Keterkaitan Body Image, Tipe Perilaku Makan, dan Kecukupan Gizi dengan Status Gizi Remaja Putri

Abstract

Masa remaja merupakan periode krusial dalam siklus kehidupan yang ditandai dengan adanya perubahan fisik, perilaku, dan psikososial yang pesat. Percepatan pertumbuhan dan perkembangan pada masa remaja menyebabkan peningkatan kebutuhan zat gizi. Asupan zat gizi yang tidak seimbang menyebabkan berbagai masalah gizi. Selain itu, perubahan fisik yang berlangsung cepat menyebabkan remaja sadar dan lebih sensitif terhadap bentuk tubuhnya. Remaja biasanya memiliki standar penilaian terhadap penampilan fisik sehingga sangat mementingkan penampilan fisik yang ideal. Remaja yang merasa tidak puas dengan bentuk tubuhnya akan melakukan berbagai upaya untuk mencapai bentuk tubuh yang diinginkannya. Remaja putri sering mengganggap dirinya kelebihan berat badan atau mudah gemuk sehingga melakukan diet yang tidak benar. Salah satu perilaku makan yang dilakukan yaitu dengan melakukan pembatasan makan (restrained eating) terhadap jenis atau jumlah makanan tertentu. Akibat dari perilaku makan yang tidak seimbang dapat berimplikasi pada ketidakseimbangan asupan zat gizi, yang selanjutnya berpotensi memengaruhi status gizi remaja putri. Penelitian ini bertujuan untuk menganalisis keterkaitan body image, tipe perilaku makan, dan tingkat kecukupan energi dan zat gizi dengan status gizi (IMT/U dan kadar Hb) remaja putri. Penelitian ini menggunakan desain cross-sectional yang dilaksanakan pada bulan Mei sampai dengan Juni 2025. Subjek penelitian merupakan siswi SMA Negeri 1 Dramaga, Kabupaten Bogor yang berjumlah 105 subjek. Teknik pengambilan subjek menggunakan purposive sampling. Sebelum penelitian dilakukan, diberikan informed consent kepada orang tua atau wali murid dan informed assent pada subjek. Setelah mendapat persetujuan, subjek penelitian mengikuti pengambilan data yang terdiri dari pengisian kuesioner terstruktur, wawancara food recall, pengukuran antropometri dan kadar hemoglobin. Pengumpulan data karakteristik subjek dan keluarga menggunakan kuesioner. Karakteristik subjek terdiri dari usia dan uang saku. Pengumpulan data karakteristik keluarga terdiri dari pendidikan terakhir ayah dan ibu, pekerjaan ayah dan ibu, pendapatan ayah dan ibu, dan besar anggota keluarga. Pengumpulan data body image menggunakan Body Shape Questionnaire dan tipe perilaku makan menggunakan Dutch Eating Behavior Questionnaire. Pengumpulan data tingkat kecukupan energi dan zat gizi berdasarkan data hasil wawancara food recall 2x24 jam. Pengumpulan data status gizi melalui pengukuran antropometri dan biokimia. Data antropometri dengan mengumpulkan data berat badan menggunakan timbangan digital dan tinggi badan menggunakan microtoice. Data biokimia dengan mengumpulkan data kadar hemoglobin menggunakan metode digital (Hemocue) dari sampel darah kapiler. Pengolahan dan analisis data menggunakan Microsoft Excel 2021, Nutrisurvey 2007, dan IBM SPSS (Statistical Program for Social Sciences) 25. Uji normalitas data menggunakan uji Kolmogrov-Smirnov. Analisis data univariat dilakukan untuk menggambarkan deskripsi karakteristik subjek, karakteristik keluarga, body image, tipe perilaku makan, tingkat kecukupan zat gizi, status gizi (IMT/U dan kadar hemoglobin). Uji bivariat menggunakan uji Rank Spearman Correlation untuk menganalisis hubungan body image dengan tipe perilaku makan (emotional eating, external eating dan restrained eating); hubungan tipe perilaku makan dengan tingkat kecukupan energi dan zat gizi; dan hubungan body image, tipe perilaku makan dan kecukupan zat gizi dengan status gizi (IMT/U dan kadar Hb). Hasil penelitian menunjukkan bahwa subjek didominasi oleh usia 17 tahun dengan uang saku perhari dibawah rata-rata (Rp 24.467). Tingkat pendidikan terakhir ayah dan ibu didominasi SMA/sederajat. Pekerjaan ayah lebih banyak sebagai petani/buruh dan ibu sebagai ibu rumah tangga, pendapatan ayah dan ibu < Upah Minimum Kabupaten Bogor, dan sebagian besar subjek termasuk dalam keluarga kecil (= 4 orang). Sebanyak 51,4% subjek memiliki body image negatif atau tidak puas dengan bentuk tubuhnya dengan aspek yang paling berhubungan adalah persepsi diri sendiri terhadap bentuk tubuh. Tipe perilaku makan lebih cenderung pada perilaku external eating, diikuti restrained eating, dan emotional eating. Subjek cenderung berperilaku external eating, yakni pilihan makan dipengaruhi oleh faktor eksternal seperti aroma, rasa, dan tampilan makanan. Mayoritas subjek dengan body image negatif memiliki asupan yang tidak memadai, yaitu 40,7% defisit energi, 85,2% defisit protein, 16,7% defisit lemak, 75,9% defisit karbohidrat, dan > 90% defisit vitamin dan mineral. Terdapat 73,3% subjek dengan status gizi normal, 15,2% gizi lebih, 7,6% obese, dan 3,8% gizi kurang. Terdapat 92,2% subjek dengan status gizi normal memiliki body image positif dan 27,8% subjek dengan status gizi lebih dan obese memiliki body image negatif. Terdapat 28,6% subjek yang mengalami anemia dan yang mengalami anemia lebih banyak proporsinya pada subjek dengan body image negatif. Uji hubungan menunjukkan bahwa semakin negatif body image maka semakin meningkatkan perilaku restrained eating, semakin tinggi skor restrained eating maka akan semakin rendah tingkat kecukupan karbohidrat. Semakin negatif body image maka akan semakin tinggi z-score IMT/U (semakin gemuk). Semakin tinggi skor restrained eating maka akan semakin tinggi z-score IMT/U (semakin gemuk). Semakin tinggi tingkat kecukupan energi, protein, lemak, dan karbohidrat maka akan semakin tinggi z-score IMT/U (semakin gemuk). Semakin tinggi tingkat kecukupan energi, protein, lemak, karbohidrat, zat besi, folat, dan vitamin B12 maka akan semakin meningkatkan kadar hemoglobin (semakin tidak anemia).

Kata kunci: anemia, body image, status gizi, tingkat kecukupan gizi, tipe perilaku makan

Adolescence is a crucial period in the life cycle and is marked by rapid physical, behavioral, and psychosocial changes. Accelerated growth and development during adolescence leads to increased nutritional needs. An unbalanced intake of nutrients results in various nutritional problems. In addition, rapid physical changes make adolescents more aware and sensitive about their body shape. Adolescents often have standards for evaluating their physical appearance and place great importance on having an ideal body image. Those who are dissatisfied with their body shape make various efforts to achieve the desired form. Female adolescents often perceive themselves as overweight or easily gain weight, leading them to engage in unhealthy dieting. One common eating behavior is restrained eating, which involves restricting certain types or amounts of food. Unbalanced eating behaviors may result in nutritional imbalances, which can, in turn, affect the nutritional status of adolescent girls. This study aimed to analyze the relationship between body image, types of eating behavior, levels of energy and nutrient adequacy, and nutritional status (BMI-for-age and hemoglobin levels) in adolescent girls. This study used a cross-sectional design and was conducted between May and June 2025. The research subjects were 105 female students from SMA Negeri 1 Dramaga, Bogor District. The subjects were selected using purposive sampling. Prior to participating in the study, informed consent was obtained from parents or guardians and informed assent from the subjects. Upon approval, the research subjects participated in data collection, which included completing structured questionnaires, food recall interviews, anthropometric measurements, and hemoglobin level assessments. Data on the subjects and family characteristics were collected using questionnaires. Subject characteristics included age and daily pocket money. Family characteristics included parents’ latest education, occupation, income, and family size. Body image data were collected using the Body Shape Questionnaire, and eating behavior types were assessed using the Dutch Eating Behavior Questionnaire. The levels of energy and nutrient adequacy were determined based on data from two 24-hour food recall interviews. Data on nutritional status were collected using anthropometric and biochemical measurements. Anthropometric data were collected by measuring body weight using a digital scale and height using a microtoice. Biochemical data were obtained by measuring hemoglobin levels in capillary blood samples using a digital method (Hemocue). Data processing and analysis were performed using Microsoft Excel 2021, Nutrisurvey 2007, and IBM SPSS (Statistical Program for Social Sciences) 25. The normality of the data was assessed using the Kolmogorov-Smirnov test. Univariate analysis was conducted to describe the characteristics of the subjects, family characteristics, body image, eating behavior types, nutritional adequacy, and nutritional status (BMI-for-age and hemoglobin levels). Bivariate analysis using Spearman Rank Correlation was performed to analyze the relationship between body image and types of eating behavior (emotional eating, external eating, and restrained eating); the relationship between eating behavior types and energy/nutrient adequacy; and the relationship between body image, eating behavior types, and nutritional adequacy with nutritional status (BMI-for-age and hemoglobin levels). The results showed that most subjects were 17 years old with daily pocket money below average (Rp 24,467). The majority of fathers and mothers had completed high school or equivalent as their latest education. Fathers were mostly farmers/laborers and mothers were predominantly housewives, with both parents’ incomes below the Bogor District minimum wage. Most subjects belonged to small families (= 4 members). A total of 51.4% of the subjects had a negative body image or were dissatisfied with their body shape, with the aspect most closely related being the self-perception of body shape. The most prevalent eating behavior was external eating, followed by restrained eating and emotional eating. Subjects tended to engage in external eating, meaning that their food choices were influenced by external factors such as aroma, taste, and appearance of food. The majority of subjects with negative body image had inadequate intakes, with 40.7% having energy deficit, 85.2% protein deficit, 16.7% fat deficit, 75.9% carbohydrate deficit, and over 90% having deficits in vitamins and minerals. Of the subjects, 73.3% had a normal nutritional status, 15.2% were overweight, 7.6% were obese, and 3.8% were undernourished. Among those with a normal nutritional status, 92.2% had a positive body image, while 27.8% of those who were overweight or obese had a negative body image. There were 28.6% of subjects with anemia, and the proportion of anemia was higher among those with a negative body image. Correlation tests showed that the more negative the body image, the more likely the subjects were to engage in restrained eating; the higher the restrained eating score, the lower the carbohydrate adequacy. A more negative body image was correlated with a higher BMI-for-age z-score (increased body weight). The higher the restrained eating score, the higher the BMI-for-age z-score (increased body weight). Greater adequacy of energy, protein, fat, and carbohydrates was associated with a higher BMI-for-age z-score (increased body weight). Increased adequacy of energy, protein, fat, carbohydrates, iron, folate, and vitamin B12 was associated with higher hemoglobin levels (decreased anemia).

Keywords: anemia, body image, eating behavior type, nutritional status, nutrient adequacy level