Racial/ethnic differences in weight concerns: protective and risk factors for the development of eating disorders and obesity among adolescent females

​Depressive symptoms and weight loss behaviors in U.S. adults

OBJECTIVE

We sought to determine whether depressive symptoms are associated with attempting to lose weight and engaging in weight loss behaviors in a large, diverse sample of adults representative of the U.S.

METHODS

Respondents were 23,106 adults, free of cardiovascular disease and diabetes, who participated in the 2005-2014 years of the National Health and Nutrition Examination Survey (NHANES). Depressive symptoms were measured using the Patient Health Questionnaire-9 (PHQ-9), and weight loss variables were obtained from a Weight History Questionnaire.

RESULTS

PHQ-9 total was not associated with attempting to lose weight in the past year (OR = 1.03, 95%CI = 1.00-1.06, p = 0.074; n = 23,106). Among respondents who attempted to lose weight (n = 9582), PHQ-9 total was associated with a lower odds of exercising (OR = 0.84, 95%CI = 0.79-0.89, p < 0.001) and a greater odds of skipping meals (OR = 1.31, 95%CI = 1.22-1.41, p < 0.001), eating diet foods/products (OR = 1.16, 95%CI = 1.08-1.24, p < 0.001), eating less food (OR = 1.09, 95%CI = 1.04-1.15, p < 0.001), taking non-prescription supplements (OR = 1.31, 95%CI = 1.23-1.41, p < 0.001), taking prescription diet pills (OR = 1.28, 95%CI = 1.10-1.49, p = 0.001), and taking laxatives/vomiting (OR = 1.55, 95%CI = 1.28-1.88, p < 0.001).

CONCLUSIONS

Although depressive symptoms were not associated with attempting to lose weight in the past year, adults who attempted to lose weight tended to employ potentially ineffective/unhealthy weight loss behaviors and avoid effective behaviors. This pattern of behaviors may be another mechanism that explains the excess risk of obesity in depressed adults and may be a modifiable target for future interventions. Given the cross-sectional nature of this study, reverse causality is a possibility. Future studies should investigate the prospective associations between depressive symptoms and weight loss behaviors.

Obesity among Black Adolescent Girls: Genetic, Psychosocial, and Cultural Influences

This article focuses on the causes, consequences, and prevention of obesity among a subgroup of the American population, Black adolescent girls. Using an ecological perspective on obesity among Black adolescent girls, including feminist-womanist perspectives and historical and medical sociological perspectives, the authors discuss genetic, psychosocial, and cultural factors that may influence the propensity of Black adolescent girls’ susceptibility to obesity and to diabetes, one of the major complications of obesity. Prevention strategies, including individual and structural interventions, are illuminated.

Ethnic differences in the effects of media on body image: the effects of priming with ethnically different or similar models

Media exposure has been positively correlated with body dissatisfaction. While body image concerns are common, being African American has been found to be a protective factor in the development of body dissatisfaction.

METHOD

Participants either viewed ten advertisements showing 1) ethnically-similar thin models; 2) ethnically-different thin models; 3) ethnically-similar plus-sized models; and 4) ethnically-diverse plus-sized models. Following exposure, body image was measured.

RESULTS

African American women had less body dissatisfaction than Caucasian women. Ethnically-similar thin-model conditions did not elicit greater body dissatisfaction scores than ethnically-different thin or plus-sized models nor did the ethnicity of the model impact ratings of body dissatisfaction for women of either race. There were no differences among the African American women exposed to plus-sized versus thin models. Among Caucasian women exposure to plus-sized models resulted in greater body dissatisfaction than exposure to thin models.

DISCUSSION

Results support existing literature that African American women experience less body dissatisfaction than Caucasian women even following exposure to an ethnically-similar thin model. Additionally, women exposed to plus-sized model conditions experienced greater body dissatisfaction than those shown thin models.

Associations of mood and anxiety disorders with obesity: comparisons by ethnicity

OBJECTIVE

The aim of this study is to compare the associations of mood and anxiety disorders (12 months and past diagnosis) with obesity among ethnically diverse adults.

METHODS

Data from Caucasians, African American, and Latinos in the National Comorbidity Survey Replication (NCS-R), National Latino and Asian American Study (NLAAS), and National Study of American Life (NSAL) were analyzed (n=17,445). Multivariate logistic regression models tested the associations between 12 month and past diagnosis of mood and anxiety disorders with obesity (body mass index ≥ 30kg/m²).

RESULTS

Approximately 52% of the sample was female and 24% obese. Among Caucasians, 12-month mood disorder (OR=1.30, 95% CI=1.05, 1.62), past diagnosis of mood disorder (OR=1.37, 95% CI=1.11, 1.69) and 12-month anxiety disorder (OR=1.40, 95% CI=1.02, 1.68) were associated with greater likelihood of obesity. Among African Americans, past year anxiety disorder (OR=1.63, 95% CI=0.92, 1.67) was associated with greater likelihood of obesity, and a trend toward an association between 12 month mood disorder (OR=1.24, 95% CI=0.92, 1.67) and obesity was observed. Similarly among Latinos, past year anxiety disorder (OR=1.45, 95% CI=1.00, 1.99) was associated with greater likelihood of obesity, and a trend toward an association between 12-month mood disorder (OR=1.26, 95% CI=0.94, 2.01) was observed. Tests of statistical interaction to assess heterogeneity of the associations of mood and anxiety disorders with obesity, comparing African Americans and Latinos to Caucasians, suggest differences in the association of past diagnosis of mood disorder with obesity (P<.10 for both groups).

CONCLUSIONS

Results suggest similar associations between 12-month mood and anxiety disorders with obesity across groups.

Influence of parents and friends on children's and adolescents' food intake and food selection

BACKGROUND

The influence of parents versus friends on youths' eating behavior has not been directly compared, and little is known about the developmental effects of social influences on their eating behavior.

OBJECTIVE

The objective was to compare the effects of mothers and friends on children's and adolescents' energy intake from sandwiches and from healthy and unhealthy snacks and dessert foods.

DESIGN

Twenty-three children (ages 5-7 y) and 27 adolescents (ages 13-15 y) ate a meal with their mother on one occasion and with a same-sex friend on another occasion.

RESULTS

Male and female children consumed less energy from unhealthy snacks when in the presence of their mothers than when in the company of their friends. Conversely, female adolescents consumed less energy from unhealthy snacks and more energy from healthy snacks when they were with their friends than when with their mothers.

CONCLUSIONS

Food selection is differentially influenced by the source of social influence and the age and sex of the child. Parents may act as an inhibitory influence on unhealthy eating for younger children. Adolescent girls may try to convey a good impression of healthy eating when eating with same-sex friends, but the eating habits of teenage boys are not as influenced by the social context. This trial is registered at clinicaltrials.gov as NCT00875576.

The presence of friends increases food intake in youth

BACKGROUND

Friendship may be uniquely relevant and influential to youths' eating behavior.

OBJECTIVE

This study examined how overweight and nonoverweight youths adjust their level of eating as a function of their familiarity with their eating partner.

DESIGN

Twenty-three overweight and 42 nonoverweight youths had the opportunity to play and eat with a friend (n = 26) or with an unfamiliar peer (n = 39). The dependent variables of interest were the amount of nutrient-dense and energy-dense foods children consumed and their total energy intake.

RESULTS

Participants eating with a friend ate substantially more than did participants eating with an unfamiliar peer. Furthermore, overweight youth, but not nonoverweight youth, who ate with an overweight partner (friend or unfamiliar peer) consumed more food than did overweight participants who ate with a nonoverweight eating partner. Matching of intake was greater between friends than between unfamiliar peers.

CONCLUSIONS

These results extend previous research by suggesting that the effect of the partners' weight statuses may add to the facilitative effect of familiarity and result in greater energy intake in overweight youth and their friends. Behavioral similarity among overweight youth may increase the difficulty of promoting long-term changes because the youths' social network is likely to reinforce overeating. This trial was registered at clinicaltrials.gov as NCT00874055.

Disordered eating attitudes and behaviors in overweight youth

Disordered eating attitudes and behaviors appear to be quite common in youth, and overweight youth have been identified as a subset of the population at particularly high risk for endorsing such symptoms. Overweight and eating disorder (ED) symptomatology independently confer significant threats to one's physical and psychosocial health, showing strong links with body weight gain and risk for ED development. When concurrent, the risk for negative health outcomes may be compounded. The purpose of this article is to review the current state of the literature as it concerns disordered eating and its correlates in overweight children and adolescents. Extant literature on the prevalence, distribution, correlates, and etiology of disordered eating attitudes and behaviors (i.e., negative attitudes toward shape and weight, unhealthy weight control behaviors, and binge eating) in overweight youth is reviewed and consolidated in order to make assessment and treatment recommendations for healthcare providers. The current literature suggests that early detection of disordered eating in overweight youth should be a priority to provide appropriate intervention, thereby helping to slow the trajectory of weight gain and prevent or reduce the long-term negative consequences associated with both conditions. Future research should focus on explicating developmental pathways, and on developing novel prevention and treatment interventions for overweight youth exhibiting disordered eating patterns.

Distress with medication side effects among persons with severe mental illness

We examined prevalence and perceived distress resulting from self-reported side effects (SEs) attributed to psychotropic medications among individuals with severe mental illness participating in a study of consumer-operated services. We examined gender and racial differences using logistic regression, conducted factor analyses of SEs, and examined correlations between distress and self-reported symptoms. Over 90% reported at least one SE, and nearly two-thirds reported a high level of distress with at least one SE. The most distressing SEs reported were embarrassment from weight gain, weight gain, dry mouth, and sedation. The likelihood of distress by particular SEs varied by gender and race.

The effect of obesity management on body image in patients seeking treatment at medical centers

OBJECTIVE

Body image dissatisfaction is common in treatment-seeking patients with obesity. We aimed to investigate the effects of obesity management on body image in patients with obesity attending Italian medical centers for weight loss programs.

RESEARCH METHODS AND PROCEDURES

A total of 473 obese patients seeking treatment in 13 Italian medical centers (80% females; age, 45.9 +/- standard deviation 11.0 years; BMI, 36.8 +/- 5.7 kg/m(2)) were evaluated at baseline and after a 6-month weight loss treatment. Body uneasiness, psychiatric distress, and binge eating were tested by Body Uneasiness Test (BUT, Part A), Symptom CheckList-90 (SCL-90), and Binge Eating Scale (BES), respectively.

RESULTS

At 6-month follow-up, the percentage weight loss was significantly higher in men (9.0 +/- 6.3%) than in women (6.8 +/- 7.3%; p = 0.010). Both men and women had a significant improvement in BUT Global Severity Index and in all of the BUT subscales with the exception of the Compulsive Self-Monitoring subscale. Linear regression analysis selected baseline psychological and behavioral measures (global score of BUT and SCL-90) and improved psychiatric distress and binge eating as independent predictors of changes in basal body dissatisfaction in females, whereas in males, changes were associated only with baseline BUT-Global Severity Index score, binge eating, and its treatment-associated improvement. Pre-treatment BMI and BMI changes did not enter the regression.

DISCUSSION

Obesity treatment, even with a modest degree of weight loss, is associated with a significant improvement of body image, in both females and males. This effect depends mainly on psychological factors, not on the amount of weight loss.

Weight-related concerns associated with smoking in young children

Studies have shown that weight concern is associated with smoking in adolescents. However, little is known about the relationship between weight concern and smoking in younger children. Analyses were conducted to determine whether children in elementary school who had tried smoking would possess greater weight concern than those who had not tried smoking. Results indicated that smokers possessed more general weight concern, F(1, 640)=5.619, p=.018, reported more dieting, F(1, 707)=11.757, p=.001, and endorsed greater concern with body size, F(1, 707)=4.113, p=.043, than non-smokers. Similar to adolescents, these results suggest that young children who have tried smoking are more concerned about weight than children who have not tried smoking.

Effect of waist circumference on reference intervals of liver-related enzyme tests in apparently healthy adult Mexican Americans, black and white Americans

BACKGROUND

We used a more comprehensible and more physiologically valid indicator of obesity-related liver disease, waist circumference (WC), rather than BMI to study the effect of obesity on liver enzymes, easily measurable surrogates of liver disease.

METHODS

WC, liver enzymes and pertinent demographic data were abstracted from NHANES III. After exclusion criteria were applied, we stratified the populations by sex and ethnicity and graphed the percentage of elevated enzymes per WC interval.

RESULTS

There was a significant relationship between enzyme activity and WC (p<0.001 for ALT, p<0.01 for ALP, p<0.01 for AST, p=0.02 for GGT and p<0.05 for LD), and the relationship was stronger in females (p<0.002) and Mexican Americans (p<0.001). The enzyme-WC relationship is much weaker in non-Hispanic black females and males.

CONCLUSION

As increases in liver enzyme activity can indicate potentially reversible liver disease, our graphs should be used by physicians to motivate obese, apparently healthy Mexican American and non-Hispanic white patients with elevated liver enzymes to reduce their WC.

Body image and eating disordered behavior in a community sample of Black and Hispanic women

OBJECTIVE

The current study examined body image concerns and eating disordered behaviors in a community sample of Black and Hispanic women. In addition, this study explored whether there are ethnic differences in the correlates or in the prediction of body image concerns.

METHOD

Participants were 120 (67 Black and 53 Hispanic) women who responded to advertisements to participate in a study of women and health. Participants completed a battery of established self-report measures to assess body image, eating disordered behaviors, and associated psychological domains.

RESULTS

Black and Hispanic women did not differ significantly in their self-reports of body image, eating disordered behaviors, or associated psychological measures. Comparisons performed separately within both ethnic groups revealed significant differences by weight status, with a general graded patterning of greater concerns in obese than overweight than average weight groups. In terms of predicting body image, multiple regression analyses testing a number of variables, including BMI, performed separately for Black and Hispanic women revealed that eating concern and depressive affect were significant predictors of body image concern for both groups.

DISCUSSION

Overall, Black and Hispanic women differed little in their self-reports of body image, eating-disordered features, and depressive affect. Higher weight was associated with a general pattern of increased body image concerns and features of eating disorders in both groups and with binge eating in Black women. Eating concerns and depressive affect emerged as significant independent predictors of body image for both ethnic groups.

Ethnicity and body dissatisfaction among women in the United States: A meta-analysis

The prevailing view in popular culture and the psychological literature is that White women have greater body dissatisfaction than women of color. In this meta-analysis, 6 main effect sizes were obtained for differences among Asian American, Black, Hispanic, and White women with a sample of 98 studies, yielding 222 effect sizes. The average d for the White-Black comparison was 0.29, indicating that White women are more dissatisfied, but the difference is small. All other comparisons were smaller, and many were close to zero. The findings directly challenge the belief that there are large differences in dissatisfaction between White and all non-White women and suggest that body dissatisfaction may not be the golden girl problem promoted in the literature. Implications for theory and treatment are discussed.

Weight preoccupation as a function of observed physical attractiveness: ethnic differences among normal-weight adolescent females

OBJECTIVE

To examine the association between observer ratings of physical attractiveness and weight preoccupation for female adolescents, and to explore any ethnic differences between Caucasian, African-American, and Hispanic females.

METHODS

Normal-weight female adolescents who had participated in the National Longitudinal Study of Adolescent Health in-home Wave II survey were included (n = 4,324). Physical attractiveness ratings were made in vivo by interviewers. Using logistic regression models stratified by ethnicity, the associations between observer-rated attractiveness and weight preoccupation were examined after controlling for demographics, measured body mass index (BMI) and psychosocial factors.

RESULTS

Caucasian female adolescents perceived as being more attractive reported significantly greater weight preoccupation compared with those rated as being less attractive. Observed attractiveness did not relate to weight preoccupation among African-American or Hispanic youth when controlling for other factors.

CONCLUSIONS

For Caucasian female adolescents, being perceived by others as more attractive may be a risk factor for disordered eating.

Association of body size estimation and age in African-American females

This cross-sectional research study tested the hypothesis that body image estimates of African-American females differ as a function of age. To test this hypothesis, body image estimates of 379 African-American females, ranging in age from 16 to 96 years, were contrasted as a function of age group, while statistically controlling body mass index. Three body size estimates, current body size, ideal body size, and reasonable body size were measured using the Body Image Assessment for Obesity. The discrepancies between current and ideal body size estimates and between current and reasonable body size estimates were also analyzed to assess for differences in body size dissatisfaction. The study found that younger African-American women (16 to 35 years) differed from older African-American women (>35 years) on measures of body size dissatisfaction. Women in the age range of 26 to 35 years reported higher estimates of current body size in comparison to women older than 35 years. The youngest age group (16 to 25 years) reported thinner ideal body size goals in comparison to women who were slightly older (26 to 35 years) and women who were older than 75 years. The pattern of body image estimates across a large age range suggests that younger African-American women, in comparison to older African-American women, may have body images that may make them more susceptible to eating disorders.

Health-related quality of life in overweight and nonoverweight black and white adolescents

OBJECTIVES

To assess the impact of obesity on quality of life (QOL) in black and white adolescents.

STUDY DESIGN

One hundred ten overweight (body mass index [BMI], 41.7 +/- 8.9 kg/m2) and 34 nonoverweight adolescents (BMI, 20.6 +/- 2.9 kg/m2) and their parents completed measures of QOL.

RESULTS

Overweight was associated with poorer adolescent-reported QOL and parent reports of their children's QOL. Examining groups by weight status and race, overweight whites reported the greatest impairment on Social/Interpersonal, Self-Esteem, and Physical Appearance QOL (all P < .01), whereas parents of overweight blacks reported the poorest General Health Perceptions scores regarding their children. Interactions between BMI z-score and race were detected for Social/Interpersonal, Self-esteem, Daily Living, Self-Efficacy, Self-regard, and Physical Appearance QOL (all P < .05): Higher BMI in whites was associated with greater impairments in QOL than in blacks. Parents reported similar relations for their children.

CONCLUSIONS

According to adolescent and parent reports, overweight is associated with poorer QOL in adolescence, regardless of race; however, compared with overweight white adolescents, blacks report less impairment in QOL. Future research is required to determine whether differences in QOL are predictive of treatment success.

Ethnic differences in the prediction of eating and body image disturbances among female adolescent psychiatric inpatients

OBJECTIVE

The current study examined predictors of eating and body image disturbances in psychiatrically hospitalized female adolescents and investigated whether the predictors differ by ethnicity.

METHOD

Participants were 427 (320 Caucasian, 53 Latina, 54 African American) female adolescent psychiatric inpatients. Predictors of eating disorder features (dietary restraint, binge eating, and purging) and body image dissatisfaction (BID) were tested separately for the three ethnic groups. In addition to the eating and BID variables, the following predictor variables were considered: depression, anxiety, impulsivity, negative self-esteem, peer insecurity, and abuse.

RESULTS

Caucasians reported significantly higher levels of dietary restraint and BID than Latinas and African Americans, whereas reports of binge eating did not differ by ethnicity. Regression analyses revealed that the predictor variables accounted for significant and substantial amounts of the variance in the four eating and body image domains. Different psychological and social variables predicted eating disorder symptoms and BID across ethnic groups.

DISCUSSION

These findings suggest, for psychiatrically hospitalized adolescent females, that different patterns of factors may contribute to the maintenance of eating and body image disturbances across ethnic groups. Future research testing models of the etiology or maintenance of these disturbances needs to include ethnicity to ascertain whether the hypothesized components operate differently by ethnicity.

Physiological aspects and clinical sequelae of energy deficiency and hypoestrogenism in exercising women

Amenorrhoea associated with reduced caloric intake and strenuous exercise leads to hypoestrogenism and is associated with clinical manifestations that include disordered eating, stress fractures, osteoporosis, and, as recently reported, a potential increase in the risk of premature cardiovascular disease. Disordered eating, menstrual irregularities and bone loss comprise the clinical condition known as the 'female athlete triad'. The aetiology of the triad is linked to a high prevalence of disordered eating and cognitive restraint. This results in inadequate caloric intake for high exercise energy expenditures that leads to energy deficiency. This in turn stimulates compensatory mechanisms, such as weight loss or energy conservation, subsequently causing a central suppression of reproductive function and concomitant hypoestrogenism. Because the aetiology of menstrual disturbances and the female athlete triad is causally linked to energy deficiency, there is no justification for fears that exercise itself is unhealthy for women. However, improved detection, monitoring, and treatment of all components of the triad in exercising women should be emphasized. This paper critically reviews the physiological aspects and clinical sequelae of energy deficiency and hypoestrogenism associated with the female athlete triad in exercising women.