejudice and body self-perception relations in young females

Abstract

BACKGROUND:

OBJECTIVE:

METHODS:

RESULTS:

CONCLUSIONS:

Keywords

1 Background

2 Material and methods

2.1 Study population

2.2 Data collection

2.2.1 Questionnaire

2.2.2 Anthropometric Measurements

2.2.3 Obesity Prejudice Scale (GAMS-27)

2.2.4 Multidimensional Body-Self Relations Questionnaire (MBSRQ)

2.3 Statistical analysis

3 Results

5 Conclusion

Funding

Conflict of interest

Ethical consideration

Author Contributions

References