Bulimic Symptomatology in High School Girls

A Measure of Objectified Body Consciousness for Preadolescent and Adolescent Youth

Objectified body consciousness (OBC)—the tendency to view oneself as an object to be looked at and evaluated by others—has received recent attention as a possible vulnerability factor for depression and disordered eating. Although OBC generally is discussed in developmental terms, extant research has examined primarily the experiences of undergraduates and adults. Our goal in this study was to develop an age-appropriate measure to allow study of OBC development during preadolescence and adolescence. We modeled the OBC-Youth after McKinley and Hyde's (1996 ) OBC-Classic to measure three components of OBC: body surveillance, body shame, and appearance control beliefs. The 14-item scale contains modified vocabulary and syntax to make it appropriate for use with preadolescent and adolescent youth. Results indicate that the OBC-Youth scale is a reliable, valid measure of OBC. Initial findings about the correlates of OBC in preadolescence are discussed.

A systematic review of the existing models of disordered eating: Do they inform the development of effective interventions?

Despite significant advances in the development of prevention and treatment interventions for eating disorders and disordered eating over the last decade, there still remains a pressing need to develop more effective interventions. In line with the 2008 Medical Research Council (MRC) evaluation framework from the United Kingdom for the development and evaluation of complex interventions to improve health, the development of sound theory is a necessary precursor to the development of effective interventions. The aim of the current review was to identify the existing models for disordered eating and to identify those models which have helped inform the development of interventions for disordered eating. In addition, we examine the variables that most commonly appear across these models, in terms of future implications for the development of interventions for disordered eating. While an extensive range of theoretical models for the development of disordered eating were identified (N=54), only ten (18.5%) had progressed beyond mere description and to the development of interventions that have been evaluated. It is recommended that future work examines whether interventions in eating disorders increase in efficacy when developed in line with theoretical considerations, that initiation of new models gives way to further development of existing models, and that there be greater utilisation of intervention studies to inform the development of theory.

College students as facilitators in reducing adolescent obesity disparity in Southern Appalachia: Team Up for Healthy Living

The proportion of obese adolescents in Southern Appalachia is among the highest in the nation. Through funding from the National Institute on Minority Health and Health Disparities--National Institutes of Health, the Team Up for Healthy Living project was a cluster-randomized trial targeting obesity prevention in adolescents through a cross-peer intervention. The specific aims of the project were to: 1) develop a peer-based health education program focusing on establishing positive peer norms towards healthy eating and physical activity (PA) among high school students, 2) test program efficacy, and 3) explore mechanisms underlying the program. The study was guided by the Theory of Planned Behavior, which presupposes that human behavior is primarily driven by attitude, subjective norms, perceived behavioral control, and social support. To deliver the intervention, undergraduate students from the disciplines of public health, nutrition, and kinesiology were hired as peer facilitators. Ten area high schools were invited to participate, were matched on demographics and then randomized to intervention or control. The primary outcomes of the study included body mass status, dietary behaviors, PA, and sedentary behaviors which were assessed at baseline and at three and twelve months post baseline. Intervention schools received Team Up for Healthy Living curriculum, which consists of eight 40-minute sessions. The curriculum focused on improving nutrition awareness, PA, leadership and communication. Control schools received their regularly scheduled Lifetime Wellness curriculum. The long-term goal of the study was to establish an effective academia-community partnership program to address adolescent obesity disparity in Southern Appalachia.

Anti-dieting advice from teammates: a pilot study of the experience of female collegiate cross country runners

Disordered eating behaviors and restrictive dieting can have negative health consequences for female athletes. Teammates can play an important role in primary and secondary prevention of these unhealthy eating practices through verbal and non-verbal communication about what behaviors are normative and desirable. The present study tested two tested hypotheses related to the way anti-dieting advice from teammates is distributed: (a) that there are significant between-team differences in the level of anti-dieting advice received, and (b) that the frequency of anti-dieting advice from teammates is positively associated with the severity of an individual's eating disorder symptomatology and negatively associated with their body mass index (BMI). Participants were female members (n = 89) of six U.S. National Collegiate Athletic Association Division I women's cross country teams. Findings revealed significant between-team differences in the frequency of anti-dieting advice, controlling for team levels of disordered eating. Eating pathology and BMI were positively associated with anti-dieting advice received. Implications for the design of interventions to encourage effective within-team communication for promoting teammate health are discussed.

Globalization and eating disorder risk: peer influence, perceived social norms, and adolescent disordered eating in Fiji

OBJECTIVE

The increasing global health burden imposed by eating disorders warrants close examination of social exposures associated with globalization that potentially elevate risk during the critical developmental period of adolescence in low- and middle-income countries (LMICs). The study aim was to investigate the association of peer influence and perceived social norms with adolescent eating pathology in Fiji, a LMIC undergoing rapid social change.

METHOD

We measured peer influence on eating concerns (with the Inventory of Peer Influence on Eating Concerns; IPIEC), perceived peer norms associated with disordered eating and body concerns, perceived community cultural norms, and individual cultural orientations in a representative sample of school-going ethnic Fijian adolescent girls (n = 523). We then developed a multivariable linear regression model to examine their relation to eating pathology (measured by the Eating Disorder Examination-Questionnaire; EDE-Q).

RESULTS

We found independent and statistically significant associations between both IPIEC scores and our proxy for perceived social norms specific to disordered eating (both p < .001) and EDE-Q global scores in a fully adjusted linear regression model.

DISCUSSION

Study findings support the possibility that peer influence as well as perceived social norms relevant to disordered eating may elevate risk for disordered eating in Fiji, during the critical developmental period of adolescence. Replication and extension of these research findings in other populations undergoing rapid social transition--and where globalization is also influencing local social norms--may enrich etiologic models and inform strategies to mitigate risk.

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.

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.

Associations between friends' disordered eating and muscle-enhancing behaviors

Dieting, unhealthy weight control and muscle-enhancing behaviors are common among adolescents: friends are a probable source of influence on these behaviors. The present study uses data provided by nominated friends to examine associations between friends' disordered eating and muscle-enhancing behaviors and participants' own behaviors in a diverse sample of American youth. Male and female adolescents (mean age = 14.4) completed surveys and identified their friends from a class roster; friends' survey data were then linked to each participant. Participants (N = 2126) who had at least one nominated friend were included in the analytic sample. Independent variables were created using the same weight control and muscle-enhancing behaviors reported by nominated friends, and were used in logistic regression models to test associations between participants' and their friends' behaviors, stratified by gender. Results indicated that dieting, disordered eating and muscle-enhancing behaviors were common in this sample, and selected friends' behaviors were associated with the same behaviors in participants. For example, girls whose friends reported extreme weight control behaviors had significantly greater odds of using these behaviors than girls whose friends did not report these same behaviors (OR = 2.39). This research suggests that friends' weight- and shape-related behaviors are a feature of social relationships, and is the first report demonstrating these associations for muscle-enhancing behaviors. Capitalizing on the social element may be important to the development of increasingly effective intervention and prevention programs.

As relações de vinculação e a imagem corporal: exploração de um modelo

Pretende-se analisar a contribuição diferencial dos principais contextos de desenvolvimento (relação parental e de pares) na forma como os adolescentes experienciam a relação com o seu corpo. A amostra é constituída por 690 adolescentes e jovens adultos (242 meninos e 448 meninas), com idades compreendidas entre os 15 e os 23 anos (M= 17,8 e DP=2,00). Os resultados do modelo de predição revelaram que o gênero e a vinculação romântica foram as variáveis que mais contribuíram para a variação da variável imagem corporal. Foi observado um efeito de mediação entre a vinculação aos pais e a imagem corporal através da relação romântica e de amizade. Os resultados sublinham a necessidade de se compreender a vivência corporal nos contextos interpessoais.

Friends' dieting and disordered eating behaviors among adolescents five years later: findings from Project EAT

OBJECTIVE

Use of disordered eating behaviors is common among adolescents, and cross-sectional research has suggested that friends may be an important influence, especially among females. The current study seeks to expand upon this literature using a longitudinal design and a large, diverse sample of male and female youth.

METHODS

A total of 2,516 adolescents provided survey data at baseline (1998-1999) and follow-up (2003-2004) regarding their friends' involvement in dieting and their own experience of chronic dieting, unhealthy weight control, extreme weight control, and binge eating. General linear modeling was used to generate predicted probabilities of disordered eating at follow-up across four levels of friends' dieting at baseline, adjusting for baseline use of disordered eating, and other covariates. Interaction terms were used to determine whether the association between friends' dieting and disordered eating differed across age cohorts.

RESULTS

One-third of participants reported that their friends were "not at all" involved in dieting at baseline, and 8.8% reported that their friends were very involved in dieting. Friends' dieting at baseline was positively associated with chronic dieting, unhealthy weight control behaviors, extreme weight control behaviors, and binge eating 5 years later among females, and with extreme weight control behaviors five years later among males. For both males and females, these associations were similar across age groups.

CONCLUSIONS

Interventions targeting friendship groups rather than focusing solely on individuals may be an important strategy for the prevention of disordered eating. Health care providers may wish to ask adolescents about their friends' eating and dieting practices so as to address these issues in a clinical setting.

Parental attitudes, body image disturbance and disordered eating amongst adolescents and young adults: a review

OBJECTIVE

The purpose of this paper was to review the existing literature regarding the contribution of parental influences to the sociocultural pressures on body image disturbance and disordered eating so as to highlight principal findings so that parents can be given practical information and identify areas that require further research.

METHODS

Relevant articles were located through Pubmed, Sciencedirect and PsychInfo, as well as the screening of bibliographies.

RESULTS

The available data suggest that parents are strong communicators of sociocultural pressures. Parental influences via verbal messages and active encouragement have been shown to have more impact on offspring's body concerns and eating behaviours than modelling effects. Both mothers and fathers are important sources of influence for their offspring.

CONCLUSION

Considering the role of parents could help improve public health management. Futher exploration of the way adolescents and young adults interpret and perceive parental attitudes and of potential protective factors is necessary.

Geographical clustering of eating disordered behaviors in U.S. high school students

OBJECTIVE

The aim of this study was to determine if eating disorder behaviors geographically clustered among U.S high school students.

METHOD

Our sample consisted of 15,349 high school students who responded to the 1999 Youth Risk Behavior Study (YRBS). Weight control and eating disordered behaviors under investigation included dieting, exercising, fasting, using diet pills, and purging to control weight in the last 30 days. We calculated pairwise odds ratios (PWORs) to determine the degree of within-county clustering.

RESULTS

Among all participants, adjusted analyses revealed that having any weight control or eating disorder symptom, severe restricting, dieting, exercising, and diet pill use each showed significant clustering (p < .05). Purging did not significantly cluster by county. The magnitude of clustering was stronger for female students than male students.

CONCLUSION

The significant clustering of weight control and eating disorder behavior in U.S. high school students confirms evidence of a social contagion effect of eating disorders.

Do friends share similar body image and eating problems? The role of social networks and peer influences in early adolescence

This study examined the role of friendship networks and peer influences in body image concern, dietary restraint, extreme weight loss behaviours (EWLBs) and binge eating in a large community sample of young adolescent females. Based on girls' self-reported friendship groups, social network analysis was used to identify 173 friendship cliques. Results indicated that clique members shared similar scores on measures of dieting, EWLB and binge eating, but not body image concern. Average clique scores for dieting, EWLB and binge eating, were also correlated significantly with clique averages on measures of perceived peer influence, body mass index and psychological variables. Multiple regression analyses indicated that perceived peer influences in weight-related attitudes and behaviours were predictive of individual girls' level of body image concern, dieting, EWLB use and binge eating. Notably, an individual girl's dieting and EWLB use could be predicted from her friends' respective dieting and EWLB scores. Findings highlight the significance of the peer environment in body image and eating problems during early adolescence.

The relationship between friendship factors and adolescent girls' body image concern, body dissatisfaction, and restrained eating

OBJECTIVE

This study examined whether poorer friendship relations predict weight concerns and dietary restraint in adolescent girls.

METHOD

Questionnaires were administered to 131 Year 9 and Year 10 girls to assess the relationship between acceptance by friends, perceived social support, friendship intimacy, and perceived impact of thinness on male (PITOF-M) and female (PITOF-F) friendships on the one hand, and body image concern, body dissatisfaction, and restrained eating on the other.

RESULTS

Friendship variables contributed significantly to the prediction of body image concern, body dissatisfaction, and restrained eating. The largest unique contribution to prediction was from the PITOF-M. Poor acceptance by friends significantly predicted the PITOF-M and PITOF-F. Whereas heavier girls were more likely to believe being thinner would improve their friendships, they did not experience poorer friendships.

DISCUSSION

Results suggest sociocultural risk factors for disordered eating and underline the importance of perceived peer affiliation on girls' body image concern and dieting.

The role of social norms and friends’ influences on unhealthy weight-control behaviors among adolescent girls

Dieting is common among adolescent girls and may place them at risk of using unhealthy weight-control behaviors (UWCBs), such as self-induced vomiting, laxatives, diet pills, or fasting. Research has suggested that social factors, including friends and broader cultural norms, may be associated with UWCBs. The present study examines the relationship between the school-wide prevalence of current weight loss efforts among adolescent girls, friends' dieting behavior, and UWCBs, and investigates differences in these associations across weight categories. Survey data were collected in 31 middle and high schools in ethnically and socio-economically diverse communities in Minnesota, USA. The response rate was 81.5%. Rates of UWCBs were compared across the spectrum of prevalence of trying to lose weight and friends' involvement with dieting, using chi(2) analysis and multivariate logistic regression, controlling for demographic factors and clustering by school. Girls with higher body mass index (BMI) were more likely to engage in UWCBs than those of lower BMI. Multivariate models indicated that friends' dieting behavior was significantly associated with UWCBs for average weight girls (OR = 1.57, CI = 1.40-1.77) and moderately overweight girls (OR = 1.47, CI = 1.19-1.82). The school-wide prevalence of trying to lose weight was significantly, albeit modestly, related to UWCBs for average weight girls (15th-85th percentile; OR = 1.17, CI = 1.01-1.36), and marginally associated for modestly overweight girls (85th-95th percentile; OR = 1.21, CI = .97-1.50), even after controlling for friends' dieting behaviors. The social influences examined here were not associated with UWCBs among underweight ( < 15th percentile) or overweight ( > 95th percentile) girls. Findings suggest that social norms, particularly from within one's peer group, but also at the larger school level may influence UWCBs, particularly for average weight girls. Implications for school-based interventions to reduce UWCBs are discussed.

The rise of eating disorders in Japan: issues of culture and limitations of the model of "westernization"

As the first non-Western nation in contemporary history to become a major industrialized economic power, Japan is central to the debate on cultural relativism in psychiatric nosologies, and the study of eating disorders in Japan contributes to the complex discussion of the impact of culture and history on the experience, diagnosis and treatment of such disorders (R. Gordon 2001; Palmer 2001). Without question, the rise in eating disorders in Japan correlated with increasing industrialization, urbanization, and the fraying of traditional family forms following World War II. While the case of Japan confirms that the existence of eating disorders appears to be linked with these broader social transformations, it also points to the importance of specific cultural and historical factors in shaping the experience of eating disorders. In this article, we explore two particular dimensions of culture in contemporary Japan: (1) gender development and gender role expectations for females coming of age; and (2) beauty ideals and the role of weight and shape concerns in the etiology of eating disorders. Our analysis of these dimensions of culture, and the data accruing from empirical and qualitative research, reveal limitations to the model of "Westernization" and call for a more culturally sensitive search for meaning in both describing and explaining eating disorders in Japan today.

Interpersonal influence and disordered eating behaviors in adolescent girls: the role of peer modeling, social reinforcement, and body-related teasing

This study investigated the association between interpersonal relationships, eating behaviors, and body esteem in a sample of adolescent girls. Participants included 876 girls who completed questionnaires regarding body esteem, eating behavior, peer pressure, and interpersonal relationships. Peer pressure was a strong predictor of eating behavior and body esteem after controlling for interpersonal variables. High externalized self-perceptions, self-reported teasing, and attributions about the importance of weight and shape for popularity and dating were important predictors of both body esteem and eating behavior. Also, girls who were nominated as popular by peers were more likely to engage in disordered eating and have lower body esteem. Results highlight the need for eating disorder prevention at the level of the peer group. Programs should focus on decreasing pressure to be thin, acceptance by peers for attributes other than appearance, and combating weight- and shape-related teasing within the school system.

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.