Weight control practices of U.S. adolescents and adults

Global Prevalence of Adolescent Use of Nonprescription Weight-Loss Products: A Systematic Review and Meta-Analysis

Importance

Use of nonprescribed weight-loss products in adolescents is a public health concern that is associated with negative physical and psychological consequences. However, the prevalence of nonprescribed weight-loss product use in adolescents is unknown.

Objective

To determine the global prevalence of nonprescription weight-loss product use in children and adolescents.

Data Sources

Four databases, including MEDLINE, PsycINFO, CINAHL (Cumulative Index of Nursing and Allied Health), and EMBASE, were searched for quantitative studies that reported prevalence data on use of nonprescription weight-loss products with no restrictions on publication date. The search was performed December 1, 2020, and updated March 6, 2023.

Study Selection

Studies were included in the meta-analysis if they reported the prevalence of weight-loss product use, were published in English, and included individuals 18 years or younger.

Data Extraction and Synthesis

Data extraction was completed by 2 independent reviewers. Data analysis determined the overall pooled proportion of weight-loss product use in total and during the past week, past 30 days, past year, or lifetime. Inverse variance heterogeneity effect models were used.

Main Outcomes and Measures

The main outcome measure was the prevalence of nonprescription weight-loss product use in adolescents for all included studies and over the past week, past month, past year, or lifetime. Subgroup analysis included separation of groups by sex, specific weight-loss product types, geographical location, and study publication time.

Results

A total of 90 articles (604 552 unique participants) were included in the meta-analysis. Of these, 50 studies (56%) were from North America. The reported prevalence of weight-loss product use in adolescents was 5.5% (96% CI, 5.5%-5.6%) overall. When identifying use of weight-loss products in the general population, prevalence was 2.0% (95% CI, 1.9%-2.1%) in the past week, 4.4% (95% CI, 4.3%-4.5%) in the past month, 6.2% (95% CI, 6.1%-6.3%) in the past year, and 8.9% (95% CI, 8.6%-9.2%) in their lifetime. Use of weight-loss products was higher among girls than boys.

Conclusions and Relevance

This meta-analysis found that use of weight-loss products occurs at high levels in adolescents, especially girls. These findings suggest that, given the ineffectiveness of these products for weight loss coupled with their harmful long-term health consequences, interventions are required to reduce use of weight-loss products in this group.

Targeting skeletal muscle mitochondrial health in obesity

Metabolic demands of skeletal muscle are substantial and are characterized normally as highly flexible and with a large dynamic range. Skeletal muscle composition (e.g., fiber type and mitochondrial content) and metabolism (e.g., capacity to switch between fatty acid and glucose substrates) are altered in obesity, with some changes proceeding and some following the development of the disease. Nonetheless, there are marked interindividual differences in skeletal muscle composition and metabolism in obesity, some of which have been associated with obesity risk and weight loss capacity. In this review, we discuss related molecular mechanisms and how current and novel treatment strategies may enhance weight loss capacity, particularly in diet-resistant obesity.

The Effect of Bigorexia Nervosa on Eating Attitudes and Physical Activity: A Study on University Students

PURPOSE

This study aims to examine the relationship between physical activity, eating attitude, and bigorexia nervosa among university students.

METHOD

A questionnaire form consisting of sociodemographic characteristics, eating habits, the Eating Attitude Scale (EAT-40), the International Physical Activity Questionnaire (IPAQ), and the Muscle Appearance Satisfaction Scale (MASS) was conducted on undergraduate students at Üsküdar University.

RESULTS

There were 1006 students who participated in this study with a mean age of 22.58 ± 2.87 years. The median "muscle appearance satisfaction" score of the obese students was statistically higher than the normal weight and underweight students. The median score for "Obesity Anxiety" was statistically higher in underweight students than in obese ones. A one-unit increase in IPAQ scores was related to an elevation of 24.9% in the MASS and a decrease of 17.9% in the EAT-40 scores, while a one-unit increase in MASS scores was related to a reduction of 12.5% in the EAT-40 scores.

CONCLUSION

Eating attitude is associated with bigorexia nervosa, and as MASS scores increase, EAT-40 scores decrease and as IPAQ scores increase, and EAT-40 scores decrease. In other words, as physical activity increases, muscle strength satisfaction elevates, and in parallel with this increase, a positive eating attitude improves.

A review of sex differences in the mechanisms and drivers of overeating

Disordered eating is often associated with marked psychological and emotional distress, and severe adverse impact on quality of life. Several factors can influence eating behavior and drive food consumption in excess of energy requirements for homeostasis. It is well established that stress and negative affect contribute to the aetiology of eating disorders and weight gain, and there is substantial evidence suggesting sex differences in sub-clinical and clinical types of overeating. This review will examine how negative affect and stress shape eating behaviors, and how the relationship between the physiological, endocrine, and neural responses to stress and eating behaviors differs between men and women. We will examine several drivers of overeating and explore possible mechanisms underlying sex differences in eating behavior.

Do sex differences in reported weight loss intentions and behaviours persist across demographic characteristics and weight status in youth? A systematic review

Background

Evidence suggests that young females are more likely to try to lose weight than young males, however whether this sex difference persists across demographic characteristics and weight status is unclear. Further, whether females are more likely than males to try to lose weight using unhealthy weight loss strategies has never been systematically assessed. The objective of this systematic review was to examine the literature on sex differences in weight loss intentions and strategies in children and adolescent observational studies to determine whether sex differences persisted across demographic characteristics (race/ethnicity, grade level) and weight status.

Methods

Relevant articles published after 1990 were identified using PubMED, Web of Science, and PsycInfo. Searches were conducted in May of 2015 and again in May of 2017. Studies conducted in the US and Canada with participants 18-years old or younger who measured weight loss strategies in the context of weight loss intention were selected. Descriptive statistics were extracted from 19 studies.

Results

Almost two-thirds of youth reported trying to lose weight. High-school and middle-school aged females reported consistently higher prevalence of weight loss intentions compared to male counterparts, as did Caucasian, African-American, and Hispanic females. The proportion of youth using unhealthy or extreme strategies reached 44 and 13%, respectively, with a similar proportion of males and females endorsing the use of each category of weight loss strategies across studies. Native-American youth reported the highest prevalence (27%) of using extreme strategies.

Conclusions

Researchers should consider demographic characteristics when reporting prevalence information for weight loss intentions and behaviours, as certain groups might require more targeted public health initiatives. Across characteristics, prevalence ranges were broad for weight loss intentions and use of particular strategies, suggesting the need to standardize and refine data collection and reporting practices in this literature.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-6179-x) contains supplementary material, which is available to authorized users.

Body size estimation of self and others in females varying in BMI

Previous literature suggests that a disturbed ability to accurately identify own body size may contribute to overweight. Here, we investigated the influence of personal body size, indexed by body mass index (BMI), on body size estimation in a non-clinical population of females varying in BMI. We attempted to disentangle general biases in body size estimates and attitudinal influences by manipulating whether participants believed the body stimuli (personalized avatars with realistic weight variations) represented their own body or that of another person. Our results show that the accuracy of own body size estimation is predicted by personal BMI, such that participants with lower BMI underestimated their body size and participants with higher BMI overestimated their body size. Further, participants with higher BMI were less likely to notice the same percentage of weight gain than participants with lower BMI. Importantly, these results were only apparent when participants were judging a virtual body that was their own identity (Experiment 1), but not when they estimated the size of a body with another identity and the same underlying body shape (Experiment 2a). The different influences of BMI on accuracy of body size estimation and sensitivity to weight change for self and other identity suggests that effects of BMI on visual body size estimation are self-specific and not generalizable to other bodies.

Intentions to Prevent Weight Gain in Older and Younger Adults; The Importance of Perceived Health and Appearance Consequences

OBJECTIVES

This study investigates whether health and appearance consequences predict intentions to prevent weight gain and whether these relationships differ in younger versus older adults and in men versus women.

METHODS

UK adults aged 18-26 years (younger adults; n = 584) or >45 years (older adults; n = 107) participated in an online survey. Logistic regression assessed associations between intentions to avoid gaining weight and age, gender as well as perceived negative consequences of weight gain for health and appearance. Co-variates were ethnicity, education, weight perception and perceived weight gain vulnerability. Interactions between age, gender and perceived health and appearance consequences of weight gain were also tested.

RESULTS

Perceived negative appearance consequences of weight gain predicted weight gain prevention intentions (OR = 9.3, p < 0.001). Health concerns were not a significant predictor of intentions overall but were a strong predictor for older adults (age × health concern interaction: OR = 13.6, p > 0.01).

CONCLUSION

Concerns about feeling unattractive predict intentions to prevent weight gain. However, health consequences of weight gain are only important motivators for older adults. Future research should identify ways to shift the focus of young people from appearance concerns towards the health benefits of maintaining a healthy weight.

Women’s Experiences of Appearance Concern and Body Control across the Lifespan: Challenging accepted wisdom

This study adopted a lifespan approach to women’s experiences of appearance concern and body control. Thirty-two women (aged 16 to 77) were interviewed about their exercise and food regulation. Results of the grounded theory analysis challenge social constructions of appearance concern as associated principally with the reproductive years, and of the body as malleable, and highlight the complexity of the relationship between appearance concern and body control. Despite frequent persistence of (or increase in) appearance concern beyond young adulthood, ‘healthier’ responses to appearance concern occurred due to changing priorities and increasing awareness. Findings highlight the utility of an inclusive and qualitative approach, and the absence of simple and sovereign factors determining an individual’s levels of appearance concern or body control.

Military service and other socioecological factors influencing weight and health behavior change in overweight and obese Veterans: a qualitative study to inform intervention development within primary care at the United States Veterans Health Administration

BACKGROUND

Obesity affects 37 % of patients at Veterans Health Administration (VHA) medical centers. The VHA offers an intensive weight management program (MOVE!) but less than 10 % of eligible patients ever attend. However, VHA patients see their primary care provider about 3.6 times per year, supporting the development of primary care-based weight management interventions. To address gaps in the literature regarding Veterans' experiences with weight management and determine whether and how to develop a primary care-based weight management intervention to both improve obesity counseling and increase attendance to MOVE!, we conducted a qualitative study to assess: 1) Veterans' personal experiences with healthy weight-related behavior change (including barriers and facilitators to behavior change and experiences with primary care providers, staff, and the MOVE! program), and 2) potential new approaches to improve weight management within primary care at the VHA including goal setting and technology.

METHODS

Overweight/obese VHA patients (aged 18-75, BMI greater than 30 or greater than 25 with at least 1 co-morbidity) were recruited for focus group sessions stratified by gender, MOVE! referral, and attendance. Each session was facilitated by a trained moderator, audio-recorded, and professionally transcribed. Using an iterative coding approach, two coders separately reviewed and coded transcripts, and met frequently to negotiate codes and synthesize emerging themes.

RESULTS

Of 161 eligible patients, 54 attended one of 6 focus groups (2 female, 4 male, 9-11 participants per session): 63 % were male, 46 % identified as African-American, 32 % White/Caucasian, 74 % were college-educated or higher, and 61 % reported having attended MOVE!. We identified two major themes: Impact of Military Service and Promotion and Sustainability of Healthy Behaviors. After service in a highly structured military environment, Veterans had difficulty maintaining weight on their own. They perceived physical activity as having more impact than diet, but chronic pain was a barrier. We identified individual/interpersonal-, community/environment-, and healthcare system-related factors affecting healthy behaviors. We also received input about Veteran's preferences and experiences with technology and setting health goals.

CONCLUSIONS

Unique factors influence weight management in Veterans. Findings will inform development of a technology-assisted weight management intervention with tailored counseling and goal-setting within primary care at the VHA.

Health beliefs and stages of changes to improve behaviors among obese and overweight women undergoing preconception care

Background:

Beginning and continuing pregnancy with obesity and being overweight has some known side effects for the mother and the fetus. Preventing these complications requires medical interventions before pregnancy. Because designing health improvement interventions requires understanding of the related factors of the behavior, the aim of this study was to determine the relation between health beliefs of women regarding the risks of obesity for pregnancy and stages of behavioral changes in women under preconception care.

Materials and Methods:

This study was a cross-sectional study that was conducted on 120 obese and overweight women under preconception care. Health belief structures including perceived sensitivity/intensity, perceived benefits, perceived barriers, and perceived self-efficacy were measured using a questionnaire, and its relation with stages of nutrition and physical activity behavior changes was evaluated according to a transtheoretical model.

Results:

Results showed a significant correlation between the stage of nutrition behavioral change and perceived sensitivity/intensity, perceived benefits, and self-efficacy (P < 0.05). In addition, the stage of physical activity behavioral change showed a negative and significant correlation with perceived barriers and a positive and low-to-moderate significant correlation with other health belief structures (P < 0.05). Furthermore, the relation of perceived sensitivity/intensity with perceived benefits and self-efficacy was positive and significant, and that with perceived barriers was negative and significant (P < 0.01).

Conclusions:

Results showed that a health belief model could be a predictor of weight adjustment behaviors including nutrition and physical activity behaviors. Therefore, educational interventions based on a health belief model could be effective for improvement of these behaviors in obese and overweight women under preconception care.

Weight perceptions in a population sample of English adolescents: cause for celebration or concern?

OBJECTIVES

To examine the proportion of normal-weight adolescents who consider themselves to be too heavy (size overestimation), and the proportion of overweight or obese adolescents who consider themselves to be about the right weight or too light (size underestimation), in large population-based samples collected over 8 years in England.

METHODS

Data were from the Health Survey for England between 2005 and 2012: an annual survey of households representative of the English population. We analysed data from 4979 adolescents (2668 boys, 2311 girls) aged 13 to 15 years old whose weight status was defined as normal weight or overweight/obese based on body mass index standard deviation scores (BMI-SDS) derived from objective measurements of height and weight and using International Obesity Task Force standards. Weight perception was based on the adolescent's choice from the following descriptors: 'about the right weight', 'too heavy' or 'too light'.

RESULTS

The majority of normal-weight adolescents (83% of boys, 84% of girls) correctly identified themselves as 'about the right weight'. Overestimation was uncommon, with only 7% of normal-weight teens (4% of boys, 11% of girls) identifying themselves as 'too heavy'. In contrast, only 60% of overweight/obese adolescents (53% of boys, 68% of girls) correctly identified themselves as 'too heavy', whereas 39% (47% of boys, 32% of girls) underestimated, identifying themselves as 'about the right weight' or 'too light'. There were no significant changes in BMI-SDS or body size estimation over time (2005-2012).

CONCLUSIONS

Overestimation of body weight among normal-weight adolescents is relatively uncommon; potentially a cause for celebration. However, almost half of boys and a third of girls with a BMI placing them in the overweight or obese BMI range perceived themselves to be about the right weight. Lack of awareness of excess weight among overweight and obese adolescents could be a cause for concern.

Misperceptions of weight status among adolescents: sociodemographic and behavioral correlates

Objective

Accurate perceptions of weight status are important motivational triggers for weight loss among overweight or obese individuals, yet weight misperception is prevalent. To identify and characterize individuals holding misperceptions around their weight status, it may be informative for clinicians to assess self-reported body mass index (BMI) classification (ie, underweight, normal, overweight, obese) in addition to clinical weight measurement.

Methods

Self-reported weight classification data from the 2007 Current Visit Information – Child and Adolescent Survey collected at Mayo Clinic in Rochester, MN, were compared with measured clinical height and weight for 2,993 adolescents.

Results

While, overall, 74.2% of adolescents accurately reported their weight status, females, younger adolescents, and proxy (vs self) reporters were more accurate. Controlling for demographic and behavioral characteristics, the higher an individual’s BMI percentile, the less likely there was agreement between self-report and measured BMI percentile. Those with high BMI who misperceive their weight status were less likely than accurate perceivers to attempt weight loss.

Conclusion

Adolescents’ and proxies’ misperception of weight status increases with BMI percentile. Obtaining an adolescent’s self-perceived weight status in addition to measured height and weight offers clinicians valuable baseline information to discuss motivation for weight loss.

Body weight and body shape concerns and related behaviours among Indian urban adolescent girls

Objective

To assess the associations of body weight and body shape concerns and related behaviours with actual weight status among urban adolescent girls.

Design

In the present cross-sectional study, a self-administered questionnaire was used to collect data on body weight and body shape concerns and related behaviours. Sociodemographic information was collected using a pre-tested schedule. Weight and height of each girl were measured to assess actual weight status.

Setting

Twin cities of Kolkata and Howrah, West Bengal, India.

Subjects

A total of 1223 adolescent girls aged 14–19 years were selected from nine schools in Kolkata and Howrah in West Bengal.

Results

Many overweight girls perceived themselves as overweight and engaged in weight-reducing activities. However, several normal-weight girls also perceived them as overweight and attempted to lose weight. Unhealthy eating practices to reduce weight were followed by both overweight and normal-weight girls and even by a few underweight girls. Multivariate binary logistic regression showed a significant association between actual weight status and use of unhealthy weight-loss measures. The likelihood of adopting unhealthy eating practices was significantly higher among overweight than normal-weight girls.

Conclusions

Health education programmes should be introduced at schools to promote effective weight-control practices that help dispel myths about weight loss.

Patient perception of ideal body weight and the effect of body mass index

OBJECTIVE

Despite much effort, obesity remains a significant public health problem. One of the main contributing factors is patients' perception of their target ideal body weight. This study aimed to assess this perception.

METHODS

The study took place in an urban area, with the majority of participants in the study being Hispanic (65.7%) or African-American (28.0%). Patients presented to an outpatient clinic were surveyed regarding their ideal body weight and their ideal BMI calculated. Subsequently they were classified into different categories based on their actual measured BMI. Their responses for ideal BMI were compared.

RESULTS

In 254 surveys, mean measured BMI was 31.71 ± 8.01. Responses to ideal BMI had a range of 18.89-38.15 with a mean of 25.96 ± 3.25. Mean (±SD) ideal BMI for patients with a measured BMI of <18.5, 18.5-24.9, 25-29.9, and ≥30 was 20.14 ± 1.46, 23.11 ± 1.68, 25.69 ± 2.19, and 27.22 ± 3.31, respectively. These differences were highly significant (P < 0.001, ANOVA).

CONCLUSIONS

Most patients had an inflated sense of their target ideal body weight. Patients with higher measured BMI had higher target numbers for their ideal BMI. Better education of patients is critical for obesity prevention programs.

Validierung einer deutschen Version des ATHLETE Fragebogens für Hochleistungssportlerinnen

Der ATHLETE ( Hinton & Kubas, 2005 ) ist ein speziell für Sportlerinnen entwickelter Fragebogen, der sportspezifische psychosoziale Risikofaktoren für gestörtes Essverhalten erfasst. Ein vergleichbares deutschsprachiges Instrument existiert bisher nicht. Die vorliegende Studie entwickelte eine deutsche Version des ATHLETE und überprüfte dessen Faktorenstruktur und psychometrische Kennwerte für Hochleistungssportlerinnen. Daten von 103 deutschen Athletinnen wurden mittels mehrerer Fragebögen und klinischem Interview an zwei Messzeitpunkten erhoben. Mit drei der ursprünglichen und drei neuen Faktoren weicht die Faktorenstruktur des deutschen ATHLETE von der der Originalversion ab. Reliabilität und konvergente Validität der Skalen sind akzeptabel bis sehr gut. Ergebnisse zur Kriteriumsvalidität fallen heterogen aus: Skalen zu Sportleridentität, Misstrauen, Perfektionismus und Elternverhalten zeigen keine oder mäßige Zusammenhänge zu Essstörungsproblemen. Nur die neuen Skalen Körper und Sport und Training zur Gewichtsregulation überzeugen als Maße zur Abschätzung der Gefährdung für gestörtes Essverhalten. Sie sind Prädiktoren für die Essstörungspsychopathologie nach 12 Monaten.

Local Wellness Policy 5 years later: is it making a difference for students in low-income, rural Colorado elementary schools?

INTRODUCTION

The federally mandated Local Wellness Policy (LWP) was intended to promote student health in schools. This study assesses the 5-year effects of the LWP on the health practices of rural elementary schools in Colorado.

METHODS

One year before and 5 years after the LWP mandate, a survey was administered to a random sample of principals, physical education (PE) teachers, and food-service managers in 45 rural, low-income elementary schools in Colorado. Response rates were 71% in 2005 and 89% in 2011.

RESULTS

Minutes for PE and recess did not increase, nor did offerings of fresh fruits and vegetables. More schools adopted policies prohibiting teachers from taking recess away as punishment (9.7% in 2005 vs 38.5% in 2011, P = .02) or for making up missed instructional time, class work, or tests in other subjects (3.2% in 2005 vs 28.2% in 2011, P = .03). More schools scheduled recess before lunch (22.6% in 2005 vs 46.2% in 2011, P = .04) and developed policies for vending machines (42.9% in 2005 vs 85.7% in 2011, P = .01) and parties (21.4% in 2005 vs 57.9% in 2011, P = .004).

CONCLUSION

Changes in school practices are modest, and arguably the important school practices such as increased PE and recess time and increased offerings of fruits and vegetables in the lunch line have not changed in the 5 years since the mandate went into effect. Further investigation is needed to identify the knowledge, skills, and attitudes as well as financial and physical resources required for school administrators to make changes in school practices.

Distorted self-perceived weight status and its associated factors among civil servants in Tamale, Ghana: a cross-sectional study

Background

Obesity has been described as an epidemic and a major public health concern globally. Distorted self-perceived weight status can negatively impact an individual’s decision to lose weight as well as adoption of healthful weight management attitudes. This study described self-perceived weight status among adults working in civil service departments in Tamale, Ghana, and compared it to their classification based on WHR. It also examined associations of distorted self-perceived weight status with weight loss attitudes, socio-demographic variables and knowledge levels on the health effects of overweight and obesity.

Methods

This cross-sectional study was undertaken from January 2011 to July 2011 among a sample of 186 civil servants living in Tamale. Out of the sample, 121 were men and 65 were women. Participants’ self-perceived weight status, socio-demographic and weight loss attitudes were assessed by means of a 10-item questionnaire. Participants’ waist and hip circumferences were measured with appropriate tools and computed into waist hip ratio (WHR) and classified based on WHO classifications.

Results

More than 80% of the participants were aged below 40 years. Generally, 56.5% (n = 105) participants had normal weight and 31.2% (n = 58) were centrally obese. The proportion of participants being centrally obese was higher in women compared to men (p < 0.0001). Forty four percent of the studied population had a distorted self-perceived weight status. Less than10% of participants self-perceived themselves as overweight/obese, in which over 47% were, in fact, overweight/obese as measured by WHR. Factors associated with distorted self-perceived weight status were being overweight/obese (Crude OR = 97.3; (35.8-264.6; p < 0.0001), aged < 40 years (Crude OR = 2.8; 95% CI = 1.3-6.5; p = 0.0102) and having inadequate knowledge on the health effects of overweight/obesity (Crude OR = 3.7; CI = 1.3-11.0; p = 0.0114). Weight loss attitudes and methods used to lose weight were not significantly associated to self-perceived weight status and WHR measured weight status.

Conclusions

Self-perceived and WHR measured weight status of participants did not conform. Distorted self-perceived weight status was not associated to weight loss attitudes but to being overweight/obese, being younger (<40 years) and having inadequate knowledge on the health effects of overweight/obesity. Educating people on accurate weight perception and the health effects of overweight/obesity should be considered in designing public health strategies to curb the rising prevalence of overweight/obesity and other non-communicable diseases in Ghana.

Characteristics and behaviors of non-overweight college students who are trying to lose weight

The purpose of the current study was to examine characteristics and behaviors of college students who perceive themselves as underweight or about the right weight, yet report trying to lose weight, as compared to their counterparts. Participants included 944 students (M = 20.4 years, 61.1 % White; 64.7 % female) at a southwestern university. A composite of perceived weight and weight-related behavior was created. Participants who reported they were under- or about the right weight and trying to lose weight were included in this composite group. Cross-sectional logistic regression analyses were run to assess characteristics and behaviors of the composite group. Individuals in this group were significantly more likely to be women, in a fraternity/sorority, have a lower body mass index, engage in regular vigorous physical activity, exercise and/or diet to lose weight, and engage in unhealthy weight-control behaviors. These individuals were not more likely than their counterparts to consume 5 or more servings of fruits/vegetables daily, to engage in moderate physical activity, or to report smoking cigarettes in the past month. Further research is needed to understand why individuals who perceive themselves as under- or about the right weight engage in certain weight-loss behaviors. Interventions to target weight-related perceptions and behaviors among college-age individuals may need to address unhealthy weight-control measures.

Adapted intervention mapping: a strategic planning process for increasing physical activity and healthy eating opportunities in schools via environment and policy change

BACKGROUND

School environment and policy changes have increased healthy eating and physical activity; however, there has been modest success in translating research findings to practice. The School Environment Project tested whether an adapted version of Intervention Mapping (AIM) resulted in school change.

METHODS

Using a pair randomized design, 10 rural elementary schools were assigned to AIM or the School Health Index (SHI). Baseline measures were collected fall 2005, AIM was conducted 2005-2006, and follow-up measures were collected fall 2006 and 2007. Outcome measures included number and type of effective environment and policy changes implemented; process measures included the extent to which 11 implementation steps were used.

RESULTS

AIM schools made an average of 4.4 effective changes per school with 90% still in place a year later. SHI schools made an average of 0.6 effective changes with 66% in place a year later. Implementation steps distinguishing AIM from SHI included use of external, trained facilitators; principal involvement; explicitly stating the student behavior goals; identifying effective environment and policy changes; prioritizing potential changes based on importance and feasibility; and developing an action plan.

CONCLUSION

The AIM process led to environment and policy changes known to increase healthy eating and physical activity.

Associations between different forms of body dissatisfaction and the use of weight-related behaviors among a representative population-based sample of adolescents

Weight management strategies have two components: weight goals and behaviors to reach weight goals. In the literature, weight goals and weight-related behaviors have both been linked with body dissatisfaction separately, but have rarely been examined simultaneously. This paper examines the associations between different forms of body dissatisfaction and various weight-related behaviors and investigates the moderating role of weight goals in these associations. Measures included weight goals (matching or mismatching current weight status), self-reported frequencies of use of weight-related behaviors, and a body dissatisfaction measure (strength of aspiring for weight gain or weight loss) from a representative population-based sample of adolescents (n = 2,346, 51 % female). Sex-specific multilevel logistic and ordinal regression analyses indicated that aspiring for a thinner body among girls was associated with more frequent use of healthy and unhealthy behaviors, whereas body dissatisfaction of any type among boys was linked to more frequent use of unhealthy behaviors. Girls aspiring for substantial weight loss and boys aspiring for substantial weight gain were more likely to use disordered health behaviors. Aiming for a goal that is mismatched with current weight status increases the use of unhealthy behaviors among body dissatisfied adolescents. We conclude that in order to elaborate interventions aimed at promoting health, research should focus on processes leading to specific forms of body dissatisfaction which in turn produce varying frequencies of use of weight-related behaviors.

Self-Care Self-Efficacy, Religious Participation and Depression as Predictors of Poststroke Self-Care Among Underserved Ethnic Minorities

Underserved ethnic minorities have multiple chronic disease risk factors, including tobacco, alcohol and substance use, which contribute to increased incidence of stroke. Self-efficacy (self-care self-efficacy), religious participation and depression may directly and indirectly influence engagement in post stroke self-care behaviors. The primary aim of the present study was to investigate the effects of self-care self-efficacy, religious participation and depression, on tobacco, alcohol and substance use in a sample of largely ethnic minority, underserved stroke survivors (n=52). Participants previously recruited for a culturally tailored secondary stroke prevention self-care intervention were included. The treatment group received three stroke self-care sessions. The usual care group completed assessments only. Both groups were included in these analyses. Main outcome measures included tobacco, alcohol and substance use. Self-care self-efficacy, religious participation and depression were also assessed. Logistic regression analyses, using self-efficacy, religious practice and depression as the referents, were used to predict binary outcomes of tobacco, alcohol and substance use at 4-weeks poststroke. Higher depression and self-care self-efficacy were associated with reduced odds of smoking and substance use. Greater participation in religious activities was associated with lower odds of alcohol use. We can conclude that incorporating depression treatment and techniques to increase self-care self-efficacy, and encouraging religious participation may help to improve stroke self-care behaviors for underserved and low socioeconomic status individuals. Results are discussed in the context of stroke self-management.

Body image, body satisfaction and dieting behavior in Japanese preadolescents: The Toyama birth cohort study

OBJECTIVES

To examine the relationships between body image, body satisfaction and dieting behavior in the context of pubertal changes in Japanese preadolescents.

METHODS

A cross-sectional study of dieting behavior among 5,244 preadolescents (2,452 boys and 2,792 girls aged 12-13) born in Toyama prefecture.

RESULTS

The percentages of those who perceived themselves fat, wanted to be thinner, and had tried dieting, which increased with body mass index (BMI), were significantly higher in girls than in boys (34.2% vs. 20.0%, 58.0% vs. 26.0%, and 17.3% vs. 5.7%, respectively). Independent of sex and BMI, those who wanted to be thinner and those who had tried dieting were more frequently observed in those who perceived themselves fat, and those who had tried dieting were more frequently observed in those who wanted to be thinner. Pubertal changes were significantly associated with dieting behavior, but their relationships to body image and body satisfaction differed between sexes; for boys, those who perceived themselves fat were more frequently observed in those without pubertal changes; whereas for girls, those who wanted to be thinner were more frequently observed in those with pubertal changes.

CONCLUSIONS

Dieting behavior of Japanese preadolescents was associated with whether they perceived themselves fat and wanted to be thinner, sometimes independent of whether they were actually overweight. Pubertal changes might induce a positive perspective of growing fat among boys and a desire to be thinner among girls, with the consequence that dieting behavior would be reinforced in those with pubertal changes.

Physical, Behavioral, and Body Image Characteristics in a Tri-Racial Group of Adolescent Girls

OBJECTIVES

The purpose of this study was to evaluate physical characteristics, nutrient intake, physical activity level, and body image in white (CC), African-American (AA), and Hispanic-American (HA) female adolescents.

RESEARCH METHODS AND PROCEDURES

High school volunteers were solicited for this study. Self-reported information was used to determine subject characteristics, family income, physical activity, body image, and nutrient intake. Physical evaluations were used to determine body mass index, percent body fat, fat distribution, resting heart rate, and blood pressure (BP).

RESULTS

Results showed that AA girls displayed significantly higher diastolic BP than HA girls (p = 0.029). CC adolescents showed greater physical activity (p = 0.010) and lower adiposity than HA adolescents (p = 0.048), as well as lower subscapular skinfold than AA adolescents (p = 0.018). AA adolescents selected a higher ideal body size than CC girls (p = 0.038). There was also a significant difference in percentage carbohydrates (p < 0.034) and cholesterol consumed (p < 0.016) among groups, with CC girls showing the highest values for carbohydrates and lowest values for cholesterol intake among groups.

DISCUSSION

Given our findings of higher adiposity and lower physical activity levels in HA adolescents and greater diastolic BP levels and subscapular skinfold in AA adolescents, more interventions should be targeted toward improving health-related variables among minority populations.

Bariatric Surgeries in North Carolina, 1990 to 2001: A Gender Comparison

OBJECTIVE

The purpose of this research was to determine the number of bariatric procedures in obese men and women in a well-defined population and to examine gender differences among bariatric patients.

RESEARCH METHODS AND PROCEDURES

Data on bariatric patients were taken from the North Carolina Hospital Discharge Database, which contains information on all nonfederal hospital discharges in North Carolina from 1990 to 2001. Using North Carolina Hospital Discharge Data, Census North Carolina resident estimates, and North Carolina obesity prevalence estimates, we constructed annual rates for bariatric procedures for the obese male and female population in North Carolina.

RESULTS

Overall, 2197 bariatric procedures were performed between 1990 and 2001. The annual rate of bariatric procedures in obese women increased rapidly, particularly between 1998 and 2001, whereas the increase for men was considerably less than that for women. Controlling for age and year of procedure, the odds ratio for obese female North Carolina residents of having a bariatric procedure was 4.96 (95% confidence interval: 4.39, 5.59) and of having a Roux-en-Y procedure was 5.57 (95% confidence interval: 4.67, 6.64) compared with obese male North Carolina residents. Controlling for age, comorbidity burden, payment source, and year of procedure, obese male North Carolina residents had a significantly greater (22%) amount of inpatient days than obese female North Carolina residents.

DISCUSSION

After controlling for population rates of obesity and year of procedure, women are more likely than men to undergo bariatric surgery, suggesting that gender-related factors may influence use. More research is needed to determine the causes for this large gender disparity.

Weight-Loss Strategies of Young Adults: Exercise Versus Dieting

This cross-sectional survey study examined weight control practices of 2,092 male and 1,748 female feshman students aged 18 years. For women, the desire for weight loss was observed at all levels of body weight. Most women (79%) wished to weigh less than their current weight, and 23% were following a restricted-calorie diet. In contrast, more men wished to gain (46%) rather than lose weight (32%), and only 3% were dieting at the time of the study. A comparison of weight control practices of men and women who wished to lose weight showed that women restricted calories far more frequently than did men. In contrast, although men were more likely to use exercise for weight control than were women, the differences between the sexes were small. A combined analysis of dieting and exercise behaviors showed that while men relied almost exclusively on intensive exercise as opposed to dieting, women employed exercise as well as dieting for the purpose of weight control.

Changes in Body Mass Index across Age Groups in Iranian Women: Results from the National Health Survey

Background. To investigate the associations between some factors with weight gain across age groups in Iranian women. Methods. Proportional odds model was used to estimate the probability of BMI categorized as a function of education, economic index, workforce, smoking, marital status, and place of residence adjusted for age, using data from the “National Health Survey in Iran” database. It included 14176 women aged 20–69 years. Results. For all covariates, age was directly associated with overweight and obesity before 60 years of age. Among women aged 20–40 years, the rates of change in probabilities of overweight and obesity were highest. Among women, being inactive, with high economic index, married, being nonsmoker, in an urban residence, with lower educational attainment, all increased the probabilities of overweight and obesity. Conclusions. Women aged 20–40 years gained weight faster than other groups. They may need additional information and more support on how to reduce their risk for weight gain through positive health behaviors.

Dieting and disordered eating behaviors from adolescence to young adulthood: findings from a 10-year longitudinal study

BACKGROUND

Disordered eating behaviors are prevalent in adolescence and can have harmful consequences. An important question is whether use of these behaviors in adolescence sets the pattern for continued use into young adulthood.

OBJECTIVE

To examine the prevalence and tracking of dieting, unhealthy and extreme weight control behaviors, and binge eating from adolescence to young adulthood.

DESIGN

Population-based, 10-year longitudinal study (Project EAT-III: Eating Among Teens and Young Adults, 1999-2010).

PARTICIPANTS/SETTING

The study population included 2,287 young adults (55% girls, 52% nonwhite). The sample included a younger group (mean age 12.8±0.7 years at baseline and 23.2±1.0 years at follow-up) and an older group (mean age 15.9±0.8 at baseline and 26.2±0.9 years at follow-up).

STATISTICAL ANALYSES PERFORMED

Longitudinal trends in prevalence of behaviors were tested using generalized estimating equations. Tracking of behaviors were estimated using the relative risk of behaviors at follow-up given presence at baseline.

RESULTS

In general, the prevalence of dieting and disordered eating was high and remained constant, or increased, from adolescence to young adulthood. Furthermore, behaviors tended to track within individuals and, in general, participants who engaged in dieting and disordered eating behaviors during adolescence were at increased risk for these behaviors 10 years later. Tracking was particularly consistent for the older girls and boys transitioning from middle adolescence to middle young adulthood.

CONCLUSIONS

Study findings indicate that disordered eating behaviors are not just an adolescent problem, but continue to be prevalent among young adults. The tracking of dieting and disordered eating within individuals suggests that early use is likely to set the stage for ongoing use. Findings suggest a need for both early prevention efforts before the onset of harmful behavioral patterns as well as ongoing prevention and treatment interventions to address the high prevalence of disordered eating throughout adolescence and young adulthood.

Body weight perception among high school students and its influence on weight management behaviors in normal weight students: a cross-sectional study

AIM

This study investigates body weight perception and its influence on weight management behaviors in normal weight adolescents in Timis County, Romania. We hypothesized that misperception of overweight in normal weight adolescents would be positively associated with unhealthy weight control behaviors.

METHODS

From 2908 respondents participating in the survey we selected a total of 2093 normal weight high school students for the analysis. Outcome measures included self-reported height and weight measurements, overweight misperceptions and weight control behaviors. Weighted prevalence estimates and odds ratios were computed.

RESULTS

There were 22.64% of normal weight students who perceived themselves as overweight. Females (36.48%) were more likely to perceive themselves as overweight than males (8.15%) (P < 0.0001). After adjusting for age and gender, students who perceived themselves as overweight were more likely to exercise (OR = 2.85; 95% CI: 2.25-3.61), eat less food, fewer calories or low fat foods (OR = 3.54; 95% CI: 2.78-4.51), fast for 24 hours or more (OR = 1.79; 95% CI: 1.28-2.49), take diet pills, powders or tea (OR = 3.93; 95% CI: 2.62-5.89), vomit or take laxatives (OR = 1.96; 95% CI: 1.15-3.34) to lose weight or to keep from gaining weight, compared to students who did not perceive themselves as overweight.

CONCLUSION

A significant proportion of normal weight high school students misperceive themselves as overweight and are engaging in unhealthy weight management behaviors. These results should be considered when establishing prevention programs and educational components that address weight misperceptions and the harmful effects of unhealthy weight control methods should be performed even among normal weight adolescents.

Relation of dietary restraint scores to activation of reward-related brain regions in response to food intake, anticipated intake, and food pictures

Prospective studies indicate that individuals with elevated dietary restraint scores are at increased risk for future bulimic symptom onset, suggesting that these individuals may show hyper-responsivity of reward regions to food and food cues. Thus, we used functional magnetic resonance imaging (fMRI) to examine the relation of dietary restraint scores to activation of reward-related brain regions in response to receipt and anticipated receipt of chocolate milkshake and exposure to pictures of appetizing foods in 39 female adolescents (mean age=15.5 ± 0.94). Dietary restraint scores were positively correlated with activation in the right orbitofrontal cortex (OFC) and bilateral dorsolateral prefrontal cortex (DLPFC) in response to milkshake receipt. However, dietary restraint scores did not correlate with activation in response to anticipated milkshake receipt or exposure to food pictures. Results indicate that individuals who report high dietary restraint have a hyper-responsivity in reward-related brain regions when food intake is occurring, which may increase risk for overeating and binge eating.

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.

Perception of overweight and self-esteem during adolescence

OBJECTIVE

To examine sex- and race/ethnicity-specific relationships between adolescents' self-esteem and weight perception.

METHOD

Descriptive analysis and logistic regression of Wave II of the National Longitudinal Study of Adolescent Health (N = 6,427 males, 6,574 females; ages 11-21) examined associations between low self-esteem and perceived overweight within body mass index (BMI) percentile categories, controlling for sociodemographics and stratified by sex and race/ethnicity.

RESULTS

25.1% and 8% of normal weight females and males, respectively, perceived themselves as overweight, with variation by race/ethnicity. Low self-esteem was most strongly associated with misperceived overweight in moderate BMI percentile categories (males: OR = 2.34; 95% CI: 1.60-3.41; females: OR = 2.39; 95% CI: 1.82, 3.16). Odds of correctly perceived overweight were higher for low (versus high) self-esteem in white and black females but not males of any race/ethnicity.

DISCUSSION

Understanding subgroup differences by race/ethnicity in perceived overweight-self-esteem relationships may inform eating disorders' prevention strategies.

Examination of a sociocultural model of excessive exercise among male and female adolescents

There is substantial evidence that sociocultural pressures and body image disturbances can lead to disordered eating, yet few studies have examined their impact on excessive exercise. The study adapted a sociocultural model for disordered eating to predict excessive exercise using data from boys and girls in early adolescence (N=421). Perceived sociocultural pressures to lose weight and build muscle, body image disturbance and appearance investment were associated with a compulsive need to exercise. Adolescents' investment in appearance and body image disturbance fully mediated the relationship between sociocultural pressures and a compulsive need for exercise. There was no support for the meditational model in predicting adolescents' frequency or duration of exercise. Results support the sociocultural model as an explanatory model for excessive exercise, but suggest appearance investment and body image disturbance are important mediators of sociocultural pressures.

Maternal perceptions of early childhood ideal body weight differ among Mexican-origin mothers residing in Mexico compared to California

OBJECTIVE

To assess maternal perceptions of children's current and ideal body sizes, and the meaning of and factors contributing to overweight in infancy and early childhood among Mexican-origin mothers living in Mexico and in California.

DESIGN

A quali-quantitative study combining focus groups and a self-administered questionnaire.

SUBJECTS/SETTING

A purposive sample of 84 low-income, Mexican-origin mothers of 4- to 6-year-old children recruited between March 2006 and January 2008 from rural and urban communities in Mexico and California.

STATISTICAL ANALYSES

Bivariate, multivariate, and qualitative analyses of maternal perceptions of children's actual and ideal body size supplemented by qualitative analyses of meaning of and factors contributing to childhood overweight/obesity.

RESULTS

Ideal child body size was considerably lower among Mexican-origin mothers living in California (3.86+/-0.56) than it was among mothers living in Mexico (4.32+/-0.83), and this difference was significant (P=0.001) after adjusting for sociodemographic covariates. Among mothers of overweight children, 82% of mothers in California were dissatisfied with their child's weight compared with 29% of mothers in Mexico (P=0.003). Focus-group results suggest that these differences in the perception of children's ideal body size can be attributable to differences in body size norms among mothers and awareness of the negative effects of obesity that occur after migration to California.

CONCLUSIONS

Maternal perceptions of early childhood overweight appear to differ among Mexican-origin women living in Mexico and California. Recognition of the negative health consequences of obesity and identification of barriers to achieving weight control are important first steps toward childhood obesity prevention. Interventions directed at Mexican-origin mothers should focus on culturally acceptable ways of transmitting weight-control information.

Predictors of initiation and persistence of unhealthy weight control behaviours in adolescents

Background

Unhealthy weight control behaviours (UWCB) among adolescents have significant health and weight consequences. The current longitudinal study aimed to identify personal and socio-environmental predictors of initiation or persistence of adolescent UWCB, in order to inform development of programs aimed at both preventing and stopping UWCB.

Methods

A diverse sample included 1106 boys and 1362 girls from 31 middle schools and high schools in the United States who were enrolled in Project EAT (Eating Among Teens). Project EAT explored personal, behavioural, and socio-environmental factors associated with dietary intake and body weight in adolescence. Participants completed questionnaires to assess demographics, UWCB (including several methods of food restriction, purging by vomiting or medications, smoking to control weight, or food substitutions) and personal and socio-environmental variables at two time points, five years apart, between 1998 and 2004. Logistic regression models examined personal and socio-environmental predictors of initiation and persistence of UWCB among Project EAT participants.

Results

Results indicate that 15.5% of boys and 19.7% of girls initiated UWCB by Time 2, and 15.9% of boys and 43.3% of girls persisted with these behaviours from Time 1 to Time 2. After controlling for race/ethnicity and weight status changes between assessments, logistic regression models indicated that similar factors and patterns of factors were associated significantly with initiation and persistence of UWCB. For both boys and girls, personal factors had more predictive value than socio-environmental factors (Initiation models: for boys: R² = 0.35 for personal vs. 0.27 for socio-environmental factors; for girls, R² = 0.46 for personal vs. 0.26 for socio-environmental factors. Persistence models: for boys: R² = 0.53 for personal vs. 0.33 for socio-environmental factors; for girls, R² = 0.41 for personal vs. 0.19 for socio-environmental factors). The weight concerns model was the strongest predictor among all individual models [Initiation odds ratios (ORs) and 95% confidence interval (CI): 4.84 (3.32-7.01) for boys and 5.09 (3.55-7.30) for girls; persistence OR (CI): 4.55 (2.86-7.14) for boys and 3.45 (2.50-4.76) for girls].

Conclusion

In general, predictors of initiation and persistence of UWCB were similar, suggesting that universal and selective prevention programs can target similar risk factors.

Casting weight goal as a function of weight status among a representative population-based sample of adolescents

This paper pursues two objectives: (1) to estimate proportions of adolescents with a weight goal that matched and mismatched weight status, and (2) to identify correlates of a mismatched weight goal. Data were from a representative population-based sample of adolescents (n=2346, 51% female; 91.5% complete data). Results showed that 69% of adolescents had a weight goal that matched weight status whereas 31% had a weight goal that mismatched weight status. Body dissatisfaction was a significant predictor of having a mismatched weight goal for both sexes while elevated psychological distress was a predictor among girls. Being body dissatisfied mediated the association between psychological distress and having a mismatched weight goal among girls. Casting weight goal as a function of weight status may allow for a better understanding of overall weight management strategies.

An adapted version of Intervention Mapping (AIM) is a tool for conducting community-based participatory research

The field of public health is increasingly using community-based participatory research (CBPR) to address complex health problems such as childhood obesity. Despite the growing momentum and funding base for doing CBPR, little is known about how to undertake intervention planning and implementation in a community-academic partnership. An adapted version of Intervention Mapping (AIM) was created as a tool for university and elementary school partners to create school-level environment and policy changes aimed at increasing student physical activity and healthy eating. After AIM was completed, interviews were conducted with school partners. Findings indicate AIM is closely aligned to 7 of 9 CBPR principles. Examples include equitable involvement of all partners, co-learning, and balancing knowledge generation and community improvement. Shortcomings, lessons learned, and suggestions for strengthening the AIM process are described.

Weight loss advice U.S. obese adults receive from health care professionals

OBJECTIVES

To estimate the prevalence of obese patients advised by health professionals about weight loss and weight loss strategies.

METHODS

A national sample of 1873 obese adults (body mass index > or = 30 kg/m(2), > or = 18 years) was surveyed. Multivariable linear regression was used to determine characteristics associated with receiving weight loss advice, and advice on diet and physical activity. Linear regression was used to evaluate characteristics associated with how much weight loss was advised.

RESULTS

Among obese adults visiting a physician (past 12 months), 39.0% reported being advised to lose weight. Men had lower odds of being advised to lose weight. Adults 40-49 years of age, reporting fair/poor health, and chronic diseases had greater odds of being advised to lose weight compared to referent groups. Among adults receiving advice on amount of weight to lose, a mean 20.9% total body weight reduction was recommended. Of those advised to lose weight, 64.2% were told to change their diet, 85.7% to increase physical activity, and 58.5% to use both strategies.

CONCLUSIONS

Obese adults should be advised by health professionals more frequently about weight loss and the use of caloric reduction and increased physical activity as the recommended weight loss strategy.