Problem dieting behaviors among young adolescents

Body-related concerns and participation in physical education among adolescent students: the mediating role of motivation

Background

There is a need to understand better factors influencing participation in physical education (PE) and the mechanisms involved. The adolescent years are characterised by increasing levels of body-related concerns. In PE, the body is judged for its physical abilities and subject to social comparisons and body judgements. Grounded in the Self-Determination Theory, this study aimed to explore whether body-related factors were associated with adolescents' involvement in PE and whether types of motivation mediated this relationship.

Methods

The study involved 2,140 (54.5% girls) secondary students (15-16-year-olds) from Norway participating in the nationally representative "Health Behaviour in School-aged Children (HBSC) study: a WHO collaborative cross-national study." Body-related factors included Body Mass Index (BMI), health complaints, body perception and dietary behaviours. Gender, age, and socioeconomic status (family affluence) were control variables. Motivation for PE was assessed with the Perceived Locus of Causality (PLOCQ) scale measuring three distinct factors: autonomous motivation, controlled motivation and amotivation. PE involvement was self-reported as weekly participation in PE classes and time spent in moderate-to-vigorous physical activity (MVPA) during PE.

Results

Gender (girl), family affluence, health complaints, not being on a diet but wanting to lose weight, and body perception (too fat) were negatively associated with weekly PE participation when adjusting for other variables. This association was largely explained by students' autonomous motivation in the case of health complaints and partly in the case of dietary behaviour and body perception. Similar results were observed for MVPA during PE lessons. Additionally, gender was associated with MVPA through amotivation.

Conclusion

The study adds new knowledge to the understanding of the relationship between body-related factors and PE, supporting that autonomous motivation is a central mechanism and an avenue for further research. The results should be considered in planning high-quality PE classes and suggest that an autonomous supportive learning climate sensitive to body-related concerns should be a priority to increase adolescent involvement in PE.

Association between diet quality indices and arterial stiffness in youth with type 1 diabetes: SEARCH for Diabetes in Youth Nutrition Ancillary Study

AIMS

We studied the association of three distinct diet quality indices and two measures of arterial stiffness in youth and young adults (YYA) aged 10 to 30 with T1D.

METHODS

Cross-sectional (n = 1421) and longitudinal (n = 520) analyses were conducted in T1D YYA participating in the SEARCH for Diabetes in Youth Study. The diet quality indices included the Dietary Approaches to Stop Hypertension (DASH) index, the Healthy Eating Index 2015 (HEI-2015), and a modified Mediterranean Diet Quality Index (mKIDMED). Arterial stiffness was measured with pulse wave velocity (PWV) and augmentation index (AIx) obtained using a SphygmoCor-Vx device and tonometer.

RESULTS

Average diet quality was moderate to poor, with mean scores of 41 (DASH, range 0-80), 55 (HEI-2015, range 0-100), 3.7 (mKIDMED, range - 3-12). None of the diet quality scores was associated with the central PWV or Aix, independent of demographic, clinical and lifestyle factors, body mass index and HbA1c. Longitudinal data yielded consistent findings with cross-sectional results.

CONCLUSIONS

This study suggests that diet quality may not function as an independent risk factor for arterial stiffening in YYA with T1D. These findings do not diminish the importance of consuming a quality diet for the management of diabetes, as demonstrated in previous work.

Smoking as a weight control strategy of Serbian adolescents

OBJECTIVES

The objective is to determine association of age, gender, BMI, body image (body satisfaction, body appearance), depression, unhealthy weight control behaviors with smoking among Serbian adolescents and specifically association of these variables with smoking for weight control among adolescent smokers.

METHODS

This is a secondary analysis of data collected from 2763 students aged 13-15 years old (49.9% boys; 50.1% girls) obtained through cross-sectional Health Behavior in School-aged Children Survey conducted in Serbia in 2018 and analyzed using multivariable logistic regression.

RESULTS

In Serbia, 12.9% adolescents 13-15 years old smoke and 6.6% smoke for weight control, while this practice was present among 48.8% of the smokers. Higher odds of smoking were found among adolescents who perceive themselves thin and good looking, while these two factors didn't play role for the smoking for weight control among smokers. Depression and unhealthy weight control behavior other than smoking significantly predicted smoking and smoking for weight control. Gender was not associated with smoking in adolescents, but among adolescent smokers, boys had two times higher chance compared to girls to report smoking for weight control.

CONCLUSIONS

Findings call for incorporating and strengthening interventions for adolescents' weight control management and mental health as part of smoking prevention and cessation programs.

Do sex differences in reported weight loss intentions and behaviours persist across demographic characteristics and weight status in youth? A systematic review

Background

Evidence suggests that young females are more likely to try to lose weight than young males, however whether this sex difference persists across demographic characteristics and weight status is unclear. Further, whether females are more likely than males to try to lose weight using unhealthy weight loss strategies has never been systematically assessed. The objective of this systematic review was to examine the literature on sex differences in weight loss intentions and strategies in children and adolescent observational studies to determine whether sex differences persisted across demographic characteristics (race/ethnicity, grade level) and weight status.

Methods

Relevant articles published after 1990 were identified using PubMED, Web of Science, and PsycInfo. Searches were conducted in May of 2015 and again in May of 2017. Studies conducted in the US and Canada with participants 18-years old or younger who measured weight loss strategies in the context of weight loss intention were selected. Descriptive statistics were extracted from 19 studies.

Results

Almost two-thirds of youth reported trying to lose weight. High-school and middle-school aged females reported consistently higher prevalence of weight loss intentions compared to male counterparts, as did Caucasian, African-American, and Hispanic females. The proportion of youth using unhealthy or extreme strategies reached 44 and 13%, respectively, with a similar proportion of males and females endorsing the use of each category of weight loss strategies across studies. Native-American youth reported the highest prevalence (27%) of using extreme strategies.

Conclusions

Researchers should consider demographic characteristics when reporting prevalence information for weight loss intentions and behaviours, as certain groups might require more targeted public health initiatives. Across characteristics, prevalence ranges were broad for weight loss intentions and use of particular strategies, suggesting the need to standardize and refine data collection and reporting practices in this literature.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-6179-x) contains supplementary material, which is available to authorized users.

Dietary quality and markers of inflammation: No association in youth with type 1 diabetes

BACKGROUND

Systemic inflammation is a key process underlying cardiovascular disease (CVD) development, and CVD risk is significantly elevated in persons with type 1 diabetes (T1D). Youth with T1D exhibit increased levels of inflammation. Studies in persons without diabetes suggest that dietary quality influences inflammation, yet little is known about dietary influences on inflammation in youth with T1D.

METHODS

This study evaluated the association of four distinct dietary quality indices (Dietary Approaches to Stop Hypertension (DASH), Healthy Eating Index 2010 (HEI2010), modified KIDMED and Total Antioxidant Capacity (TAC)) with biomarkers of inflammation (C-reactive protein (CRP), fibrinogen and interleukin-6 (IL-6)) in a sample of 2520 youth with T1D participating in the SEARCH for Diabetes in Youth Study.

RESULTS

Average diet quality was moderate to poor, with mean scores of 43 (DASH, range 0-80), 55 (HEI2010, range 0-100), 3.7 (mKIDMED, range 3-12) and 7237 (TAC). None of the four diet quality scores was associated with the selected biomarkers of inflammation in any analyses. Evaluation of a non-linear relationship or interactions with BMI or levels of glycemic control did not alter the findings. Replication of analyses using longitudinal data yielded consistent findings with our cross-sectional results.

CONCLUSIONS

Biomarkers of inflammation in youth with T1D may not be directly influenced by dietary intake, at least at the levels of dietary quality observed here. More work is needed to understand what physiologic mechanisms specific to persons with T1D might inhibit the generally beneficial influence of high dietary quality on systemic inflammation observed in populations without diabetes.

Weight-related concerns and diet behaviors among urban young females: A cross-sectional study

Background:

Females are more likely than males to perceive themselves as too heavy, this has been explained in terms of the equation of “female beauty with extreme thinness.” Therefore, females are in general prone to develop unhealthy behaviors for weight management. Wrong weight control behaviors have significant health consequences.

Objectives:

To investigate the body weight concerns, body satisfaction, and weight control behaviors among young females and their association with age and socioeconomic status (SES).

Materials and Methods:

A cross-sectional study conducted in urban areas from a major city in South India. About 650 healthy unmarried females aged 15–25 years formed the study population. Self-reporting questionnaires were used to obtain relevant data. The categorical data were analyzed using Chi-square, correlation, and regression analyses by SPSS version 16.

Results:

Most overweight and obese subjects perceived themselves as overweight. Adolescents were more likely to report themselves as overweight. The perceived weight, body satisfaction, and weight control behaviors are influenced by weight status and age of the subjects. However, SES of the participants did not exhibit effect of others’ opinion about their weight and body satisfaction as well as weight management behaviors.

Conclusion:

The high prevalence of weight-related concerns suggests that all females should be reached with appropriate information and interventions. Healthy weight control practices need to be explicitly promoted and unhealthy practices discouraged. Young females need special attention toward weight management.

The contribution of school environmental factors to individual and school variation in disordered weight control behaviors in a statewide sample of middle schools

We investigated the contribution of school environmental factors to individual and school variation in disordered weight control behaviors (DWCB). Analyses were based on self-report data gathered from 18,567 middle-school students in 2005 and publicly available data on school characteristics. We observed large differences across schools in percent of students engaging in DWCB in the past month, ranging from less than 1% of the student body to 12%. School-neighborhood poverty was associated with higher odds of DWCB in boys. Preventive strategies need to account for wide variability across schools and environmental factors that may contribute to DWCB in early adolescence.

Concerns related to eating, weight, and shape: typologies and transitions in men during the college years

OBJECTIVE

How to best classify concerns related to eating, weight, and shape (CREWS) in men remains an open question. Research on men considering CREWS during different developmental periods could be particularly informative.

METHOD

Focusing on one potentially dynamic developmental period, this study charts the course of CREWS in men over the college years. Latent class/latent transition analysis identified typologies of weight- and shape-influenced self judgment, limiting attempts, fasting, overeating, binge eating, self-induced vomiting, and laxative or diuretic abuse for 1,025 men over the four traditional college years.

RESULTS

Three classes emerged: (1) no obvious pathological eating-related concerns (61-65%); (2) a high likelihood of limiting attempts and a moderately high likelihood of overeating (31-34%); (3) pervasive bulimic-like concerns (4-6%). Class membership was highly stable across assessment occasions.

DISCUSSION

The results contribute to the growing literature on empirically derived classifications of CREWS and indicate that for many men CREWS are a chronic presence during the college years.

Sugar-sweetened and diet beverage consumption is associated with cardiovascular risk factor profile in youth with type 1 diabetes

The prevalence of cardiovascular disease (CVD) risk factors among youth with type 1 diabetes is high and associated with age, gender, and race/ethnicity. It has also been shown that youth with type 1 diabetes often do not follow dietary recommendations. The objective of this cross-sectional observational study was to explore the association of sugar-sweetened and diet beverage intake with A1c, plasma lipids, adiponectin, leptin, systolic, and diastolic blood pressure in youth with type 1 diabetes. We examined data from 1,806 youth age 10-22 years with type 1 diabetes, of which 22% were minority (10% Hispanic, 8% African Americans, 4% other races) and 48% were female. Sugar-sweetened beverage, diet beverage, and mineral water intake was assessed with a food frequency questionnaire. After adjustment for socio-demographic and clinical covariates, physical activity and total energy intake, high sugar-sweetened beverage intake (at least one serving per day vs. none), was associated with higher levels of total cholesterol, LDL cholesterol, and plasma triglycerides, but not with A1c. High diet beverage intake was associated with higher A1c, total cholesterol, LDL cholesterol, and triglycerides. These associations were partially confounded by body mass index, saturated fat and total fiber intake. High sugar-sweetened beverage intake may have an adverse effect on CVD risk in youth with type 1 diabetes. Diet beverage intake may be a marker of unhealthy lifestyle which, in turn, is associated with worse metabolic control and CVD risk profile in these youth. Youth with diabetes should be encouraged to minimize sugar-sweetened beverage intake.

A risk model for preadolescent disordered eating

OBJECTIVE

This study tested this risk model for disordered eating in preadolescent girls: pubertal onset is associated with increases in negative urgency (the personality tendency to act rashly when distressed); negative urgency influences eating disorder symptoms by shaping psychosocial learning (expectancy formation), thus indirectly influencing symptom levels; and many influences on purging are mediated by binge eating.

METHOD

Nine hundred five fifth grade girls completed questionnaire measures of eating pathology, negative urgency, and dieting/thinness and eating expectancies.

RESULTS

Binge eating and purging behaviors were present in fifth grade girls. As anticipated, pubertal status was associated with higher levels of negative urgency, negative urgency was associated with each expectancy measure, quadratic dieting/thinness and eating expectancies were associated with binge eating, and binge eating was associated with purging.

DISCUSSION

It is important and feasible to develop risk models for preadolescent eating disordered behaviors. Our model that integrates puberty, personality, and psychosocial learning appears promising.

Factors associated with inappropriate weight loss attempts by early adolescent girls in Japan

Attempting to lose weight by normal or underweight adolescent girls is a serious issue in many countries. It has been reported that the mode of attempted weight loss does not differ between normal weight and overweight girls. These inappropriate weight loss attempts (IWLA) by normal or underweight adolescent girls is associated with various health issues, but factors associated with IWLA have only been marginally elucidated. In this study, we applied a single multivariate regression analysis to clarify independent factors for IWLA. Study subjects were 134 pairs of early adolescent girls (aged 12-15) and their mothers. In addition to IWLA, many factors including height, weight, body image, perceived weight status, depressive symptoms, media influence and self-esteem were surveyed in both mothers and daughters and subjected to multivariate analysis. Approximately half of girls surveyed had IWLA, even though all were of normal weight and 62.9% knew that they were of normal weight. IWLA were independently associated with depressive symptoms (OR (95% CI); 2.80 (1.21-6.50), p=0.016) independent of actual or perceived weight status. Factors significantly associated with IWLA by the girls were percentage deviation of weight from standard weight (%DW) and media influence on the girls themselves, and media influence on and self-esteem of their mothers. IWLA, which were frequently observed among early adolescent girls even among those of normal weight, were closely related to depressive status. IWLA were significantly associated with not only factors related to the girls (1.09 (1.04-1.14), p=0.001), but also with maternal psychological factors (1.06 (1.00-1.13), p=0.035) conveyed by the media. Future prospective or interventional studies are required to clarify whether these factors could be targeted in an effort to prevent IWLA.

Association of DASH diet with cardiovascular risk factors in youth with diabetes mellitus: the SEARCH for Diabetes in Youth study

BACKGROUND

We have shown that adherence to the Dietary Approaches to Stop Hypertension (DASH) diet is related to blood pressure in youth with type 1 and type 2 diabetes mellitus. We explored the impact of the DASH diet on other cardiovascular disease risk factors.

METHODS AND RESULTS

Between 2001 and 2005, data on total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, low-density lipoprotein particle density, apolipoprotein B, body mass index, waist circumference, and adipocytokines were ascertained in 2130 youth aged 10 to 22 years with physician-diagnosed diabetes mellitus. Dietary intake was assessed by food frequency questionnaire, categorized into the DASH food groups, and assigned an adherence score. Among youth with type 1 diabetes mellitus, higher adherence to the DASH diet was significantly and inversely associated with low-density lipoprotein/high-density lipoprotein ratio and A(1c) in multivariable-adjusted models. Youth in the highest adherence tertile had an estimated 0.07 lower low-density lipoprotein/high-density lipoprotein ratio and 0.2 lower A(1c) levels than those in the lowest tertile adjusted for confounders. No significant associations were observed with triglycerides, low-density lipoprotein particle density, adipocytokines, apolipoprotein B, body mass index Z score, or waist circumference. Among youth with type 2 diabetes mellitus, associations were observed with low-density lipoprotein particle density and body mass index Z score.

CONCLUSIONS

The DASH dietary pattern may be beneficial in the prevention and management of cardiovascular disease risk in youth with diabetes mellitus.

Correlates of dietary intake in youth with diabetes: results from the SEARCH for diabetes in youth study

OBJECTIVE

To explore demographic, socioeconomic, diabetes-related, and behavioral correlates of dietary intake of dairy, fruit, vegetables, sweetened soda, fiber, calcium, and saturated fat in youth with diabetes.

METHODS

Cross-sectional study of youth 10-22 years old with type 1 (T1DM, n = 2,176) and type 2 diabetes (T2DM, n = 365). Association of dietary intake, demographics, socioeconomic status, behavioral, and diabetes-related measures was explored with quantile regression.

RESULTS

T1DM males had lower consumption of vegetables, fruit, and fiber, and higher consumption of soda and saturated fat than females (P < .01). African Americans had lower dairy and higher soda intake than non-Hispanic T1DM whites (P < .01). Soda consumption was higher in older T2DM youth than in younger participants (P < .01). Lifestyle and physical activity patterns were also significantly associated with dietary intake.

CONCLUSIONS AND IMPLICATIONS

Identified demographic and behavioral correlates may help dietitians to focus on groups of youth with diabetes who have lower adherence to a healthful diet. Diet counseling groups may be tailored according to these major determinants.

Weight-related concerns and weight-control behaviors among overweight adolescents in Delhi, India: a cross-sectional study

BACKGROUND

Obesity is emerging as a public health problem among adolescents in India. The aim of this study was to describe specific weight-related concerns among school-going youth in Delhi, India and to assess the prevalence of weight control behaviors, including healthy and unhealthy ones. Differences by weight status, gender, grade level, and school-type (a proxy for SES in this setting) are considered.

METHODS

This study is cross-sectional by design. A sample of eighth and tenth graders (n=1818) enrolled in Private (middle-high SES) and Government (low SES) schools (n=8) in Delhi, India participated. All students' height and weight were measured. Students participated in a survey of weight-related concerns and weight-control behaviors, as well. Mixed-effects regression models were used to test for differences in weight-related concerns and weight-control behaviors across key factors of interest (i.e., weight status, gender, grade level, and SES).

RESULTS

The combined prevalence of obesity and overweight was 16.6%, overall. Controlling one's weight was important to overweight and non-overweight youth, alike (94.2% v. 84.8%, p<0.001). Significantly more overweight or obese youth reported trying to control their weight last year, compared to those who were not overweight (68.1% v. 18.0%, p<0.001). Healthy weight control behaviors were more common than unhealthy or extreme practices, although the latter were still prevalent. Half of the overweight or obese students misclassified their weight status, while about 1 in 10 non-overweight youth did the same. Body dissatisfaction was highest among overweight youth and girls.

CONCLUSIONS

Interventions to promote healthy weight control should be pertinent to and well-received by school-going youth in India. Healthy weight control practices need to be explicitly encouraged and unhealthy practices reduced. Future interventions should address issues specific to body image, too, as body dissatisfaction was not uncommon among youth.

Identification and management of eating disorders in children and adolescents

The incidence and prevalence of eating disorders in children and adolescents has increased significantly in recent decades, making it essential for pediatricians to consider these disorders in appropriate clinical settings, to evaluate patients suspected of having these disorders, and to manage (or refer) patients in whom eating disorders are diagnosed. This clinical report includes a discussion of diagnostic criteria and outlines the initial evaluation of the patient with disordered eating. Medical complications of eating disorders may affect any organ system, and careful monitoring for these complications is required. The range of treatment options, including pharmacotherapy, is described in this report. Pediatricians are encouraged to advocate for legislation and policies that ensure appropriate services for patients with eating disorders, including medical care, nutritional intervention, mental health treatment, and care coordination.

A prospective investigation of interpersonal influences on the pursuit of muscularity in late adolescent boys and girls

This project examined whether interpersonal pressure to be muscular predicted late adolescents' pursuit of muscularity. Participants were 199 adolescents (16-19 years), mothers (n = 175), and friends (n = 159), assessed at two annual times. Pressure to be muscular was assessed with adolescents', mothers', and friends' reports of their relationships. Adolescents reported pressure from fathers and romantic partners, appearance satisfaction, disordered eating, and pursuit of muscularity. Adolescents', mothers', and friends' reports of pressure related to pursuit of muscularity at both times. Adolescents' perceptions and mothers' reports prospectively predicted pursuit of muscularity. Findings highlight the relevance of relationships to pursuit of muscularity in late adolescents.

Disordered eating and unhealthy weight loss practices: which adolescents are at highest risk?

Early diagnosis of unhealthy weight loss practices (UWLP) among adolescents improves treatment outcomes. Analysis of population-based school survey data in Oregon demonstrated that the 11.6% reporting UWLP were more likely to perceive themselves as overweight, depressed, and to have abused substances. Targeted screening of adolescents can help identify those with UWLP.

Weight control behaviors among overweight, normal weight and underweight adolescents in Palestine: findings from the national study of Palestinian schoolchildren (HBSC-WBG2004)

OBJECTIVE

The objective of the study is to examine the relationship between weight-control behaviors and self-reported sociodemographic characteristics, weight status, and perception of body weight in a large, representative sample of adolescents in the West Bank and Gaza Strip territories of Palestine.

METHOD

Self-report measures of sociodemographic characteristics, body weight perception, height and weight, and weight-control behaviors were completed by 8,885 male and female students aged 12-18 years from 405 randomly selected schools as part of the 2003/2004 Palestinian Health Behavior in School-aged Children Study (HBSC).

RESULTS

In both genders, dieting to lose weight was common among adolescents and significantly higher among overweight than among underweight or normal weight adolescents. Extreme weight-control behaviors (vomiting, diet pills, or laxatives) and smoking were more common among boys than girls, and extreme weight-control behaviors were particularly common among underweight boys. Older adolescents were less likely than younger adolescents to engage in weight-control behaviors. Perception of body weight as too fat was an influential factor in following an unhealthy diet to lose weight.

DISCUSSION

Practices to control weight, particularly extreme and unhealthy weight-control behaviors, are common among adolescents in the Palestinian territories. These findings suggest the need to design appropriate prevention and early intervention programs for adolescents in Palestine.

Predictors of initiation and persistence of unhealthy weight control behaviours in adolescents

Background

Unhealthy weight control behaviours (UWCB) among adolescents have significant health and weight consequences. The current longitudinal study aimed to identify personal and socio-environmental predictors of initiation or persistence of adolescent UWCB, in order to inform development of programs aimed at both preventing and stopping UWCB.

Methods

A diverse sample included 1106 boys and 1362 girls from 31 middle schools and high schools in the United States who were enrolled in Project EAT (Eating Among Teens). Project EAT explored personal, behavioural, and socio-environmental factors associated with dietary intake and body weight in adolescence. Participants completed questionnaires to assess demographics, UWCB (including several methods of food restriction, purging by vomiting or medications, smoking to control weight, or food substitutions) and personal and socio-environmental variables at two time points, five years apart, between 1998 and 2004. Logistic regression models examined personal and socio-environmental predictors of initiation and persistence of UWCB among Project EAT participants.

Results

Results indicate that 15.5% of boys and 19.7% of girls initiated UWCB by Time 2, and 15.9% of boys and 43.3% of girls persisted with these behaviours from Time 1 to Time 2. After controlling for race/ethnicity and weight status changes between assessments, logistic regression models indicated that similar factors and patterns of factors were associated significantly with initiation and persistence of UWCB. For both boys and girls, personal factors had more predictive value than socio-environmental factors (Initiation models: for boys: R² = 0.35 for personal vs. 0.27 for socio-environmental factors; for girls, R² = 0.46 for personal vs. 0.26 for socio-environmental factors. Persistence models: for boys: R² = 0.53 for personal vs. 0.33 for socio-environmental factors; for girls, R² = 0.41 for personal vs. 0.19 for socio-environmental factors). The weight concerns model was the strongest predictor among all individual models [Initiation odds ratios (ORs) and 95% confidence interval (CI): 4.84 (3.32-7.01) for boys and 5.09 (3.55-7.30) for girls; persistence OR (CI): 4.55 (2.86-7.14) for boys and 3.45 (2.50-4.76) for girls].

Conclusion

In general, predictors of initiation and persistence of UWCB were similar, suggesting that universal and selective prevention programs can target similar risk factors.

Associations of trying to lose weight, weight control behaviors, and current cigarette use among US high school students

BACKGROUND

Approximately one-quarter of high school students currently use cigarettes. Previous research has suggested some youth use smoking as a method for losing weight. The purpose of this study was to describe the association of current cigarette use with specific healthy and unhealthy weight control practices among 9th-12th grade students in the United States.

METHODS

Youth Risk Behavior Survey data (2005) were analyzed. Behaviors included current cigarette use, trying to lose weight, and current use of 2 healthy and 3 unhealthy behaviors to lose weight or to keep from gaining weight. Separate logistic regression models calculated adjusted odds ratios (AORs) for associations of current cigarette use with trying to lose weight (Model 1) and the 5 weight control behaviors, controlling for trying to lose weight (Model 2).

RESULTS

In Model 1, compared with students who were not trying to lose weight, students who were trying to lose weight had higher odds of current cigarette use (AOR = 1.30, 95% CI: 1.15-1.49). In Model 2, the association of current cigarette use with the 2 healthy weight control behaviors was not statistically significant. Each of the 3 unhealthy weight control practices was significantly associated with current cigarette use, with AORs for each behavior approximately 2 times as high among those who engaged in the behavior, compared with those who did not.

CONCLUSION

Some students may smoke cigarettes as a method of weight control. Inclusion of smoking prevention messages into existing weight management interventions may be beneficial.

Associations between smoking and extreme dieting among adolescents

This study examined the association between cigarette smoking and dieting behaviors and trends in that association among US adolescents in grades 9-12 between 1999 and 2007. Youth Risk Behavior Survey datasets were analyzed using the multivariable logistic regression method. The sample size of each survey year ranged from 13,554 to 15,273 with girls representing 49-51% of the sample (N = 71,854). About 62% of the entire study participants were whites and 14% were blacks. Prevalence estimates of current smoking and corresponding 95% confidence intervals were computed across four comparison groups formed by gender and body weight. Extreme dieting was an independent predictor of smoking. Extreme dieters showed a higher variability of smoking behavior than their peers. The magnitude of the association between smoking and extreme dieting became smaller in recent years among adolescents but remained unchanged among non-overweight girls over that same time period. When adolescent smoking behavior is examined, the intensity of dieting behavior should be considered within its association with other co-occurring unhealthy behaviors.

Is thinness more prevalent than obesity in Portuguese adolescents?

BACKGROUND & AIMS

There is little information regarding the prevalence of thinness in European adolescents. This was assessed in a convenience sample of children and adolescents from the Lisbon area (Portugal).

METHODS

Cross-sectional study including 2494 boys and 2519 girls aged 10-18 years. Body mass index (BMI), waist and hip were measured using standardized methods; thinness was defined using international criteria. Body fat was assessed by bioelectrical impedance.

RESULTS

In girls, prevalence of thinness, overweight and obesity were 5.6%, 19.7% and 4.7%, respectively, whereas the corresponding numbers in boys were 3.9%, 17.4% and 5.3%. Prevalence of thinness increased whereas obesity decreased with age: from 1.5% to 7.6% for thinness and from 9.2% to 3.8% for obesity in girls aged 10 and 18, respectively. In boys, the corresponding trends were from 0% to 7.3% for thinness and from 10.6% to 3% for obesity. After adjusting for age, differences were found between BMI groups for weight, body fat percentage, fat mass, lean mass, waist and hip, while no differences regarding height were found between thin and normal weight participants.

CONCLUSIONS

The prevalence of thinness is more frequent than obesity after age 14 in girls and 16 years in boys. Thinness is associated with a decreased body weight and body fat, whereas no consistent effect on height was noted.

The Effects of Peer Influence on Disordered Eating Behavior

Peer influence has been found to be correlated with a host of harmful health behaviors. However, little research has been conducted investigating the relationship between peer influence and disordered eating. The present study surveyed 6th-, 7th-, and 8th-grade girls and boys using the Eating Disorder Inventory (EDI) and Inventory of Peer Influence (I-PIEC). This study found a significant positive correlation between peer influence and disordered eating. Multiple regression analyses revealed that peer influence was equally present in both males and females. There were no significant differences between males and females and EDI or I-PIEC scores. The likeability construct of peer influence was the most significant predictor of disordered eating in this study. School nurses are in a unique position to educate both male and female students about the dangers of disordered eating behaviors as well as identify students who may be at risk for these behaviors.

Association of eating attitudes between teenage girls and their parents

BACKGROUND

Mothers of eating disordered adolescents were more likely to have an eating disorder. However, some contradictory findings were reported because some studies failed to find this association.

AIMS

The main objective of the study was to determine the association of eating attitudes in adolescent girls with eating attitudes in their parents.

METHODS

A sample of 969 girls from Osona County (Barcelona, Spain) and their parents participated in the study. Girls completed the Eating Attitudes Test (EAT-26) and their weight and height were measured. Parents completed questionnaire with self-reported weight and height, demographic characteristics and EAT-26.

RESULTS

10.1% of girls showed high EAT-26 scores (> 20 points), indicating abnormal eating attitudes. Female adolescents were almost three times more likely to have abnormal eating attitudes if their mothers scored high on EAT-26 (OR = 2.8; 95% CI 1.5-5.2). Other significant predictors of high EAT-26 scores were age and obesity.

CONCLUSIONS

An abnormal eating attitude of the mother was identified as a potential risk factor in the development of eating disorders in female adolescents.

How do children with eating disorders differ from adolescents with eating disorders at initial evaluation?

PURPOSE

To compare the clinical presentation of children with eating disorders (ED) to that of adolescents with ED.

METHODS

Demographic, medical, and psychiatric data of all 959 in- and outpatients (85 males, 874 females) 8-19 years of age diagnosed with ED that presented to an academic center between 1997 and 2005 were examined via retrospective record review. Young patients (n = 109) were defined as aged < 13 years at presentation, and older patients (n = 850) > or = 13 years and < 20 years.

RESULTS

Compared with older adolescents (mean 15.6 years, SD 1.4), younger patients (mean 11.6 years, SD 1.2) were more likely to be male (chi2 = 9.25, p < .005) or diagnosed with eating disorder not otherwise specified (EDNOS) (chi2 = 5.09, p < or = .05), and less likely to be diagnosed with bulimia nervosa (BN) (chi2 = 13.45, p < or = .001). There were no significant differences in anorexia nervosa (AN) diagnoses between groups. Young patients were less likely to report purging (chi2 = 26.21, p < .001), binge eating (chi2 = 26.53, p < .001), diet pill (chi2 = 13.31, p < .001) or laxative use (chi2 = 6.82, p < .001) when compared with older teens. Young patients weighed less in percentage ideal body weight (p < .05), had a shorter duration of disease (p < .001), and had lost weight more rapidly than older adolescent patients (p < or = .001).

CONCLUSIONS

There are important diagnostic and gender differences in younger patients. Young ED patients presented at a lower percentage of ideal body weight and had lost weight more rapidly, which may put them at higher risk for future growth sequelae than their older counterparts.

Self-weighing in adolescents: helpful or harmful? Longitudinal associations with body weight changes and disordered eating

PURPOSE

This study addresses the question: Is frequent self-weighing related to changes in body weight and disordered eating behaviors over a 5-year period among adolescent females and males?

METHODS

Project EAT is a 5-year population-based longitudinal study. Participants completed surveys exploring factors associated with eating and weight concerns. Participants included 2516 adolescents who were transitioning from early to middle adolescence (younger cohort) and from middle to late adolescence (older cohort).

RESULTS

In the older cohort of females and in both cohorts of males, frequent self-weighing at Time 1 was not associated with weight changes at Time 2 (5 years later), after adjusting for Time 1 weight status and sociodemographic characteristics. In the younger cohort of females, Time 1 frequent self-weighing predicted weight increases at Time 2. In both cohorts of females, but not in males, Time 1 frequent self-weighing predicted higher prevalences of Time 2 disordered eating behaviors, including unhealthy weight control behaviors and binge eating, after adjusting for Time 1 behavioral outcomes, weight status, and sociodemographic characteristics.

CONCLUSIONS

Frequent self-weighing was not associated with weight change, with the exception of predicting weight increases in younger females. In females, but not males, self-weighing predicted a higher frequency of binge eating and unhealthy weight control behaviors. Although further research is needed to explore the potential merits and problems associated with regular self-weighing, the findings suggest that population-based obesity prevention strategies targeting adolescents should avoid messages likely to lead to frequent self-weighing.

Risky Business: What Primary Care Practitioners Need to Know About the Influence of the Media on Adolescents

Media can be powerfully prosocial, educational, and entertaining. Negative effects do exist, however, and they have been well documented. Despite the power of the new multinational media conglomerates and the intransigence of the entertainment industry,practitioners can make a difference in the future.

Risky weight control among university students

OBJECTIVE

The objectives of the current study were to investigate risky weight control measures (vomiting or pills) among university students in Lebanon and to assess their relation to demographic, scholastic, and health risk behavioral characteristics.

METHOD

The study used a cross-sectional design. A proportionate random sample of 2,013 students was selected from public and private universities in Greater Beirut. Each participant completed a self-administered anonymous questionnaire.

RESULTS

Among participating students, 123 (6.1%) reported practicing risky weight control measures. Multivariate analysis indicated that younger females, cigarette smokers, engaged/married students, and those with a higher body mass index (BMI) were at increased odds of performing risky weight control measures.

CONCLUSION

Health awareness measures need to be proposed and, if possible, implemented to better define the motives and methods of weight reduction among Lebanese youth.

Weighing both sides: morality, mortality, and framing contests over obesity

Despite recent and growing media attention surrounding obesity in the United States, the so-called obesity epidemic remains a highly contested scientific and social fact. This article examines the contemporary obesity debate through systematic examination of the claims and claimants involved in the controversy. We argue that four primary groups-antiobesity researchers, antiobesity activists, fat acceptance researchers, and fat acceptance activists-are at the forefront of this controversy and that these groups are fundamentally engaged in framing contests over the nature and consequences of excess body weight. While members of the fat acceptance groups embrace a body diversity frame, presenting fatness as a natural and largely inevitable form of diversity, members of the antiobesity camp frame higher weights as risky behavior akin to smoking, implying that body weight is under personal control and that people have a moral and medical responsibility to manage their weight. Both groups sometimes frame obesity as an illness, which limits blame by suggesting that weight is biologically or genetically determined but simultaneously stigmatizes fat bodies as diseased. While the antiobesity camp frames obesity as an epidemic to increase public attention, fat acceptance activists argue that concern over obesity is distracting attention from a host of more important health issues for fat Americans. We examine the strategies claimants use to establish their own credibility or discredit their opponents, and explain how the fat acceptance movement has exploited structural opportunities and cultural resources created by AIDS activism and feminism to wield some influence over U.S. public health approaches. We conclude that notions of morality play a central role in the controversy over obesity, as in many medical disputes, and illustrate how medical arguments about body weight can be used to stymie rights claims and justify morality-based fears.

Weight control measures among university students in a developing country: a cultural association or a risk behavior

OBJECTIVE

The purpose of the study was to determine the prevalence of university students, in Lebanon, trying to lose weight and assess the relation of trying to lose weight with demographic, scholastic and health behavioral factors.

METHODS

The study was cross-sectional conducted in the academic year 2000-2001. A proportionate random sample of 2,013 students was selected among five public and private universities in Beirut. Participants completed a self-administered anonymous questionnaire that included questions on trying to lose weight, demographic, scholastic, and health behavioral factors including smoking, alcohol, and seat belt use. Bivariate and stepwise logistic regression analyses were performed to examine the association between trying to lose weight and the above-mentioned characteristics.

RESULTS

The overall prevalence of students trying to lose weight was 30%, with 71% of them being under weight or normal weight. Use of medications and inducement of vomiting constituted 12% and 11%, respectively. Stepwise logistic regression analysis showed that the variables significantly associated with trying to lose weight were socio-economical factors rather than risky behaviors. Students who were at increased odds of performing such methods were females OR = (2.08, 95% CI = 1.6-2.5), employed (OR = 1.36, 95% CI = 1.01-1.8), and registered in a private university (OR = 1.69, 95% CI = 1.25-2.0). The major of students was also a significant predictor.

CONCLUSION

In Lebanon, weight reduction could be re-enforced by socio-economical factors and not necessarily be an adolescent risk behavior.

Prevalence of eating disorders in Latina adolescents: associations with substance use and other correlates

PURPOSE

To estimate the occurrence and correlates of anorexia nervosa and bulimia nervosa-related symptoms in a Latina sample of U.S. adolescents.

METHOD

Approximately 1866 Latinas ranging in age from 11-20 years old are included in this study. These adolescents are a sub-sample from the National Longitudinal Survey on Adolescent Health. Along with self-reports of eating disorder-related variables, we measured related biological, contextual, behavioral, and psychosocial correlates, including use of various substances.

CONCLUSION

Chi-square analysis showed the prevalence in all Latina sub-groups was relatively consistent with the U.S. trends. Latinas of higher socioeconomic status were more at risk for eating disorders. Body dissatisfaction, negative affectivity, substance use, and low self-esteem were all positively correlated with eating disorder symptoms. These results suggest screening and treatment services are needed across groups of Latina adolescents.

Smoking as a weight-control strategy among adolescent girls and young women: a reconsideration

Many studies have reported that adolescent girls and young women smoke to control their weight. The majority of these studies are cross-sectional and report on correlational data from quantitative surveys. This article presents data from ethnographic interviews with 60 smokers, interviewed in high school and in follow-up interviews at age 21. Contrary to previous research, this study found little evidence for the sustained use of smoking as a weight-control strategy. In high school, smokers were no more likely than nonsmokers to be trying to lose weight. In the follow-up study, 85 percent of informants replied that they had never smoked as a way to control their weight. One-half of informants at age 21 believed that smoking as a weight-control strategy would be ineffective, while the other one-half had no idea whether it would work or not. Researchers need to exert caution in propagating the idea that smoking is commonly used as a conscious and sustained weight-control strategy among adolescent females and young women.

High prevalence of abnormal eating and weight control practices among U.S. high-school students

OBJECTIVE

This study sought to determine the prevalence and to identify correlates of abnormal eating and weight control practices in U.S. high-school students.

METHOD

A three-stage cluster design technique was used to select 15,349 students from 144 different high schools. Each completed the 1999 Youth Risk Behavior Survey (YRBS) Questionnaire.

RESULTS

Abnormal eating and weight control practices during the past month were reported by over 26% of female students and 10% of male students. Rates of abnormal eating and weight control practices varied by ethnicity and geographic location. Other correlates of abnormal eating and weight control practices included having an underweight body mass index (BMI): (OR=1.39, 95% CI=1.01-1.91), exercising to control weight in past 30 days (OR=1.51, 95% CI=1.30-1.76), dieting to control weight in past 30 days (OR=3.89, 95% CI=2.65-5.73), and interactions between gender and both weight perception and weight satisfaction.

DISCUSSION

The high proportion of U.S. high-school students who have participated in abnormal eating and weight control practices in the past month demands immediate attention. The identified correlates may help target prevention and control programs.

Dieting practices in high school students

OBJECTIVE

The purpose of this research was to determine the patterns and frequency of dieting behaviors in a high school population in a metropolitan area.

DESIGN

Dieting practices were assessed by using a survey instrument consisting of demographic questions and questions regarding dieting practices.

SUBJECTS/SETTING

The survey was administered to 10th-grade male and female students at a multiethnic, urban, public high school in the Los Angeles area. One hundred fifty-three surveys were distributed in the classroom setting, with 146 usable surveys analyzed.

STATISTICAL ANALYSES

Statistical analyses included simple frequencies, chi 2, Fisher exact test, t tests, and two-way analysis of variance. A significance level of.05 was used for all statistical analyses.

RESULTS

The population with a body mass index greater than 25 was 26.6% and, therefore, at risk of being overweight. Of those who have tried dieting, 54.7% often diet to control their weight. Limiting portion size was practiced by about 34% of those who had tried dieting techniques. In addition, counting calories and counting grams of fat were reported by 31.4% and 41.9% of these students, respectively. Of interest, 64.8% of the students who had tried dieting reported that they tried to eat and/or purchase foods that were low in fat. Approximately, 44% of these students used meal skipping to control their weight.

CONCLUSIONS

The high prevalence of dieting behaviors suggests that urban adolescents should be reached with appropriate interventions. Safe dieting strategies should be an integral part of any nutrition education and weight loss intervention.

A Biopsychosocial Model of Disordered Eating and the Pursuit of Muscularity in Adolescent Boys

This review provides an evaluation of the correlates and/or risk factors associated with disordered eating and the pursuit of muscularity among adolescent boys. One of the main conclusions is that similar factors and processes are associated with both behavioral problems. Several factors found to be consistently associated with disordered eating among boys are also similar to those found with girls. These include body mass index, negative affect, self-esteem, perfectionism, drug use, perceived pressure to lose weight from parents and peers, and participation in sports that focus on leanness. However, as many of the findings have only been verified using cross-sectional designs, prospective studies are now needed.

Eating disorders in children and adolescents

Anorexia nervosa and bulimia nervosa are common disorders in the pediatric population. This article is designed to help the clinician develop a detailed understanding of these disorders as they affect children and adolescents. The etiology, diagnosis, complications, and treatment of these eating disorders are discussed. The special circumstances of diabetes mellitus, athletics, and the interface with the obese patient also are covered. The need to correctly identify a patient with the disorder, perform the appropriate testing, and organize the most appropriate treatment is required from virtually every primary care practitioner.

Identifying and treating eating disorders

Pediatricians are called on to become involved in the identification and management of eating disorders in several settings and at several critical points in the illness. In the primary care pediatrician's practice, early detection, initial evaluation, and ongoing management can play a significant role in preventing the illness from progressing to a more severe or chronic state. In the subspecialty setting, management of medical complications, provision of nutritional rehabilitation, and coordination with the psychosocial and psychiatric aspects of care are often handled by pediatricians, especially those who have experience or expertise in the care of adolescents with eating disorders. In hospital and day program settings, pediatricians are involved in program development, determining appropriate admission and discharge criteria, and provision and coordination of care. Lastly, primary care pediatricians need to be involved at local, state, and national levels in preventive efforts and in providing advocacy for patients and families. The roles of pediatricians in the management of eating disorders in the pediatric practice, subspecialty, hospital, day program, and community settings are reviewed in this statement.

Substance use and weight loss tactics among middle school youth

OBJECTIVE

Diet pills (DP) and vomiting or laxative (VL) use as weight loss tactics are associated with substance use in older adolescent populations. This study examined the association of weight loss tactics and substance use among middle school students.

METHODS

A Youth Risk Behavior Survey was administered to 6,957 middle school students in eastern North Carolina. Multiple logistic regression examined substance use as predictors of DP and VL use.

RESULTS

DP and VL use was reported by 6.0% and 7.1% of students, respectively, with each reported more frequently by females and White students. Regression analysis demonstrated alcohol, cigarette, or marijuana use as predictors for individual race/gender groups whereas steroid use was a predictor for all race/gender groups. We found a clustering effect of alcohol and cigarette use with both DP and VL use.

DISCUSSION

Substance use is associated with weight loss tactics as early as middle school. More research in the areas of clustering of behaviors and age at onset is needed.

Development of Body Modification and Excessive Exercise Scales for adolescents

The present study was designed to develop a Body Modification Scale (BMS) to measure body change among adolescents and to modify an Excessive Exercise Scale (EES) into a shorter form for adolescents. Two hundred and twenty-one girls and 192 boys from Grades 7 to 10 completed the BMS and the EES. Factor analysis revealed three identical factors for the BMS for girls and boys: weight loss, weight gain, and muscle mass. Two identical factors for girls and boys were also revealed for the EES. Both factor structures were further validated on a separate sample of 286 adolescents (140 girls, 146 boys). The BMS and EES demonstrated excellent reliability (alpha > .86) and high test-retest reliability (alpha > .82) over 1 month. Good concurrent validity was also found for the weight loss factor of the BMS. These findings demonstrate the utility of these two scales for use with adolescents.

The role of puberty, media and popularity with peers on strategies to increase weight, decrease weight and increase muscle tone among adolescent boys and girls

OBJECTIVE

The present study was concerned with the impact of pubertal development, relationships with peers and perceived pressure from the media on body dissatisfaction and body change behaviors among adolescent boys and girls. In particular, the study investigated the underresearched area of strategies to increase weight and muscle. The exploration of body change strategies among adolescent boys has been a neglected area of research.

METHODS

Respondents were 1185 adolescents (527 males, 598 females) who were enrolled in Grades 7 and 9. Participants completed measures of pubertal development, media and peer influence, body dissatisfaction and strategies to lose weight, increase weight and to increase muscle.

RESULTS

The findings demonstrated that girls were more likely than boys to adopt strategies to lose weight, whereas boys were more likely to adopt strategies to increase muscle tone (but not weight). For boys in both Years 7 and 9, the main predictors of body change strategies were puberty and, to a lesser extent, perceived popularity with peers. The major influences for Years 7 and 9 girls were puberty and the media, but these mainly focused on weight loss. For Year 9 girls, perceived popularity with opposite-sex peers also predicted body dissatisfaction and strategies to increase muscle tone.

CONCLUSION

The implications of these findings for understanding factors related to a range of body change strategies for adolescent boys and girls are discussed.

The Youth Risk Behavior Surveillance System: updating policy and program applications

To monitor behaviors that place adolescents at increased risk for premature morbidity and mortality, the Centers for Disease Control and Prevention developed the Youth Risk Behavior Surveillance System (YRBSS). This system measures six categories of behaviors, including behaviors that contribute to violence and unintentional injuries; tobacco use; alcohol and other drug use; sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases, including HIV infection; unhealthy dietary behaviors; and inadequate physical activity. This article summarizes how some education and health agencies and nongovernmental organizations, in collaboration with community agencies, school boards, parents, and youth, use YRBSS data to describe risk behaviors, create awareness, supplement staff development, set and monitor program goals, develop health education programs, support health-related legislation, and seek funding. Ways in which YRBSS data are distributed electronically also are summarized.