Associations between friends' disordered eating and muscle-enhancing behaviors

Insight Into the Adolescent Patient Experience With Nonalcoholic Fatty Liver Disease

OBJECTIVES

Nonalcoholic fatty liver disease (NAFLD) is the leading chronic liver disease in youth, yet little is known about the adolescent patient's experience with NAFLD, which is key for treatment engagement. We examined adolescents' experiences with NAFLD diagnosis, thoughts on how NAFLD affects their daily life, understanding and perceptions of diagnosis and treatment, and impressions of how to improve care.

METHODS

Utilizing a mixed-method design, adolescents with NAFLD (N = 16; Mean age = 15.8 years; Mean BMI = 37 kg/m 2 ) participated in focus groups. To supplement qualitative data, adolescents and their caregiver completed measures assessing illness perceptions, adolescent quality of life, and eating/activity behaviors.

RESULTS

Focus group themes suggested reactions to diagnosis varied from unconcerned to anxious. NAFLD diagnosis occurred within the context of other psychological/medical concerns and was not perceived to affect most adolescents' daily lives. Although adolescents understood general contributors to NAFLD, comprehension of their diagnosis varied. Adolescents were more likely to make lifestyle changes when families were supportive, and they preferred tailored recommendations for health behavior change from the healthcare team. Notably, 62.5% of adolescents were more concerned about their weight than NAFLD. Almost half (43.8%) identified as food insecure.

CONCLUSIONS

Adolescents with NAFLD may benefit from personalized treatment. Care could be enhanced by ensuring comprehension of diagnosis, problem-solving personal, and family barriers and increasing family support. Harnessing adolescents' desire for weight loss may be a more salient driver for change in disease status. Interventions should also address systemic barriers such as food insecurity to ensure equitable care.

Association between subjective degree of influence in class and thinness among adolescents in Japan

Social status in school, measured by subjective degree of influence in class (DOI), may influence thinness among adolescents. This study examined the association between subjective degree of influence in class and thinness among Japanese adolescents. Data were obtained from the Kochi Child Health Impact of Living Difficulty (K-CHILD) study in 2016, which Was a population-based study targeting 5th, 8th and 11th grade adolescents living in Kochi Prefecture, Japan (N = 9,998). DOI was assessed by adolescents via questionnaire. Weight and height were given by caregivers for 5th grade adolescents, whilst they were self-reported for 8th and 11th grade adolescents. Collected data on weight and height were used to calculate body mass index z-scores of WHO standards. Models included grade, gender, number of friends, household income, location of school and depressive symptoms as covariates. The results showed that both high and low DOI were positively associated with thinness after adjustment for other individual covariates (high DOI, OR = 1.59, 95% CI 1.05-2.43; low DOI, OR = 2.04, 95% CI 1.36-3.06). Further stratification by gender revealed that low DOI was positively associated with thinness (OR = 2.14, 95% CI 1.34-3.44) among boys, but there was no association among girls. Both high and low DOI were associated with the risk of being thin in adolescents. Focusing on DOI for adolescents may be important to address thinness among adolescents. Further studies are needed to examine the causality between DOI and thinness in adolescents.

Do emerging adults know what their friends are doing and does it really matter? Methodologic challenges and associations of perceived and actual friend behaviors with emerging adults' disordered eating and muscle building behaviors

Disordered eating and muscle building behaviors are common among emerging adults, and friends may be a particularly salient social influence. Epidemiologic research often includes questions about participants' perceptions of their friends. A less common approach, with greater logistical challenges, is to ask for friend nominations and then survey friends about their actual behaviors. The comparability of these different approaches is unknown. This study addresses the following research questions: 1) What is the feasibility of collecting data from emerging adults' friends in epidemiologic research? 2) Do perceptions of friends' weight- and shape-related behaviors align with friends' actual behaviors? and 3) Are perceptions or friends' actual behaviors more strongly and consistently associated with emerging adults' behaviors? Participants (N = 2383) in the EAT (Eating and Activity over Time)-2018 study in Minnesota, USA, were asked to nominate up to three friends and provide data about those friends' weight- and shape-related behaviors (i.e. perceptions); nominated friends were invited to complete an abbreviated survey and report on their own same behaviors (i.e. actual). Among the invited friends, 191 responded and were linked to the 152 EAT 2018 participants who nominated them. Descriptive statistics, Spearman's correlations, and logistic regression were used to address the research questions. The response rate for nominated friends was very low (9.9%), suggesting this approach may have low feasibility for epidemiologic studies of emerging adults. Emerging adults' perceptions of their nominated friends' weight and shape-related behaviors generally did not align well with the behaviors reported by those friends. Furthermore, analytic models found different associations between friends' behavior and EAT 2018 participant behaviors, depending on the measure of friends' behavior used (perceived or actual). Careful consideration of the pros and cons of each study design is essential to build an evidence base and support interventions regarding emerging adults' weight- and shape-related health.

Yoga practice among ethnically/racially diverse emerging adults: Associations with body image, mindful and disordered eating, and muscle-enhancing behaviors

BACKGROUND

This study explores cross-sectional associations between yoga and body image, mindful eating, disordered eating, and muscle-enhancing behaviors among a population-based sample of ethnically/racially diverse emerging adults.

METHOD

An ethnically/racially diverse population-based sample of 1,568 emerging adults (18-26 years) completed surveys as part of EAT 2010-2018 (Eating and Activity over Time). Models were adjusted for sociodemographic characteristics and body mass index (BMI).

RESULTS

Practicing yoga at least 30 min/week was reported by 12.7% (n = 210) of the sample. Yoga practitioners had higher levels of mindful eating than those not practicing yoga. Although effect sizes were small, yoga practitioners were more likely than non-yoga practitioners to use steroids (3.8 vs. 0.7%, p < .001, h = 0.22) or protein powder/shakes (35.1 vs. 25.3%, p < .010, h = 0.21) to increase their muscle size/tone. Body satisfaction, unhealthy weight control behaviors, and binge eating tended to be similar among yoga practitioners and non-yoga practitioners. There was a significant interaction between BMI and yoga in predicting body satisfaction with a trend toward a positive impact among yoga practitioners at higher BMI values. Interactions between yoga practice and all body image attitudes and behaviors across gender and ethnicity/race were not statistically significant.

DISCUSSION

Young people from diverse ethnic/racial backgrounds who practice yoga are more likely to engage in mindful eating but have equal or elevated levels of unhealthy body image attitudes and behaviors as compared to non-yoga practitioners. Further research should explore how yoga is best taught and practiced to ensure that it is beneficial for body image and related behaviors.

The Peer Context of Dieting: The Relationship between Young Adults' Dieting Frequency and Their Friends' Weight-Related Characteristics

Previous research found that weight-related behaviors and body weight tends to be similar between individuals and peers. Rather little is known how different domains of weight-related behaviors co-evolve in peer networks. Hence, this study explores how young adults' self-reported dieting relates to perceived body weight and weight control behaviors of their peers. A Swedish two-wave panel survey with ego-centric network data was analyzed with negative binomial regression models. Nineteen-year-old men and women in the first wave, and 23-year-olds in the follow-up sample were examined. Men at age 19 showed an increased dieting propensity when being exposed to underweight peers. Compared to men, women's dieting at age 19 was more strongly related to their own body image concerns, and peers' weight-related behaviors like physical exercising and unhealthy eating. The associations between dieting and peers' weight-related characteristics for men and women deteriorated from age 19 to age 23. The findings suggest that women's dieting-in comparison to dieting in men-is more strongly related to the peer context. The decrease in associations between men's and women's dieting and peers' weight-related characteristics from age 19 to age 23 may reflect a weakened importance of the peer context in early adulthood.

Unhealthy weight control behaviors among youth: Sex of sexual partner is linked to important differences

Unhealthy weight control behaviors (UWCBs) have been decreasing for most youth over time, yet little is known whether these behaviors have changed for sexual minority (e.g., non-heterosexual) youth. This is important because many studies have found that sexual minorities report some of the highest rates of UWCBs. To determine whether or not these behaviors have changed over time, given the extreme changes in social contexts over the past two decades, we utilised three waves of the Minnesota Student Survey (N = 55,597, M_age = 17). In doing so, we report trends, disparities, and changes in disparities of UWCBs. Overall, the prevalence of UWCBs has declined from 1999 to 2010 for all youth, but there are alarming disparities by sex of sexual partner. We found that both- and same-sex partnered male youth were more likely to fast, use diet pills, and vomit on purpose to lose weight compared to their opposite-sex partnered counterparts in all three survey years; specifically, both-sex partnered boys were up to 5.5× as likely to vomit on purpose compared to their opposite-sex partnered counterparts. Likewise, both-sex partnered girls were more likely to use diet pills and vomit on purpose to lose weight compared to opposite-sex partnered girls in all three survey years. Additionally, the disparity in fasting to lose weight widened for the same-sex partnered females compared to the opposite-sex partnered females from 1998 to 2004. This has implications for UWCB interventions and preventions targeted specifically towards sexual minorities.

Decreased eating frequency linked to increased visceral adipose tissue, body fat, and BMI in Hispanic college freshmen

Background

To investigate the relationship between eating frequency and specific adiposity markers in a potentially high-risk and understudied population of Hispanic college freshmen.

Methods

This study included 92 Hispanic college freshmen (18–19 y). The following cross-sectional data were collected: height, weight, waist circumference, body mass index (BMI), dietary intake, body composition, physical activity, hepatic fat, visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT).

Results

Infrequent eaters ate 44% less often (2.5 ± 0.2 vs. 4.5 ± 0.8, p ≤ 0.01) and consumed 27% more calories per EO (p ≤ 0.01), while consuming 21% less kcals per day (p ≤ 0.01) compared to frequent eaters. Infrequent eaters had 8% higher BMIs (24.8 ± 4.4 vs. 22.9 ± 3.2 kg/m²) (p = 0.02), 60% higher BMI z-scores (0.5 ± 1.0 vs. 0.2 ± 1.0, p = 0.03), 21% higher VAT (298.3 ± 153.8 vs. 236.8 ± 78.2 ml, p = 0.03), 26% higher SAT (1150.1 ± 765.4 vs. 855.6 ± 494.6 ml, p = 0.03), and 8% higher total body fat (27.6 ± 10.8 vs. 25.3 ± 8.8%, p = 0.04) compared to frequent eaters while showing no significant difference in physical activity. These findings seem to be driven by females more than males.

Conclusions

These findings suggest that infrequent eating is related to increased adiposity in Hispanic college freshmen, despite a decreased daily energy intake and no significant differences in physical activity. Yet, more research is needed to understand the underlying mechanisms of these findings, as well as investigate any potential causal relationship between eating frequency and adiposity in Hispanic youth.

Social Mechanisms for Weight-related Behaviors among Emerging Adults

Objective

The purpose of this research was to qualitatively assess young people's perceptions about how friends' impact eating and physical activity (PA) behaviors.

Methods

Emerging adults (N=52; mean age=18.7±0.6 years; 50% female) attending a large 4-year college campus in the southwest were enrolled in focus groups (N=10). Following saturation, the research team met to establish consensus and co-create a codebook from which two researchers independently coded each focus group. Coders continually discussed themes to ensure consistency of coding.

Results

Initially, youth reported that their friends' did not influence their eating/PA. The major social facilitators identified by students were encouragement, social cues, celebrations, shared experiences, pressure.

Conclusion

Several social facilitators impacted eating and PA. These factors should be considered when designing obesity interventions with emerging adults.

Is Friendship Network Weight Status Associated with One's Own Psychological Well-being? It Depends on One's Own Weight Status

Drawing on multiple theoretical perspectives (e.g., social comparison theory, reward theory, evolutionary theory), the present research examined the relations of self and friendship network weight status to body satisfaction, self-esteem, and depression. A diverse, population-based sample of adolescents completed measures of well-being and were measured for height and weight. Boys had greater self-esteem if their male friendship networks' weight status mismatched, versus matched, their own weight status (d = .23). Conversely, boys had greater body satisfaction if their female friendship networks' weight status matched, versus mismatched, their own weight status (d = .18). For girls, the relations of male and female friendship networks' weight status with well-being did not vary by one's own weight status. Evolutionary theory appears to best explain the observed patter of results, and clinicians may want to consider friends' weight status when dealing with adolescents' body satisfaction issues.

Multicontextual correlates of energy-dense, nutrient-poor snack food consumption by adolescents

Frequent consumption of energy-dense, nutrient-poor snack foods is an eating behavior of public health concern. This study was designed to inform strategies for reducing adolescent intake of energy-dense snack foods by identifying individual and environmental influences. Surveys were completed in 2009-2010 by 2540 adolescents (54% females, mean age = 14.5 ± 2.0, 80% nonwhite) in Minneapolis-St. Paul, Minnesota schools. Daily servings of energy-dense snack food was assessed using a food frequency questionnaire that asked about consumption of 21 common snack food items, such as potato chips, cookies, and candy. Data representing characteristics of adolescents' environments were collected from parents/caregivers, friends, school personnel, Geographic Information System sources, and a content analysis of favorite television shows. Linear regression was used to examine relationships between each individual or environmental characteristic and snack food consumption in separate models and also to examine relationships in a model including all of the characteristics simultaneously. The factors found to be significantly associated with higher energy-dense snack food intake represented individual attitudes/behaviors (e.g., snacking while watching television) and characteristics of home/family (e.g., home unhealthy food availability), peer (friends' energy-dense snack food consumption), and school (e.g., student snack consumption norms) environments. In total, 25.5% of the variance in adolescents' energy-dense snack food consumption was explained when factors from within each context were examined together. The results suggest that the design of interventions targeting improvement in the dietary quality of adolescents' snack food choices should address relevant individual factors (e.g., eating while watching television) along with characteristics of their home/family (e.g., limiting the availability of unhealthy foods), peer (e.g., guiding the efforts of a peer leader in making healthy choices), and school environments (e.g., establishing student norms for selecting nutrient-dense snack foods).

Weight management behaviors in a sample of Iranian adolescent girls

PURPOSE

Attempts to obtain the ideal body shape portrayed in advertising can result in behaviors that lead to an unhealthy reduction in weight. This study was designed to identify contributing factors that may be effective in changing the behavior of a sample of Iranian adolescents.

METHODS

Three hundred fifty adolescent girls from high schools in Kerman, Iran participated in a cross-sectional study based on a self-administered questionnaire. Multifactorial logistic regression modeling was used to identify the factors influencing each of the contributing factors for body management methods, and a decision tree model was constructed to identify individuals who were more or less likely to change their body shape.

RESULTS

Approximately one-third of the adolescent girls had attempted dieting, and 37 % of them had exercised to lose weight. The logistic regression model showed that pressure from their mother and the media; father's education level; and body mass index (BMI) were important factors in dieting. BMI and perceived pressure from the media were risk factors for attempting exercise.

CONCLUSIONS

BMI and perceived pressure from relatives, particularly mothers, and the media were important factors in attempts by adolescent girls to lose weight.

Misperception of peer weight norms and its association with overweight and underweight status among adolescents

Previous research has revealed pervasive misperceptions of peer norms for a variety of behaviors among adolescents such as alcohol use, smoking, and bullying and that these misperceptions are predictors of personal behavior. Similarly, misperception of peer weight norms may be a pervasive and important risk factor for adolescent weight status. Thus, the comparative association of actual and perceived peer weight norms is examined in relation to personal weight status. Secondary school students in 40 middle and high schools (n = 40,328) were surveyed about their perceptions of the peer weight norm for same gender and grade within their school. Perceived norms were compared to aggregate self-reports of weight for these same groups. Overestimation of peer weight norms by more than 5 % occurred among 26 % of males and 20 % of females (by 22 and 16 lb on average, respectively). Underestimation occurred among 38 % of males as well as females (by 16 and 13 lb on average, respectively). Personal overweight status based on body mass index (BMI) was much more prevalent among respondents who overestimated peer weight norms as was personal underweight status among respondents who underestimated norms. Perception of the peer norm was the strongest predictor of personal BMI among all personal and school variables examined for both male and female students. Thus, reducing misperceived weight norms should be given more attention as a potential avenue for preventing obesity and eating disorders.

Friends Like Me: Associations in Overweight/Obese Status among Adolescent Friends by Race/Ethnicity, Sex, and Friendship Type

BACKGROUND

Little is known about how interpersonal friend relationships are associated with obesity in young people, particularly with regard to how race/ethnicity, type of friendship, and sex affect the association between friends' and adolescents' weight status. This study examined associations in weight status among adolescents and their friends, exploring magnitudes of associations across friendship type, sex, and race/ethnicity.

METHODS

As part of EAT-2010 (Eating and Activity in Teens), friend nominations and anthropometrics were obtained from adolescents (n = 2099: 54% female; 80% nonwhite; mean age: 14.2 ± 1.9 years). Generalized estimating equation logistic regression models were used to test associations between adolescents' overweight/obese status and friends' (i.e., friend group, female friends, male friends, female best friends, and male best friends) overweight/obese status. Interactions by adolescent race/ethnicity were examined.

RESULTS

The majority of significant associations were observed among white female adolescents' who had a 22-40% higher prevalence of overweight/obesity if their friends were overweight compared to white females whose friends were not overweight. In contrast, there were few significant differences for other adolescent female and male racial/ethnic groups for girls and boys. Results for friend groups and best friends were generally similar to one another.

CONCLUSIONS

The association between friend and adolescent overweight/obese status depended on adolescents' sex, race/ethnicity, and friendship type. Given the similarities among friends, obesity interventions targeting youth, especially white females, should consider involving friends.

Environmental factors associated with disordered weight-control behaviours among youth: a systematic review

OBJECTIVE

Environmental factors may be very important in the development of disordered weight-control behaviours (DWCB) among youth, yet no study to date has conducted a review that synthesizes these findings. The purpose of the present study was to systematically review existing literature on environmental influences on DWCB among youth and to identify conceptual and methodological gaps in the literature.

DESIGN

Systematic review.

SETTING

Studies were identified through a systematic search using PubMed, PsycINFO, Google Scholar and secondary references. Inclusion criteria included observational studies published in peer-reviewed journals from 1994 to 2012 that examined environmental exposure(s) associated with DWCB among youth.

SUBJECTS

Ninety-three studies, the majority of which utilized a cross-sectional design (75 %; n 70), were identified. Longitudinal studies' follow-up time ranged from 8 months to 10 years.

RESULTS

Parental, peer and media influences have been extensively studied as factors associated with DWCB among youth. Fewer studies have examined behavioural settings (i.e. homes, schools, neighbourhoods) or sectors of influence other than the media on DWCB. No studies utilized multilevel methods to parse out environmental influences on DWCB. Most studies (69 %, n 64) did not explicitly utilize a theory or model to guide the research.

CONCLUSIONS

Findings indicate that exploring a wider range of environmental influences on DWCB, specifically behavioural settings and sectors of influence, using diverse study samples and multilevel methodology is needed to advance the field and to inform the design of comprehensive prevention programmes that target DWCB and other weight-related behaviours.

Associations between sugar-sweetened beverage consumption and fast-food restaurant frequency among adolescents and their friends

OBJECTIVE

To assess associations between adolescents and their friends with regard to sugar-sweetened beverage (SSB)/diet soda intake and fast-food (FF) restaurant visits.

DESIGN

Population-based, cross-sectional survey study with direct measures from friends.

SETTING

Twenty Minneapolis/St Paul schools during 2009-2010.

PARTICIPANTS

Adolescents (n = 2,043; mean age, 14.2 ± 1.9 years; 46.2% female; 80% non-white).

MAIN OUTCOME MEASURES

Adolescent SSB/diet soda intake and FF visits.

ANALYSIS

Generalized estimating equation logistic models were used to examine associations between adolescents' SSB/diet soda intake and FF visits and similar behaviors in nominated friends (friend groups and best friends). School-level (middle vs high school) interactions were assessed.

RESULTS

Significant associations were found between adolescents and friends behaviors for each of the beverages assessed (P < .05), but they varied by friendship type and school level. Five of 6 models of FF visits (including all FF visits) were significantly associated (P < .05) among adolescents and their friends. Significant interactions by school level were present among adolescents' and friends' FF visits, with associations generally for high school participants compared with middle school participants (P < .05).

CONCLUSIONS AND IMPLICATIONS

Findings suggest that for many beverages and FF restaurant types, friends' behaviors are associated, especially FF visits for older adolescents. Nutrition education efforts may benefit by integrating knowledge of the impact of adolescents' friends on FF visits.

Examining associations between adolescent binge eating and binge eating in parents and friends

OBJECTIVE

Binge eating is prevalent among adolescents, but little is known about how parents and friends may influence such behaviors. This study examined associations between adolescent binge eating behaviors, and similar behaviors in their parents and friends.

METHOD

Participants were 2,770 target adolescent boys and girls who had at least one friend and/or parent who also participated. Logistic regression, stratified by gender, examined associations between parents' and friends' self-reported binge eating, and similar behaviors in target adolescents.

RESULTS

Girls' binge eating was associated with their male friends' (odds ratio = 2.33; p = 0.03) and fathers' binge eating (odds ratio = 3.38; p = 0.02), but not with their female friends' or mothers' binge eating (p > 0.05). For boys, binge eating was not associated with parents' or friends' behavior.

DISCUSSION

Adolescent girls' binge eating is associated with similar behaviors in their other-sex parents and friends. Results should be replicated, and mechanisms explaining this relation should be further explored.

Influence of friends on children's physical activity: a review

We examined evidence for friendship influences on children's physical activity (PA) through systematic searches of online databases in May 2012. We identified 106 studies (25 qualitative) published in English since 2000 that analyzed indicators of friendship influences (e.g., communication about PA, friends' PA, and PA with friends) among persons younger than 19 years. Children's PA was positively associated with encouragement from friends (43 of 55 studies indicating a positive relationship), friends' own PA (30/35), and engagement with friends in PA (9/10). These findings are consistent with friends influencing PA, but most studies did not isolate influence from other factors that could explain similarity. Understanding friendship influences in childhood can facilitate the promotion of lifelong healthy habits. PA with friends should be considered in health promotion programs.