The Association between Inappropriate Weight Control Behaviors and Suicide Ideation and Attempt among Korean Adolescents

Association between body shape misperception and unhealthy eating behaviors among Korean adolescents

BACKGROUND/OBJECTIVES

Body shape misperception (BSM) is the disagreement between the subjectively perceived body size and body mass index. This study investigated the association between BSM and unhealthy eating behaviors (UEB) among Korean adolescents.

SUBJECTS/METHODS

This cross-sectional study used data from the 2019 Korea Youth Risk Behavior Web-based Survey with 55,748 participants. UEB were measured according to the weekly consumption frequency of caffeinated energy drinks, fast food, carbonated beverages, and sugar-sweetened beverages. The covariates included demographic and socioeconomic characteristics and health-related factors. Multiple logistic regression analysis determined the association between BSM and UEB.

RESULTS

Among the participants, 37,607 (67.5%) reported UEB. The gap between UEB among those with BSM was the largest between the underestimated and accurately estimated groups. Participants who underestimated their body shape were likelier to engage in UEB (adjusted odds ratio [AOR], 1.18; 95% confidence interval [CI], 1.11-1.25). Both sexes with underestimation of body size showed an association with UEB compared to those with accurate estimations (girls: AOR, 1.19; 95% CI, 1.09-1.30; boys: AOR, 1.16; 95% CI, 1.08-1.26).

CONCLUSIONS

Underestimating body shape can provoke UEB among Korean adolescents. The need for appropriate school health interventional programs to prevent underestimating body shape is emphasized to avoid UEB.

The association of weight control attempts with suicidality: The role of objective weight status and weight perception among adolescents of United States

BACKGROUND

The evidence for the association of weight control attempts with suicidality by objective weight status, subjective weight perception, and distorted weight perception among adolescents was limited.

METHODS

Data were extracted from a national representative sample of Youth Risk Behavior Surveys in the United States from 2011 to 2019. Binary logistic regression models with complex sampling designs were used to explore the association of weight control attempts, objective weight status, and weight perception with suicidality.

FINDINGS

The adolescents attempting to lose weight had higher weighted prevalence of suicidal ideation, suicide plan, suicide attempt, and suicide attempt with medical treatment compared with other attempts of weight control. Totally, attempting to lose weight was significantly associated with increased risk of suicidal ideation (OR: 1.17, 95%CI: 1.05-1.30) and suicide attempt (OR: 1.26, 95%CI: 1.10-1.46) when adjusting objective weight status, weight perception and all other covariates. In the subgroup analyses, attempting to lose weight was significantly associated with increased risk of suicidality in the adolescents of normal weight, underweight, perceived normal weight, perceived underweight, right estimation of objective weight status.

LIMITATIONS

Uncertain causal relationship existed because of cross-sectional design.

CONCLUSIONS

The risk of suicidality associated with weight control attempts varied among different subgroups. The findings in this study suggest that not only objective weight status but also weight perception should be with consideration when performing weight control attempts.

Unhealthy weight control behaviors and related factors by gender and weight status: Results from a nationally representative sample of Korean adolescents

Given the serious consequences of unhealthy weight control behaviors (UWCB) among adolescents, identifying factors contributing to it in this population is crucial. Although gender differences have been reported as UWCB-related factors, studies on weight status remain limited. Hence, using a nationally representative sample, we investigated the differences in UWCB-related factors by gender and weight status. Most sociodemographic, health-related behavior, psychosocial, and school factors were remarkably correlated with UWCB in the normal-weight female group; however, they demonstrated most inconsistent correlations in the overweight female group. Overall, this study suggests that UWCB-preventing interventions in adolescents should be customized by gender and weight status.

Associations Between Weight Perception, Unhealthy Weight Control Behavior, and Suicidal Ideation and Planning Among Korean Adolescents: A National Cross-Sectional Secondary Analysis

PURPOSE

This study aimed to investigate the associations between weight perception, unhealthy weight control behavior, and suicidal ideation and planning and identify the role of unhealthy weight control behavior as a mediator in these associations among Korean adolescents.

DESIGN AND METHODS

This national cross-sectional secondary study used data from the 2015-2017 Korea Youth Risk Behavior Web-Based Surveys, with a final sample of 96,285 adolescents who tried to manage their weight in the 30 days prior to the surveys. A multivariate logistic regression was conducted.

RESULTS

Both adolescent groups who perceived themselves to be underweight or overweight were significantly linked to a greater likelihood of suicidal ideation and planning (COR, 95% CI = 1.249, 1.141-1.367; COR, 95% CI = 1.339, 1.282-1.399) respectively. While adolescents with perceptions of being underweight are associated with suicidal ideation and planning through the suppression effect of unhealthy weight control behavior (Pathway A: OR, 95% CI = 0.628, 0.587-0.671), adolescents with perceptions of being overweight are linked with the same through the mediation effect (Pathway A: OR, 95% CI = 1.195, 1.141-1.251).

CONCLUSIONS

Adolescents with perceptions of being overweight are highly likely to have unhealthy weight control behavior that can be linked to the possibility of suicidal ideation and planning, while adolescents with perceptions of being underweight are comparatively less likely to engage in such behavior.

PRACTICE IMPLICATIONS

It is necessary to identify the status of weight perception among adolescents and closely monitor the unhealthy weight control behavior to prevent suicidal ideation and planning.

Bingeing, Purging, and Suicidal Ideation in Clinical and Non-Clinical Samples of Youth

Suicidal ideation is a serious mental health concern reported by adolescents. Despite understanding of increased suicidal ideation in patients with eating disorders (EDs) and obesity, few studies have compared how disordered eating (bingeing, vomiting and over exercising) is associated with suicidal ideation in clinical and non-clinical samples of youth across the ED and weight spectrum. The present study aimed to 1) comparatively examine rates of suicidal ideation and disordered eating behaviors in clinical samples of youth with EDs, complex obesity, or from the community, and 2) examine whether disordered eating was associated with suicidal ideation above and beyond age, body mass index, diagnosis, treatment-seeking status, and depressive symptoms in large samples of males vs. females in an attempt to understand whether these behaviors should lead to concern regarding suicidal ideation. Data from charts on treatment-seeking adolescents diagnosed with either an ED (N = 315), severe complex obesity (N = 212), and from the community (N = 3036) were pooled together for comparative purposes. Results showed that suicidal ideation was higher in youth seeking treatment for an ED (50.2%) and obesity (23.7%) as compared to youth from the community (13%). Binary logistic regression analyses revealed that vomiting (OR = 1.73 for females, 8.17 for males) and over-exercising (OR = 1.47 for females, 1.68 for males) was significantly associated with suicidal ideation in both males and females. Findings underscore the importance of screening for suicidal ideation in youth who report vomiting or over-exercising despite diagnostic presentation, age, weight, or treatment setting.

Gender Differences in Risk Factors Influencing Unhealthy Weight Control Behaviors among Adolescents

This study was conducted to identify risk factors that influence the probability and severity of unhealthy weight control behaviors (UWCBs) and to consider gender difference. Data were obtained from a national survey. The study population was composed of 66,068 adolescents in grades 7-12 at 400 middle schools. The effect of the independent variables on UWCBs was analyzed using zero inflated negative binominal regression. Higher body mass index group, overweight perception, appearance stress, and depressive mood were found to be risk factors of UWCBs' probability in both genders. For boys, older age, underweight, accurate or under-perception of weight, and depressive mood influenced severity of UWCBs. For girls, older age, appearance stress, and depressive mood influenced severity of UWCBs. The new findings mean to consider the range of UWCBs experienced, which can offer more sensitive and predictable information. Further interventions should be developed to consider gender specific risk factors.

Isolating the Association of Sleep, Depressive State, and Other Independent Indicators for Suicide Ideation in United States Teenagers

According to the Centers for Disease Control and Prevention, suicide is the second leading cause of death in American teenagers, and is a growing public health concern. This study uses multivariable logistic regression to investigate the independent relationship between suicide ideation and sleep duration in teenagers using the 2015 Youth Behavior Risk Surveillance Study, controlling for demographic, behavioral, and other factors found to be associated. Sleep durations of 4-5 hours and 6-7 hours per night were associated with approximately 75-80% and 20-40% increased adjusted odds of suicide ideation, as compared to teens sleeping the recommended 8 hours or more, and should be considered as a potential important indicator for adolescent suicidal ideation in primary-care screens.

Contextual Association between Political Regime and Adolescent Suicide Risk in Korea: A 12-year Repeated Cross-Sectional Study from Korea

This study evaluated associations between contextual political determinants and individual adolescent suicide risk (SR). Using repeated cross-sectional individual-level data of 829,861 students in the Korea Youth Risk Behavior Web-based Survey and national contextual-level data during 2005⁻2016, cross-classified random effects models were conducted to estimate fixed period and cohort effects of political determinants on SR. Adolescent SR was reduced during conservative presidential regimes. Contrary to presidencies' period effects, conservative regimes had negative cohort effects on adolescent SR. The odds of suicide attempt and depression increased in the grade cohorts affected by college entrance examination policies of conservative regimes. Politics has significantly impacted adolescent SR despite differences in period and cohort effects of politics. These findings imply the need to encourage adolescents' political participation in choosing political forces with policies favorable to their own mental health.

Association of Body Mass Index with Suicide Behaviors, Perceived Stress, and Life Dissatisfaction in the Korean General Population

OBJECTIVE

The purpose of the present study was to investigate the association between Body Mass Index, suicide, perceived stress, and life dissatisfaction in a general population sample of Korean adults.

METHODS

A total of 6,022 nationally representative adults aged 18 to 74 were selected using a multistage cross-sectional cluster sampling method. Questionnaires regarding suicide behaviors, perceived stress, and life satisfaction were completed by the participants. They also reported their heights and weights, which were used to calculate BMI. Psychiatric disorders were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, using the Korean version of the Composite International Diagnostic Interview.

RESULTS

The results showed that being underweight was associated with higher risk for suicide ideation [odds ratio (OR), 1.6; 95% confidence interval (Cl), 1.18-2.05] and suicide attempt (OR, 2.0, 95% Cl, 1.23-3.31). Likewise, obesity also increased the risk of suicide ideation (OR, 1.3; 95% Cl, 1.11-1.56) although not suicide attempt. Furthermore, underweight individuals were more likely to report severe level of perceived stress (OR, 1.7; 95% Cl, 1.26-2.17) and life dissatisfaction (OR, 1.3; 95% Cl, 1.07-1.68). All of the results remained significant after adjusting for age, gender, education, and psychiatric illnesses.

CONCLUSION

This study found that being underweight is a significant risk factor for suicide and poor subjective wellbeing in Korea. It suggests that BMI status may be an important modifiable factor for improving mental health in Korea.

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

OBJECTIVE

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

METHOD

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

RESULTS

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

DISCUSSION

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