Family meals and food insecurity in Spanish adolescents

The world is not on track to achieve the goal of food security for the global population by 2030. New approaches to understand individuals' food insecurity are needed, especially insecurity related to children and adolescents, since it is associated with health and psychosocial problems. The study aimed to characterise the family dinners among a representative cohort of schooled adolescents (n = 1017) and their parents (n = 261) in Terrassa (Catalonia, Spain) and how family dinners could be related to household food insecurity. The survey findings revealed that in 2022, 19.2% of the adolescents were experiencing household food insecurity. Adolescents with a lower socioeconomic status and of foreign origin showed the highest likelihood of experiencing household food insecurity. Household food security was also associated with some characteristics of family dinners, such as better quality and a higher frequency (seven or more dinners eaten together per week). Based on this finding, possible ways in which family dinners could offer a beneficial effect, alleviating the consequences of food insecurity in adolescents, are discussed. In line with the 2030 Agenda and the Sustainable Development Goal of guaranteeing food security, the promotion of family dinners and their quality, frequency, and duration to leverage the beneficial effect in states of household food insecurity in Spanish adolescents should be taken into account to design actions and public campaigns in Spain.

Obesity stigma and its impact on health: A narrative review

Weight stigma and weight bias are pervasive in our society and are based on wrong assumption that obesity derives basically from a lack self-discipline and personal responsibility, obviating recent evidence showing that obesity is a prevalent, complex, progressive, and relapsing chronic disease that results from the interaction between behavioural, environmental, genetic, and metabolic factors. This narrative review provides an overview of recent research on this problem, mainly focused on the negative impact of weigh stigma on health. Overall, recent evidence shows that weight stigma can contribute to worsening obesity-related problems and creating additional barriers to effective obesity care and prevention. In addition, a brief description of some of the most important international initiatives to address the weight stigma is provided.

Spanish validation of the Modified Weight Bias Internalization Scale (WBIS-M) for adolescents

PURPOSE

Weight Bias Internalization (WBI) is pervasive and potentially damaging for health. Little is known about WBI in youth. As negative effects of WBI have been observed when controlling for BMI, measures that allow WBI to be assessed across different weight categories are needed. The Modified Weight Bias Internalization Scale (WBIS-M) is one of the most frequently used scales in this field. Our purpose was to obtain a Spanish validated version of the WBIS-M for adolescents across different weight statuses.

METHODS

The data were collected from 298 secondary students (mean age 14.31; 48.32% girls; 18.8% were overweight and 6.4% had obesity). Internal structure was examined by a cross-validation analysis, using both exploratory and confirmatory factor analyses in different subsamples.

RESULTS

Item 1 showed a psychometric anomalous functioning and was deleted. The one-factor structure of the 10-item version was confirmed with adequate fit ([EFA (KMO = 0.915, χ2(55) = 1075.633, p < 0.0001)]; [CFA (χ2(35) = 200.515; GFI = 0.995; PGFI = 0.992; NFI = 0.991; SRMR = 0.060)]). Internal consistency was high [Formula: see text] ω = 0.93). Significant correlations with the same set of external variables assessed in the original version (anti-fat bias, self-esteem, mood, body dissatisfaction, drive for thinness, binge eating), all of them correlates of WBI in adolescents, were found. Girls and participants with obesity obtained higher scores.

CONCLUSION

The results provide support for the validity and reliability of our WBIS-M version for use with adolescents across weight categories in Spain.

LEVEL OF EVIDENCE

Level III, evidence obtained from well-designed cohort studies.

Family Meals, Conviviality, and the Mediterranean Diet among Families with Adolescents

Two aspects that characterize the Mediterranean diet (MD) are "what" and "how" we eat. Conviviality relates to "how" we eat and to the pleasure of sharing meals with significant people. The most studied concept is "family meals", which includes conviviality, which involves "enjoying" family meals. Given the lack of research on convivial family meals in Mediterranean countries, the purpose of this qualitative study was to analyze the family meal representations and practices of families with 12- to 16-year-old adolescents to assess whether they responded to a pattern of conviviality, and to examine their association with MD adherence. Twelve semi-structured interviews were conducted and food frequency and family meal questionnaires were administered. A food pattern analysis was carried out and digital photos of meals were analyzed to examine eating habits and meal composition, respectively. The findings showed that parents believed family meals are a space for socialization and communication. Items relating to the conviviality of family meals identified in the study were meal frequency, meals at the table, lack of digital distractions, pleasant conversations, and time spent on family meals. Attention should be paid to conviviality in Mediterranean families when designing multi-approach strategies to promote healthy eating among adolescents.

Incorporating peer support during in vivo exposure to reverse dropout from prolonged exposure therapy for posttraumatic stress disorder: Clinical outcomes

Objective Prolonged exposure is characterized by reported dropout rates ranging from 25% to 40%. This premature attrition is also observed in other evidence-based treatments for posttraumatic stress disorder. While home-based telehealth delivery of prolonged exposure resolves logistical barriers to care such as travel time and cost, dropout appears unaffected. A previous study on dropouts from prolonged exposure delivered via telehealth found that Veterans, particularly those receiving care via telehealth, reported problems with in vivo exposure and that having a peer to offer support during in vivo exposure assignments might have prevented their attrition from treatment. Methods The present pilot study treatment was designed in a manner consistent with the aforementioned Veteran suggestions, specifically to involve peers offering verbal support and encouragement during in vivo exposure homework. Such a treatment modification might be particularly useful for those receiving care via telehealth, given increased difficulties with exposure reported when this treatment delivery modality is used. It was hypothesized that dropouts would agree to reengage in treatment with a peer and would subsequently evince improvement in posttraumatic stress disorder and depression scores as a result of this treatment reengagement. Results Of 82 dropouts from prolonged exposure, 29 reentered treatment when offered peer support during exposure (12 in telehealth and 17 in person). Conclusion Treatment reentry was effective insofar as indices of both posttraumatic stress disorder and depression were significantly reduced in both telehealth and in person groups, indicating that using peers in this way may be an effective means by which to return Veterans to care, and ultimately reduce symptomatology.

Roundtable on the Prevention of Eating Disorders: The Catalan public policy initiative

The field of prevention of body image problems and eating disorders has made major advances in recent years, particularly in the development and evaluation of prevention programmes. However, few programmes achieve good long-term results because, among other reasons, the sociocultural influences affecting the development of these problems do not stop. Moreover, accelerating progress in this field is required, transferring their impact onto a larger scale. These reasons justify the need to progress in the development of public policy interventions. This paper describes a recent Catalan initiative in this sphere: the Roundtable on the Prevention of Eating Disorders, made up of different public and private sectors of Catalan society. It specifically details the main actions carried out, such as: media campaigns to reduce weight-related teasing and encouraging self-esteem, encouraging family meals and promoting help-seeking among those affected; the creation of a new informative website about these matters in the Department of Health; the production of a Decalogue of Best Practices for the promotion of self-esteem and positive body image in social media and advertising; and actions to prevent the promotion of eating disorders on the Internet. The Roundtable is the most comprehensive Catalan (and Spanish) public policy activity undertaken until now for the prevention of eating disorders.

Body image dissatisfaction, physical activity and screen-time in Spanish adolescents

This cross-sectional study contributes to the literature on whether body dissatisfaction is a barrier/facilitator to engaging in physical activity and to investigate the impact of mass-media messages via computer-time on body dissatisfaction. High-school students ( N = 1501) reported their physical activity, computer-time (homework/leisure) and body dissatisfaction. Researchers measured students’ weight and height. Analyses revealed that body dissatisfaction was negatively associated with physical activity on both genders, whereas computer-time was associated only with girls’ body dissatisfaction. Specifically, as computer-homework increased, body dissatisfaction decreased; as computer-leisure increased, body dissatisfaction increased. Weight-related interventions should improve body image and physical activity simultaneously, while critical consumption of mass-media interventions should include a computer component.

Sociocultural influences and body change strategies in Spanish adolescent boys of different weight status

The aim of the present study was to examine the association between sociocultural influences to attain an ideal body and body change strategies (BCS) in Spanish adolescent boys of different weight status. A total of 594 Spanish boys (M=13.94 years, SD=0.20) participated. Measures included in the study were weight status according to body mass index (BMI), sociocultural influences (perceived pressures to attain an ideal body, general internalization of an ideal body, internalization of an athletic-ideal body), BCS to lose/control weight (dieting, healthy and unhealthy weight-control behaviors), and BCS to gain weight and muscles. Underweight boys engaged more frequently in weight-gain behaviors. Overweight boys reported higher levels of perceived sociocultural pressures and general internalization compared to normal-weight boys, and were more likely to be engaged in BCS to lose/control weight compared with the other weight-status groups. There were no differences between groups in terms of internalization of an athletic-ideal body and BCS to increase muscles. Future research and prevention programs should consider male-specific behaviors and weight-status differences.

Self-perceived weight status, dieting, and unhealthy weight-control behaviors among Spanish male adolescents

INTRODUCTION

Self-perceived weight status among adolescents has been associated with weight-control behaviors. However, this relationship varies across weight status.

OBJECTIVES

The aim of this study was to examine the effect of self-perceived weight status on dieting and unhealthy weight-control behaviors among Spanish male adolescents, across weight status.

METHOD

Participants were 597 Spanish male adolescents (M = 13.94 years old, SD = 0.60). Body weight and height were measured in situ. Self-perceived weight status, dieting, and unhealthy weight-control behaviors were evaluated.

RESULTS

The adolescents were inaccurate on estimating their weight status. Those who were overweight or obese, or who perceived themselves to be so, were more likely to report dieting and unhealthy weight-control behaviors.

DISCUSSION

There is a need to promote healthier eating behaviors among adolescents, and to take into account the fact that self-perceived weight status may hinder the adoption of such behaviors.

CLOCK 3111 T/C SNP interacts with emotional eating behavior for weight-loss in a Mediterranean population

OBJECTIVE

The goals of this research was (1) to analyze the role of emotional eating behavior on weight-loss progression during a 30-week weight-loss program in 1,272 individuals from a large Mediterranean population and (2) to test for interaction between CLOCK 3111 T/C SNP and emotional eating behavior on the effectiveness of the weight-loss program.

DESIGN AND METHODS

A total of 1,272 overweight and obese participants (BMI: 31±5 kg/m2), aged 20 to 65 years, attending outpatient weight-loss clinics were recruited for this analysis. Emotional eating behavior was assessed by the Emotional Eating Questionnaire (EEQ), a questionnaire validated for overweight and obese Spanish subjects. Anthropometric measures, dietary intake and weight-loss progression were assessed and analyzed throughout the 30-week program. Multivariate analysis and linear regression models were performed to test for gene-environment interaction.

RESULTS

Weight-loss progression during the 30-week program differed significantly according to the degree of emotional eating behavior. Participants classified as 'very emotional eaters' experienced more irregular (P = 0.007) weight-loss, with a lower rate of weight decline (-0.002 vs. -0.003, P<0.05) in comparison with less emotional eaters. The percentage of weight-loss was also significantly higher in 'non-emotional eaters' (P = 0.009). Additionally, we identified a significant gene-environment interaction associated with weight-loss at the CLOCK 3111 T/C locus (P = 0.017). By dichotomizing the emotional eating behavior score, linear regression analysis indicated that minor C allele carriers with a high emotional score (> = 11), lost significantly less weight than those C carriers with a low emotional score (<11) (P = 0.005).

CONCLUSIONS

Emotional eating behavior associates with weight-loss pattern, progression and total weight-loss. Additionally, CLOCK 3111 T/C SNP interacts with emotional eating behavior to modulate total weight loss. These results suggest that the assessment of this locus and emotional eating behavior could improve the development of effective, long-tern weight-management interventions.

A school-based program implemented by community providers previously trained for the prevention of eating and weight-related problems in secondary-school adolescents: the MABIC study protocol

Background

The prevention of eating disorders and disordered eating are increasingly recognized as public health priorities. Challenges in this field included moving from efficacy to effectiveness and developing an integrated approach to the prevention of a broad spectrum of eating and weight-related problems. A previous efficacy trial indicated that a universal disordered eating prevention program, based on the social cognitive model, media literacy educational approach and cognitive dissonance theory, reduced risk factors for disordered eating, but it is unclear whether this program has effects under more real-world conditions. The main aim of this effectiveness trial protocol is to test whether this program has effects when incorporating an integrated approach to prevention and when previously-trained community providers implement the intervention.

Methods/design

The research design involved a multi-center non-randomized controlled trial with baseline, post and 1-year follow-up measures. Six schools from the city of Sabadell (close to Barcelona) participated in the intervention group, and eleven schools from four towns neighboring Sabadell participated in the control group. A total of 174 girls and 180 boys in the intervention group, and 484 girls and 490 boys in the control group were registered in class lists prior to baseline. A total of 18 community providers, secondary-school class tutors, nurses from the Catalan Government’s Health and School Program, and health promotion technicians from Sabadell City Council were trained and delivered the program. Shared risk factors of eating and weight-related problems were assessed as main measures.

Discussion

It will be vital for progress in disordered eating prevention to conduct effectiveness trials, which test whether interventions are effective when delivered by community providers under ecologically valid conditions, as opposed to tightly controlled research trials. The MABIC project will provide new contributions in this transition from efficacy to effectiveness and new data about progress in the integrated approach to prevention. Pending the results, the effectiveness trial meets the effectiveness standards set down by the Society for Prevention Research. This study will provide new evidence to improve and enhance disordered eating prevention programs.

Trial registration

Current Controlled Trials ISRCTN47682626

Impact of a School-Based Disordered Eating Prevention Program in Adolescent Girls: General and Specific Effects Depending on Adherence to the Interactive Activities

This study assessed the impact of a school-based program aimed at preventing disordered eating. The program was based on the media-literacy approach and has interactive format. The program was assessed under strong methodological conditions. Seven schools with 263 Spanish adolescent girls in the area of Barcelona, were randomly assigned to either the complete prevention program condition, the partial program condition or the non-treatment control condition, and assessed at pre, post and 6-month follow-up. The program was effective in generating positive changes at follow-up. The effects sizes (ESd= 0.29 to ESd= 0.38) were greater, on average, than that obtained up to now in selective-universal programs, and similar or greater than that achieved by targeted prevention programs. The results indicate a greater and relevant effect size of the intervention in those participants who completed the inter-session interactive activities (ESd= 0.29 to ESd= 0.45) although the differences were not significant. These results suggest the importance of monitoring adherence to the activities in all programs defined as “interactive”. The implications and limitations of this study are discussed.

Integrated prevention of obesity and eating disorders: barriers, developments and opportunities

OBJECTIVE

The serious consequences of obesity and eating disorders (ED), difficulties encountered in treatment and the high prevalence of these conditions are important reasons to develop efforts aimed at their prevention. The implementation of integrated interventions aimed at preventing risk factors for both obesity and ED constitutes a very exciting development. In the present paper we discuss and review the main reasons for an integrated approach to the spectrum of eating- and weight-related problems, which include anorexia nervosa, bulimia nervosa, anorexic and bulimic behaviours, unhealthy dieting practices, body dissatisfaction, binge-eating disorder, overweight and obesity. Given differences between the fields with regard to current perspectives and objectives, key barriers to an integrated approach to prevention are discussed. In order to show the possibilities of development of this approach, we review the main contributions made to date in the fields of both obesity and ED prevention. In particular, environmental approaches in the prevention of obesity and ED are reviewed, given their potential for preventing a broad spectrum of eating- and weight-related problems. Furthermore, several examples of initiatives that have utilized an integrated approach to prevention are discussed.

DESIGN

Narrative review.

CONCLUSIONS

We recommend a scenario in which the two fields share knowledge to enhance the difficult work of preventing and treating both ED and obesity.

Validation of a questionnaire on emotional eating for use in cases of obesity: the Emotional Eater Questionnaire (EEQ)

INTRODUCTION

Emotions have a powerful effect on our choice of food and eating habits. It has been found that in some people there is relationship between eating, emotions and the increased energy intake. This relationship should be measurable to better understand how food is used to deal with certain mood states and how these emotions affect the effectiveness of weight loss programs.

OBJECTIVE

To develop and analyze the psychometric characteristics of a questionnaire on emotional eating for obesity easy to apply in clinical practice.

SUBJECTS AND METHODS

A ten-item questionnaire called Emotional-Eater-Questionnaire (EEQ) was developed and administered to a total of 354 subjects (body mass index, 31 ± 5), aged 39 ± 12, who were subjected to a weight-reduction program. The questionnaire was specifically designed for obesity. Analysis of the internal structure, internal consistency, test-retest reliability and convergent validity with Mindful-Eater-Questionnaire (MEQ) were conducted.

RESULTS

After principal components analysis, the questionnaire was classified in three different dimensions that explained 60% of the total variance: Disinhibition, Type-of-food and Guilt. Internal consistency showed that Cronbach's alpha was 0.773 for the "Dishinibition" subscale, 0.656 for the "Type of food" subscale and 0.612 for the "Guilt" subscale. The test-retest stability was r = 0.70. The data showed that the percentage of agreement between the EEQ and the MEQ was around 70% with a Kappa index of 0.40; P < 0.0001.

CONCLUSION

We have presented a new questionnaire, which classifies individuals as a function of the relation between food intake and emotions. Such information will permit personalized treatments to be designed by drawing up early strategies from the very beginning of treatment programmes.

Unhealthy weight-control behaviours, dieting and weight status: a cross-cultural comparison between North American and Spanish adolescents

The aim of the current study was to examine and compare dieting and unhealthy weight-control behaviours (UWCB) in population-based samples in two large urban areas in Spain (Barcelona) and in the USA (Twin Cities of Minneapolis and St. Paul, Minnesota). Additionally, use of UWCB across weight categories was explored in both samples. Participants included 1501 adolescents from Barcelona (48% girls, 52% boys) and 2793 adolescents from the Twin Cities (53% girls, 47% boys). The main outcome measures were dieting, UWCB (less extreme and extreme) and weight status. Although dieting and UWCB were prevalent in both samples, particularly among girls, the prevalence was higher in the US sample. In both countries, the report of dieting and use of UWCB was highest among overweight and obese youth. Prevention interventions that address the broad spectrum of eating and weight-related problems should be warranted in light of the high prevalence and co-occurrence of overweight and unhealthy weight-related behaviours.

Psychometric properties of the Perception of Teasing Scale in a Spanish adolescent sample: POTS-S

The present study examines the psychometric properties of the Spanish version of the Perception of Teasing Scale (POTS-S). Participants were 1559 adolescents. They completed a translated version of the POTS and versions validated in Spanish population of the Rosenberg Self-Esteem Scale, the Body Dissatisfaction and Drive for Thinness subscales of the Eating Disorders Inventory-2, and the Children's Eating Attitudes Test. The results showed that the POTS-S retains the original structure of two factors, weight and competency, with satisfactory fit indices. The POTS-S constitutes a shorter questionnaire than the original version; specifically, it consists of 9 items instead of 11. The POTS-S showed good internal consistency and satisfactory test-retest stability. The relationship between the weight subscale and the variables related to eating and weight were statistically significant. As regards the competency subscale, the correlations were all lower than those for the weight subscale, except in the case of the self-esteem variable. The POTS-S showed good psychometric properties, indicating its suitability as an instrument for assessing the perception of teasing in Spanish adolescents.

Analysis of the factor structure of the Sociocultural Attitudes Towards Appearance Questionnaire (SATAQ-3) in Spanish secondary-school students through exploratory structural equation modeling

The aims of the present study were: (1) to assess the factor structure of the SATAQ-3 in Spanish secondary-school students by means of exploratory factor analysis (EFA), confirmatory factor analysis (CFA) and exploratory structural equation modeling (ESEM) models; and (2) to study its invariance by sex and school grade. ESEM is a technique that has been proposed for the analysis of internal structure that overcomes some of the limitations of EFA and CFA. Participants were 1559 boys and girls in grades seventh to tenth. The results support the four-factor solution of the original version, and reveal that the best fit was obtained with ESEM, excluding Item 20 and with correlated uniqueness between reverse-keyed items. Our version shows invariance by sex and grade. The differences between scores of different groups are in the expected direction, and support the validity of the questionnaire. We recommend a version excluding Item 20 and without reverse-keyed items.

[Opinions of general practitioners, psychiatrists and psychologists on the clinical practice guidelines for depression]

AIM

To explore the views on clinical practice guidelines (CPG) of general practitioners (GP), psychiatrists, and psychologists.

DESIGN

Descriptive-exploratory qualitative study based on semi-structured individual and group interviews.

SETTING

Public primary health care and mental health centres in Barcelona, Sabadell, Cornellà de Llobregat and Gavà.

PARTICIPANTS AND CONTEXT

A total of 31 health professionals (10GPs, 11 psychiatrists, and 10 psychologists) interviewed at their work place or at the research unit between October 2007 and June 2008.

METHOD

Convenience sample. Participants were heterogeneous as regards sex, age, experience and workplace. Interviews were recoded and transcribed. Content analysis. Triangulation between techniques and results comparisons with participants was carried out as quality control.

RESULTS

The main advantages of CPGs were that they helped in decision making and gave security. On the other hand, participants were sceptical about the objectivity of GPC and considered that recommendations could not be applied to their individual patients. Additionally, they perceived CPG as inflexible. At the time of the study, GPs did not know of any CPG for depression. Specialists knew several CPGs but they did not use them as they prioritise their own experience.

CONCLUSIONS

There are some erroneous ideas about what a CPG is. If we want to implement CPGs, it is important to carry out some previous work presenting what a CPG is, what it is not and when it could be useful.

A controlled assessment of school-based preventive programs for reducing eating disorder risk factors in adolescent Spanish girls

This study assesses the impact of an eating disorders universal preventive program on a representative sample of Spanish adolescents in the area of Barcelona, Spain. 323 adolescent girls were assigned to three experimental conditions: complete intervention, partial intervention, and non-treatment. The program obtained a significant change in reducing the influences of the aesthetic body ideal and in improving the knowledge of nutrition. Nevertheless, attained post-treatment changes dissipate at the 6 month follow-up. In our opinion, the lack of lasting effects should be attributed to a series of considerations such as format, tests not validated for this age, or insufficient research.

Dieting in Spanish adolescent girls

This article examines the relation between dieting and non-dieting adolescent girls and body mass index (BMI), eating attitudes and the influence of the aesthetic body shape model. Three hundred forty-nine Spanish adolescent girls in their second year of secondary education were selected. The research design was a cross-sectional ex post facto study and validated measures were used to assess the main variables. Fourteen per cent of the sample was on a diet. Of this group, 69% were overweight, 70% had disordered eating attitudes and 70% were influenced by the current aesthetic body shape model. In all situations, the scores for dieters were significantly higher than those for non-dieters. Although there is not yet any clear consensus with regards to how adolescents interpret the term 'diet', the results indicate major differences between dieters and non-dieters and that those who self-report that they are on a diet present elements of the risk of developing eating and weight disorders.

Obesity, diet and restrained eating in a Mediterranean population

OBJECTIVE

To evaluate links between obesity, gender and restrained eating in a representative sample of adolescents in Catalonia, Spain.

DESIGN

Several surveys were conducted in which measurements were taken of a sample of adolescents living in the city of Barcelona.

SUBJECTS

610 subjects (57% girls and 43% boys) with ages ranging between 15-17, from 22 schools in Barcelona.

MEASUREMENTS

Weight, height, Body Mass Index (BMI) as measurement of obesity, subscale "Diet' of the Eating Attitudes Test (EAT) as measurement of concern for dieting, and subjects' negative or affirmative responses to the questions as to whether they were following a diet at the time of the study.

RESULTS

15% of the sample was found to be obese (13.5% presented grade I obesity-BMI 25-29.9 kg/m2, 1.3% presented grade II obesity-BMI 30-40 kg/m2, 0.2% presented grade III obesity-BMI > 40 kg/m2). Dieting has a strong influence on normal-weight female adolescent populations in Spain. Such girls are more concerned about dieting and are more likely to follow a diet independent of the extent to which they are overweight. Obese subjects are more likely to show greater concern for their diet and to be on a diet than those of normal-weight. The restrained behaviour observed in obese subjects is not related to the type of restraint evaluated using instruments such as the "Diet' subscale of the EAT.

CONCLUSION

Our results show a lower prevalence of obesity in Spain (a European sample) than in the United States. But the prevalence of obesity is not insignificant. It would appear that there is no linear relationship between the degree of excess weight and the restraint boundary. The prevalence of restrained eating behaviour among young adolescent girls in Spain is high. Given the dangers of such attitudes, it is becoming increasingly necessary to develop preventive programmes to combat them.