Weight and eating concerns among pre- and young adolescent boys and girls

Dieting and the self-control of eating in everyday environments: an experience sampling study

OBJECTIVE

The literature on dieting has sparked several debates over how restrained eaters differ from unrestrained eaters in their self-regulation of healthy and unhealthy food desires and what distinguishes successful from unsuccessful dieters. We addressed these debates using a four-component model of self-control that was tested using ecological momentary assessment, long-term weight change, and a laboratory measure of inhibitory control.

DESIGN

A large sample of adults varying in dietary restraint and inhibitory control (as measured by a Stroop task) were equipped with smartphones for a week. They were beeped on random occasions and provided information on their experience and control of healthy and unhealthy food desires in everyday environments.

MAIN OUTCOME MEASURES

The main outcome measures were desire strength, experienced conflict, resistance, enactment of desire, and weight change after a 4-month follow-up.

RESULTS AND CONCLUSIONS

Dietary restraint was unrelated to desire frequency and strength, but associated with higher conflict experiences and motivation to use self-control with regard to food desires. Most importantly, relationships between dietary restraint and resistance, enactment of desire, and long-term weight change were moderated by inhibitory control: Compared with dieters low in response inhibition, dieters high in response inhibition were more likely to attempt to resist food desires, not consume desired food (especially unhealthy food), and objectively lost more weight over the ensuing 4 months. These results highlight the combinatory effects of aspects of the self-control process in dieters and highlight the value in linking theoretical process frameworks, experience sampling, and laboratory-based assessment in health science.

STATEMENT OF CONTRIBUTION

What is already known on this subject? Dieting is a multifaceted process that can be viewed from the lens of self-control. Dietary restraint measures can be used to capture dieting status, but it is relatively unclear what differentiates successful from unsuccessful dieters (e.g., differences in desire frequency, desire strength, motivation, executive functions). What does this study add? A novel four-step conceptual model of self-control is applied to eating behaviour in everyday life. This model allows a fine-grained look at the self-control process in restrained eaters (dieters) as compared to non-dieters. Dieters and non-dieters do not differ in desire frequency and strength (they are not simply more tempted). Dieters high (as compared to low) in inhibitory control are more likely to engage in self-control. Dieters high (as compared to low) in inhibitory control are more likely to resist unhealthy food desires. Dieters high (as compared to low) in inhibitory control are more likely to loose weight over a 4-month period. Together, the study shows clear differences among successful and unsuccessful dieters that can be linked to differences in executive functioning (inhibitory control). The present article is one of the first studies combining a conceptual model with smartphone experience sampling to study weight control and thus paradigmatic from a methodological perspective.

Is there a role for primary care physicians' screening of excessive weight and eating concerns in adolescence?

OBJECTIVES

To determine the extent to which adolescents with excessive weight concerns and eating concerns are in contact with primary care physicians and could thus be identified in primary care.

STUDY DESIGN

A representative sample of 7548 (16 to 20 years old) students completed a self-administered questionnaire on health-related topics (2002 Swiss Multicenter Adolescent Health Survey). Adolescents with excessive weight and eating concerns were compared with control subjects for frequency of somatic complaints and primary care visits in the past year. Analyses were stratified by sex. Logistic regression was used to adjust for confounders.

RESULTS

Excessive weight and eating concerns were frequent in adolescents, particularly in girls (girls, 13.9%; boys, 1.6%). Adolescents with these concerns reported more frequent somatic complaints compared with their peers. Nearly 80% of them were in contact with a primary care physician at least once a year.

CONCLUSION

Primary care physicians are in contact with adolescents who have excessive weight and eating concerns. Identification of these concerns should be encouraged for appropriate management.

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.

Partial eating disorders among adolescents: a review

PURPOSE

Many adolescents do not fulfill all the DSM-IV criteria's for anorexia nervosa and bulimia, but do nevertheless suffer from partial eating disorders (EDs). This review focuses on the definition, epidemiology and clinical aspects of these disorders.

METHODS

Search on Medline & PsycINFO, review of websites, screening of bibliographies of articles and book chapters.

RESULTS

There is still no consensus on the definition of these disorders, which cover a wide range of severity. Affected adolescents often suffer from physical and psychological problems owing to co-morbidity or as a consequence of their eating patterns: chronic constipation, dyspeptic symptoms, nausea, abdominal pain, fatigue, headaches, hypotension, menstrual dysfunction as well as dysthymia, depressive and anxiety disorders, or substance misuse and abuse. In comparison with those who are unaffected, adolescents with partial ED are at higher risk of evolving into full ED. However, most of them evolve into spontaneous remission. Adolescents with partial ED engaged, over a period of several months, in potentially unhealthy weight-control practices, suffering from intense fear of gaining weight and a disturbed body weight/image should be offered therapeutic support.

CONCLUSION

Future research should focus on the exact delineation of various subtypes of clinical presentations in partial ED and on evidence-based treatment and follow-up of these various situations.

Body image dissatisfaction among males across the lifespan: a review of past literature

OBJECTIVE

Most past research has focused on body dissatisfaction among females. This paper provides a review and evaluation of studies that have examined body dissatisfaction among males. Body dissatisfaction in males has been associated with poor psychological adjustment, eating disorders, steroid use, exercise dependence, as well as other health behaviors. It is therefore important to understand the level of body dissatisfaction, as well as the factors that are related to this construct.

METHOD

The review is divided into three sections: body dissatisfaction among children, adolescents and adults. Within each section, levels of body dissatisfaction are examined, as well as the research that relates to sociocultural influences on body dissatisfaction. Difficulties in drawing valid conclusions from the data due to methodological problems are highlighted.

RESULTS

From the current data, it would appear that there are strong similarities in the levels of body dissatisfaction of male and female children, with most children demonstrating high levels of body satisfaction. During adolescence, boys are about equally divided between wanting to lose weight and increasing weight, but there are few studies that have examined a desire for increased muscle size. In adulthood, men evidence a stronger desire to lose weight as they get older.

CONCLUSION

Overall, past studies have primarily focused on questions that are relevant to females, and there is a need to conduct studies that evaluate areas of body dissatisfaction that have greater relevance for males. This will then allow a better understanding of the relationship between body dissatisfaction and psychological and behavioral problems experienced by males at all stages of the lifespan.

Body dissatisfaction among White and African American male and female college students

Body size perception has been shown to be highly influenced by cultural factors including race. This study assessed body size perceptions of a convenience sample of college students (N=630). Included in a paper-and-pencil survey were current height and weight (body mass index (BMI)=wt [kg]/ht(2) [m]), perceived BMI, desired MI and perceptions of BMIs desired by others. Also assessed were perceptions of underweight, acceptable weight and overweight/obesity. African American females were found to have a higher current BMI than Whites (P< or =.001), higher desired BMI (P< or =.001) and higher BMI perceived to be desired by others (P< or =.001). African American and White males did not differ on any of these measures. Most (83%) underweight (BMI<19) African American females perceived themselves as underweight while only about one-half of underweight (56%) White females perceived themselves as underweight. Almost half (43%) of White females and about a fourth (27%) of African American females of acceptable BMI range (BMI=19-25) desired to be in the underweight range. Of those who were overweight (BMI=25-30), 20% of the Whites and only 3.0% of the African Americans chose an underweight silhouette as being desired. While African Americans and White males tended to have similar perceptions that there remains sociocultural influences in African American females regarding acceptance of a large body size.

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.

[Risk factors related with eating disorders in a community of adolescents]

OBJECTIVE

To detect risk factors related with eating disorders.

DESIGN

Descriptive, cross-sectional study.

SETTING

5 secondary schools in the Virgen de Rocío health area in Seville, Spain.

PARTICIPANTS

789 students enrolled in the first and second years of compulsory secondary school, and their families. MAIN MEASURES. Body mass index, risk behaviors related with food and exercise, influence of the mass media on models of desirable body types, and family climate. Data were obtained with three validated questionnaires: the Eating Attitudes Test (EAT-40), the CIMEC-26, and the Family Environment Scale (FES).

RESULTS

In 6.9% of the participants, BMI was between 15 and 17, reflecting slight malnutrition. On the EAT scale, 68 participants (8.8%) had scores that were indicative of illness or risk of illness, and 25 (3.3%) could be diagnosed as having eating behavior disorder according to DSM-IV criteria. According to the CIMEC questionnaire, 104 participants (13.5%) were found to be significantly vulnerable to media pressures, and 85 (11.1%) were considered highly vulnerable. Parents' comments on eating behavior were related with the results on the EAT-40 CIMEC questionnaires (P=.01). No statistically significant relationship was found between family climate scores and the scores on the EAT-40 or CIMEC questionnaires. Students in rural or suburban area schools scored higher on the EAT-40 (P=.04) and CIMEC (P=.01) than students in urban or city center schools.

CONCLUSION

The identification of persons considered at risk will allow us to use primary prevention programs more efficiently.

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.

Examining gender, racial, and age differences in weight concern among third, fifth, eighth, and eleventh graders

Weight management and concern, body weight beliefs, and perceptions of friend's and family's weight concerns were examined in this study by race, grade, and gender. A stratified random sample was used to select schools within nine districts in South Carolina and an anonymous self-report paper-pencil questionnaire was completed by the students. The final sample included 3151 African American (42.3%) and White (57.7%) children (51.7% female) in the third (n=599), fifth (n=686), eighth (n=1168), and eleventh (n=698) grades. White girls were more likely to report being overweight (P=.0042), having higher personal weight concerns (P<.0001), and perceiving higher friend (P<.0001) and family weight concerns (P<.0001) than the African American girls. Using multiple regression, 29.8% of the variance in the children's personal weight concern scores was explained by perceptions of family's weight concerns (R(2)=.1659), gender (R(2)=.0762), perceptions of friend's weight concerns (R(2)=.0392), grade (R(2)=.0094), a Race x Gender interaction (R(2)=.0042), and race (R(2)=.003). Most of the children, particularly the white girls, have personal weight concerns and dieting practices which place them at risk for possible health problems. These results support the need for nutrition interventions and education in early childhood. Programs to prevent obesity and eating disorders should be tailored for differences by gender, grade, and race.

Postdisaster emotional distress, depression and event-related variables: findings across child and adolescent developmental stages

OBJECTIVE

Developmental approaches have not been widely used in child and adolescent posttraumatic stress disorder research, and little is known about developmental differences in response to postdisaster trauma. Our objective was to investigate postdisaster depression and emotional distress psychopathology across a broad child and adolescent developmental range.

METHOD

Six months following a bushfire disaster, 2379 grade 4-12 school students -completed an extensive self-report battery, which included the Impact of Event Scale and the Birleson Depression Inventory. Generalized linear models were constructed to model the effects of multiple covariates on continuous outcome measures of depression and emotional distress.

RESULTS

Significant independent predictors of persisting depressive symptoms were increased symptoms of emotional distress; increased symptoms of anxiety; evacuation experience; and school grade. Significant independent predictors of emotional distress were persisting depressive symptoms; perception of threat to self or to parents; evacuation experience; and school grade. Gender was not a significant predictor in either the depression or emotional distress multivariate models. Complex, non-linear relationships between depression, emotional distress and school grade were found.

CONCLUSION

This study suggests that important developmental differences in postdisaster psychological responses exist across a broad spectrum of developmental stages in children.

Changes in food habits in healthy Swedish adolescents during the transition from adolescence to adulthood

OBJECTIVE

To investigate the change in food habits in Swedish adolescents between 15 and 21 y of age with reference to age, sex, region and socioeconomic background.

DESIGN

A longitudinal study from 1993 to 1999.

SETTING

Two different regions in Sweden, the university city of Uppsala and the industrial town of Trollhättan.

SUBJECTS

On three different occasions, 1993, 1995 and 1999, 208 adolescents, 96 males and 112 females, were studied.

METHODS

A food frequency questionnaire containing 29 different food groups was used. The questionnaire also contained questions about food habits and amounts of some food items and socioeconomic conditions of the participants and their families.

RESULTS

At 17 and 21 y of age, the adolescents consumed significantly more often pasta, vegetables, coffee and tea compared to age 15, while the frequency consumption of fat spread, milk, bread, potatoes, carrots and buns and biscuits decreased. The changes between 15 and 17 were smaller than between age 17 and 21. At age 21, the males decreased their intake of fruit, while the females decreased their intake of meat. No-meat consumers among females increased from 2 to 13%. Higher educational level of the mothers of the adolescents was associated with more frequent consumption of vegetables and pasta between ages 17 and 21. Milk consumption decreased significantly in both sexes. Breakfast habits did not change: 90% had breakfast five times/week or more.

CONCLUSIONS

Food habits change significantly during adolescence along with lifestyle changes. Therefore, health promotion during adolescence ought to be more supported by the society.

Dietary restraint and negative affect as mediators of body dissatisfaction and bulimic behavior in adolescent girls and boys

Stice's dual pathway model of dietary restraint and negative affect was examined in both adolescent girls and boys. Self-report measures assessing body dissatisfaction, dietary restraint, negative affect and bulimic behavior were administered to 267 girls and 199 boys aged between 12 and 16 years. The findings for the girls were consistent with Stice's model, in that they indicated that both dietary restraint and negative affect mediated the relationship between body dissatisfaction and bulimic behavior. For the boys who desired a thinner body size, only negative affect was found to mediate the relationship between body dissatisfaction and bulimic behavior. On the other hand, for boys who desired a larger body size, both body dissatisfaction and dietary restraint were found to exert an independent effect on bulimic behavior. As boys can aspire to two contrasting and seemingly opposite body size ideals, the findings highlight that the relationship between body dissatisfaction, dietary restraint, negative affect and bulimic behavior are more complex in males than in females. Further research using longitudinal designs is needed in order to test the directional and bidirectional nature of the observed interrelationships.

Associated health risks of adolescents with disordered eating: how different are they from their peers? Results from a high school survey

In this study, we compare health risks of adolescents with disordered eating to those of their peers without disordered eating. A self-report health survey from a community sample of 1769 high school students was used to compare emotional, medical, and social behaviors of these two groups. Risk data for disordered eating students was compared within and across genders. Adolescents with disordered eating are at increased risk for emotional and physical health problems compared to their peers. Overall health risks for boys and girls with disordered eating are quite similar. However, boys with disordered eating develop associated health risk profiles that differentiate them from male peers by having increased mental health, sexual and physical abuse, and general health problems. Girls with disordered eating have associated health risks for substance use and sexual risk-taking that distinguished them from their female peers.

The role of global negative self-evaluations in the influence of body weight on weight and eating concerns

The aim of this study was to test a model based on the assumption that a social comparison-process of body mass index could lead to weight and eating concerns by lowering self-evaluation. Three hundred and ninety-five girls from five age cohorts (in grades five through nine at the time of data collection) participated in a questionnaire-based study. Support for a model where global negative self-evaluations played a mediating role was found among the oldest girls who perceived slimness norms among their peers. Among girls not perceiving a norm of thinness, and among younger girls perceiving such a norm, the model found no support. The proposed model gives an explanation of how the dynamic process of social norms of thinness, body weight and self-evaluation, can cause some girls to become concerned about their body weight.

Black and White women's weight-related attitudes and parental criticism of their childhood appearance

Black (27%) and White (73%) women (n = 215) completed a survey assessing weight concern, ideal body size beliefs, body dissatisfaction, attitudes toward overweight body size, and parental criticism of their childhood appearance. Sixty-four percent of the women reported they were currently trying to lose weight and 63% desired a body size thinner than their own. High weight concern and negative attitudes toward overweight persons were reported, respectively, by 45% and 17%, of the women. The only significant difference found by race was weight concern as White women rated this significantly higher than Black women. No significant frequencies of choice were associated with the women's socioeconomic level. Self-reported ratings of weight concern were significant and positively associated with those for body dissatisfaction, negative attitudes toward overweight persons, negative attitudes toward one's own overweight, and criticism of childhood appearance by mothers or fathers.

The prevention of eating disorders: a review of the research on risk factors with implications for practice

TOPIC

Eating disorders are a significant health problem among children and adolescents. A synthesis of recent research findings on the risk factors for eating disorders describes prevention strategies for practice.

PURPOSE

To present research findings on risk factors for eating disorders that specifically relate to prevention for advanced practice. Current investigations are reviewed and critiqued for biologic, psychological, family, and sociocultural risk factors. A critique of the research and findings from important studies describes strategies for prevention of eating disorders for advanced practice.

SOURCES

Published literature and clinical and research expertise of the author.

CONCLUSIONS

Identifiable risk factors for eating disorders are found in children as well as adolescents. Findings from risk factor research provide the advanced practice nurse strategies for prevention of eating disorders. Few prevention programs exist; even fewer have been tested. An important clinical and research focus for advanced practice nurses is the prevention of eating disorders.

Global negative self-evaluations, weight and eating concerns and depressive symptoms: a prospective study of adolescents

A longitudinal study with four sequential cohorts of girls and boys in early to mid-adolescence (n = 607) was used to assess adolescent changes in global negative self-evaluation, depressive symptoms and weight and eating concerns. The effects of these areas on one another over time were also assessed. Over the six months between the two data collection times, both the girls and the boys experienced an improvement in depressive symptoms, while the boys also experienced a decrease in weight concerns. The results indicated that global negative self-evaluations could predict weight and eating concerns in boys and girls, while weight concerns could predict depressive symptoms in girls. These results are of particular interest, since these relationships have not been previously examined in a longitudinal study.

Body dissatisfaction and dieting in young children

OBJECTIVE

To develop a broader understanding of young children's knowledge and beliefs about dieting and body dissatisfaction.

METHOD

Sixty-two third through sixth-grade boys and girls completed audiotaped interviews and questionnaires regarding eating behavior, attitudes toward dieting, and body dissatisfaction.

RESULTS

Fifty percent of all children wanted to weigh less and 16% reported attempting weight loss. Children were well informed about dieting and were most likely to believe that dieting meant changing food choices and exercising as opposed to restricting intake. Their primary source of information was the family. Seventy-seven percent of children mentioned hearing about dieting from a family member, usually a parent.

DISCUSSION

Young children are knowledgeable about dieting and the concept of dieting does not necessarily mean caloric restriction to them. These data suggest that the family can play a powerful role in countering the development of eating concerns and body dissatisfaction in children.

Overweight, weight concerns, and bulimic behaviors among girls and boys

OBJECTIVE

To assess the prevalence rates and correlates of overweight, concern with weight, and bulimic behaviors.

METHOD

A survey was completed by a population-based sample of 16,114 boys and girls aged 9 to 14 years.

RESULTS

Although fewer girls (19%) than boys (26%) were overweight, more girls (25% versus 22%) perceived themselves as overweight (p < .001). The proportion of girls reporting trying to lose weight increased with age (p < .001). The prevalence of binge eating at least monthly increased with age among the girls, but remained stable among the boys. The prevalence of purging was low (< or = 1%) and comparable between genders until age 13. Among the 13- and 14-year-olds, girls were significantly more likely than boys to report using laxatives or vomiting to control weight (p < or = .001). Purging was independently positively associated with stage of pubertal development (girls: odds ratio [OR] = 2.1, 95% confidence interval [CI] 1.6-2.7; boys: OR = 1.5, 95% CI 1.0-2.2) and overweight (girls: OR = 1.9, 95% CI 1.2-3.0; boys: OR = 2.7, 95% CI 1.4-5.1).

CONCLUSIONS

Misperception of being overweight and concern with weight were common. Purging was a very rare behavior, but increased with pubertal development. Among the girls, the prevalence increased sharply around the onset of adolescence.

Racial/ethnic and gender differences in concern with weight and in bulimic behaviors among adolescents

This study examined cross-sectional gender and racial/ ethnic differences in bulimic behaviors among adolescents. Subjects were 704 male and 621 female students at a large urban public high school in the Northeast. Approximately 61% of the girls and 43% of the boys reported trying to lose weight or maintain their current weight; 2.0% of the students reported using laxatives or vomiting to control their weight. The use of these behaviors to control weight was only slightly more common among girls than boys (2.7% vs. 1.4%, p = 0.1). Although more black than white girls used laxatives or vomiting to control weight (odds ratio [OR] = 11.9, 95% confidence interval [CI] 1.5-95.3), there were no racial/ethnic differences in these behaviors among boys. However, Hispanic boys were twice as likely as white boys to binge eat at least monthly (OR = 2.0, 95% CI 1.1-3.6). Our results suggest that bulimic behaviors affect male and female adolescents from a variety of racial/ethnic backgrounds. In addition, in contrast to the large gender differences in the prevalence of dieting and binge eating, more modest differences were documented in the prevalence of using vomiting and laxatives to control weight.

Factors that may influence future approaches to the eating disorders

The past thirty years have seen dramatic changes in our approach to the eating disorders. These include marked improvements in the recognition and understanding of the disorders, and the reduction of the morbidity and mortality of anorexia and bulimia nervosa. Bulimia nervosa itself, now the focus of so much attention, was described less than twenty years ago. While these gains, including those in the level of knowledge and appreciation by the public, have been transmitted to the benefit of patients, there remain significant difficulties in treating people with eating disorders. Critical research may address gaps in knowledge and lead to more efficacious treatments. At the same time, however, changes in the health care system are occurring rapidly and these will have an effect on both research and treatment. The purpose of the present article is to highlight scientific and systemic factors that the authors feel will play an important role in how people with eating disorders are responded to in the coming years. In addressing the eating disorders we are confining our remarks to anorexia and bulimia nervosa, and not to obesity; the latter would require consideration of many other issues, beyond the scope of this review.

Disordered eating: can women accurately recall their binging and purging behaviors 10 years later?

OBJECTIVE

To test women's ability to recall their past binging and purging behaviors.

DESIGN

Ten-year follow-up study of women who had participated in a cross-sectional survey during college.

SUBJECTS

In 1982, a sample of freshman and senior women at a large university in the Boston area were questioned about their weight, dieting history, bulimic symptoms, and eating patterns, attitudes, and concerns. In 1992, all subjects who responded to the 1982 survey were followed up to assess changes in bulimic symptoms and ability to recall past behaviors.

RESULTS

Among the 476 women who responded to both surveys, the percentage in 1992 who reported having ever binged and/or purged was less than the percentage in 1982, indicating that the recall of past behaviors was less than perfect. Denial in 1992 of ever having engaged in the behaviors ranged from 22% among the women who were self-inducing vomiting in 1982 to 64% among the women who had reported current fasting or strict dieting in 1982. Recall of past behaviors in 1992 was better among the women who had been current bingers or purgers in 1982.

CONCLUSION

Our results demonstrate that ability to recall past binging and purging is only modest. Therefore to better understand the mental and physical health consequences of these behaviors this information should be collected prospectively.

The spectrum of eating disturbances

OBJECTIVE

The purpose of this paper was to review and summarize the research literature on the spectrum of eating disturbances.

METHOD

Literature was searched using a computer data base to identify recent articles related to the prevalence and occurrence of disturbed eating patterns as well as full and partial syndrome eating disorders (EDs).

RESULTS

This review indicates that the prevalence of partial syndrome EDs in nonclinical populations is at least twice that of full syndrome EDs, and that there is a progression in some individuals from less to more severe disturbances in eating behavior.

DISCUSSION

These findings suggest the need for careful, scientific evaluation of risk factors for EDs in both children and adults. A longitudinal research program in progress is described which aims to identify the risk factors for EDs.

The effects of race, household income, and parental education on nutrient intakes of 9- and 10-year-old girls. NHLBI Growth and Health Study

Nutrient intakes of 2149 black and white, 9- and 10-year-old girls varied by race, household income, and parental education. Of the three variables, higher education was most consistently associated with more desirable levels of nutrient intakes, that is, lower percentage of dietary fat and higher levels of vitamin C, calcium, and potassium. Higher income was related to higher intakes of vitamin C, but lower intakes of calcium and iron. Higher income was associated with lower percentage of dietary fat. After adjustment for income and education, race was associated with intakes of calcium, vitamin C, and to a lesser extent, percentages of kilocalories from total fat and polyunsaturated fat, and potassium. Black girls had a significantly lower intake of calcium (720 versus 889 mg) and a higher intake of vitamin C (91 versus 83 mg). Proportions of the cohort with inadequate or excessive intakes of micronutrients and macronutrients were also estimated. A high proportion of girls exceeded the recommended intake level of 30% of kilocalories from total fat (90% of black girls; 84% of white girls) and 10% of kilocalories from saturated fat (92 and 93%, respectively). Low intakes of calcium (40% of black girls and and 20% og white girls) and zinc (36 and 38%, respectively) commonly were found for girls of both names.

Adolescents' perceptions of their peers' health norms

OBJECTIVES

The purpose of this study was to determine the relative importance adolescents place on preventive health behaviors.

METHODS

Data were from a survey of California adolescents (n = 5040). Respondents were asked how important it was to their peers to avoid drugs, marijuana, cigarettes, heavy drinking, and drinking and driving and to maintain seat belt use, fitness, weight control, and healthy eating habits. Results were compared with data from a similar national survey (n = 6126).

RESULTS

California teenagers perceived that their peers gave top priority to weight control: 85% of California teenagers believed that weight control was of high concern to girls in their age group. Avoiding drugs, not drinking and driving, and maintaining fitness ranked in the top five behaviors. The lowest ranked health behaviors were seat belt use, heavy drinking, and, last, eating healthily. In the national survey, healthy eating also ranked last. Although not identical in rank, teenage priorities for other health behaviors were consistent with the California results.

CONCLUSION

Efforts are needed to bring adolescent health norms more into line with the objective risks of their health choices during this critical period of socialization.

Dieting attitudes and behavior in urban high school students: implications for calcium intake

PURPOSE

Adolescence is a time of rapid gain in bone density which may be influenced by calcium intake. This study assessed whether dieting concerns, known to be prevalent in adolescent girls, were associated with the calcium intake of adolescents of varying ethnicity.

METHODS

Students (n = 856) completed an instrument which assessed current weight, desired weight, height, age, ethnicity, calcium intake using a food frequency questionnaire, dieting concerns using the Eating Attitudes Test dieting subscale (DS), taste enjoyment of dairy products, and type of milk consumed.

RESULTS

Among 782 students with useable responses, most girls (69.1%) wanted to lose weight and most boys (54.2%) wanted to gain weight. Asian girls had lower body mass index (BMI) than Caucasians (19.3 +/- 2.1 vs 20.8 +/- 2.6 kg/m2, p < 0.05), but desired BMI did not vary by ethnicity in either girls or boys. Asian girls also had lower DS scores than Caucasians, but the difference was not significant with current BMI as a covariate. Girls' DS scores were higher than those of boys (6.3 +/- 6.5 vs 2.3 +/- 3.2, p < 0.001), and estimated calcium intakes were lower (815 +/- 528 vs 1149 +/- 701 mg/day, p < 0.001); however, DS scores were not associated with calcium intake for either sex. Especially among girls, dieting and body size concerns were associated with taste enjoyment of certain dairy products, and with the type, but not the amount, of milk consumed. Girls using skim milk had higher DS scores than those using low-fat or whole milk.

CONCLUSIONS

In this non-clinical sample, greater concern about dieting and body size did not directly compromise calcium intake but was associated with the type of milk used.

The relationship of caloric intake to frequency of dieting among preadolescent and adolescent girls

OBJECTIVE

To assess the relationships of concern with weight and shape, frequency of dieting, body mass index (weight/height2), and energy intake among 431 preadolescent and adolescent girls from a working-class New England suburb.

METHOD

A cross-sectional study design used self-report measures of concern with weight, frequency of dieting, and average dietary intake.

RESULTS

Approximately 30% of the girls in each age stratum were above the national age-standardized 85th percentile for body mass index (BMI). Body mass index was positively associated with concern about weight and shape (r = 0.46, p = 0.0001) and frequency of dieting (r = 0.49, p = 0.0001). Extreme concern with weight and shape was most common among the obese preadolescent and adolescent girls; however, dissatisfaction was also present among the underweight females. Fifty percent of the girls who were below the national age-standardized 15th percentile for BMI reported their ideal weight is less than their current weight, implying that among young women thinness is not adequate protection against dissatisfaction with weight and shape. Frequency of dieting was positively associated with concern about weight and shape (r = 0.53, p = 0.001) but not physical activity (r = -0.04, p = 0.36). Overall, we did not find strong evidence that dieters were eating less than their nondieting peers. Only among high school students was there a significant negative association between frequency of dieting and energy intake (r = -0.20, p = 0.01), suggesting that "dieting" may have a different meaning to preadolescents and adults.

CONCLUSIONS

These findings indicate that self-reported frequent dieting in preadolescent and young adolescent girls is more indicative of extreme concern with weight than of decreased energy intake. Furthermore, extreme concern with weight and shape is most common among the obese preadolescent and adolescent girls.

Body image and eating behavior in adolescents

Approximately two-thirds of adolescent girls at any age are dissatisfied with their weight, the proportion increasing with actual weight. Slightly more than half of all girls are dissatisfied with the shape of their bodies, an attitude which also is positively correlated with body weight. Girls are most likely to be distressed about excess size of their thighs, hips, waist and buttocks, and inadequate size of their breasts. Those who are dissatisfied with their bodies are more likely to engage in potentially harmful weight control behaviors, such as dieting, fasting, self-induced vomiting, diuretic use, laxative use and diet pill use. Those who diet are more likely to begin in early adolescence, to be white than black, to be of higher socioeconomic status, to engage in other eating-related practices and to have a poor body image and self esteem. Boys who are underweight are most likely to be dissatisfied with their weight and many with normal weight wish to weigh more. Approximately one-third of boys are dissatisfied with their body shape, desiring larger upper arms, chest and shoulders. Dieting and purging are less likely than exercise to be chosen by boys as methods of weight control. Dieting among boys is more likely to be associated with increased body weight and some sports, such as wrestling. Body consciousness and altered body image are widespread among adolescents, and may be associated with potentially harmful eating practices in both sexes, but more so in girls.

Gender differences in depression: historical changes

Depression has been widely reported to be more prevalent among females than among males. In this study we demonstrate that gender differences in depression occur only among individuals born during particular historical periods, and test the utility of a model focusing on changes in women's opportunities for academic and professional achievement in predicting periods of significant gender differences in depression. Based on reanalysis of data reported by Klerman et al., we find gender differences in depression among people 40 years of age and older to be high among cohorts that reach adolescence during periods of increasing opportunities for female achievement. Among cohorts that reach adolescence during periods of stable or decreasing opportunities for women, gender differences in depression are not significant at any age.

Perceptions of weight and attitudes toward eating in early adolescent girls

Sixth grade girls (n = 206) responded to questions about their weight, body image, dieting practices, and attitudes toward weight and eating. Results suggested that feeling too fat and wishing to lose weight were becoming normative for young adolescent girls in that the majority of girls wished to weigh less and said that they dieted at least occasionally. For most girls, weight concerns had emerged between the ages of 9 to 11. A sizeable proportion of girls seemed to have adopted a "dieting mentality," claiming to be avoiding fat, counting calories, thinking excessively about food, feeling guilty after eating and overeating, and exercising to lose weight. Such practices were common even among girls who did not describe themselves as overweight or who were satisfied with their appearance. The emergence of these attitudes and behaviors at increasingly younger ages is of grave concern, as several of them are risk factors for the development of serious eating disorders.