Weight concerns and eating patterns: a survey of university students in Europe

OBJECTIVE

To assess a wide range of health-related behaviours, beliefs and knowledge in educated young adults.

DESIGN

A standardized questionnaire was developed, translated, and administered in university classes.

SUBJECTS

16,486 university students in 21 European countries.

DEPENDENT VARIABLES

Reported and self-perceived body size, eating practices and weight concerns.

RESULTS

Body Mass Index (BMI; weight (kg)/height (m)2) was slightly different between countries, and rather low overall (20.5 in women and 22.0 in men). These low values can be attributed to the young age of respondents (21.4 years) and to their presumably high socio-economic status. Very few were overweight (8%) and less than 1% were obese. In spite of the low BMI, many perceived themselves as overweight, especially among women. Trying to lose weight (44% of women, 17% of men) and dieting (14% in women and 3% in men) were not uncommon, although large differences existed between countries. Dieting affected snack and meal patterns: dieters reported fewer snacks and female dieters also reported fewer meals than non-dieters. Breakfast was skipped by almost twice as many dieters as non-dieters. Some evidence of anorexia nervosa (dieting in very underweight individuals) appeared.

CONCLUSION

The data suggest excessive responses to weight loss pressures and imperfect translation of nutritional advice into behaviours.

Social variation in attitudes to obesity in children

OBJECTIVE

To evaluate variations in children's attitudes to obesity in relation to age, gender and social class.

DESIGN

Evaluation of sex, age and social class differences in judgements of figure drawings varying in body shape.

SUBJECTS

180 children aged from 4-11 from six schools, varying in the social background of their pupils.

MEASUREMENTS

Self ratings of body shape, choices of ideal body shape now and in adulthood from a range of line drawings of figures varying in fatness, and behavioural and personality stereotype judgements of illustrations of thin, average and fat children.

RESULTS

Few children in this age group were fat and few felt too fat; though a substantial minority felt too thin. Girls selected thinner ideal figures than boys. Children demonstrated strongly negative attitudes to obesity, which were less favourable among those who were older and from the higher social status schools.

CONCLUSION

There are significant social variations in attitudes to obesity which might be important in understanding variations in the prevalence of obesity and weight control practices.

Cholesterol and psychological well-being

The debate about possible adverse effects associated with low or lowered serum cholesterol has raised important scientific questions concerning the links between lipids and behaviour. One of the most unexpected findings has been an association between cholesterol-lowering treatment and accidental death. A similar association has also emerged among the prospective cohort studies, with higher-than-expected numbers of suicide deaths in the lowest cholesterol groups. These observations have prompted speculation that behavioural or emotional disturbances could be part of the process linking lipids and accidental death. In this paper, the epidemiological literature is reviewed briefly, then the evidence for depression as a mediating condition is discussed. Two conclusions are drawn from this review of the literature. One is that understanding the relationship between the biology of lipids and the psychobiology of mood is demonstrably an important scientific and public health issue. The second is that the introduction of new treatments or preventive programmes should include a careful evaluation of the psychological as well as the physical effects.

Tobacco smoking in young adults from 21 European countries: association with attitudes and risk awareness

Information concerning tobacco smoking was obtained in a survey of 16,483 students aged 18-30 years from 21 European countries. Belief in the benefits to health of not smoking were also assessed. Risk awareness was measured in terms of knowledge of the links between smoking and disease. The overall age-adjusted prevalence of smoking was 33.1% in men and 29.0% in women, but wide variations were observed across country samples. Significant sex differences were found in only a minority of cases. The inclusion of respondents who stated that they had sometimes smoked in the past substantially reduced variations in prevalence across country samples. Beliefs in the health benefits of not smoking were consistently associated with smoking behaviour. Awareness of the link between smoking and lung cancer was uniformly high, but awareness of the role of smoking in heart disease varied considerably across country samples, and averaged only 64.4% in men and 62.9% in women. In the majority of countries, risk awareness was greater among smokers than non-smokers. The results suggest that in this selected sector of the population of young adults in Europe, sex differences in smoking are relatively minor, robust associations between attitudes and smoking behaviour can be identified, and there are major gaps in risk awareness.

Breast self-examination: attitudes and practices among young women in Europe

Breast self examination (BSE) is recommended for the early detection of breast cancer in the European Code against Cancer. Evidence from North America suggests that there is reasonable public awareness of its importance, but compliance with regular BSE is reported by only a minority of young women. Attitudes to and practice of BSE has rarely been studied outside North America. In the present study, attitudes to BSE were evaluated by questionnaire in a sample of 16,486 students aged 17-30 from 20 European countries. Frequency of BSE practice was reported by the 9,181 women in the sample. Information on public recommendations concerning BSE was obtained from cancer organizations in each country. The data were collected as part of the European Health Behaviour Survey, an international study on health beliefs and health behaviour. The results showed that BSE was recommended in 16 countries and 'breast awareness' in two, while two countries did not recommend self-examination. 54% of women reported as never having practiced BSE. Regular practice (monthly) was reported by only 8% of the sample, with another 36% reporting occasional BSE. Significant differences emerged between centres in different countries ranging from 6% to 15% reporting regular BSE. Attitude towards BSE was a significant predictor of BSE practice within each centre and across all centres combined. Attitudes towards BSE were significantly less positive in the two centres from countries without BSE recommendations than in the others, but levels of practice were similar.(ABSTRACT TRUNCATED AT 250 WORDS)

The assessment of obesity: theoretical background and practical advice

Developments in understanding the causes and consequences of obesity have important implications for the assessment of weight problems. Simple measurement of body weight is no longer sufficient. The evaluation should include measures of body composition, dietary quality, energy expenditure, risk factor status and body image. In this paper, the arguments in favour of a broader-based evaluation of obesity are presented and a range of assessment methods are discussed.

Body image and dieting in pregnancy

The present study evaluated body image, body satisfaction and dieting practices in pregnancy: a stage of life when social pressures for slimness might be expected to be relaxed. Pregnant women had lower scores on the Drive for Thinness subscale of the Eating Disorder Inventory, and when Body Mass Index was controlled for, had significantly lower Body Dissatisfaction Scale scores than non-pregnant women. They also rated themselves as less overweight in terms of body size. Dietary restraint was lower and current attempts to lose weight were less frequent in the pregnant group. However, there was no evidence that pregnancy was associated with any relaxation of body image ideals: pregnant women chose a similar size of figure to non-pregnant women as their ideal. These results suggest that the state of pregnancy can be associated with reduced weight concern despite an increased body size, but the effect appears to be state-dependent and is not mediated by shifts in body size ideals.

Into the dangerous world: an in vivo study of information processing in agoraphobics

The differential processing of threatening information in anxious patients is now well established, but there has been little attention to situational variation in information processing. A review of the experimental literature suggests that agoraphobics should show interference in the performance of the modified Stroop task for threat words and that this interference should increase in phobic situations. In the present study, agoraphobics and normal controls carried out the Stroop task either in a safe setting or a public place. Agoraphobics showed greater interference with threat words but this interference was not affected by setting. The implications of this result are considered.

Adult disclosure of sexual abuse: a primary cause of psychological distress?

There is evidence for a high incidence of childhood sexual abuse among adult psychiatric populations and some practitioners have noted a worsening of psychiatric symptomatology around the time of disclosure. Disclosure of abuse can result in hostile and rejecting responses from significant others in the victim's social support network. This paper surveys research evidence relating to the disclosure of abuse, and it is argued that for some adults, the disclosure of sexual abuse may be a primary cause of psychological distress, resulting in the dissolution of social support systems and increasing the individual's vulnerability to psychiatric disorder. The implications of the model for therapeutic practice are discussed.

What the experts think: a European survey of expert opinion about the influence of lifestyle on health

This paper describes an assessment of expert medical and epidemiological opinion about the role of lifestyle in health, carried out by means of a questionnaire survey of senior members of academic departments of public health, epidemiology and social medicine in Western European universities. Estimates were made of the influence of eight lifestyle factors--smoking, alcohol consumption, exercise, stress, body weight, dietary fat, fibre and salt--on the aetiology or course of five disorders: heart disease, high blood pressure, lung cancer, breast cancer and diabetes. One hundred and fifty responses were received from scientists and clinicians from 16 countries. Respondents had an average of 17.8 years experience in their discipline (range 5-40 years). The only links to be endorsed as definite by over 90% of respondents were those between smoking and both heart disease and lung cancer. However, more than 70% considered alcohol consumption, exercise, stress body weight and dietary fat to be definite or probable influences on heart disease. Smoking, alcohol, exercise, stress, body weight and salt intake were endorsed as relevant to high blood pressure by more than 70%. Opinions differed widely about the influence of lifestyle on breast cancer and diabetes. Experts from the United Kingdom and Republic of Ireland were less positive than respondents from other countries about the influence of stress, dietary fat, fibre and salt on disease. The results indicate that comparatively few lifestyle factors were believed to be unequivocally related to any of the five disorders. Experts from the UK and Ireland were generally les likely to endorse lifestyle-disease links than those from other European countries.(ABSTRACT TRUNCATED AT 250 WORDS)

Naughty but nice: a laboratory study of health information and food preferences in a community sample

The influence of information about the fat content of food and cardiovascular disease (CVD) prevention on taste ratings and food intake in a test meal was examined. Forty Ss were allocated at random to CVD information or control conditions. Ss rated 2 brands of yogurt and 2 cheese sandwiches, with 1 flavor of each food labeled full-fat and the other low-fat. In fact, fat levels were identical, and the label-flavor pairings were counterbalanced. Overall, Ss gave lower liking ratings to the low-fat labeled foods. However, Ss in the information condition tended to eat a smaller proportion of the full-fat sandwiches. The results supported the utility of a laboratory setting for evaluating the influence of health-relevant information on responses to food.

Testicular self-examination: attitudes and practices among young men in Europe

BACKGROUND

Testicular self examination (TSE) is recommended for the early detection of testicular cancer. Evidence from North America suggests there is only limited public awareness of its importance among the young male population. Compliance with regular TSE is found in only a small minority of young men. Attitudes toward and practice of TSE have rarely been studied outside North America.

METHOD

Attitudes to TSE were evaluated by questionnaire in a sample of 16,486 students. Frequency of TSE practice was reported by the 7,304 men in the sample. The data were collected as part of the European Health Behavior Survey, an international study on health beliefs and health behavior.

RESULTS

Eighty-seven percent of men reported never having practiced TSE. Regular practice (monthly) was reported by only 3% of the sample, with another 10% reporting occasional TSE. Significant differences emerged between countries, ranging from 76% of German men to 98% of Icelandic men reporting no TSE. Men rated TSE as less important to health than women. Attitude toward TSE among men was a significant predictor of TSE practice.

CONCLUSION

Both the low levels of TSE and the low ratings of the importance of TSE suggest that young men in Europe are unaware of the value of this comparatively simple method of early detection of cancer. If a highly educated population group in the "at risk" age category is not carrying out the recommendations, it is unlikely that there are higher levels of compliance in other groups. These results suggest an important role for health education in the early detection of testicular cancer.

Effects of concurrent diazepam treatment on the outcome of exposure therapy in agoraphobia

In a study designed to evaluate the impact of benzodiazepine use on the outcome of behaviour therapy, 91, severe, chronic agoraphobics (46 BDZ users and 45 non-users) were randomly allocated on a double-blind basis to in vivo exposure with low-dose diazepam (ED) or placebo (EP). Drug doses were adjusted on the basis of weekly psychiatric assessments over weeks 1-4. Patients had 8 x 2 hr exposure sessions (weeks 5-12) and were then withdrawn from medication (weeks 13-16). Re-assessments were completed at weeks 4, 12 and 16, and follow-up assessments at approx 20, 46 and 72 weeks. In the analysis of the results, the clinical outcome was evaluated in relation to the therapeutic regime (ED vs EP) and prior BDZ use (users vs non-users). The results showed that the ED group had greater changes in anxiety than the EP group during the drug manipulation phases (anxiety increasing during BDZ withdrawal). There were no group differences in agoraphobic symptoms and no evidence that the outcome of the behavior therapy was significantly affected by concurrent BDZ treatment. There were significant improvements in agoraphobic symptoms over the treatment period, with no evidence for relapse of treatment gains on withdrawal from BDZ, nor for differential responses over the one year follow-up. Initial differences between users and non-users were less marked than expected, although there was a trend for more drop-outs among users across both ED and EP groups.

Self-esteem, parental appraisal and body size in children

This study investigates the influence of body size, parental appraisal of body size, and children's beliefs about parental appraisal, on self-esteem in children from 9 to 11 years old. Parents' and children's responses to a matched question about body size suggest that children are accurate predictors of parental evaluation and that their self-esteem scores are influenced both by actual parental dissatisfaction and beliefs about parental dissatisfaction. For boys, lower self-esteem is associated both with thinness and being perceived as too thin. For girls, lower self-esteem is more associated with fatness.

Cognitive predictors of health behaviour in contrasting regions of Europe

Four important health behaviours--dietary fat avoidance, regular exercise, smoking and alcohol consumption--were assessed by questionnaire, together with measures of risk awareness and beliefs about the importance of each behaviour for health, in comparable samples of young adults from eight countries: Belgium, England, Germany, Hungary, Ireland, Poland, Portugal and Spain. Results from 3223 men and 3930 women were analysed. Substantial differences in the prevalence of behaviours were identified, but no country consistently showed the most or least healthy profile across behaviours. Women tended to smoke and drink less than men and attempted to avoid dietary fat to a greater extent, while men exercised more than women. Ratings of the importance of behaviours for health were high, while risk awareness showed wide variations, with lower scores from samples in southern and eastern Europe. Across countries, few associations were observed between the prevalence of behaviour and either mean belief ratings or risk awareness. However, in comparisons of people who did and did not perform each behaviour, beliefs were consistently associated with practice. In multiple regression, beliefs about the importance of the behaviour for health independently accounted for 11.3 per cent of the variance in exercise, 18.9 per cent of the variance in smoking and 4.5 per cent of the variance in alcohol consumption. The association between beliefs and dietary fat avoidance was also substantial. In contrast, the relationships between risk awareness and behaviour were mixed. People who avoided dietary fat were more aware than others of the health risks of fat. But non-smokers were less aware than smokers of the risks of smoking, and people who drank regularly were more aware of the dangers of alcohol than were non-drinkers. The results are discussed in the context of the contribution of health psychology to European health promotion.

The psychological costs of screening for cancer

The benefits of cancer screening programmes accrue to those who have cancer or identifiable precancerous conditions, and in whom the disease progression is slowed or halted by earlier intervention. The costs accrue to the rest of the population for whom there is no direct benefit to health. Attention has been given to the medical risks of screening procedures and to the economic costs, but there has been very little regard paid to the psychological costs. The aim of this paper is to evaluate the psychological impact of screening. Screening participants who are found to have untreatable disease, or for whom the interventions prove ineffective, have a greater proportion of their life as a cancer patient with all the associated psychological (and perhaps physical) distress, but no increase in their life expectancy. Those who receive false positive results may experience acute psychological distress produced by the prospect of a grave diagnosis before they are found to be free from serious disease. Even the procedure of screening itself, with the disturbance of the invitation, the discomfort of the tests and the wait for the diagnosis, can have a significant impact upon some patients. This paper evaluates the psychological costs which may be involved across the whole screening procedure, from the possible alarm of receiving an invitation to participate in screening, to the trauma of a cancer diagnosis for someone who had been unaware of any symptoms.

Physical symptoms and illness attributions in agoraphobia and panic

The cognitive model of panic disorder proposes that panic patients interpret physical symptoms in a catastrophic way, thus precipitating panic attacks. This study describes the development of a questionnaire measure designed to assess beliefs about the health implications of various symptoms. Two groups, agoraphobics and normals, were compared on a variety of measures. Agoraphobics showed much higher panic frequency, fear of anxiety, and prevalence of frightening cognitions when anxious, but did not score higher than normals when assessing seriousness of symptoms. The implications of these results are considered.

Eating style and eating behaviour in adolescents

The relationship between eating style, attitudes towards food and food intake was investigated in 846 British adolescent schoolchildren. Eating style was assessed with the Dutch Eating Behaviour Questionnaire, attitudes towards food with a series of specially prepared questions, and food intake with a diet history taken by a dietitian. The results showed that restraint, external and emotional eating were associated with very different profiles of attitudes and behaviour. Restrained subjects had a higher body weight, more negative attitudes towards food, a lower likelihood of overeating and a lower overall energy intake. External eaters had a lower body weight, positive attitudes to food, and reported a higher energy intake. Emotional eaters fell in between in some ways, with some signs of situational loss of control combined with a negative attitude towards overeating. While external eating appeared to be attenuated by restraint, emotional eating was enhanced by it. The implications of these eating styles for later patterns of eating and weight are discussed.