Sociodemographic and personal characteristics of adolescents engaged in weight loss and weight/muscle gain behaviors: who is doing what?

Global Prevalence of Adolescent Use of Nonprescription Weight-Loss Products: A Systematic Review and Meta-Analysis

Importance

Use of nonprescribed weight-loss products in adolescents is a public health concern that is associated with negative physical and psychological consequences. However, the prevalence of nonprescribed weight-loss product use in adolescents is unknown.

Objective

To determine the global prevalence of nonprescription weight-loss product use in children and adolescents.

Data Sources

Four databases, including MEDLINE, PsycINFO, CINAHL (Cumulative Index of Nursing and Allied Health), and EMBASE, were searched for quantitative studies that reported prevalence data on use of nonprescription weight-loss products with no restrictions on publication date. The search was performed December 1, 2020, and updated March 6, 2023.

Study Selection

Studies were included in the meta-analysis if they reported the prevalence of weight-loss product use, were published in English, and included individuals 18 years or younger.

Data Extraction and Synthesis

Data extraction was completed by 2 independent reviewers. Data analysis determined the overall pooled proportion of weight-loss product use in total and during the past week, past 30 days, past year, or lifetime. Inverse variance heterogeneity effect models were used.

Main Outcomes and Measures

The main outcome measure was the prevalence of nonprescription weight-loss product use in adolescents for all included studies and over the past week, past month, past year, or lifetime. Subgroup analysis included separation of groups by sex, specific weight-loss product types, geographical location, and study publication time.

Results

A total of 90 articles (604 552 unique participants) were included in the meta-analysis. Of these, 50 studies (56%) were from North America. The reported prevalence of weight-loss product use in adolescents was 5.5% (96% CI, 5.5%-5.6%) overall. When identifying use of weight-loss products in the general population, prevalence was 2.0% (95% CI, 1.9%-2.1%) in the past week, 4.4% (95% CI, 4.3%-4.5%) in the past month, 6.2% (95% CI, 6.1%-6.3%) in the past year, and 8.9% (95% CI, 8.6%-9.2%) in their lifetime. Use of weight-loss products was higher among girls than boys.

Conclusions and Relevance

This meta-analysis found that use of weight-loss products occurs at high levels in adolescents, especially girls. These findings suggest that, given the ineffectiveness of these products for weight loss coupled with their harmful long-term health consequences, interventions are required to reduce use of weight-loss products in this group.

Pilot feasibility and acceptability trial of BE REAL's BodyKind: A universal school-based body image intervention for adolescents

Body dissatisfaction is prevalent among adolescents and a primary risk factor for eating disorders, yet there are few body image interventions for older adolescents that support development of positive body image. Therefore, we assessed the feasibility, acceptability and preliminary effectiveness of BodyKind, a four-lesson, mixed gender, teacher-led, school-based curriculum for older adolescents, that combines principles of self-compassion, compassion for others, cognitive dissonance, and social activism to address contemporary adolescent body image concerns (i.e., appearance bias, comparisons on social media) and strengthen positive body image development. The sample contained 147 adolescents, predominantly racial/ethnic minorities (>95%), 54.8% male, 41.5% female and 4.1% gender-minority students aged 15-18 years (M=16.24, SD=.96) from a low-income, inner-city high school in the Midwestern US. Two teachers received training and delivered the curriculum to students. This single arm, mixed methods trial assessed student and teacher acceptability, teacher fidelity and student intervention outcomes. Despite reasonable teacher fidelity, recruitment/attendance rates, post-intervention data loss (35% attrition) limited evaluations of program effectiveness and study feasibility. Important learnings regarding study feasibility will inform optimisation for future school-based trials. Findings demonstrate high acceptability of BodyKind among teachers and adolescents in a lower socioeconomic school setting, and further randomized controlled effectiveness trials are required.

Racial and Ethnic Disparities in Weight Loss Behaviors Among US College Students

Purpose

Weight loss behaviors are prevalent among college students and are associated with adverse physical and psychological outcomes, such as an elevated risk of developing an eating disorder. While cross-ethnic differences have been reported, no consistent pattern has emerged. The purpose of this study was to examine racial and ethnic differences in weight loss behaviors among female and male college students.

Patients and Methods

The American College Health Association-National College Health Assessment (ACHA-NCHA) II-C survey data from the collection periods from 2015 to 2019 was used. A total of 426,425 students participated in the survey. Most participants were White (60%) and female (68.5%). Information on students' age, body mass index (BMI), and self-rated health was also collected. Logistic regression analyses were performed to determine cross-ethnic differences in weight loss methods among female and male students.

Results

Students' weight loss behaviors were assessed and included dieting, exercising, vomiting or taking laxatives, and the use of diet pills in the past 30 days. More than half of the participants attempted to lose weight through exercise (53.5%), and 40.3% of students dieted to lose weight in the past month. Purging and the use of diet pills were endorsed by 2.9% and 2.8% of the participants, respectively. With few exceptions, male students from racial and ethnic minority backgrounds were more likely to engage in extreme weight control practices (ie, vomiting or taking laxatives, taking diet pills) than White male students, while female students from racial and ethnic minority backgrounds were less likely to use diet and exercise as weight loss methods than White female students. For all outcomes, Biracial/Multiracial and Hispanic/Latino male students were more likely to attempt weight loss than White male students. Biracial/Multiracial female students more frequently endorsed extreme weight control behaviors than White female students.

Conclusion

The results of the present study add to the growing body of literature on the relationship between race and ethnicity and weight loss behaviors. The findings indicate the need for tailored educational and intervention programs on college campuses.

Black adolescents' appearance concerns, depressive symptoms, and self-objectification: Exploring the roles of gender and ethnic-racial identity commitment

There is a dearth of research examining Black adolescents' body image, with even less work examining gender differences or the influence of ethnic-racial identity (ERI) commitment. It is critical to understand how culturally relevant aspects of appearance-beyond commonly measured ideals such as thinness and muscularity-are particularly relevant to Black adolescents. The present study of Black youth (n = 252; 55% girls, 45% boys, ages 13-18, M_age = 15.5) explored the roles of gender and ERI commitment in the associations between skin tone, hair, and facial satisfaction and appearance esteem, depressive symptomatology, and self-objectification. With a few exceptions, satisfaction with skin tone, hair, and face were significantly associated with higher appearance esteem and lower self-objectification and depressive symptoms, even when controlling for weight and muscle tone satisfaction. Findings were similar across genders, with some associations stronger among Black girls relative to boys. Among youth with higher ERI commitment, associations were stronger between skin tone, hair, and facial satisfaction and some indicators of wellbeing. Findings elucidate the role of culturally relevant appearance concerns of Black adolescents and the potential benefits of ERI commitment. This work can inform culturally sensitive research practices and therapeutic interventions related to Black youth's body image experiences.

Parents know best: Caregiver perspectives on eating disorder recovery

OBJECTIVE

This study used mixed methods to evaluate caregiver perspectives on recovery from an eating disorder.

METHOD

Caregivers (N = 387) completed an online survey about their child's weight history, treatment history, illness trajectory, and recovery.

RESULTS

Children were predominantly females with adolescent onset anorexia nervosa and currently 18.4 years old on average. Qualitative analysis of caregivers' open-ended definitions of recovery revealed seven distinct recovery domains, including (a) weight (45%); (b) body image, eating disorder cognitions, and related emotions (54%); (c) eating behavior (71%); (d) independence and responsibility in eating disorder management (28%); (e) physical health (21%); (f) psychological well-being (31%); and (g) life worth living (27%). Most (72%) reported that their child had achieved partial or full recovery at some point in their lifetime. Only 20% reported that their child had ever achieved full recovery, but 93% of those had sustained recovery over time (i.e., no relapses since achieving recovery). Physical recovery occurred on average 2.7 years after eating disorder onset, followed shortly by social and emotional recovery (2.9 years), and finally behavioral (3.4 years) and cognitive (3.9 years) recovery, which occurred at weights 6-7 pounds higher than those at which physical recovery was achieved.

DISCUSSION

Findings suggest that caregivers hold a multifaceted view of recovery that includes not only weight restoration and symptom reduction, but also full engagement in social and occupational activities, establishment of a meaningful life, cognitive flexibility, and emotional well-being. These data support clinical observations that physical and behavioral recovery precede cognitive recovery.

The Role of Body Image in Internalizing Mental Health Problems in Spanish Adolescents: An Analysis According to Sex, Age, and Socioeconomic Status

During adolescence there is a relatively high prevalence of weight problems and eating disorders. Furthermore, body image plays an important role in weight control and eating behaviors as well as in mental health. This study analyses the influence of body mass index, perception of being overweight, and body image satisfaction (BIS) on internalizing symptoms related to mental health in adolescents. In addition, sex, age, socioeconomic status (SES), dieting, and physical activity are taken into consideration. This research is based on the international study Health Behaviour in School-aged Children (HBSC). The sample consists of 4531 Spanish adolescents from 13 to 18 years old. Participants were selected through random multi-stage sampling stratified by conglomerates. Two instruments were employed: the HBSC questionnaire and the Youth Self-Report (Achenbach System of Empirically Based Assessment, ASEBA). Results demonstrated that BIS –the emotional component related to body image– was the main predictor of adolescent internalizing symptoms. In addition, results show double-inequalities according to the interaction effects of sex, age, and SES. Likewise, interesting results are shown regarding how dieting behaviors to lose or gain weight/volume and physical activity relate to body image perception and satisfaction, as well as with internalizing symptoms. This study highlights important body image aspects relevant to intervention and prevention of internalized mental health problems in adolescence.

Disordered Eating Among a Diverse Sample of First-Year College Students

OBJECTIVE

A cross-sectional study of first-year college students was conducted to identify the prevalence and predictors of disordered eating (DE).

METHODS

College freshmen students, aged 18 years, (n = 106) completed the Eating Disorder Examination Questionnaire (EDE-Q) and a supplemental survey. A subset of the sample (n = 77) underwent measurements of height, weight, and body composition. DE was defined as an elevated (3) weight, shape, eating concern, or dietary restraint EDE-Q subscale score.

RESULTS

The sample, consisting of 56.6%, 15.1%, 11.3%, and 11.3% Latino/a, Asian, African American, and Caucasian students, respectively (37% male), reported a 31.1% prevalence of DE. The current desire to lose weight was the strongest predictor of DE (odds ratio = 15.3; 95% confidence interval = 2.8, 82.5). Other variables linked to DE or elevated EDE-Q subscale scores included body mass index (BMI) 25.0 kg/m², vegetarianism, weight loss in the past year, female gender, and eating breakfast < 5 d/wk. Participants with BMI 25.0 kg/m² and the current desire to lose weight (n = 23) or following a vegetarian diet (n = 5) exhibited the highest prevalence of DE (78.3% and 80.0%, respectively). A higher proportion of Latinas reported binge episodes compared to female Caucasian, Asian, and African American students (36.4% vs. 0.0%, 6.7%, and 28.6%, respectively, p = 0.056, χ² = 7.6). Males, versus females, were more likely to report excessive exercise (56.4% vs. 37.3%, p = 0.056, χ² = 3.6).

CONCLUSIONS

This study adds to the current body of literature on DE by providing a diverse sample and potentially novel predictors and risk factors for DE.

Risk factors for disordered weight control behaviors among Korean adolescents: Multilevel analysis of the Korea Youth Risk Behavior Survey

OBJECTIVE

To investigate the prevalence and risk factors for disordered weight control behaviors (DWCB) in South Korean adolescents at multiple levels, including individual, family, school, and geographic area.

METHOD

We drew participants from the 11th Korea Youth Risk Behavior Web-based Survey, conducted in 2015, with 65,529 adolescents (31,687 girls, 33,842 boys) aged 12-18 years. DWCB was defined as engaging in any of the following behaviors for weight control over the past month: fasting, one-food diet (eating only one food over an extended period of time for weight control), vomiting, and taking laxatives/diuretics/unprescribed diet pills. Sex-stratified four-level multilevel logistic models examined potential predictors of DWCB, including age, body-mass index, puberty, perceived household economic status, parental education, living structure, school type and sex-composition, percentage of students participating in school nutrition programs, and urbanicity.

RESULTS

Overall, 6.2% of Korean adolescents (8.9% of girls, 3.7% of boys) exhibited any DWCB. We found significant between-school variation among girls and boys and between-classroom variation among girls. Older age, overweight/obesity, pubertal maturity, high household economic status (vs. mid-range economic status), and vocational schooling (vs. general) were positively associated with DWCB among girls and boys. Low household economic status (vs. mid-range economic status), higher parental education, and coeducational schooling (vs. single-sex) were positively associated with DWCB among girls only.

DISCUSSION

The findings suggest that DWCB are prevalent among Korean adolescents across age, sex, and socioeconomic status. Social contextual factors including school and familial environmental factors, as well as individual characteristics, should be considered when developing effective prevention strategies.

Demographic differences in and correlates of perceived body image discrepancy among urban adolescent girls: a cross-sectional study

Background

Understanding factors related to girls’ body image discrepancy, which is the difference between self-perceived current or actual and ideal body size, is important for addressing body-related issues and preventing adverse sequelae. Two aims were to: 1) examine demographic differences in body image discrepancy; and 2) determine the association of body image discrepancy with weight status, percent body fat, physical activity, sedentary behavior, and cardiovascular (CV) fitness among young adolescent girls.

Methods

The cross-sectional study included a secondary analysis of baseline data from a group randomized controlled trial including 1519 5th–8th grade girls in 24 U.S. schools. Girls completed physical activity and sedentary behavior surveys. To indicate perceived current/actual and ideal body image, girls selected from nine body figures the one that represented how they look now and another showing how they want to look. Girls wore accelerometers measuring physical activity. Height, weight, and percent body fat were assessed. The Progressive Aerobic CV Endurance Run was used to estimate CV fitness. Independent t-test, one- and two-way ANOVA, correlational analyses, and hierarchical linear regressions were performed.

Results

The majority (67.5%; n = 1023) chose a smaller ideal than current/actual figure. White girls had higher body image discrepancy than Black girls (p = .035). Body image discrepancy increased with increasing weight status (F_3,1506 = 171.32, p < .001). Moderate-to-vigorous physical activity (MVPA) and vigorous physical activity were negatively correlated with body image discrepancy (r = −.10, p < .001; r = −.14, p < .001, respectively), but correlations were not significant after adjusting for race and body mass index (BMI), respectively. Body image discrepancy was moderately correlated with CV fitness (r = −.55, p < .001). After adjusting for demographics, percent body fat, but not CV fitness or MVPA, influenced body image discrepancy. Girls with higher percent body fat had higher body image discrepancy (p < .001).

Conclusion

This study provided important information to guide interventions for promoting a positive body image among girls.

Trial registration

ClinicalTrials.gov Identifier NCT01503333, registration date: January 4, 2012.

Psychometrics of the "Self-Efficacy Consumption of Fruit and Vegetables Scale" in African American women

PURPOSE

Assess the psychometric properties of the Self-Efficacy Consumption of Fruit and Vegetable Scale (F/V scale) in African American women.

SETTING

Midwestern Health Maintenance Organization.

SUBJECTS

221 African American women age 40-65 with BMI≥30 MEASURES: F/V scale was compared to eating efficacy/availability subscale reported on the WEL and mean micronutrient intake (vitamins A, C, K, folate, potassium, and beta-carotene reported on 3-day food records.

RESULTS

F/V scale construct validity and internal consistency were assessed and compared to: 1) the original scale validation in Chinese women, 2) WEL scale, and 3) to micronutrient intake from 3-day food records. Total scale scores differed between African American women (μ=1.87+/-0.87) and Chinese (μ=0.41). In a Chinese population, F/V scale factored into two subscales; the F/V factored into one subscale in African American women. Construct validity was supported with correlation between the F/V scale and the eating efficacy WEL subscale (r²=-0.336, p=0.000). There was not a significant correlation between dietary consumption of micronutrients representative of fruit and vegetable intake and the F/V scale.

CONCLUSION

The F/V scale developed for Chinese populations can be reliably used with African American women.

Developmental trajectories of compensatory exercise and fasting behavior across the middle school years

Compensatory exercise and fasting behavior, in the absence of binge eating and purging, appear to be important eating disorder behaviors that are associated with dysfunction, but little is known about these behaviors in youth. We studied the trajectories of their development in non-binge eating and non-purging girls during early adolescence. Using a longitudinal design, we assessed 564 girls six times over the three years of middle school (grades 6 through 8) and developed trajectories specifying different developmental patterns in relation to the behaviors. Prior to this period, when the girls were in 5th grade (elementary school), we assessed risk factors to predict girls' subsequent trajectory group membership. Compensatory exercise trajectory groups included a non-engagement group, a group that increased in the behavior, and a group that decreased in the behavior. There were two fasting trajectory groups, one consistently engaging in the behavior and the other consistently not. Elementary school levels of depression, eating expectancies, and thinness expectancies predicted subsequent trajectory group membership. Risk for compensatory exercise and fasting should be evaluated as early as in 5th grade. Targeted interventions should focus on girls in late elementary school or middle school, as this appears to be a critical developmental and maintenance period for compensatory exercise and fasting behavior.

Emotional Freedom Techniques in the Treatment of Unhealthy Eating Behaviors and Related Psychological Constructs in Adolescents: A Randomized Controlled Pilot Trial

CONTEXT

In Australia and throughout much of the world, rates of obesity continue to climb as do the prevalence of eating disorders, particularly in adolescents. Psychological consequences of childhood obesity include low self-esteem, depression, body dissatisfaction, and social maladjustment (Young-Hyman et al., 2012).

OBJECTIVE AND INTERVENTION

This feasibility study sought to examine the impact of a six-week Emotional Freedom Techniques (EFT) group treatment program upon eating behaviours, self-esteem, compassion, and psychological symptoms.

DESIGN

Forty-four students were randomly allocated to either the EFT group or the waitlist control group.

RESULTS

Results revealed a delayed effect for both groups at post-intervention, with improved eating habits, self-esteem, and compassion at follow-up. Findings provide preliminary support for EFT as an effective treatment strategy for increasing healthy eating behaviours and improving associated weight-related psychopathology.

The Role of School Contexts in Adolescents' Weight-Loss Behaviors and Self-Perceptions of Overweight

Using the National Longitudinal Study of Adolescent to Adult Health and multi-level modeling, this study investigates the role high schools social contexts play in the development of adolescents' weight-loss behaviors and overweight self-perceptions. Overall, the results indicate that there is an important association between adolescents' weight-loss behaviors and self-perceptions of overweight and the weight-related context of their school. For example, both adolescent boys and girls are less likely to engage in weight-loss behaviors when overweight is prevalent among their same-sex schoolmates. However, gender differences are also found. For example, while adolescent boys' self-perceptions of overweight are significantly associated with their same-sex schoolmates' characteristics and behaviors, this is not the case for adolescent girls. Overall, these findings suggest that meso-level social contexts - like schools - may be particularly important to how individuals incorporate macro-level beliefs or values - like gendered body ideals - into their own behaviors and self-concepts.

Utilizing non-traditional research designs to explore culture-specific risk factors for eating disorders in African American adolescents

Over the past three decades, there has been an increase in the number of empirical investigations of the phenomenology of eating disorders among African American adolescents. Despite efforts to understand racial/ethnic differences, relatively few eating disorder models address the important sociocultural factors that exert powerful influences on beliefs and behaviors related to weight status and eating patterns in this population. Nevertheless, researchers must be culturally competent in order to develop appropriate models. Therefore, we propose an approach to developing researcher cultural competence by addressing potential barriers that may hinder efforts to explore relevant, culturally appropriate factors that contribute to eating disturbance in African American girls. In this regard, we highlight the importance of integrative collaboration that can assist in identification and exploration of potential risk factors that may lead to model generation. We believe such information will lead to the development of culturally appropriate assessments, models, and, ultimately, interventions.

A Dual Pathway Model of Steroid Use among Adolescent Boys: Results from a Nationally Representative Sample

Anabolic-androgenic steroid (AAS) use is associated with medical and psychiatric complications; however, despite the identification of psychosocial correlates of AAS use, comprehensive models have rarely been assessed. Thus, AAS use as a function of self-perceived weight status, victimization, and depressive symptoms was examined via simultaneous multiple mediation with non-parametric bootstrapping. Data from the 2009 National Youth Risk Behavior Survey (YRBS) was utilized. The target population consisted of all public, Catholic, and other private school students in grades 9 through 12 in the United States. The sample comprised 8,065 adolescent high school males. The global and individual indirect effects of self-perceived underweight status to AAS use through depressive symptoms and victimization were significant. However, the victimization pathway was revealed to be stronger in magnitude than the depressive pathway. Depressive symptoms and victimization are two pathways in which self-perceived underweight status predicts AAS use among adolescent boys.

Effects of gender, media influences, and traditional gender role orientation on disordered eating and appearance concerns among Latino adolescents

This study examined the main and interaction effects of gender, traditional gender role orientation, and media-influenced sociocultural values and ideals about appearance in a sample of 96 Latino adolescents controlling for age, country of origin, and BMI. Girls and less traditionally oriented youth reported significantly more disordered eating and appearance concerns than did boys and more traditionally oriented youth. Gender moderated the relationship between traditional gender role orientation and disordered eating and appearance concerns. Contrary to our hypothesis, media-influenced sociocultural values and ideals about appearance did not significantly predict disordered eating and appearance concerns. However, the interaction between gender and sociocultural values and ideals about appearance was significant. Our findings highlight the importance of continued research on gender, media, and cultural influences as they relate to disordered eating and appearance concerns among Latino youth.

The association between disturbed eating behavior and socioeconomic status: the Online Korean Adolescent Panel Survey (OnKAPS)

BACKGROUND

A limited amount of research, primarily conducted in Western countries, has suggested that higher socioeconomic status (SES) is associated with higher risk of eating disorders (EDs). However, little is known about this association in Asian countries. We examined the association of SES with disturbed eating behavior (DEB) and related factors in Korean adolescents.

SUBJECTS

A nationwide online panel survey was conducted in a sample of adolescents (n = 6,943, 49.9% girls). DEB was measured with the 26-item Eating Attitudes Test (EAT-26). Participants who scored ≥20 on the EAT-26 were considered to have DEB. Participants' SES was determined based on self-reported household economic status.

RESULTS

The prevalence of DEB was 12.7%: 10.5% among boys and 14.8% among girls. Both boys and girls with DEB were more likely to perceive themselves as obese, experience higher levels of stress, and have lower academic achievement. The risk for DEB was significantly higher in boys of higher SES than in those of middle SES (OR = 1.45, 95%CI = 1.05-1.99 for high SES; OR = 5.16, 95%CI: 3.50-7.61 for highest SES). Among girls, higher risk of DEB was associated with the highest and lowest SES (OR = 1.52, 95%CI: 1.13-2.06 for lowest SES; OR = 2.22, 95%CI: 1.34-3.68 for highest SES).

CONCLUSIONS

Despite the lower prevalence of obesity in Korea compared with Western countries, the prevalence of DEB in Korean adolescents was high, especially among girls. Moreover, the association between SES and DEB followed a U-shaped curve for girls and a J-shaped curve for boys.

Associations between different forms of body dissatisfaction and the use of weight-related behaviors among a representative population-based sample of adolescents

Weight management strategies have two components: weight goals and behaviors to reach weight goals. In the literature, weight goals and weight-related behaviors have both been linked with body dissatisfaction separately, but have rarely been examined simultaneously. This paper examines the associations between different forms of body dissatisfaction and various weight-related behaviors and investigates the moderating role of weight goals in these associations. Measures included weight goals (matching or mismatching current weight status), self-reported frequencies of use of weight-related behaviors, and a body dissatisfaction measure (strength of aspiring for weight gain or weight loss) from a representative population-based sample of adolescents (n = 2,346, 51 % female). Sex-specific multilevel logistic and ordinal regression analyses indicated that aspiring for a thinner body among girls was associated with more frequent use of healthy and unhealthy behaviors, whereas body dissatisfaction of any type among boys was linked to more frequent use of unhealthy behaviors. Girls aspiring for substantial weight loss and boys aspiring for substantial weight gain were more likely to use disordered health behaviors. Aiming for a goal that is mismatched with current weight status increases the use of unhealthy behaviors among body dissatisfied adolescents. We conclude that in order to elaborate interventions aimed at promoting health, research should focus on processes leading to specific forms of body dissatisfaction which in turn produce varying frequencies of use of weight-related behaviors.

The relationship between body mass index and unhealthy weight control behaviors among adolescents: the role of family and peer social support

Adolescents classified as overweight or obese are more likely to use unhealthy weight control behaviors such as skipping meals or fasting than their healthy weight peers. Adolescents with low perceived social support may be at particular risk. Therefore, the purpose of the present study was to investigate the association between adolescent overweight and obesity, indices of perceived peer and family social support, and their interaction in the use of unhealthy weight control behaviors among adolescents. The present study used data from the 2001-2002 Health Behavior in School-Aged Children collaborative survey. Participants included 4598 adolescent girls and boys in the ninth and tenth grades. Results of binary logistic regression analyses showed that obese boys and girls were more likely to use unhealthy weight control behaviors than their healthy weight peers. Boys and girls who endorsed difficult communication with their parents, low levels of parent school support, or frequent bullying were more likely to engage in unhealthy weight control behaviors than relevant comparison groups. Among girls, poor classmate relationships were associated with increased use of unhealthy weight control behaviors whereas fewer friendships were associated with decreased use. Results suggest that adolescents are at high risk for use of unhealthy weight control behaviors and would benefit from interventions to increase knowledge and social support for achieving and maintaining a healthy weight.

Prevalence of weight-related concerns and behaviours among New Zealand young people

AIM

The study aims to describe the prevalence of weight loss behaviours and weight-related concerns among a nationally representative sample of adolescents in New Zealand.

METHODS

Data for this study were collected as part of Youth'07, a nationally representative survey of the health and well-being of 9107 secondary school students in New Zealand.

RESULTS

More than one third of males and 65% of females tried to lose weight in the past year. Approximately 10% of males and 29% of females reported using at least one of the unhealthy weight control behaviours in the past year (fasted, skipped meals, smoked, vomited, diet pills). Among females and males, using unhealthy weight control behaviours was most prevalent among those who were older, overweight and lived in high-deprivation areas.

CONCLUSION

Unhealthy weight control behaviours among New Zealand adolescents are common and warrant future research and discussion to understand why so many young people use unhealthy weight loss strategies.

Child and caregiver reports of weight control behaviors in pediatric obesity

BACKGROUND

This study examined agreement and disagreement between child and caregiver reports of healthy, unhealthy, and extreme weight control behaviors (WCBs) in overweight and obese children.

METHODS

Participants were 93 youth 10-17 years old [M = 12.9; standard deviation (SD) = 2.1] attending an outpatient pediatric obesity clinic and their caregivers. Children and caregivers completed a measure examining child use of healthy, unhealthy, and extreme WCBs. Caregivers also completed a demographic questionnaire.

RESULTS

Significant differences between child and caregiver reports were found for child engagement in healthy, t(88) = 2.13, p < 0.05, and unhealthy WCBs, t(91) = 2.19, p < 0.05. Children endorsed using more WCBs to lose or maintain weight within the past year compared to caregiver report. No differences were found for extreme WCBs t(92) = 1.72, p = 0.09. Agreement between child and caregiver reports of WCBs ranged from slight to moderate (Cohen kappa = 0.11 to 0.43) for healthy WCBs, fair to moderate (0.25 to 0.44) for unhealthy WCBs, and fair to substantial (0.36 to 0.66) for extreme WCBs.

CONCLUSIONS

Comparing child and caregiver reports of different WCBs used by children is important due to the differences and ranges of agreement found. Agreement between child and caregiver reports of WCBs in this sample was higher than in previous research. These findings highlight the importance of including both child and caregiver reports of healthy, unhealthy, and extreme WCBs in future research.

Identifying the 'red flags' for unhealthy weight control among adolescents: findings from an item response theory analysis of a national survey

Background

Weight control behaviors are common among young people and are associated with poor health outcomes. Yet clinicians rarely ask young people about their weight control; this may be due to uncertainty about which questions to ask, specifically around whether certain weight loss strategies are healthier or unhealthy or about what weight loss behaviors are more likely to lead to adverse outcomes. Thus, the aims of the current study are: to confirm, using item response theory analysis, that the underlying latent constructs of healthy and unhealthy weight control exist; to determine the ‘red flag’ weight loss behaviors that may discriminate unhealthy from healthy weight loss; to determine the relationships between healthy and unhealthy weight loss and mental health; and to examine how weight control may vary among demographic groups.

Methods

Data were collected as part of a national health and wellbeing survey of secondary school students in New Zealand (n = 9,107) in 2007. Item response theory analyses were conducted to determine the underlying constructs of weight control behaviors and the behaviors that discriminate unhealthy from healthy weight control.

Results

The current study confirms that there are two underlying constructs of weight loss behaviors which can be described as healthy and unhealthy weight control. Unhealthy weight control was positively correlated with depressive mood. Fasting and skipping meals for weight loss had the lowest item thresholds on the unhealthy weight control continuum, indicating that they act as ‘red flags’ and warrant further discussion in routine clinical assessments.

Conclusions

Routine assessments of weight control strategies by clinicians are warranted, particularly for screening for meal skipping and fasting for weight loss as these behaviors appear to ‘flag’ behaviors that are associated with poor mental wellbeing.

Differentiating the effects of maternal and peer encouragement to diet on child weight control attitudes and behaviors

Obese and overweight youth are more at risk for engaging in frequent dieting, unhealthy weight control behaviors and report more body dissatisfaction than their normal weight peers. Previous research has indicated that peer and maternal encouragement to diet is predictive of unhealthy weight related behaviors and attitudes. The current study aims to examine if maternal and peer encouragement to diet equally mediate the relationship between youth BMI z-score and (a) unhealthy weight control behaviors, (b) diet frequency and (c) body dissatisfaction in a sample of racially diverse boys and girls. Participants were 94 children/adolescents between the ages of 8-17. Results were stratified by gender. Three bootstrapped multiple mediation models were conducted to examine each outcome variable. Results indicated that maternal encouragement to diet mediated the relationships predicting unhealthy weight control and diet frequency for girls, but not for boys. Peer encouragement to diet significantly mediated the relationship predicting unhealthy weight control behaviors, with increased peer encouragement associated with fewer unhealthy weight control behaviors for girls. Peer encouragement to diet was not a significant mediator for any of the outcomes for boys. Results suggest that maternal encouragement to diet may play a larger role than peer encouragement to diet in predicting unhealthy weight attitudes and behaviors for girls.

Socioeconomic disparities in emerging adult weight and weight behaviors

OBJECTIVES

To explore weight, weight behaviors, and tobacco and alcohol use among emerging adults by parental education and financial strain.

METHODS

Cross-sectional analyses of 2010 survey data from an urban Minnesota public 4-year university and 2-year community college (n=1201).

RESULTS

Low parental education was associated with lower fruit/vegetable consumption and physical activity and more fast food and unhealthy weight control. Financial strain was associated with less physical activity and more unhealthy weight control, binge drinking, and tobacco use.

CONCLUSIONS

Unique relationships exist between socioeconomic indicators and emerging adult health behaviors. Additional research is needed to understand financial context among emerging adults.

Dietary attitudes and diseases of comfort

This article reviews Western dietary attitudes and lifestyle choices by identifying the environmental, social and personal factors that determine said attitudes and choices. Environmental factors exert a major influence on, and complicate, dietary behavior, primarily by facilitating the consumption of meals away from home and by minimizing time dedicated to meal preparation and consumption. Social factors, from mass media to advertising and cultural traditions, also influence food intake, to an extent that is still underestimated. Ignorance of the real influence of environment and society on food choices could well blind consumers to the real significance of such choices. Accordingly, this review discusses differing aspects of emerging dietary trends and/or philosophies, and underlines their potentially harmful influence on health. Western countries are increasingly witnessing a dichotomy between the findings of nutritional science and the choices that dietary trends propose and impose. Coinciding with the obesity epidemic and the spread of other food-related diseases, this dichotomy calls for the development of effective preventive strategies.

Association of web-based weight loss information use with weight reduction behaviors in adolescent women

PURPOSE

To examine the association between seeking weight loss information from the Internet and weight loss behaviors.

METHODS

A self-administered survey was conducted on 3,181 women, aged 16-24 years, between August 2008 and August 2010. Questions were asked on use of the Internet to obtain weight loss information and various weight loss practices. Multivariate logistic regression analyses were performed to examine the association between seeking weight loss information online and practicing these weight loss behaviors.

RESULTS

In all, 39% used the Internet to seek weight loss information. Women who obtained weight loss information from the Internet were more likely to exercise (odds ratio [OR]: 1.31, 95% confidence interval [CI]: 1.07-1.60), use diet pills (OR: 4.14, 95% CI: 2.93-5.84), laxatives (OR: 2.02, 95% CI: 1.15-3.54), diuretics (OR: 7.89, 95% CI: 2.88-21.61), vomit after eating (OR: 2.56, 95% CI: 1.24-5.30), skip meals (OR: 2.77, 95% CI: 2.26-3.39), smoke more cigarettes (OR: 1.56, 95% CI: 1.14-2.14), and stop eating carbohydrates (OR: 3.09, 95% CI: 1.81-5.26) after adjusting for age, race/ethnicity, body mass index, and education.

CONCLUSIONS

Many young women engage in unhealthy weight loss behaviors which they may learn online. Interventions are needed to instruct young women on safe practices to lose weight.

Unhealthy weight control behaviors among adolescents

This article examined moderators of the association between BMI and unhealthy weight control behaviors suggested by the Dual Pathway Model among 4,529 adolescents from the Health Behavior in School-Aged Children survey. An obese classification was associated with unhealthy weight control behaviors for boys and girls. Low life satisfaction, high negative affect, and body size dissatisfaction were associated with unhealthy weight control behaviors among boys as was low life satisfaction for girls. Among girls, healthy weight classification, coupled with low negative affect or body size satisfaction, was protective against unhealthy weight control behaviors. Improved self-care may decrease obesity and unhealthy weight control behaviors.

Weight comments by family and significant others in young adulthood

Weight teasing is common among adolescents, but less is known about the continuation of this experience during young adulthood. The present study uses survey data from a diverse sample of 2287 young adults, who participated in a 10-year longitudinal study of weight-related issues to examine hurtful weight comments by family members or a significant other. Among young adults, 35.9% of females and 22.8% of males reported receiving hurtful weight-related comments by family members, and 21.2% of females and 23.8% of males with a significant other had received hurtful weight-related comments from this source. Hispanic and Asian young adults and overweight/obese young adults were more likely to report receiving comments than those in other groups. Weight teasing during adolescence predicted hurtful weight-related comments in young adulthood, with some differences by gender. Findings suggest that hurtful weight talk continues into young adulthood and is predicted by earlier weight teasing experiences.

Unhealthy weight control behaviours in adolescent girls: a process model based on self-determination theory

This study used self-determination theory (Deci, E.L., & Ryan, R.M. (2000). The 'what' and 'why' of goal pursuits: Human needs and the self-determination of behavior. Psychological Inquiry, 11, 227-268.) to examine predictors of body image concerns and unhealthy weight control behaviours in a sample of 350 Greek adolescent girls. A process model was tested which proposed that perceptions of parental autonomy support and two life goals (health and image) would predict adolescents' degree of satisfaction of their basic psychological needs. In turn, psychological need satisfaction was hypothesised to negatively predict body image concerns (i.e. drive for thinness and body dissatisfaction) and, indirectly, unhealthy weight control behaviours. The predictions of the model were largely supported indicating that parental autonomy support and adaptive life goals can indirectly impact upon the extent to which female adolescents engage in unhealthy weight control behaviours via facilitating the latter's psychological need satisfaction.

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.

Pursuit of Muscularity in Adolescent Boys: Relations Among Biopsychosocial Variables and Clinical Outcomes

Adolescent boys (n = 269) were assessed for levels of several risky behaviors related to the pursuit of muscularity, including substance use (anabolic steroids, prohormones, and ephedrine) dieting to gain weight, and symptoms of muscle dysmorphia (MD). The association between these behaviors and a variety of putative biological, psychological, and social risk factors were also evaluated. Concerning rates for lifetime use of steroids (2.6%), prohormones (4.5%), and ephedrine (6%) were found. Multiple regression analyses indicated that MD and sports participation significantly predicted substance use. Body dissatisfaction and body mass index were significant predictors of dieting to gain weight. Additionally, negative affect, media influence, and sports participation predicted symptoms of MD.

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.

Disturbed eating attitudes and behaviors in South Korean boys and girls: a school-based cross-sectional study

PURPOSE

This study was designed to assess the prevalence and correlates of disturbed eating attitudes and behaviors in South Korean students.

MATERIALS AND METHODS

In a cross-sectional survey, 2,226 fourth and seventh grade students filled out questionnaires on eating attitudes and behaviors (Eating Attitude Test -26, EAT-26), coping strategies, fear of being overweight, behavioral problems, anxiety, depression, and self-esteem.

RESULTS

Disturbed eating attitudes and behaviors were found in 7 percent of students. In the multivariate analyses, disturbed eating attitudes and behaviors were associated with the passive coping strategies, fear of being overweight, total behavioral difficulties, fourth grade, and high socioeconomic status (SES). Differences in the associations were found between boys and girls. There were significant associations between elevated EAT-26 scores and passive coping strategies, desired underweight body mass index (BMI), and low SES in boys; and between elevated EAT-26 scores and passive coping strategies, fear of being overweight, behavioral problems, being in the fourth grade, and high and low SES in girls.

CONCLUSION

In South Korean children, disturbed eating attitudes and behaviors were associated with various psychological and sociocultural factors; some gender-related differences are also evident.

Sizing up peers: adolescent girls' weight control and social comparison in the school context

Using the National Longitudinal Study of Adolescent Health and multi-level modeling, we examine the role of social comparison with schoolmates in adolescent girls' weight control. Specifically, we focus on how girls' own weight control is influenced by the body sizes and weight-control behaviors of their schoolmates. Our findings suggest that comparisons with similar others (in this case, girls of a similar body size) appear to have the strongest association with individual girls' reports of trying to lose weight. For example, the odds that an overweight girl is engaged in weight control increase substantially when many overweight girls in her school are also trying to lose weight. This study highlights how schools play an important role in shaping girls' decisions to practice weight control and demonstrates how social comparison theory improves our understanding of how health behaviors are linked to social contexts.

Casting weight goal as a function of weight status among a representative population-based sample of adolescents

This paper pursues two objectives: (1) to estimate proportions of adolescents with a weight goal that matched and mismatched weight status, and (2) to identify correlates of a mismatched weight goal. Data were from a representative population-based sample of adolescents (n=2346, 51% female; 91.5% complete data). Results showed that 69% of adolescents had a weight goal that matched weight status whereas 31% had a weight goal that mismatched weight status. Body dissatisfaction was a significant predictor of having a mismatched weight goal for both sexes while elevated psychological distress was a predictor among girls. Being body dissatisfied mediated the association between psychological distress and having a mismatched weight goal among girls. Casting weight goal as a function of weight status may allow for a better understanding of overall weight management strategies.

Body perceptions, weight control behavior, and changes in adolescents' psychological well-being over time: a longitudinal examination of gender

This study used the National Longitudinal Study of Adolescent Health to explore gender differences in the relationship between body perceptions and behavior and changes in adolescents' psychological well-being over a one-year time period. The sample included 12,814 adolescents (51% girls) aged 11-20 comprised of 68% Non-Hispanic White, 15% African American, 12% Hispanic, and 4% Asian. Perceptions of being larger or more developed generally decreased girls' psychological well-being over time. Body perceptions and behavior did not significantly influence changes in boys' psychological well-being over time. Non-Hispanic White girls were the most influenced and Non-Hispanic White boys were the least influenced by body perceptions and behavior. Perceived relative development influenced early adolescent girls, whereas perceptions of being overweight influenced middle to late adolescent girls. Additionally, trying to lose weight influenced middle adolescent boys and girls. These results imply that body perceptions and behavior disadvantage girls' psychological well-being relative to boys during adolescence.

Interpersonal influences on late adolescent girls' and boys' disordered eating

Perceived socio-cultural pressure to be thin has an important impact on disordered eating during early and middle adolescence, but less is known about late adolescence. Most prospective studies included only girls, and less is known about the influence on boys. This study investigated interpersonal influences on changes in late adolescent boys' and girls' symptoms of disordered eating over one year. Participants were a community sample of late adolescents 16-19 years of age (N=199; 49.75% girls), their mothers, and friends. Structural equation modeling revealed that interpersonal pressure to be thin and criticism about appearance predicted increases in disordered eating over time. Late adolescents', mothers' and friends' reports of pressure were associated with disordered eating at Time 1 and Time 2. Further, adolescents' perceptions and friends' reports of pressure to be thin predicted changes in disordered eating over time. Findings underscore the significance of interpersonal relationships for disordered eating during late adolescence in both girls and boys.

The role of motivation to eat in the prediction of weight control behaviors in female and male adolescents

OBJECTIVE

To examine whether motivation to eat variables predict changes in dieting and weight control behaviors in both gender groups over time.

METHOD

Greek adolescents (n=247), aged 14-18 years, completed questionnaires measuring different dimensions of motivation to eat, dieting, healthy and unhealthy weight control behaviors. Dieting and weight control behaviors were measured five months later.

RESULTS

Compliance motivation positively predicted changes in dieting in males and a number of unhealthy weight control behaviors in females. Coping motivation negatively predicted meal skipping in both genders and was associated with a lower risk of vomiting in females. Social motivation positively predicted eating less high fat food in males while pleasure motivation was associated with a reduced likelihood of eating more fruits and vegetables in females and a reduced risk of fasting in males.

CONCLUSION

Intervention programs designed to facilitate healthy and circumvent unhealthy weight control practices in adolescents should attend to gender differences in motivational factors shown to predict dieting and weight control behaviors. For females it may be important to minimize compliance motivation whereas for males, programs that foster social motivation to eat might be appropriate.

Body weight dissatisfaction and communication with parents among adolescents in 24 countries: international cross-sectional survey

Background

Parents have significant influence on behaviors and perceptions surrounding eating, body image and weight in adolescents. The aim of this study was to examine the prevalence of body weight dissatisfaction, difficulty in communication with the parents and the relationship between communication with parents and adolescents' dissatisfaction with their body weight (dieting or perceived need to diet).

Methods

Survey data were collected from adolescents in 24 countries and regions in Europe, Canada, and the USA who participated in the cross-sectional 2001/2002 Health Behaviour of School-Aged Children (HBSC) study. The association between communication with parents and body weight dissatisfaction was examined using binary logistic regression analysis.

Results

Body weight dissatisfaction was highly prevalent and more common among girls than boys, among overweight than non-overweight, and among older adolescents than younger adolescents. Difficulty in talking to father was more common than difficulty in talking to mother in all countries and it was greater among girls than among boys and increased with age. Difficulties in talking to father were associated with weight dissatisfaction among both boys and girls in most countries. Difficulties in talking to mother were rarely associated with body weight dissatisfaction among boys while among girls this association was found in most countries.

Conclusion

The findings suggest that enhanced parent communication might contribute in most countries to less body dissatisfaction in girls and better communication with the father can help avoiding body weight dissatisfaction in boys. Professionals working with adolescents and their families should help adolescents to have a healthy weight and positive body image and promote effective parent – adolescent communication.

Consumo de suplementos por jovens freqüentadores de academias de ginástica em São Paulo

A preocupação com a aparência e a estética pode levar ao consumo indiscriminado de suplementos nas academias. Os fatores relacionados ao consumo de suplementos em 201 jovens entre 15 e 25 anos freqüentadores de academias de ginástica da cidade de São Paulo foram investigados através da aplicação de formulário próprio. O uso de suplementos é relatado por 61,2% (n = 123) da amostra. Os homens usam mais suplementos que as mulheres (p < 0,001) e os adolescentes tendem a utilizar mais que os adultos jovens (p = 0,07). Os suplementos mais utilizados são bebidas esportiva (12%), hipercalóricos (12%), aminoácidos (10%), proteínas (10%) e creatina (8%), basicamente por auto-prescrição (42,8%) e pela indicação de treinadores (27,5%). O consumo de suplementos é significativamente maior entre aqueles que se exercitam há mais tempo; freqüentam a academia há mais tempo; e ficam na academia mais horas/semana. Ter amigos usuários (p = 0,03) e/ou um usuário em casa (p = 0,01) influencia no consumo de suplementos. O consumo de suplementos é uma prática que faz parte da realidade das academias de ginástica e o ambiente é favorecedor do uso desses produtos.