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PubMed1997

Correlation of anthropometric measurements of mothers and their newborns.

This cross-sectional study was designed to assess the influence of the nutritional status of the mother upon the anthropometric measures of their babies. It was conducted at three different hospitals of Dhaka city during a short period of 5 weeks in 1992. One hundred and fifty mothers with their newborns were studied to correlate their anthropometric measurements. Weight, height/length and mid-arm-circumference were measured. The study showed that the correlation between weight of mother and weight of her newborn was stronger than that between heights (length) and mid-arm-circumferences of the mothers and the newborn. Correlation between mid-arm-circumference of mother and newborn was statistically insignificant whereas correlations of other variables were statistically significant. Height of mother and length of newborn daughter were less well correlated than height of mother and length of newborn son which showed relatively significant correlation (p < 0.05). The study indicates that the anthropometric measures of the newborn babies might be an outcome of the nutritional status of the mother.

Adult↗

PubMed2004

Muscle strength in obese elderly women: effect of recreational physical activity in a cross-sectional study.

BACKGROUND: Muscle strength (MS) may be impaired in obese persons, and this impairment may be a consequence of both obesity and low physical fitness. OBJECTIVE: We investigated whether MS differed between obese [body mass index (BMI; in kg/m2 > 29], normal-weight (BMI = 24-29), and lean (BMI < 24) elderly subjects and compared the MS of sedentary and active subjects according to their BMI group. DESIGN: The study included 215 obese [ (+/- SD) age: 80.0 +/- 3.5 y; BMI: 31.9 +/- 2.6], 630 normal-weight (age: 80.2 +/- 3.7 y; BMI: 26.3 +/- 1.4), and 598 lean (age: 80.7 +/- 3.5 y; BMI: 21.6 +/- 1.8) women with good functional ability. A cross-sectional design was used. Anthropometric measures (weight, height); measures of appendicular skeletal muscle mass (by dual-energy X-ray absorptiometry), isometric knee and elbow extension (by statergometer), and isometric handgrip strength (by dynamometer); and data on health status and self-reported recreational physical activity (RPA: walking, gymnastics, cycling, swimming, gardening) were collected. RESULTS: Absolute (unadjusted) MS was higher in obese than in lean women (P < 0.01), except for handgrip strength (P > 0.05). When adjusted for age, height, RPA, pain, depression, and appendicular skeletal muscle mass, MS did not differ significantly between obese, normal-weight, and lean subjects, except for knee extension (significant interaction effect with RPA; P = 0.01). With increasing BMI, lower limb strength did not change in the sedentary women but increased in active (> or = 1 h/wk in > or = 1 RPA for > or = 1 mo) women. All adjusted MS measures in active participants were significantly higher (P < 0.001) than those in their sedentary peers. CONCLUSION: The adjusted MS of elderly women is not associated with obesity but is higher in active subjects than in sedentary ones, especially in the lower limbs of obese subjects.

Aged↗

PubMed2001

Comparison of Body Mass Index by self-reported versus measured height and weight.

This study compared differences between self-reported and measured height and weight and subsequent Body Mass Index. College students (N=62) were asked to complete a health questionnaire as accurately as possible. Height and weight were self-reported without the knowledge that these variables would be subsequently measured. Self-reported and measured heights, weights, and calculated Body Mass Indexes were statistically compared. Analysis indicated that measured height was significantly less than self-reported height for men, but weight was not significantly different. Calculated Body Mass Index for men was not significantly different, however, self-reported Body Mass Index resulted in placement in the Normal range (18.5 to 24.9) category and measured Body Mass Index placement in the Overweight category (25.0 to 29.9). Women's self-reported and measured heights were not significantly different; however, self-reported weight was significantly less than measured. Further, significantly different Body Mass Indexes were found for women. It was concluded that self-reported height and weight might be viewed with caution in Body Mass Index assessment for convenience samples of college-age subjects.

Adult↗

PubMed2004

Measurement of dialyzer clearance, dialysis time, and body size: death risk relationships among patients.

BACKGROUND: Urea pharmacokinetic equation systems have contributed to better understanding of treatment dose among hemodialysis patients. The methods are indirect, however, and require the measurement of blood urea nitrogen (BUN) concentration before and after a dialysis session to estimate the total treatment dose that clinicians prescribe [urea clearance x dialysis time (Kt)] indexed to an estimate of body size [the volume of urea distribution in the body (V)] yielding the ratio, Kt/V. New technology permits direct on-line measurement of average small molecule clearance (Kecn) during each dialysis treatment that can be multiplied by time (t) to give a direct measurement of total treatment dose (Kt). This study evaluated the relationship of measured Kt with death risk. It also evaluated the relationship of simple body size measures to risk and also the combination of one such measure [body surface area (BSA)] with Kt to death risk. METHODS: The data were taken from the Fresenius Medical Care (NA) (FMCNA) clinical database that included patients who had outcome data, height and weight measurements, and at least one average Kecn and t measurement during April 2002. Kecn, t, and the body size measures [body weight, body mass index (BMI), and BSA)] were averaged during the month. Those values were used as predictors of survival during the next 1 year in unadjusted and case mix adjusted proportional hazards (Cox) models. RESULTS: Increasing values of Kecn, t, Kt and all of the body size measures were associated with lower death risk. The body size measure most closely associated with risk was the BSA that was used in subsequent models. Kt and BSA were independent risk predictors. There was a significant interaction between Kt and BSA in the case mix but not the unadjusted model indicating that the risk burden of lower total dialysis dose, Kt, may be greater among small than large patients. CONCLUSION: The direct measurement of dialysis dose during each treatment is practical and the values reported by it are clinically relevant. Higher dose was associated with better survival in both small and large patients treated three times weekly. Furthermore, smaller patients may require proportionately greater total dose than larger patients to achieve comparable survival.

Aged↗

PubMed1999

An initial evaluation of a commercial weight loss program: short-term effects on weight, eating behavior, and mood.

OBJECTIVE: This paper describes an initial, 4-week evaluation of a commercial weight loss program. RESEARCH METHODS AND PROCEDURES: Respondents (n = 985) to newspaper advertisements in two metropolitan areas were assigned to 4 weeks of either the Weight Watchers program or to a Self-Help condition. Weight loss, psychological vitality, and eating behavior were evaluated before and after the 4-week intervention. RESULTS: Weight Watchers participants showed greater improvements than Self-Help participants on all measures; weight losses averaged 1.87 and 0.77 kg, respectively. The superior outcomes shown by Weight Watchers participants on measures of vitality and eating behavior were still evident when extent of weight loss was controlled. Weight losses across different sites, incomes, and levels of obesity were similar. DISCUSSION: Although the present study's intervention and outcome assessments were short-term, the promising results obtained suggest that longer term studies should be undertaken.

Adult↗

PubMedDate not supplied

A 6-month observational study of the relationship between weight loss and behavioral symptoms in institutionalized Alzheimer's disease subjects.

OBJECTIVE: Weight loss is a common occurrence in Alzheimer's disease (AD). This study was undertaken to investigate the relationship between weight loss and behavioral symptoms in institutionalized AD subjects. DESIGN: Observational study. SETTING: Two facilities that included assisted living and nursing care. PARTICIPANTS: Residents with probable or possible AD (n = 32). MEASUREMENTS: Weight was measured monthly. At baseline, month 3, and month 6, a knowledgeable staff member provided information that included the Neuropsychiatric Inventory: Nursing Home Version (NPI-NH, ie, a measure of behavioral symptoms) and a questionnaire regarding eating habits, food intake, and appetite. Two-day calorie counts were done and accelerometers were worn to monitor physical activity. RESULTS: At baseline, the mean body mass index (BMI) was 24.0 (standard deviation, 3.5) with 12 subjects exhibiting a BMI <22. BMI was negatively associated with the baseline NPI-NH total score (Spearman Correlation Coefficient -0.52, P <0.01), which indicates that subjects with low BMIs were more likely to have higher frequency and severity of behavioral problems. Individual behavior scores for agitation/aggression (-0.40, P <0.05), depression (-0.31, P = 0.08), irritability/lability (-0.47, P <0.01), aberrant motor behavior (ie, pacing, -0.42, P <0.05), nighttime behavior (-0.37, P = 0.05), and appetite/eating (-0.48, P <0.01) at baseline were negatively correlated with baseline BMI. Behaviors not correlated with BMI were delusions, hallucinations, elation, apathy, and disinhibition. Although this was a small sample followed for a relatively short time period, change in specific NPI-NH scores from baseline to month 6 were correlated with the change in weight over the 6-month period. Both agitation/aggression (-0.37, P = 0.05) and disinhibition (-0.45, P <0.05) showed negative correlation with weight change, which indicates an association between changes in these behaviors and weight loss. There were no significant differences between those who lost weight (n = 13) and those who did not (n = 19) on baseline variables, which included age, comorbidity, functional status, and NPI-NH. However, those who lost weight had a significantly higher BMI at baseline than those who gained weight. CONCLUSIONS: These preliminary results suggest that behavioral disturbances play a role in low body weight and weight loss in AD subjects.

Aged↗

PubMed2005

Measured and reported weight change for women using a vaginal contraceptive ring vs. a low-dose oral contraceptive.

BACKGROUND: Women often stop hormonal contraception because of perceived weight change. We conducted a randomized trial comparing the contraceptive vaginal ring to a low-dose oral contraceptive (OC). We examined the difference between women's reported and measured baseline weights and looked at factors affecting perceived weight change. METHODS: We randomized 201 participants to either the vaginal ring or an OC for three cycles. We weighed participants upon enrollment (n=194) and at exit (n=167), using the same instrument for all measurements. Participants also provided self-reported height and their reactions to perceived weight changes. RESULTS: Baseline weight and body mass index were similar for both groups (mean weight=145.9 lb). Measured weight was, on average, 4.4 lb more than reported weight; this difference was greater in overweight and obese participants. Participants gained an average of 2.8 lb over 3 months; this gain did not differ between groups or by baseline weight. Subjects who reported a "bad change" in weight at exit (n=34) gained an average of 4.4 lb, whereas those who reported "no change" (n=112) gained 2.2 lb and those who reported a "good change" (n=14) gained 3.3 lb. CONCLUSION: Participants underreported their weight, and this difference was greater for heavier women. There was little weight change for the women in our study. Participants' opinions about weight change were not correlated with measured weight changes.

Administration, Intravaginal↗

PubMed1997

Hyponatremia and weight changes in an ultradistance triathlon.

OBJECTIVE: To describe the weight changes and the incidence of hyponatremia during an ultradistance triathlon in the athletes who attend medical care after the race. DESIGN: Descriptive research. SETTING: The 1996 New Zealand Ironman Triathlon in which each athlete swam 3.8 km, cycled 180 km, and ran 42 km. PARTICIPANTS: Ninety-five athletes attending for medical care after the race were studied. One hundred sixty-nine athletes who did not attend for medical care were also weighed before and after the race. MAIN OUTCOME MEASURES: Weights were measured at race registration and on finishing the race. Whole-blood sodium concentration was measured in those athletes with clinical evidence of fluid or electrolyte disturbances. RESULTS: Weights were significantly decreased at the end of the race in the athletes seeking medical care (n = 48, mean % delta wt = -2.5%, p < 0.001) and also in the athletes who did not seek medical care (n = 169, mean % delta wt = -2.9%, p < 0.001). Seventeen percent of race starters sought medical attention. Dehydration accounted for 26% of primary diagnoses and hyponatremia for 9%. One athlete with hyponatremia (Na 130 mEq/L) is described who drank 16 L over the course of the race, with a weight gain of 2.5 kg. This is consistent with the hypothesis of fluid overload as the cause of his hyponatremia. Hyponatremia accounted for four of five admissions to the hospital after the race. An inverse relationship between postrace sodium concentrations and percentage change in body weight was observed (r = -0.63). CONCLUSIONS: Hyponatremia is an important risk to the health of athletes competing in an ultradistance triathlon, with fluid overload the likely aetiology.

Adult↗

PubMed1990

The prediction of percentage of fat in pork carcasses.

Forty-seven market-weight pigs were slaughtered in order to determine percentage of chemical fat and in an attempt to determine an easily obtainable and inexpensive method to predict this value. The hams and 8-9-10 rib loin sections were removed from the left side of each carcass and dissected into subcutaneous and seam fat, individual muscles, skin and bone. Weights and chemical analysis were determined for each component. Numerous weights, measurements and specific gravity were determined on the carcass, ham and loin section of each pig. Percentage of chemical fat of each ham, loin section and carcasses was determined and correlated with the various weights and measurements taken. Stepwise regression was used to develop prediction equations using carcass data, specific gravity, ham or loin measurements or various combinations of these as dependent variables. The single best indicator of the decimal fraction of chemical fat in the pork carcass was determined to be specific gravity of the carcass half, the prediction equation using this variable had an R-square of .64. By adding 10th rib fat thickness to this equation, the R-square increased to .72. The best equation using carcass variables included 10th rib fat and marbling (R-square = .67). The loin section proved to be an accurate indicator of composition; ham measures were not as accurate as specific gravity and carcass measurements for predicting percentage of carcass fat. This research suggests that the percentage of chemical fat in the pork carcass can be predicted by an easy and inexpensive means.

Adipose Tissue↗

PubMed2006

Measures of adiposity and risk of breast cancer in older postmenopausal women.

OBJECTIVES: To determine whether higher adiposity is associated with greater breast cancer risk in older postmenopausal women. DESIGN: Prospective cohort study with mean follow-up of 11.3 years. SETTING: Four U.S. clinical centers. PARTICIPANTS: Seven thousand five hundred twenty-three women (mean age 73.5) enrolled in the Study of Osteoporotic Fractures. MEASUREMENTS: Weight, height, and waist and hip circumference were measured at baseline. Body composition was determined using bioelectrical impedance. Risk factor information was obtained by interview and questionnaire. Bone mineral density was measured using dual energy x-ray absorptiometry. The outcome was incident invasive breast cancer, confirmed using medical records. RESULTS: After adjustment for multiple risk factors, including bone density, women in the uppermost quartiles of weight, weight gain since age 25, body mass index, waist circumference, and percentage of body fat had higher breast cancer rates than women in the first quartiles of each measure. For example, breast cancer rates were 49% higher for women in the uppermost quartile of weight (hazard ratio (HR)=1.49, 95% confidence interval (CI)=1.05-2.10), 64% higher for women in the top quartile of weight gain since age 25 (HR=1.64, 95% CI=1.15-2.34), and 58% higher for women in the top quartile of percentage of body fat (HR=1.58, 95% CI=1.11-2.23) than for women in the lowest quartile of each measure. The associations between adiposity measures and breast cancer rates were not altered when the analyses were limited to very elderly women (> or = 70). CONCLUSION: Higher adiposity is an independent risk factor for breast cancer in elderly women.

Adiposity↗

PubMed2000

Changes in serum prostate-specific antigen following prostatectomy in patients with benign prostate hyperplasia.

PURPOSE: To investigate how prostatectomy for patients with benign prostate hyperplasia (BPH) affected the serum prostate-specific antigen (PSA) levels. METHODS: In 193 patients who underwent prostatectomy for BPH, serum PSA levels were measured before and three months after the operation. The total prostate weight measured by transrectal ultrasonography (TRUS) and the weight of the surgical specimen were examined in relation to the pretreatment PSA value and the changes in PSA levels after the operation. RESULTS: The transition zone volume measured by TRUS could well estimate the weight of the surgical specimen in patients who underwent subcapsular prostatectomy and transurethral resection of the prostate. The concentration of preoperative serum PSA showed a significant correlation with the prostatic volume and with the transition zone volume. Removal of 1 g of BPH tissue reduced serum PSA levels by an average of 0.18 ng/mL. The change in serum PSA levels after the prostatectomy correlated with the total prostatic gland volume and with the transition zone volume. CONCLUSIONS: The elevated PSA levels in patients with BPH were caused by the enlargement of the transition zone. After the resection of the adenoma, PSA levels should be expected to decrease to the normal range.

Adenoma↗

PubMed2006

Obesity, disordered eating, and eating disorders in a longitudinal study of adolescents: how do dieters fare 5 years later?

OBJECTIVE: To determine if adolescents who report dieting and different weight-control behaviors are at increased or decreased risk for gains in body mass index, overweight status, binge eating, extreme weight-control behaviors, and eating disorders 5 years later. DESIGN: Population-based 5-year longitudinal study. PARTICIPANTS: Adolescents (N=2,516) from diverse ethnic and socioeconomic backgrounds who completed Project EAT (Eating Among Teens) surveys in 1999 (Time 1) and 2004 (Time 2). MAIN OUTCOME MEASURES: Weight status, binge eating, extreme weight control, and self-reported eating disorder. STATISTICAL ANALYSIS: Multiple linear and logistic regressions. RESULTS: Adolescents using unhealthful weight-control behaviors at Time 1 increased their body mass index by about 1 unit more than adolescents not using any weight-control behaviors and were at approximately three times greater risk for being overweight at Time 2 (odds ratio [OR]=2.7 for girls; OR=3.2 for boys). Adolescents using unhealthful weight-control behaviors were also at increased risk for binge eating with loss of control (OR=6.4 for girls; OR=5.9 for boys) and for extreme weight-control behaviors such as self-induced vomiting and use of diet pills, laxatives, and diuretics (OR=2.5 for girls; OR=4.8 for boys) 5 years later, compared with adolescents not using any weight-control behaviors. CONCLUSIONS: Dieting and unhealthful weight-control behaviors predict outcomes related to obesity and eating disorders 5 years later. A shift away from dieting and drastic weight-control measures toward the long-term implementation of healthful eating and physical activity behaviors is needed to prevent obesity and eating disorders in adolescents.

Adolescent↗

PubMed1992

Relation of obesity and body fat distribution to endometrial cancer in Shanghai, China.

In a case-control study involving 268 cases of endometrial cancer and an equal number of population controls, we assessed the relationship of risk to body weight and fat distribution, examining weight at various ages and current anthropometric measurements. Weight gain during later adulthood and resultant high body masses were important risk predictors, indicating that obesity is an important risk factor, even in an area where the prevalence of obesity and incidence of endometrial cancer are low. Certain fat distribution patterns were related to risk of endometrial cancer independent of general obesity. In particular, fat deposits on the trunk were associated with elevated risks, with the odds ratio for the highest versus lowest quartile of subscapular skinfolds remaining significant even after adjustment for body mass index (odds ratio = 2.9; 95% confidence interval, 1.1-7.3). Central versus peripheral obesity, as measured by the subscapular:triceps ratio, also was related to increased risk, although the association failed to remain significant after adjustment for body mass (highest to lowest quartile, odds ratio = 1.7). In contrast, upper body obesity, as assessed by the waist:thigh ratio, was unrelated to risk. These results support the need for future studies assessing the relationship of hormonal and other biological parameters of fat distribution to assist in identifying causal mechanisms for this tumor.

Adolescent↗

PubMed1996

Obesity, diet and restrained eating in a Mediterranean population.

OBJECTIVE: To evaluate links between obesity, gender and restrained eating in a representative sample of adolescents in Catalonia, Spain. DESIGN: Several surveys were conducted in which measurements were taken of a sample of adolescents living in the city of Barcelona. SUBJECTS: 610 subjects (57% girls and 43% boys) with ages ranging between 15-17, from 22 schools in Barcelona. MEASUREMENTS: Weight, height, Body Mass Index (BMI) as measurement of obesity, subscale "Diet' of the Eating Attitudes Test (EAT) as measurement of concern for dieting, and subjects' negative or affirmative responses to the questions as to whether they were following a diet at the time of the study. RESULTS: 15% of the sample was found to be obese (13.5% presented grade I obesity-BMI 25-29.9 kg/m2, 1.3% presented grade II obesity-BMI 30-40 kg/m2, 0.2% presented grade III obesity-BMI > 40 kg/m2). Dieting has a strong influence on normal-weight female adolescent populations in Spain. Such girls are more concerned about dieting and are more likely to follow a diet independent of the extent to which they are overweight. Obese subjects are more likely to show greater concern for their diet and to be on a diet than those of normal-weight. The restrained behaviour observed in obese subjects is not related to the type of restraint evaluated using instruments such as the "Diet' subscale of the EAT. CONCLUSION: Our results show a lower prevalence of obesity in Spain (a European sample) than in the United States. But the prevalence of obesity is not insignificant. It would appear that there is no linear relationship between the degree of excess weight and the restraint boundary. The prevalence of restrained eating behaviour among young adolescent girls in Spain is high. Given the dangers of such attitudes, it is becoming increasingly necessary to develop preventive programmes to combat them.

Adolescent↗

PubMed2005

Accuracy of reported weight and menstrual status in teenage girls with eating disorders.

OBJECTIVE: The current study investigated the accuracy of reported current and historical weights and of menstrual status in teenage girls with eating disorders. METHOD: Reported current weight in one interview was compared with measured weight at another occasion. Reported historical weights were compared with documented weights from growth charts of the school health services. Reports of menstrual status from two different interviews were compared. RESULTS: The overall correlation between reported and measured/documented weight was high. Current weight was reported with high accuracy in all diagnostic groups and without tendencies to underreport. Patients with bulimia nervosa, but not those with anorexia nervosa, underreported their historical top weight. The most common reason for large discrepancies between reported and documented historical weights was that the two weights compared referred to different time points. The reports on menstrual status were divergent for 13% of the patients, most notably 4 of 15 patients on oral contraceptives had been categorized as having menstruations in one of the interviews. CONCLUSION: Reported weight history and menstrual status are of high accuracy in teenage girls with eating disorders.

Adolescent↗

PubMed1984

Oral rehydration therapy in the home by village mothers in Burma.

Acceptability and effectiveness of oral rehydration therapy (ORT) when given by mothers in the home under village conditions was investigated in six (two control and four test) communities at Htauk-kyant near Rangoon, Burma. The control and test village communities had populations of 2085 and 4278 respectively, of which 218 and 623 were children under five. In the test villages, Oral Rehydration Salts (ORS) were made constantly available by providing each household with one packet of ORS, which was replenished whenever a used packet was returned to the field workers during their daily surveillance rounds. In control villages ORS packets were not provided. Daily diarrhoea surveillance was made for one year, including daily weighing of each child with diarrhoea, and across-episode weight changes were calculated. Monthly mass anthropometric measurements (weight and height) were carried out on over 90% of all children in test and control villages. Stool samples were investigated for bacterial aetiological agents. In test villages 327 children developed diarrhoea (52% of all children) with a total of 639 episodes and an incidence of 1.3 episodes per child per year. 314 diarrhoea episodes (49% of all) occurred in 67 children who had three or more episodes each. ORS was readily accepted and administered by mothers in 96% of the diarrhoea episodes. The impact of ORS on mortality and morbidity could not be demonstrated as there was no death, nor necessity for admission to hospital for diarrhoea in either test or control village populations.(ABSTRACT TRUNCATED AT 250 WORDS)

Body Height↗

PubMed1991

The stabilizing influence of divalent ions and Na+ on the di-decameric structure of Yoldia limatula hemocyanin.

The stabilizing influence of Ca2+, Mg2+, Ba2+ and Na+ on the di-decameric structure of the hemocyanin of the bivalve, Yoldia limatula has been investigated by light-scattering molecular weight measurements and by analytical ultracentrifugation. The molecular weight (Mw) data, examined as a function of decreasing divalent ion and sodium ion concentrations at pH 8.0 and at a constant hemocyanin concentration of 0.10 g.l-1, show biphasic transition profiles, with a sharp initial decline in Mw as the concentration of the stabilizing cations is reduced. The analysis of the molecular weight data is best described in terms of the four-species, di-decamer-decamer-dimer-monomer scheme of association-dissociation equilibria. About 25 to 35 bound divalent ions and about 10 bound Na+ ions per half-molecule or decamer are required in order to account for the initial step of the observed transitions. The subsequent transitions representing the decamer to dimer and the dimer to monomer steps of the reaction account for the additional binding of three to four and two to four cations per dimer and per monomer, respectively. The relatively large number of divalent ions per decamer suggests strong ionic stabilization of the decamer to decamer contacts within the parent di-decameric assembly of Yoldia hemocyanin. This is consistent with earlier observations showing relatively few hydrophobic groups at the decamer to decamer contact areas.

Animals↗

PubMed2000

Social desirability and self-reported weight and height.

The present study examines the relationship between the desire to conform to perceived societal norms and the misreporting of weight and height. Self-reported and measured weights and heights for 56 young, healthy non-obese volunteers were assessed and compared to scores on the Marlowe Crowne Social Desirability Scale (MCSDS). Discrepancies between actual and self-reported weights for females were directly related to actual weight (r = 0.66, P<0.0001). The same was not true for males (r = 0.03). Height was significantly overreported, regardless of gender (P<0.004). Most importantly, for females, MCSDS scores were significantly correlated with the discrepancy between actual and self-reported weights after statistically adjusting for differences in actual weight (r = 0.51, P<0.0001). Results suggest that the misreporting of weight among young, non-obese women may be directly influenced by the desire to conform to perceived societal norms.

Adolescent↗