


































Food Science and Nutrition Studies 

ISSN 2573-1661 (Print) ISSN 2573-167X (Online) 

Vol. 3, No. 3, 2019 

www.scholink.org/ojs/index.php/fsns 

84 
 

Original Paper 

Differences in Dietary Intake of Women with Standard Weight 

but Varying Body Fat Percentages in Japan 

Minatsu Kobayashi1,2*, Mayuko Hirata1, Eri Abe2 & Mieko Horiguchi3 

1 Department of Food Science, Faculty of Home Economics, Otsuma Women’s University, Tokyo, 

Japan  

2 Institute of Human Culture Studies, Otsuma Women’s University, Tokyo, Japan 

3 Department of Domestic Science, Junior College Division, Otsuma Women’s University, Tokyo, 

Japan 

* Minatsu Kobayashi, Department of Food Science, Faculty of Home Economics, Otsuma Women’s 

University, Tokyo, Japan; Institute of Human Culture Studies, Otsuma Women’s University, Tokyo, 

Japan 

 

Received: June 13, 2019          Accepted: June 24, 2019        Online Published: July 8, 2019 

doi:10.22158/fsns.v3n3p84        URL: http://dx.doi.org/10.22158/fsns.v3n3p84 

 

Abstract 

“Hidden obese people” have a high body fat percentage (BFP) despite having a normal BMI (18.5 

<BMI ≦ 25.0 BFP ≧30) due to an excessive accumulation of visceral fat, which increases their risk 

of lifestyle-related diseases. We aimed to identify factors that contribute to hidden obesity among 

Japanese female students at the Nutritionist Training Facility University using their anthropomorphic 

measurements, lifestyle characteristics and nutritional intake. Characteristics of participants with 

hidden obesity physique (18.5 <BMI ≦ 25.0 and BFP >30%) (n = 160) and standard physique (18.5 

<BMI ≦ 25.0 and BFP <30%) (n = 376) were compared using Student’s t-test or Welch’s t-test. The 

participants with hidden obesity physique have lower intake of energy (p = 0.044) and fat (p = 0.036) 

and a higher intake of carbohydrates (p = 0.023), cereals (p = 0.009) and sugary beverages (p = 

0.020). This study suggests that a reduction in carbohydrate-dense foods is effective in preventing 

hidden obesity. 

Keywords 

Body fat percentage, BMI, Carbohydrate-dense foods, hidden obesity 

 

 

 



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1. Introduction 

Body mass index (BMI) which is calculated from the height and weight is used as an indicator of 

obesity worldwide (WHO Expert Consultation, 1995). The report of a WHO Expert Consultation stated 

that at BMIs lower than the existing WHO cut-off point for overweight (= 25 kg/m2), a substantial 

proportion of Asian people have a high risk of type 2 diabetes and cardiovascular disease (WHO Expert 

Consultation, 2004). However, an excessive accumulation of body fat is a risk factor for many diseases 

such as diabetes mellitus, dyslipidaemia of lipid metabolism, hypertension, and myocardial diseases 

(Wulan, Westerterp, & Plasqui, 2010). Therefore, it is important to consider not only body weight but 

also body fat in assessing for obesity. 

Compared to other developed countries, the percentage of young Japanese women who are categorized 

as underweight (BMI <18.5) is high. The Japan national survey of 2017 showed that 20.7% of Japanese 

women in their twenties were underweight (Ministry of Education, Culture, Sports, Science & 

Technology in Japan, 2017). Additionally, among persons with a BMI within the normal range, persons 

with normal body weight with a high body fat percentage (BFP), the so-called ‘hidden obese persons’ 

are of increasing importance (Omori, Tanaka, & Nakajima, 2016). The ‘hidden obesity’ among young 

women is thought to be due to a decrease in muscle mass and bone mass, and an increase in body fat 

volume among persons whose diet is of poor quality due to a strong “desire for thinness” (Niibori, 

Hatsushika, Takanami, & Akedo, 2013). People with a strong “desire to be thin” tend to have a high 

score on the Eating Attitude Test (EAT-26), which is a screening test for eating disorders (Uehara & 

Sakakibara, 2015). Among young women, there is a risk of consuming a poor diet due to a strong 

desire to be slender, resulting in anemia, menstrual abnormality and eating disorders (Nicholls & Viner, 

2005). In addition, of the body weight of a young woman also affects her future pregnancies and 

childbirth. Pregnant women who are underweight have a higher risk of giving birth to infants of low 

weight (Suzuki, Nomura, Takenoshita, Ando, & Kido, 2016). A mothers’ weight in pregnancy also 

affects foetal development (Kiserud et al., 2018) and predisposes to the infant to an earlier onset of 

lifestyle-related diseases (Fukuoka, 2016). Additionally, after menopause, there is an increased risk of 

osteoporosis and fractures. Therefore it is important to institute the appropriate measures to maintain a 

healthy body weight (Gallagher & Tella, 2014). 

In the literature, there are reports that illustrate that the BMI is an indicator of the relationship between 

adolescent female physique and nutritional status (Koike, Hardy, & Richards, 2016); however, limited 

reports exist that consider BFP as an indicator of nutrition status (Parizkova, 1994). In this study, we 

assessed the nutritional status of young women using BMI and BFP by classifying them as follows: 

(BMI <18.5), (18.5 ≦ BMI < 25.0 and BFP <30), (18.5 ≦ BMI < 25.0 and BFP ≧30) and (BMI 

≧ 25.0). We then compared the food and nutrient intake of participants with “standard physique” 

(18.5 ≦ BMI < 25.0 and 20 ≦ BFP <30) to those of participants with “hidden obesity physique” 

(18.5 ≦ BMI < 25.0 and BFP ≧30) (Sasamori, 2002). 

 



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2. Method 

2.1 Participants and Ethical Considerations 

We measured the height, weight and body fat ratios of 670 female students at the Nutritionist Training 

Facility University located in Tokyo Japan between 2012 and 2017. We assessed lifestyle 

characteristics using questionnaire, dietary intake using a food frequency questionnaire and assessed 

their food intake, total energy and nutrient intake.  

Informed consent was obtained from all students. This study was approved by the Ethics Committee of 

the Otsuma Women’s University (Permission number: 25-0006). 

2.2 Determination of Physique and Biochemical Indicators 

Height was measured using a metal height gauge YS 101 - S (Yoshida Works Co., Ltd.). Body weight, 

BFP, body fat mass, muscle mass and basal metabolism were measured using a body composition 

analyser InBody770 (In Body Japan Co., Ltd.). BMI was calculated using the following formula: 

BMI = weight (kg) / (height (m))2 

Study participants were classified using BMI and BFP as follows into 4 groups; “BMI <18.5”, “18.5 

≦ BMI < 25.0 and BFP <30”, “18.5 ≦ BMI < 25.0 and BFP ≧ 30” and “BMI ≧ 25”. 

Blood pressure and pulse were measured using digital automatic sphygmomanometer HEM-7000 

(OMRON Ltd.). Osteo sono-assessment index (OSI) was measured using Ultrasonic bone evaluation 

device AOS-100NW (Hitachi Aloka Medical Ltd.). 

2.3 Assessment of Lifestyle Characteristics 

Participants were asked about average weekly exercise time which is stronger than the intensity of 

walking. Residence were asked using the following categories: “living alone, living with family, or 

dormitory”. Bowel frequency was asked using the following categories: “once a day or more than once 

a day, 5-6 times per week, 3-4 times per week, twice per week or less than twice per week”. Bowel 

movement was asked using the following categories: “loose stool, normal stool, hard stool, or 

repetition of diarrhea and constipation”. Sleeping time was asked using the following categories: “less 

than 5 hour, 6 hour, 7 hour, or more than 8 hour”. Satisfaction of daily life was asked using the 

following categories: “satisfied, anything satisfied, anything is not satisfied, and not satisfied”. 

Menstrual cycle was asked using the following categories: “regularly and irregularly”. 

2.4 Estimation of Food and Nutrient Intakes 

Information on dietary intake was obtained using a 165-item semi-quantitative food frequency 

questionnaire (FFQ). Participants were asked to report their average frequency of consumption and 

portion size for each item during the past year. Nutrient intake was evaluated using a previously 

described method (Sasaki, Kobayashi, Ishihara, & Tsugane, 2003). The FFQ was modified as follows. 

Participants were presented with the eight frequency categories that included: none, once/month, 2-3 

times/month, once/week, 2-3 times/week, 4-6 times/week, once/day and more than 2 times/day. Portion 

sizes were also described for every food item. Coefficients for the categories of relative portion size 

were presented in the five categories of 0.5, 0.75, 1.0, 1.25 and 1.5.  



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The composition values of the 165 foods on the FFQ were multiplied by the frequencies and relative 

portion sizes for the food items from the FFQ. Intakes of total energy and 38 nutrients for each food 

were calculated using a food composition table developed for the FFQ based on the Standard Tables of 

Food Composition in Japan, 2017 edition (Watanabe & Kawai, 2018). Food and nutrient intake were 

energy adjusted using the residual method (Henriquez-Sanchez et al., 2009). Estimated nutrient intake 

was validated using a 3-day dietary record, a modified FFQ that gives reasonably valid estimates of 

energy, and nutrient and food intake (Takada, 2017). 

2.5 Statistical Analysis  

Participants were classified into 4 groups, however only two groups were indicated in the analysis: 

“standard physique” (18.5 ≦ BMI < 25.0 and BFP <30) and “hidden obesity physique” (18.5 ≦ 

BMI < 25.0 and BFP ≧ 30%). Differences in biochemical indicators, food and nutrient intake 

estimated from FFQ by physique status, and exercise time were assessed using the Student’s t-test or 

Welch’s t-test. Lifestyle characteristics were assessed using the Fisher’s exact test. Data were analyzed 

using SAS statistical software ver. 9.4. (SAS Institute Inc.). All analyses were considered significant at 

the 0.05 level. 

 

3. Result 

A total 670 participants were interviewed. They were categorized as follows: lean students (n = 101), 

fat students (n = 33) and normal BMI (n = 536) who were then classified into standard physique (n = 

376) and hidden obesity physique (n = 160) groups.  

The distribution of participants by physique status is shown in Table 1. Of the 670 participants, 376 

(56.1%) had a standard physique and 160 (23.9%) a hidden obesity physique.  

Biological indicators of participants by physique status are shown in Table 2. Participants with a 

standard physique were taller than those with a hidden obesity physique (p=0.033). Conversely, when 

compared to participants with a standard physique, those with hidden obesity physique were heavier 

and had higher BMI, BFP, Body fat mass (p<0.0001) and diastolic blood pressure (p=0.002).  

Lifestyle characteristics of participants by physique status are shown in Table 3. There were no 

statistically significant differences between participants with a standard physique and those with a 

hidden obesity physique. The frequency of bowel movements did not differ by physique status. There 

was a higher proportion of participants with hard stool among those with a hidden obesity physique 

compared to those with a standard physique (p=0.081). Although participants with hidden obesity 

physique spent less time exercise than those with standard physique, this was not statistically 

significant (p=0.530). 

Energy and nutrient intake for 38 nutrients of participants by physique status are shown in Table 4. 

Energy intake was higher (p=0.044) and total fat and saturated fat intake were also higher (p=0.036, 

p=0.017) among participants with a standard physique compared to participants with a hidden obesity 

physique. Conversely, compared to participants with a standard physique, carbohydrate intake was 



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higher (p=0.023) and Manganese and Iodine intake also were higher (p=0.001, p=0.013) among 

participants with a hidden obese physique.  

Food intake by participant physique status is shown in Table 5. The intake of cereals and beverages 

other than alcohol was higher (p=0.009, p=0.020) among participants with a hidden obese physique 

compared to that among participants with a standard physique. In this study, drinking-water was not 

included in their beverages and there were no differences in the estimated intake of drinking-water by 

physique status (data not shown). Conversely, compared to participants with a hidden obesity physique, 

the intake of confectionery was higher (p=0.047) among participants with a standard physique. 

 

Table 1. The Distribution of the Physique of the Participant (n=670) 

 
Frequency % 

BMI <18.5  101 15.1 

18.5 ≦ BMI <25.0 and BFP <30 376 56.1 

18.5 ≦ BMI <25.0 and BFP ≧ 30 160 23.9 

BMI ≧ 25 33 4.9 

 

Table 2. Biological Indicator of Standard Group and Hidden Obese Group 

  
Standard group (n=376) Hidden obese group (n=160) 

P value* 

  
mean ± SD mean ± SD 

Height cm 158.8 ± 4.9 157.8 ± 5.1 0.0333 

Weight kg 51.2 ± 4.6 55.2 ± 4.7 <0.0001 

BMI 
 

20.3 ± 1.2 22.1 ± 1.3 <0.0001 

Body fat percentage 

(BFP) 
% 25.8 ± 2.6 32.3 ± 2.0 <0.0001** 

Body fat mass g 13.3 ± 2.3 17.9 ± 2.1 <0.0001 

Muscle mass g 35.7 ± 3.1 35.2 ± 2.9 0.079  

Basal metabolism  kcal 1182.0 ± 82.2 1184.2 ± 81.3 0.773  

Systolic blood pressure mmHg 105.5 ± 9.8 106.3 ± 10.3 0.379  

Diastolic blood pressure mmHg 66.7 ± 7.1 69.2 ± 8.9 0.002**  

Pulse times 72.7 ± 11.2 74.4 ± 10.8 0.093  

Osteo sono-assessment 

index  
OSI(×106) 2.9 ± 0.4 2.9 ± 0.3 0.908**  

Hidden obese group; Participants with 18.5≦BMI<25.0 and BFP ≧ 30; Standard group; Participants 

with 18.5≦BMI<25.0 and 20 ≦ BFP <30. 

* Student t-test; ** Welch’s t-test 

 



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Table 3. Lifestyle Characteristics of Standard Group and Hidden Obese Group 

 
Standard group (n=376) Hidden obese group (n=160) P value* 

Exercise time  
   

min per 1 week 58.2±127.6 50.9±111.6 0.530**  

Residence 
   

alone 18.6 20.0 0.548  

with family 77.7 75.6 
 

dormitory 3.7 3.8 
 

Bowel frequency 
   

≧ once a day 52.8 45.0 0.331  

5-6 times / week 18.1 23.8 
 

3-4 times / week 21.1 23.1 
 

< 2 times / week 8.0 8.1 
 

Bowel movement 
   

loose stool 8.0 6.9 0.081  

normal stool 76.8 68.8 
 

hard stool 11.7 20.0 
 

repetition of diarrhea and 

constipation 
3.5 4.4 

 

Sleeping time 
   

less than 5 hour 30.4 25.6 0.430  

6 hour  55.2 61.3 
 

7 hour  13.1 11.9 
 

more than 8 hour 1.3 1.3 
 

Satisfaction of life 
   

satisfied 16.3 17.5 0.313  

anything satisfied 65.1 57.5 
 

anything is not satisfied 14.4 20.6 
 

not satisfied 4.0 3.8 
 

Menstrual cycle 
   

regularly 72.5 73.0 0.861  

irregularly 25.6 26.4 
 

Hidden obese group; Participants with 18.5≦BMI<25.0 and BFP ≧ 30; Standard group; Participants 

with 18.5≦BMI<25.0 and 20 ≦ BFP <30. 

* Fisher’s exact test; ** Student’s t-test 

 



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Table 4. Energy and Nutrient Intake*** of Standard Group and Hidden Obese Group 

 
Standard group (n=376) Hidden obese group (n=160) 

P value* 

 
mean ± SD mean ± SD 

Energy (kcal) 1654.8 ± 548.9 1568.3 ± 407.0 0.044**  

Protein (g) 53.3 ± 7.1 52.1 ± 6.6 0.074  

Total fat (g) 52.1 ± 10.1 50.0 ± 10.4 0.036  

SFA (g) 18.0 ± 4.2 17.0 ± 4.4 0.017  

MUFA (g) 18.2 ± 3.8 17.5 ± 3.9 0.082  

PUFA (g) 10.6 ± 2.6 10.3 ± 2.6 0.318  

Cholesterol (mg) 234.1 ± 73.6 234.2 ± 76.4 0.993  

Carbohydrate (g) 204.3 ± 27.0 210.1 ± 25.8 0.023  

Total dietary fibers (g) 8.7 ± 2.2 8.4 ± 2.4 0.251  

Natrium（mg) 1672.9 ± 577.5 1664.6 ± 643.3 0.884  

Potassium (mg) 1867.3 ± 391.5 1845.5 ± 422.3 0.565  

Calcium (mg) 492.0 ± 185.8 465.8 ± 175.0 0.129  

Magnesium (mg) 206.0 ± 37.7 203.1 ± 42.2 0.419  

Phosphorus (mg) 846.8 ± 146.3 825.5 ± 136.0 0.117  

Iron (mg) 6.1 ± 1.3 6.1 ± 1.4 0.936  

Zinc (mg) 6.9 ± 0.8 6.8 ± 0.7 0.861  

Copper (mg) 0.9 ± 0.2 0.9 ± 0.2 0.743  

Manganese (mg) 2.8 ± 1.0 3.1 ± 1.3 0.001**  

Iodine (µg) 629.4 ± 202.4 682.3 ± 232.6 0.013**  

Serene (µg) 48.7 ± 11.1 48.4 ± 10.7 0.768  

Chrome (µg) 4.3 ± 1.7 4.1 ± 1.7 0.302  

Molybdic (µg) 156.8 ± 53.2 159.1 ± 53.2 0.648  

Alpha-carotene (µg) 365.2 ± 293.4 398.2 ± 326.5 0.249  

Beta-carotene (µg) 1674.6 ± 876.7 1727.4 ± 1043.0 0.575**  

Vitamin A (µg) 587.3 ± 413.1 550.1 ± 329.5 0.270**  

Vitamin D (µg) 4.4 ± 1.7 4.3 ± 1.7 0.699  

Alpha-tocopherol (mg) 5.9 ± 2.1 5.8 ± 2.1 0.640  

Vitamin K (µg) 179.98 ± 102.2 169.2 ± 110.5 0.276  

Vitamin B1 (mg) 0.71 ± 0.11 0.69 ± 0.1 0.210  

Vitamin B2 (mg) 1.1 ± 0.31 1.14 ± 0.30 0.754  

Niacin (mgNE) 11.3 ± 2.3 11.3 ± 2.14 0.767  

Vitamin B6 (mg) 0.9 ± 0.1 0.9 ± 0.1 0.833  

Vitamin B12 (µg) 4.6 ± 1.8 4.4 ± 1.7 0.267  



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Folate (µg) 224.6 ± 61.6 229.1 ± 65.6 0.441  

Pantothenic acid (mg) 5.2 ± 0.9 5.1 ± 0.9 0.294  

Biotin (µg) 26.5 ± 6.5 26.6 ± 6.2 0.800  

Vitamin C (mg) 65.0 ± 24.9 68.1 ± 28.5 0.238**  

Salt (g) 4.2 ± 1.5 4.1 ± 1.6 0.815  

Alcohol (g) 4.0 ± 6.6 3.7 ± 6.8 0.574  

Hidden obese group; Participants with 18.5≦BMI<25.0 and BFP ≧ 30; Standard group; Participants 

with 18.5≦BMI<25.0 and BFP <30. 

* Student t-test, ** Welch’s t-test, *** each nutrient were adjusted with residual method 

 

Table 5. Food Intake*** of Standard Group and Hidden Obese Group 

 
Standard group (n=376) Hidden obese group (n=160) 

P value* 
(g) mean ± SD mean ± SD 

cereals 223.2 ± 59.6 237.8 ± 58.6 0.009  

Potatoes and starches 25.2 ± 14.4 24.2 ± 15.2 0.483  

Sugars 3.0 ± 3.3 2.7 ± 2.8 0.375**  

Beans 39.0 ± 24.8 36.3 ± 28.4 0.283**  

Nuts and seeds 1.6 ± 3.1 1.6 ± 2.8 0.834  

Vegetables 125.0 ± 58.2 125.7 ± 65.0 0.906  

Green vegetables 48.5 ± 26.2 46.8 ± 27.4 0.507  

White vegetables 71.3 ± 39.6 73.3 ± 41.4 0.590  

Pickles 5.3 ± 6.0 5.5 ± 7.9 0.807**  

Fruits 80.3 ± 59.7 76.0 ± 58.9 0.448  

Mushroom 8.3 ± 6.7 8.0 ± 5.8 0.528**  

Seaweed 5.1 ± 4.7 4.6 ± 4.0 0.249**  

Fish 39.0 
 

18.0 37.9 
 

17.0 0.505  

Meats 71.8 
 

30.1 69.2 
 

30.3 0.358  

Eggs 23.0 ± 16.6 25.2 ± 16.2 0.167  

Dairy 169.7 ± 132.7 160.7 ± 111.9 0.423**  

Fats & Oils 9.5 ± 3.7 9.3 ± 3.5 0.440  

Confectionery 76.3 ± 45.0 68.6 ± 38.5 0.047**  

Alcohol beverage 54.2 ± 92.9 54.4 ± 127.9 0.986**  

Beverage other than alcohol 836.6 ± 609.9 1004.4 ± 817.8 0.020**  

Hidden obese group; Participants with 18.5≦BMI<25.0 and BFP ≧ 30; Standard group；Participants 

with 18.5≦BMI<25.0 and BFP <30. 

* Student t-test; ** Welch’s t-test; *** each food were adjusted with residual method. 



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4. Discussion 

In our study, 24% of participants had hidden obesity, even though their BMIs were within the normal 

range. In a study of young Taiwanese, 29.7% of women were diagnosed with hidden obesity (Hung, 

Chen, Guo, Chang, & Jan, 2017). There were differences in biological indicators, lifestyle, nutrients 

and food intake between the standard physique group and hidden obesity physique group. In particular, 

the hidden obesity group had a higher intake of cereals, beverages and carbohydrates. 

Although it the body fat mass is higher in persons with a hidden obesity physique, there were no 

differences in muscle mass and bone density between the two groups. In this study, participants with a 

standard physique spent more time exercise, but the difference in exercise time did not seem to be 

enough to affect muscle mass or bone density. There were only two persons with a standard physique 

and three persons with a hidden obesity physique that were diagnosed with hypertension based on a 

systolic blood pressure of 140 mm Hg or more or diastolic blood pressure of 90 mm Hg or more. 

However, the mean of blood pressure was higher among persons with a hidden obesity physique, 

especially the diastolic blood pressure. In a recent study of college students that explores differences in 

blood pressure levels across adiposity, it was found that both waist circumference and fat mass 

percentages acted as mediators between cardiorespiratory fitness and blood pressure (Diez-Fernandez 

et al., 2017). 

In persons with a hidden obesity physique, a higher proportion had hard stools; on the other hand, their 

dietary fiber intake was low. Dietary fiber intake is effective in relieving constipation (Suares & Ford, 

2011; Yang, Wang, Zhou, & Xu, 2012). On the other hand, the intake of water or fluid foods relieves 

hard stools (Kira, 2013). Although persons with a hidden obesity physique had a higher intake of 

beverages (other than alcohol), there were no differences in the estimated intake of drinking-water or 

water amount in foods by physique status. 

The diet consumed by the hidden obesity group was characterized by a low intake of fat and SFA and a 

high intake of carbohydrates. In addition, they had a low intake of sweets and a high intake of cereals 

and sweet beverages other than alcohol. In a study of women in New Zealand, the BFP was directly 

related to the energy density diet pattern, such as red meat, processed meat or deep-fried foods 

(Schrijvers, McNaughton, Beck, & Kruger, 2016). Because our study participants were young women, 

particularly among those with a hidden obesity physique, it is possible they reduced the intake of fat 

and sweets for the purposes of dieting, which may have led to an increase in the intake of cereals and 

sweet beverages. Several randomized controlled trials have reported differences in the effect of 

low-carbohydrate diets and low-fat diet on weight reduction (Tobias et al., 2015). Low-fat diet, 

particularly low SFA diet, has generally been evaluated for its effectiveness in reducing CVD risk (Hu 

& Willett, 2002). However, low-carbohydrate diets are associated with not only reduction in body 

weight, but also a reduction in the levels of total cholesterol and triglyceride and an increase in HDL 

cholesterol levels (Bueno, de Melo, de Oliveira, & da Rocha Ataide, 2013). A recent randomized 

controlled trial reported no differences in the effect of low-carbohydrate diets and low-fat diet on 



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weight reduction (Gardner et al., 2018). Although the effect of low-carbohydrate diets and low-fat diet 

on the weight reduction is controversial, there may be a number of our study participants who had a 

desire to reduce their weight that selected the low-fat diet. Because the hidden obesity group tended to 

refrain from total fat intake, SFA intake and snack intake, and the hidden obesity group was expected to 

have a strong desire to lose weight. 

This study had some limitations. Firstly, because participants were students at the Nutritionist Training 

Facility University, they may have been knowledgeable about the relationship between nutrition and 

health risks, and this may have had implications on the differences in their eating and lifestyle habits. 

Nevertheless, dietary intake among persons with a hidden obesity physique was characterized by a low 

intake of fat, a low intake of SFA and a high intake of carbohydrates. Secondly, although the FFQ used 

to estimate food and nutrient intake in this study has been validated, the accuracy of the absolute value 

of the available intake may not be guaranteed due to the type of the dietary survey conducted. However, 

our results appear to correctly reflect the difference in the average value of the food and nutrient intake 

level in the hidden obesity group and the standard group. Thirdly, we could only compare the daily 

exercise time of the hidden obesity group to the standard group; the intensity of the exercise and the 

activity level in the daily life were not made. 

 

5. Conclusion 

In this study, approximately one quarter of young women with standard BMI were reclassified as 

having a hidden obesity physique based on a body fat ratio of 30% or more. Among all participants, 

those with a hidden obesity physique had a low intake of fat, a low intake of SFA and a high intake of 

carbohydrates. Obesity is not only identified by BMI but also by BFP (hidden obesity), which is related 

to the risk of diabetes mellitus, abnormality of lipid metabolism, hypertension and myocardial disease. 

Therefore, the results of this study should be utilized in dietary education in order to reduce the number 

of persons with hidden obesity. 

 

Acknowledgement 

We are deeply grateful to all participants who took part in this study, and to hospital staff for their 

cooperation. 

 

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