Introduction

Obesity is a systemic, chronic and multifactorial disease, characterized by the abnormal or excessive accumulation of fat in the body, caused by lifestyles, genetics, and environmental conditions¹. It is also determined by factors such as globalization, education, culture, economy, urbanization and sociopolitical environment. The latter ones are easily adaptable during childhood, but they may develop multiple chronic diseases with risk factors such as genetics, sedentary lifestyle, poor diet, among others, ².

In the world, obesity affects more than 3.5 million children and adolescents. Mexico ranks second with 32.4%³. And in Nuevo León, 33% of the 18-year-old population is obese⁴. A BMI greater than 30 (obesity) is a risk determinant for a large number of chronic diseases, such as diabetes, cancer and cardiovascular diseases⁵. The World Health Organization estimates that 58% of all cases of diabetes and 42% of certain cancers are attributable to a high body mass index⁶.

Obesity is influenced by lifestyles, but also by its relationship with society, since people may discriminate other due to their weight. Nowadays there is a relationship between the functional and psychological aspects of adolescents, causing problems such as anxiety, depression, social isolation, and low self-esteem. These as result of discrimination, which may occur as consequence of obesity in the different stages of life^{2,7 8}.

Attitudes refer to general evaluations where people highlight the favorable and unfavorable aspects of people. Faced with obesity, the main attitudes manifested by adolescents are those of rejection or disinterest, in accordance with the perception they present or to the assessment that they provide to themselves⁹. Perception is the assessment that an individual makes from the information received through his senses such as sight and hearing, together with those cultural and social factors learned from childhood. Perception has an influence on psychological and physical factors⁸.

The socio-cultural context is a factor that has an influence on people, accepting aesthetic preferences determined by culture, perceptions and opinions, based on physical characteristics. In this sense, the discrimination and prejudice generated toward people with obesity are in constant increase within society, school and work environment, and in general within interpersonal relationships, causing lack of healthcare¹⁰.

All this previously described context helped to consider the following objective, to identify the attitude and perception toward obesity in adolescents.

Material and Methods

Descriptive-discursive study of integrative review prepared in the guide The Preferred Reporting Items for Systematic Review and Meta-Analy sis Protocols (PRISMA-P) 2015. Basic articles were included, aimed at assessing the attitude and perception of obesity in adolescents. The inclusion criteria were articles published in some journal, in Spanish and English, within 2010 - 2019. The search period was from August 2019 to December 2019.

The resolution method was through critical reading, in which the problem of interest and clear and precise definition of the objective were sought. The study methodology was analyzed in depth in order to determine its quality, mainly in the material and methods section, as well as the conclusion in accordance to the results of the analysis. The sources consulted included the following databases: SciELO, Redalyc, ScienceDirect, Google Scholar, Ebsco, and Conricyt. For the search DeCS descriptors were used, namely, Attitude, Adolescent, Perception, Obesity, Chronic Disease, Schoolchildren, Social environment, and Nursing as well as the Boolean operators AND, OR, NOT. Filters used to contextualize the search: Research areas such as Attitude, Adolescent, Perception, and Obesity.

In order to organize the selected articles, the Mendeley bibliographic manager was used. In a search made through the databases 649 articles were found in the SciELO library, 987,254 in Redalyc, 3,701in ScienceDirect, 28,200 in Ebsco, 2,772 in Conrycit, and 50,600 in Google Scholar, thus, obtaining a total of 1,073,176 articles.

Subsequently, the titles were read and the abstracts were reviewed, from which repeated researches that did not meet the search descriptors and inclusion criteria were not selected. Such selection process was carried out through a critical and comprehensive reading of each paper, in which ten articles were relevant figure 1.

Figure1.  Search results by descriptor and database. Source: self made 

Results

The search gave a total of 1,073,176 quotations, considering the inclusion criteria of the 459 remaining references selected through title reading, of which 102 were selected in order to read their abstracts; by means of a review of duplicate articles, of which 10 full-text quotations were chosen and located to evaluate their methodological quality. And finally, for their systematic review.

The flow diagram shows the variables that characterize the articles analyzed. The results are presented in a discursive and discussed way with the integration of the different studies by means of cores that relate to each fragment with what is stated in the objective of this review.

Table 1 summarizes the results of the attitude and perception of obesity in adolescents, considering the following items: country, year, results obtained, among other data. Of the selected articles, four belong to Mexico, three are from Spain, one from Peru, one from India and one from Jordan. According to the language, seven are in Spanish and three in English, in relation to the year of publication four are from 2018, three from 2016, one from 2013 and two from 2012.

All the articles analyzed were descriptive, with populations from 80 to 1000 surveyed users; the most used instruments were the Attitude toward Obesity (AFA, Anti-fat Attitudes Questionnaire), beliefs about the obese people scale (BAOP) as well as instruments validated by the author, in relation to the statistical program, most articles were worked on the SPSS, in its different versions.

Most articles analyzed evidenced that adolescents have a negative attitude toward obesity, and the perception they present is also negative since they feel rejected by society, which is identified as a serious psychosocial problem, and also as a risk factor, since they consider that it affects their body and their physical activity, as well as the image that others have about them¹¹.

Attitudes refer to general evaluations made to people to determine if their attitudes are favorable or unfavorable, a result of the objects and people of their social environment. In relation to the attitudes toward obesity and overweight that are related to negative beliefs and exaggerated insistence on the importance of the physical appearance and therefore people’s perception¹¹.

Discussion

In relation to the articles found, these denoted many of the beliefs, stereotypes and attitudes toward obesity that people have ingrained due to cultural, psychological, social, etc., beliefs. In most of the studies a negative perception toward obese people was identified, but positive within the psychological factor.

A greater relevance of negative attitude was identified. Pastor and Bonilla²² mentioned that there are disapproved attitudes toward the person, whether verbally or not, in order to achieve social approval based on stereotypes and on the demand of projecting a beautiful and thin image to society.

The results report that negative attitudes affect women, mostly due to the fact that they are more concerned than men about their aesthetics, either by aesthetic patterns as a reflection of cultural valúes. According to Sampedro et. Al²³, they identified that the advertising media have a great impact on women so that they worry more about their body weight and about developing an aesthetic figure.

The discrimination and stigmatization that society develops toward overweight or obese people have an influence on many areas. Prejudices toward obesity require raising awareness and educating the population to change their perspective and ideology about their psychosocial factor, thus promoting tolerance. Puhl, Latner, O’Brien, Luedicke, Forhan and Danielsdottir²⁴ found similar data in their study identifying discrimination and social stigmatization which mainly affect people who are overweight or obese.

Ramos et al. ²⁵ found that the perception that someone has about his or her body is of great importance to be able to respond to the body perception that he or she has, classifying it from very low to very high. Body image is a determining factor in today’s society and it has a big impact on the psychosocial response that is shown to people.

Conclusión

The results found in this study reflect the importance of working on psychological factors in adolescents, since the majority of them show a negative perception and a rejection attitude. Influencing them will prevent the increase in bulling rates or even suicides, main consequences of obesity.

The promotion and implementation of physical activities within universities could be an important factor to foster physical activities and sports. It is necessary to increase awareness, since the percentage of obese people is increasing and a strategy to decrease such increase would be the modification of negative attitudes in this age group.