Frequent dieting among adolescents: psychosocial and health behavior correlates

Friendship quality, body dissatisfaction, dieting and disordered eating in adolescent girls

OBJECTIVES

This study examined relationships between adolescent girls' body dissatisfaction and disordered eating, quality of same-sex peer relationships and beliefs about thinness in interpersonal relationships, before and after controlling for depression.

DESIGN

Correlations between body image, eating and friendship variables were examined before and after controlling for depressive symptoms. Top and bottom quartiles on symptom variables were identified and analyses of variance, with and without depressive symptoms entered as a covariate, were used to compare scores between groups on friendship variables.

METHODS

Grade 10 girls (N=324) completed self-report questionnaires.

RESULTS

Consistent relationships were observed between body dissatisfaction and disordered eating, and negative friendship qualities (friend alienation, friend conflict), but not positive friendship qualities (friend communication, friend trust and peer acceptance). The strength of relationships with negative friendship qualities was reduced when depressive symptoms were taken into account. High and low symptom groups differed on perceived friend concern with weight and advantages of thinness in interpersonal relationships before and after controlling for depressive symptoms.

CONCLUSIONS

Results suggest the importance of addressing negative aspects of peer relationships, social anxieties and beliefs about the importance of thinness in the peer environment as well as depressive symptoms, in interventions for body dissatisfaction and eating problems.

Friendship group influences on body dissatisfaction and dieting among adolescent girls: a prospective study

PURPOSE

Although some studies among adolescent girls found that friends within friendship groups were rather similar on dieting and/or body image constructs, these studies were limited by their cross-sectional designs. The current prospective study is the first to examine friendship group influences on eating disorder risk factors, including body dissatisfaction, weight concerns, dietary restraint, and dieting in adolescent girls.

METHODS

Design was a two-wave prospective study with 1-year interval. Of 863 girls (mean age = 13.8, SD = .7), 344 were members of one of the 103 reciprocal friendship groups identified using social network analysis.

RESULTS

Reciprocal friends were similar with respect to body image and dieting constructs. However, initial friendship group levels of body dissatisfaction, weight concerns, dietary restraint, and dieting did not predict individual body image and dieting variables 1 year later.

CONCLUSIONS

The current findings attest to the significance of reciprocal friendship group correlates of eating disorder risk factors, but suggest that during early-to-mid-adolescence, levels of body image concerns and dieting within reciprocal friendship groups do not influence adolescents' own body image concerns and dieting over 1 year of time.

Gender differences in body consciousness and substance use among high-risk adolescents

This study explores the association between private and public body consciousness and past 30-day cigarette, alcohol, marijuana, and hard drug use among adolescents. Self-reported data from alterative high school students in California were analyzed (N = 976) using multilevel regression models to account for student clustering within schools. Separate regression analyses were conducted for males and females. Both cross-sectional baseline data and one-year longitudinal prediction models indicated that body consciousness is associated with specific drug use categories differentially by gender. Findings suggest that body consciousness accounts for additional variance in substance use etiology not explained by previously recognized dispositional variables.

Psychosocial factors and health perceptions in parents and children who are overweight or obese

This study examined the relationships among weight status (BMI), health perceptions, and psychosocial characteristics in children, parents, and parent-child dyads. A convenient sample of 114 parent-child dyads participated. All children were overweight or obese. Parents and children completed questionnaires by self-report or interview. Questionnaires included the Parenting Stress Index-Short Form (PSI), the Parents' Stage of Change (SOC) Questionnaire, and the Pediatric Quality of Life Inventory (PedsQL). Child's mean age was 10.34 years (s.d. = 1.87), mean BMI was 28.13 kg/m(2) (s.d. = 5.46), and mean BMI z-score was 2.17 (s.d. = 0.38). Parent mean age was 37.28 years (s.d. = 12.66) and mean BMI was 34.07 kg/m(2) (s.d. = 8.18). Most parents (68.5%) reported that they and their children (70.7%) were African American and many (44.3%) reported that they and their children were Hispanic. Significant correlations included: child health perceptions and child BMI (r = 0.309, P < 0.001) and parent perception of weight and parent BMI (r = 0.691, P < 0.001). For parent-child dyads, one correlation approached significance (child health perceptions and parent stage of change (r = -0.269, P < 0.01). Findings suggest that characteristics of parent-child dyads may be important considerations in the management of childhood obesity.

Patterns in weight reduction behaviour by weight status in schoolchildren

Objective

To investigate the relationships between weight reduction behaviour among non-overweight schoolchildren and dietary habits, perception of health, well-being and health complaints.

Design

Analysis of the 2006 Health Behaviour in School-aged Children survey, a cross-sectional study involving schoolchildren aged 10–17 years.

Setting

Schools in the Republic of Ireland.

Results

The proportion of children (n3599) engaged in weight reduction behaviour (‘dieting’ among non-overweight students) was 10·3 %. Older children, females and those from higher social classes (SC) were more likely to report such behaviour. Non-overweight schoolchildren who reported weight reduction behaviour were less likely than those not engaged in such behaviour to frequently consume sweets, soft drinks, crisps and chips/fried potatoes (OR from 0·39 (95 % CI 0·17, 0·89) to 0·72 (95 % CI 0·53, 0·99)); were more likely to consume diet soft drinks (OR 1·50 (95 % CI 1·03, 2·18); and were more likely to miss breakfast during the week (OR 0·62 (95 % CI 0·48, 0·80). The risk of subjective health complaints increased (OR from 1·47 (95 % CI 1·13, 1·91) to 1·92 (95 % CI 1·48, 2·49)); as did body dissatisfaction (OR 9·17 (95 % CI 6·99, 12·02)), while perception of health and well-being decreased (OR 0·47 (95 % CI 0·36, 0·61)) to 0·54 (95 % CI 0·41, 0·70)). All analyses were controlled for age, gender and SC.

Conclusions

Weight reduction behaviour among non-overweight schoolchildren is associated with considerable risk to physical health and emotional well-being. Since the risks associated with such behaviour varies by weight status, health professionals and researchers need to consider these issues in parallel.

Body Image, Acculturation, and Substance Abuse Among Boys and Girls in the Southwest

This study explored body image as measured by perceptions of weight and appearance and its impact on adolescent drug use among predominately Mexican American middle school students in the southwest. Outcomes analyzed included lifetime and recent alcohol, cigarette, and marijuana use and antidrug norms. Disliking one's looks was more of a risk factor for boys, whereas negative weight perceptions were more of a risk factor for girls. Relative to more acculturated (English-dominant) Latinos (N=903), non-Latino Whites (N=121), and other non-Latino youth (N=107), less acculturated (Spanish-dominant) Latino youth (N=212) reported the poorest body image. However, more acculturated Latino youth with poor body image had the greatest risk of substance use. More acculturated Latino boys who disliked their looks reported relatively greater amounts of recent alcohol use, and those who rated their bodies as too thin reported higher lifetime cigarette use, a greater amount and frequency of recent cigarette use, and weaker antidrug norms. More acculturated Latina girls who thought they were too fat reported a greater amount and frequency of recent cigarette use. These findings suggest that low levels of acculturation may protect some Latino youth with poor body image from coping via substance use. In addition, they suggest that poor body image among some Latinos may result less from adoption of American thinness ideals but rather from attitudes and behaviors that devalue the characteristics of Latino appearance.

Associations between smoking and extreme dieting among adolescents

This study examined the association between cigarette smoking and dieting behaviors and trends in that association among US adolescents in grades 9-12 between 1999 and 2007. Youth Risk Behavior Survey datasets were analyzed using the multivariable logistic regression method. The sample size of each survey year ranged from 13,554 to 15,273 with girls representing 49-51% of the sample (N = 71,854). About 62% of the entire study participants were whites and 14% were blacks. Prevalence estimates of current smoking and corresponding 95% confidence intervals were computed across four comparison groups formed by gender and body weight. Extreme dieting was an independent predictor of smoking. Extreme dieters showed a higher variability of smoking behavior than their peers. The magnitude of the association between smoking and extreme dieting became smaller in recent years among adolescents but remained unchanged among non-overweight girls over that same time period. When adolescent smoking behavior is examined, the intensity of dieting behavior should be considered within its association with other co-occurring unhealthy behaviors.

Associations between family dinner frequency and specific food behaviors among grade six, seven, and eight students from Ontario and Nova Scotia

PURPOSE

Family dinner frequency has recently been associated in the literature with improved dietary profiles and healthy body weight in children and adolescents. However, it is not known whether family dinners are associated with other commonly reported food behaviors (fast food and soft drink consumption, breakfast skipping, and dieting) and attitudes (body weight concerns and self-efficacy for healthy eating) among Canadian students in grades 6, 7, and 8.

METHODS

A total of 3223 participants from Northern Ontario (Porcupine Region), Southern Ontario (Peel Region, Region of Waterloo, Toronto District), and Nova Scotia completed the Food Behavior Questionnaire during the 2005-2006 academic school year. Ordinal logistic regression analyses were used to determine the associations between family dinner frequency and food behaviors and attitudes.

RESULTS

Higher family dinner frequency was significantly associated with less soft drink consumption, consuming breakfast on the day of the survey, the absence of a high body weight concern, having higher self-efficacy for healthy eating when at home with family, and during social times with friends.

CONCLUSIONS

Researchers and clinicians should be aware of these associations when planning family based healthy eating strategies.

Body weight dissatisfaction and communication with parents among adolescents in 24 countries: international cross-sectional survey

Background

Parents have significant influence on behaviors and perceptions surrounding eating, body image and weight in adolescents. The aim of this study was to examine the prevalence of body weight dissatisfaction, difficulty in communication with the parents and the relationship between communication with parents and adolescents' dissatisfaction with their body weight (dieting or perceived need to diet).

Methods

Survey data were collected from adolescents in 24 countries and regions in Europe, Canada, and the USA who participated in the cross-sectional 2001/2002 Health Behaviour of School-Aged Children (HBSC) study. The association between communication with parents and body weight dissatisfaction was examined using binary logistic regression analysis.

Results

Body weight dissatisfaction was highly prevalent and more common among girls than boys, among overweight than non-overweight, and among older adolescents than younger adolescents. Difficulty in talking to father was more common than difficulty in talking to mother in all countries and it was greater among girls than among boys and increased with age. Difficulties in talking to father were associated with weight dissatisfaction among both boys and girls in most countries. Difficulties in talking to mother were rarely associated with body weight dissatisfaction among boys while among girls this association was found in most countries.

Conclusion

The findings suggest that enhanced parent communication might contribute in most countries to less body dissatisfaction in girls and better communication with the father can help avoiding body weight dissatisfaction in boys. Professionals working with adolescents and their families should help adolescents to have a healthy weight and positive body image and promote effective parent – adolescent communication.

Healthy Eating Index-C is compromised among adolescents with body weight concerns, weight loss dieting, and meal skipping

The objective was to describe weight concerns, dieting, and meal skipping of adolescents and to determine associations with the Healthy Eating Index-C (HEI-C). Data, that were collected using the Food Behaviour Questionnaire, revealed that participants (male=810, female=1016) in grades 9/10 reported weight concerns (n=518), dieting (n=364), and skipping breakfast (n=498), lunch (n=252), and/or dinner (n=129). Of those dieting or weight concerned (n=602), 61% were healthy weight and of those not dieting or weight concerned (n=1224), 13% were overweight/obese. The ordinal logistic regression analysis revealed that HEI-C was likely to be rated lower among those weight concerned and dieting (p<.001), and among those that skipped the breakfast meal (p<.001). The current study identified inappropriate weight concerns and dieting that compromised diet quality and has implications for future intervention and policy development.

Eating behaviour, body image, and self-esteem of adolescent girls in Malaysia

This cross-sectional study was undertaken with 489 secondary school girls, ages 15-17 years, to examine disordered eating behaviours of adolescent girls in Malaysia and to estimate associations with body weight, body-size discrepancy, and self-esteem. Dietary restraint, binge eating, body image, and self-esteem were assessed using the Restrained Eating scale of the Dutch Eating Behaviour Questionnaire, the Binge Scale Questionnaire, the Contour Drawing Rating Scale, and the Rosenberg Self-Esteem Scale, respectively. Pearson correlations estimated associations between variables. There were 3.1% underweight, 9.8% at risk of being overweight, and 8.6% overweight girls. A total of 87.3% were dissatisfied with their own body size. Dietary restraint and binge eating were reported by 36.0% and 35.4%, respectively. Body Mass Index (r = .34, p < .01) and body-size dissatisfaction (r = .24, p < .01) were significantly associated with dietary restraint and binge eating, but self-esteem (r = -.20, p < .001) was significantly associated only with binge eating.

Long-term Outcomes of the ATHENA (Athletes Targeting Healthy Exercise & Nutrition Alternatives) Program for Female High School Athletes

Adolescence and emerging adulthood are critical windows for establishing life-long behaviors. We assessed long-term outcomes of a prospective randomized harm reduction/health promotion program for female high school athletes. The intervention's immediate beneficial effects on diet pill use and unhealthy eating behaviors have been reported; however, tobacco, alcohol and marijuana use were not immediately altered (Elliot et al, 2004). One to three years following graduation, positive benefits in those domains became evident, and intervention students reported significantly less lifetime use of cigarettes, marijuana, and alcohol. Sport teams may be effective vehicles for gender-specific interventions to promote competency skills and deter harmful actions, and those benefits may manifest when acquired abilities are applied in new environments following high school graduation.

Psychobiology and behavioral strategies. Physical activity, sport participation, and suicidal behavior: U.S. high school students

PURPOSE

To evaluate the associations of physical activity and sports team participation with suicidal behavior among U.S. high school students.

METHODS

Data were from the 2003 Youth Risk Behavior Survey (N = 10,530 respondents). Exposure variables included physical activity (inactive, insufficient, moderately intensive, regular vigorously intensive, and frequent vigorously intensive) and sports team participation. Outcome variables were suicide ideation (seriously considering and/or planning suicide) and suicide attempts. Hierarchical logistic regressions were run, controlling for age, race, smoking, alcohol use, drug use, geographic region, unhealthy weight-control practices, and body mass index/weight perceptions.

RESULTS

Compared with inactive students or sports team nonparticipants, the odds of suicide ideation were lower among boys reporting frequent vigorous-intensity physical activity (adjusted odds ratio (AOR) = 0.48; 95% confidence interval (CI) = 0.29, 0.79) and sports team participation, respectively (AOR = 0.65; 95% CI = 0.48, 0.86). The odds of suicide attempts were also lower among frequently vigorously active boys (AOR = 0.44; 95% CI = 0.21, 0.96) and sports team participants (AOR = 0.61; 95% CI = 0.40, 0.93). The odds of suicide attempts were lower for regular vigorously active girls compared with inactive girls (AOR = 0.67; 95% CI = 0.45, 0.99) and sports team participants compared with nonparticipants (AOR = 0.73; 95% CI = 0.57, 0.94). Associations with one exposure variable generally weakened when adjustment was made for the other exposure variable, or for feeling sad and hopeless.

CONCLUSIONS

The association of physical activity and sports team participation with suicide ideation and suicide attempts varied by sex. Further research is needed to clarify these different associations.

Attitudes and health behaviours of young adolescent omnivores and vegetarians: a school-based study

This study aimed to identify attitudes, health behaviours, social adjustment and self-reported health of vegetarian and omnivore teenagers and determine characteristics independently related to vegetarian status. Participants were 630 Grade 9 students, ages 13-15 years, in seven schools in Ontario, Canada. Vegetarian status was determined using a 19-item food inventory. The vegetarian group included lacto, ovo and/or lacto-ovo and semi-vegetarians. Omnivores consumed red meat at least monthly. Social adjustment factors included school misbehaviour, low academic performance, authority-defying risks and unsafe/illegal risks. Logistic regression estimated the relationship of characteristics to vegetarian status. The sample comprised 25 vegetarians (4%) and 605 omnivores. Analyses focussed mainly on females; 22 vegetarians and 315 omnivores. Dieting behaviours (current, frequent and past year), alcohol use, poorer social adjustment and poorer self-rated health were positively related to vegetarian eating (p<.05). Among females (using logistic regression), past year dieting (OR 9.88; 95% CI 2.19-44.47) and alcohol use (OR 2.91; 95% CI 1.02-8.32) predominated in the presence of attitudes that personal health and animal rights are very important. The model predicted 79.9% of cases. Teenage vegetarians were distinctive in health behaviours. The independent, positive association of alcohol use with vegetarian eating is a unique and concerning finding. Dieting behaviours were strongly, independently and positively linked to female vegetarian eating. Further studies with a greater range of behaviours would be useful to more fully characterize teenage vegetarians and explore subgroups.

Disordered eating attitudes and behaviours among adolescents in Hong Kong: prevalence and correlates

AIMS

To study the prevalence of disordered eating attitudes and behaviours among adolescents in Hong Kong and to examine the socio-demographic and behavioural correlates.

METHODS

Three secondary schools with different academic performance were selected from the Eastern District of Hong Kong. A total of 2382 students enrolled in Forms 1-7 at the three schools completed a specially designed questionnaire. The questionnaire contained questions on socio-demographic information, body weight satisfaction, exposure to mass media, health behaviours as well as the Eating Attitudes Test - 26 (EAT-26). Data were analysed using Student's t-test, chi2 analysis and multivariate logistic regression models.

RESULTS

Disordered eating (EAT score > or =20) was present in 52 (3.9%) adolescent boys and 68 (6.5%) adolescent girls. The youngest case was only 11 years old. A high degree of body weight dissatisfaction was shared by our adolescents. Teenage girls, overweight youths and those with poor academic performance were at increased risk of having disordered eating. Strong associations were found between disordered eating and other health-compromising behaviours including smoking, alcohol and soft drug use, delinquent behaviours, suicidal ideation and self-harm behaviours. Exposure to entertainment, beauty and youth magazines was positively related to disordered eating.

CONCLUSIONS

Disordered eating is prevalent among adolescents in Hong Kong. It remains a significant public health challenge to our community. Prevention programmes targeting youths at the greatest risk should be considered.

Effects of lifestyle intervention and metformin on weight management and markers of metabolic syndrome in obese adolescents

PURPOSE

The purposes of this study are threefold: to determine what components of the metabolic syndrome are present in obese adolescents, to determine what differences exist in the effects of lifestyle intervention versus lifestyle intervention plus metformin on weight management and select markers of metabolic syndrome in obese adolescents, and to determine which factors predict weight loss in obese adolescents treated with lifestyle changes and metformin.

DATA SOURCES

The study was a secondary data analysis utilizing a retrospective chart review of 63 obese adolescents aged 11 through 18 who were treated for obesity at the LeBonheur Youth Lifestyle Clinic from January 1, 2000, through June 30, 2005. Lifestyle interventions included diet, exercise, and counseling. The medication utilized was metformin. Outcomes evaluated included body mass index, relative body mass index (RBMI), weight, waist and hip circumference, blood pressure, serum lipid levels, fasting plasma glucose, 2-h oral glucose tolerance tests, and insulin levels. Changes in mean values between groups were evaluated using the General Linear Models procedure. Logistic regression was utilized to determine which factors might predict weight loss.

CONCLUSIONS

The metformin group (N= 37) tended to be heavier, older, and had more components of the metabolic syndrome than the nonmetformin group (N= 26). All components of the metabolic syndrome were present in both groups (overall prevalence 55%). Both groups had a downward trend in RBMI, a surrogate marker for weight loss, but only the metformin group had a significant loss in RBMI points from baseline to end. There was a trend toward better diastolic blood pressure at 6 months in the metformin group (p= 0.06), which was not seen in the nonmetformin group. The only predictors of weight loss were higher RBMI (those who were heavier lost more) and the absence of type 2 diabetes mellitus (type 2 DM) (those with type 2 DM were less likely to lose 10 or more points in RBMI).

IMPLICATIONS FOR PRACTICE

All components of the metabolic syndrome are present in obese adolescents. The use of lifestyle changes and lifestyle changes plus metformin both produce some degree of weight loss, but subjects on metformin in this study lost significantly more RBMI points than those on lifestyle changes alone. Subjects with type 2 DM are less likely to lose weight than those without type 2 DM. Larger studies and studies with subjects more representative of the general population need to be carried out to assist in the development of evidence-based practice guidelines.

Dietary restraint and disinhibition are associated with increased alcohol use behaviours and thoughts in young women social drinkers

Previous studies have identified a positive relationship between dietary restraint and alcohol use. However, it is unclear whether heavier drinking is associated with higher dietary restraint per se, or restraint combined with a tendency towards disinhibition. The aim of the present study was to examine alcohol use behaviours in women classified using both restraint and disinhibition scores. Forty-four young female social drinkers gave self-reported measures of their drinking behaviour, including frequency and quantity of alcohol consumed and frequency of drunkenness and binge drinking. Attentional bias for alcohol-related stimuli was also assessed using a dot probe detection task. Finally, the Temptation and Restraint Inventory was used to investigate whether preoccupation with drinking might underlie the relationship between dietary and drinking behaviours. Women classified as both highly restrained and disinhibited tended to report more episodes of drunkenness, showed an attentional bias for alcohol-related words, and had greater cognitive preoccupation with drinking compared to other dietary groups. These data suggest that a tendency towards overeating (disinhibition) combined with attempts at restriction is associated with increased alcohol use behaviours, perhaps due to a greater preoccupation with alcohol.

Far from ideal: weight perception, weight control, and associated risky behaviour of adolescent girls in Nova Scotia

OBJECTIVE

To examine the prevalence of weight-related concerns, unhealthy weight-control behaviour, and associated risky behaviour among adolescent girls, and to ascertain whether these girls had discussed a healthy weight with their physicians.

DESIGN

Anonymous, self-report, cross-sectional survey.

SETTING

Four high schools in rural Nova Scotia.

PARTICIPANTS

Adolescent girls in grades 10 to 12.

MAIN OUTCOME MEASURES

Weight perception, prevalence of weight-control behaviour, associations between weight perception and risky behaviour, associations between disordered eating behaviour and other risky behaviour.

RESULTS

Overall response rate was 76%. Half the 1133 participants saw themselves as not being the "right" weight; 60% were trying to lose weight. During the past 30 days, 16% of the girls were attempting to control or lose weight and had engaged in disordered eating behaviour. In univariate analysis, perception of being either overweight or underweight was significantly associated with suicidal thoughts, suicide planning, and risk of depression. In multivariate analysis, positive associations were found between disordered eating behaviour and suicidal thoughts (odds ratio [OR] 4.2, 95% confidence interval [CI] 2.6 to 6.7), suicide planning (OR 2.9, 95% CI 1.7 to 4.7), suicide attempts (OR 3.4, 95% CI 1.8 to 6.6), and ever having had vaginal intercourse (OR 1.6, 95% CI 1.1 to 2.5). Only 22% of respondents had spoken with a doctor about a healthy weight.

CONCLUSION

Weight concerns are prevalent among adolescent girls in Nova Scotia. Many of them, especially those who see themselves as overweight or underweight, engage in unhealthy weight-control methods. Perceived underweight and overweight and disordered eating behaviour have strong associations with depression and self-harming behaviour. Few participants had discussed a healthy weight with a physician. Health professionals should be aware of the associations between weight perception and disordered eating behaviour and other risky behaviour.

Weight-related concerns associated with smoking in young children

Studies have shown that weight concern is associated with smoking in adolescents. However, little is known about the relationship between weight concern and smoking in younger children. Analyses were conducted to determine whether children in elementary school who had tried smoking would possess greater weight concern than those who had not tried smoking. Results indicated that smokers possessed more general weight concern, F(1, 640)=5.619, p=.018, reported more dieting, F(1, 707)=11.757, p=.001, and endorsed greater concern with body size, F(1, 707)=4.113, p=.043, than non-smokers. Similar to adolescents, these results suggest that young children who have tried smoking are more concerned about weight than children who have not tried smoking.

Why Does Dieting Predict Weight Gain in Adolescents? Findings from Project EAT-II: A 5-Year Longitudinal Study

OBJECTIVE

Dieting has been found to predict weight gain in adolescents, but reasons for this association remain unclear. This study aimed to explore potential mechanisms by which dieting predicts weight gain over time in adolescents.

DESIGN

Population-based, 5-year longitudinal study.

PARTICIPANTS

Adolescents (n=2,516) from diverse ethnic and socioeconomic backgrounds who completed Project EAT (Eating Among Teens) surveys in 1999 (Time 1) and 2004 (Time 2).

MAIN OUTCOME MEASURE

Body mass index (BMI) change over 5 years.

STATISTICAL ANALYSIS

Multiple regressions were used to examine associations between Time 1 dieting and Time 2 binge eating, breakfast consumption, fruit and vegetable intake, and physical activity. Associations were then examined between these behaviors and BMI change. Finally, to test for mediating effects, associations between dieting and BMI change were examined with and without the inclusion of these behaviors, and regression coefficients were compared.

RESULTS

In female adolescents, dieting predicted increased binge eating (P<0.001) and decreased breakfast consumption (P=0.030). In male adolescents, dieting predicted increased binge eating (P<0.001), decreased physical activity (P=0.006), and a trend toward decreased breakfast consumption (P=0.064). These behaviors were also associated with increases in BMI. The association between dieting and BMI increase was weakened, but still remained significant, after binge eating, breakfast consumption, fruit/vegetable intake, and physical activity were included in the model being tested. Thus, the longitudinal association between dieting and BMI increase was partially mediated by these behaviors.

CONCLUSIONS

In part, dieting may lead to weight gain via the long-term adoption of behavioral patterns that are counterproductive to weight management.

Race and gender differences in the association of dieting and gains in BMI among young adults

OBJECTIVE

To assess the relationship between dieting and subsequent weight change and whether the association varies by gender or race/ethnicity.

RESEARCH METHODS AND PROCEDURES

Male (n = 4100) and female (n = 4302) participants in the National Longitudinal Study of Adolescent Health who provided information on weight and height at baseline and two follow-up assessments and were not missing information on weight control strategies or race were studied. Generalized estimating equations were used to assess whether dieting to lose or maintain weight at Wave I or II predicted BMI (kg/m(2)) change between adolescence and young adulthood (Wave II to III). Analyses were stratified by gender and took sampling weights and clustering into account.

RESULTS

At Wave I, the mean age of the participants was 14.9 years. Approximately 29.3% of female participants and 9.8% of male participants reported dieting in Wave I or II. Fewer African Americans than whites (6.2% vs. 10.0% and 25.5% vs. 31.2%, p = 0.007 and p = 0.02, among males and females, respectively) reported dieting. Between Waves II and III, participants gained on average 3.3 kg/m(2). Independent of BMI gain during adolescence (Waves I to II), female participants who dieted to lose or maintain weight during adolescence made larger gains in BMI during the 5 years between Waves II and III (mean additional gain, 0.39 kg/m(2); 95% confidence interval, 0.08 to 0.71) than their nondieting peers. The association was not significant among the male participants. The association was largest among African-American female participants.

DISCUSSION

The results suggest that not only is dieting to lose weight ineffective, it is actually associated with greater weight gain, particularly among female adolescents. Female African-American dieters made the largest BMI gains.

Associations between juvenile delinquency and weight-related variables: analyses from a national sample of high school students

OBJECTIVE

This study examined direct and conditional associations between juvenile delinquency and weight-related variables in a national sample of high school students.

METHOD

Data from the 2003 Youth Risk Behavior Survey (YRBS) of 12,713 high school students aged 14 to 17 were examined. Logistic regression analyses were used to analyze the data.

RESULTS

Bivariate and multivariate analyses indicated that juvenile delinquents were more likely than nondelinquents to use fasting, vomiting, and drugs to lose weight or to keep from gaining weight. Multivariate analyses also showed that delinquents were more likely than nondelinquents to perceive themselves as overweight, but the two groups did not differ in regard to actual overweight status. Tests of interactions in multivariate analyses indicated that the associations between delinquent status and specific, weight-related variables were stronger among younger than among older adolescents, as well as among female than among male adolescents.

CONCLUSIONS

Future research should examine risk and protective factors for unhealthy weight control behaviors and perceptions among delinquents.

Binge eating and purging in a multi-ethnic community sample

OBJECTIVE

The purpose of the present study is to document the frequency of three eating disorder-related behaviors (binge eating; self-induced vomiting; and use of laxatives, diuretics, and diet pills) among a multi-ethnic community sample.

METHOD

A questionnaire was administered to 1225 Hispanic, Asian, black, and white women and men. Participants responded to items (based on DSM-IV diagnostic criteria for eating disorders) about binge eating and purging behavior.

RESULTS

Binge eating and purging were more common among women than among men in Hispanic, black, and white subsamples (frequency rates were similar among Asian men and women). Ethnic differences were found in frequency of purging among women (ethnicity was not associated with behavior rates among men). Fewer Asian than Hispanic, black, and white women induced vomiting and used laxatives, diuretics, and diet pills as weight control methods.

CONCLUSION

The fact that frequency rates differed as a function of participant sex and ethnicity underscores the importance of considering both of these group variables when examining disordered eating and weight control behaviors.

Prevalence and correlates of chronic dieting in a multi-ethnic U.S. community sample

Despite the increasing rates of obesity in the U.S. and corresponding rise in weight-related concerns among men and women in all ethnic groups, most research in the U.S. has been conducted using white female samples. This study explored the prevalence and correlates of chronic dieting (high levels of dietary restraint) among a U.S. communitybased sample of Hispanic, Asian, Black, and White women and men (N=1257). Chronic dieting was more common among women than men, and less common among Asians than other ethnic groups. Across the total sample, dietary restraint was positively correlated with weight history, disordered eating attitudes, distorted body experiences, and depression, and was negatively correlated with self-esteem. Female chronic dieters showed the highest degree of disturbance; compared with female non-dieters (and male chronic dieters), they reported lower self-esteem, higher depression, and more disordered eating attitudes. As hypothesized, they also exhibited a higher degree of acculturation to Anglo-American society. Male chronic dieters had more disordered eating attitudes and experienced greater body distortion than male non-dieters. Interestingly, these results were not moderated by ethnicity. Although the prevalence of chronic dieting differs among ethnic groups living in the U.S., the psychological characteristics related to eating and weight appear similar for individuals who diet, irrespective of ethnicity.

Diet and personality: Associations in a population-based sample

BACKGROUND

Large portions of the population of the United States of America fail to follow dietary recommendations. Psychological factors may contribute to non-adherence.

OBJECTIVE

Establish the associations between heritable personality styles, attitudes towards food, and habitual eating behavior.

DESIGN

Variables were assessed by questionnaire in a population-based sample of 629 subjects. Associations were established using correlation and regression analysis, taking gender, demographic, lifestyle and other factors into account.

RESULTS

Differences in personality style were reflected in diet. For example, hostility and anxiety-proneness was associated with greater likelihood to continue eating when satiated, while sociability and low impulsivity correlated with greater monitoring and control of dietary intake and body weight. Immaturity, aloofness, self-consciousness and self-gratification were associated with greater susceptibility to hunger and lack of persistence with increased snack and alcohol consumption. These associations differed for the sexes and were stronger for attitudes towards food than actual eating behavior. Taking other factors into account reduced the number of significant associations between diet and personality, particularly for habitual eating behavior.

CONCLUSIONS

Associations exist between personality and diet. However, the strength of these associations is influenced by demographic, lifestyle and other factors. These findings have implications for future studies and efforts aimed at changing unhealthy dietary habits.

Risk factors and patterns of onset in binge eating disorder

OBJECTIVE

The current study examined risk factors in women with binge eating disorder (BED) who began binging before dieting (binge-first [BF]) compared with women with BED who began dieting before binging (diet-first [DF]). It further aimed to replicate findings regarding eating disorder and general psychopathology among BF versus DF subtypes.

METHOD

One hundred fifty-five women with BED completed the Oxford Risk Factor Interview to retrospectively assess risk factors occurring before eating disturbance onset. Clinical interview assessed eating disorder and general psychopathology.

RESULTS

Overall, no significant differences in risk factors emerged between the groups. The BF group had a significantly earlier onset of BED than the DF group. In contradistinction to previous studies, the DF group endorsed more eating disorder psychopathology and lifetime diagnosis of any substance use disorder.

CONCLUSION

Limited support was seen for different risk factors in BF versus DF women, suggesting similar etiologic pathways in both subtypes.

A population-based study of body image concerns among urban Chinese adults

Using a nationally representative Chinese urban sample of 930 women and 893 men aged 20-45 who were married or had a steady sexual partner, this study examines the prevalence, risk factors and sequelae of body image concerns. Women's weight loss desires begin at modest BMI levels and are more pronounced among youth, among people of urban origin, and among the educated. Women also have stronger body image concerns if they are single, living in coastal areas, taller or larger than their partner, or if their relationship with their partner is poor. Moreover, women who perceive themselves as unattractive and who want to lose weight report more psychological distress. These findings suggest that China has joined the worldwide diffusion of the thin ideal, with negative consequences for women.

Temporal Changes in Anthropometric Measurements of Idealized Females and Young Women in General

This study examined the temporal anthropometric changes in idealized female body images in the media (i.e., Playboy magazine Playmates of the Year, Miss America Pageant winners, and fashion models) and young women in general across eight decades. Overall, all anthropometric measures differed significantly over time. BMI for all women in the idealized groups tended to decline significantly over time, while the BMI for YoungWomen increased significantly. Models tended to have the smallest bust and hips, Playmates the largest bust, and young women in general the largest waist and hips. The general trend for all groups was to move from a less curvaceous body shape in the early part of the twentieth century to a more curvaceous shape at mid-century and returning to a less curvaceous shape at the end of the century. Idealized women have a body size unlike that of Young Women and the chasm between the media- defined ideal and reality is continuing to diverge.

Influences of mothers' dieting behaviors on their junior high school daughters

We investigated the influences of mothers' dieting behaviors on their junior high school daughters. We assessed dieting behaviors and eating habits in 221 pairs of mothers and their junior high school daughters using questionnaires. The subjects were classified into an extraordinary-diet (Ex-D) group, who attempted to diet rapidly with unhealthy methods, a structured-diet (St-D) group, who attempted to diet gradually with healthy methods, and a non-diet (N-D) group, using the questionnaire scores. 1) A significant correlation was observed in the distribution of dieting behavior groups between the mothers and their daughters. 2) The scores for dieting behavior of the mothers whose daughters were classified into the Ex-D group were significantly higher in several question items compared with those of the mothers whose daughters were classified into the N-D group. 3) The scores for eating consciousness of the mothers whose daughters were classified into the Ex-D group were significantly lower for the item "Cooking is a fun pastime" compared with those of the mothers whose daughters were classified into the St-D or N-D groups. 4) The number of experiences of conversation with daughters about diet for the mothers whose daughters were in the Ex-D group was significantly higher than that for the mothers whose daughters were classified into the N-D group. The mothers' dieting behavior, eating consciousness, and number of conversations with daughters about diet influenced dieting behaviors in their junior high school daughters. Appropriate education of mothers would be useful to prevent their daughters' inappropriate diet.

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

OBJECTIVE

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

METHOD

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

RESULTS

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

DISCUSSION

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

The relationship between dieting and body image, body ideal, self-perception, and body mass index in Turkish adolescents

OBJECTIVE

The current study examined the roles of body image, ideal body weight, self-perception, and body mass index (BMI) on the dieting behavior of Turkish adolescents.

METHOD

The 531 subjects who participated in the study ranged from 15 to 17 years old and were recruited from five selected high schools in Ankara. They completed the Self-Perception Profile for Adolescents (SPPA), the Body Image Satisfaction Questionnaire (BISQ), and the Dieting Status Measure (DiSM). Height and weight were measured.

RESULTS

Dieting adolescents received significantly lower scores than nondieters for most of the BISQ items and for the physical appearance and global self-worth subscales of the SPPA. A thinner body ideal, the physical appearance domain of self-concept, and low global self-worth were the predicting factors of frequent dieting. However, BMI and body image dissatisfaction were not predicting factors.

DISCUSSION

The results indicate that a thinner body ideal, low self-worth, and low physical self-concept have more significant effects on body dissatisfaction and dieting than being actually overweight does. Furthermore, high physical self-concept scores and body satisfaction may not necessarily preclude having a thinner body ideal and, hence, dieting in girls.

High prevalence of abnormal eating and weight control practices among U.S. high-school students

OBJECTIVE

This study sought to determine the prevalence and to identify correlates of abnormal eating and weight control practices in U.S. high-school students.

METHOD

A three-stage cluster design technique was used to select 15,349 students from 144 different high schools. Each completed the 1999 Youth Risk Behavior Survey (YRBS) Questionnaire.

RESULTS

Abnormal eating and weight control practices during the past month were reported by over 26% of female students and 10% of male students. Rates of abnormal eating and weight control practices varied by ethnicity and geographic location. Other correlates of abnormal eating and weight control practices included having an underweight body mass index (BMI): (OR=1.39, 95% CI=1.01-1.91), exercising to control weight in past 30 days (OR=1.51, 95% CI=1.30-1.76), dieting to control weight in past 30 days (OR=3.89, 95% CI=2.65-5.73), and interactions between gender and both weight perception and weight satisfaction.

DISCUSSION

The high proportion of U.S. high-school students who have participated in abnormal eating and weight control practices in the past month demands immediate attention. The identified correlates may help target prevention and control programs.

Body weight, body image, and eating behaviours: relationships with ethnicity and acculturation in a community sample of young Australian women

A study was conducted to investigate associations between ethnicity and acculturation status and risk factors for eating disorders among young adult women. A community sample of 14,779 women aged 18-23 completed a comprehensive mail-out survey, which incorporated questions on country of birth, length of time spent in Australia, body weight, weight dissatisfaction, dieting, binge eating, and compensatory disordered eating behaviours. Results showed that risk factors for eating disorders were present across a range of ethnic groups. Further, a strong acculturation effect was observed, such that the longer the time spent in Australia, the more women reported weight-related values and behaviours similar to those of Australian-born women. Results challenge claims that risk factors for disordered eating are restricted to Caucasian females in Western societies. Implications for understanding ethnic and sociocultural influences on body weight, dieting, and disordered eating are considered.

Acculturation and overweight-related behaviors among Hispanic immigrants to the US: the National Longitudinal Study of Adolescent Health

Little is known about the factors underlying the striking increase in overweight occurring between first and second generation US immigrants. Using data from the National Longitudinal Study of Adolescent Health, this study addressed two goals. First, we determined which measures of acculturation (defined as the acquisition of dominant cultural norms by members of a non-dominant group) were important. Second, we determined how the acculturation process affected differences in overweight and its proximate determinants (e.g., physical activity, diet, and smoking) as immigrants acculturated to American society. In addition, we sought to elucidate the role of underlying structural factors (e.g., family income and crime) and acculturation factors (e.g., language spoken at home and proportion of foreign-born neighbors) in generation differences in overweight. Results showed clear structural and acculturation differences between foreign and US-born immigrants to the US. Foreign-born immigrants were more likely to have lower family income and maternal education, and to live in areas of higher immigrant density and greater linguistic isolation. In addition, results suggested rapid acculturation of overweight-related behaviors, such as diet, smoking, and inactivity, in US-born relative to foreign-born immigrants. Multivariate analysis indicated that longer US residence was associated with increased overweight among Puerto Ricans and Cubans. Predicted probabilities showed that controlling for acculturation and proximate factors increased overweight among foreign-born adolescents, but had minimal impact for US-born adolescents. Thus, without the beneficial pattern of: acculturation factors, diet, and physical activity, first generation Hispanic adolescents would have higher overweight prevalence. We found important generation differences in structural, acculturation, and proximate overweight determinants. These lifestyle differences between foreign- and US-born Hispanic adolescent immigrants are likely to underlie the striking increase in overweight prevalence between first and subsequent generation of US residence.

Relation between dieting and weight change among preadolescents and adolescents

OBJECTIVE

To assess whether dieting to control weight was associated with weight change among children and adolescents.

METHODS

A prospective study was conducted of 8203 girls and 6769 boys who were 9 to 14 years of age in 1996, were in an ongoing cohort study, and completed at least 2 annual questionnaires between 1996 and 1999. Dieting to control weight, binge eating, and dietary intake were assessed annually from 1996 through 1998 with instruments designed specifically for children and adolescents. The outcome measure was age- and sex-specific z score of body mass index (BMI).

RESULTS

In 1996, 25.0% of the girls and 13.8% of the boys were infrequent dieters and 4.5% of the girls and 2.2% of the boys were frequent dieters. Among the girls, the percentage of dieters increased over the following 2 years. Binge eating was more common among the girls, but in both sexes, it was associated with dieting to control weight (girls: infrequent dieters, odds ratio [OR]: 5.10; frequent dieters, OR: 12.4; boys: infrequent dieters, OR: 3.49; frequent dieters, OR: 7.30). During 3 years of follow-up, dieters gained more weight than nondieters. Among the girls, frequency of dieting was positively associated with increases in age- and sex-specific z scores of BMI (beta = 0.05 and beta = 0.04 for frequent and infrequent dieters vs nondieters). Among the boys, both frequent and infrequent dieters gained 0.07 z scores of BMI more than nondieters. In addition, boys who engaged in binge eating gained significantly more weight than nondieters.

CONCLUSIONS

Although medically supervised weight control may be beneficial for overweight youths, our data suggest that for many adolescents, dieting to control weight is not only ineffective, it may actually promote weight gain.

Perceived importance of being thin and smoking initiation among young girls

BACKGROUND

Smoking among adolescents remains unacceptably high and the difference in potential risk factors for smoking initiation between male and female adolescents has been explored. Although the association between smoking initiation and dieting behaviour has been observed among girls, the mechanism of the association is unknown.

OBJECTIVE

To examine prospectively the association between perceived importance of being thin at baseline and smoking initiation among girls.

DESIGN

A four year prospective cohort survey including perceived importance of being thin at baseline and smoking behaviour, conducted in 1993 and 1996.

SETTING AND PARTICIPANTS

273 Massachusetts female adolescents aged 12-15 years at baseline who reported having smoked no more than one cigarette by the time of the baseline survey, drawn from households sampled by random digit dialing.

MAIN OUTCOME MEASURE

Progression to established smoking, defined as having smoked 100 or more cigarettes in their lifetime.

RESULTS

After adjusting for age, smoking status at baseline, and race/ethnicity, girls who valued thinness most strongly and somewhat strongly were both more likely to have become established smokers, compared to the girls who valued thinness least strongly. The odds ratios are 4.5 (95% confidence interval (CI), 1.4 to 16.7) and 3.4 (95% CI 1.04 to 10.9), respectively.

CONCLUSIONS

The level of perceived importance of being thin among young female adolescents predicts future smoking initiation. Smoking prevention programmes designed for female adolescents may therefore benefit from the inclusion of content related to importance of being thin.

Impairments in working memory associated with naturalistic dieting in women: no relationship between task performance and urinary 5-HIAA levels

The present study investigated the question of whether the previously observed impairments of working memory characteristic of dieting to lose weight can be explained in terms of preoccupying cognitions relating to body shape or to alterations in serotonergic function resulting from a low dietary intake of tryptophan. The population comprised female non-dieting, lower restrained eaters (N=23), non-dieting higher restrained eaters (N=11) and current dieters (N=19). Each participant completed three tasks, each of which selectively loaded on to a different sub-component of working memory. The tasks comprised the Tower of London task, a letter string recall task and a mental rotation task. In addition, all participants completed self-report measures of body shape concern and affective state. Serotonin turnover was assessed by means of 24 h urine sample collection for each participant on their day of testing. This was analysed (via HPLC) for levels of the main serotonin metabolite 5-HIAA.The results of the present study broadly replicated previous findings of a Central Executive and Phonological Loop (but not Visuo-Spatial Sketchpad) deficit in those subjects who reported themselves to be currently dieting. Tower of London task performance also significantly correlated with self-reported feelings of fatness and body shape disparagement. There were no group differences in 5-HIAA levels nor did 5-HIAA levels correlate with task performance. However, there was a significant negative correlation between 5-HIAA levels and self-reported depression. These results support the hypothesis that the variables mediating this deficit are preoccupying cognitions concerning body shape. They do not support the hypothesis that the serotonergic function of dieters is compromised, although this conclusion is tentative.

Perception of self-physique and eating behavior of high school students in Japan

The authors investigated the condition of self-physique perception and eating behavior, and the relationship between self-physique perception and eating behavior of high school students in Japan. Regarding self-physique perception, subjects were shown six pictures of physiques and asked to choose one physique each for their actual physique and their ideal physique. With respect to eating behavior, the Japanese version of the Eating Attitudes Test (EAT)-26 was used. Groups of underweight girls, normal girls, and normal boys tended to regard their actual physiques as rather broad, demonstrating that many girls are excessively preoccupied with thinness. The rate of eating problems was 11.2% for the girls and 2.4% for the boys. For both boys and girls, those who idealized the thinner physique scored higher in terms of the EAT score and factor I score. Education regarding body perception and diet must be undertaken as soon as possible in Japan.

Associates of obesity and weight dissatisfaction among Finnish adolescents

OBJECTIVE

We investigated behavioural and socio-economic factors associated with obesity and weight dissatisfaction among Finnish adolescents.

DESIGN

A total of 60,252 Finnish adolescents aged 14 to 16 years filled in a questionnaire about their health, health behaviour and socio-economic background. Food choices were obtained by using a short food-frequency questionnaire. Obesity was defined as a weight at least 120% of the sex- and height-specific mean weight for subjects.

RESULTS

Of girls and boys, 54% and 66%, respectively, were satisfied with their weight. Among dissatisfied normal-weight adolescents, 81% of girls but only 48% of boys thought they were overweight. Of obese boys, 25% were satisfied with their weight. For both genders, obesity and weight dissatisfaction were associated with economic problems in the family. In girls, an association was also found with poor school performance, low educational level of parents and not having evening meals at home; and in boys, with physical inactivity and not eating school lunch. Smoking was more common among girls who were dissatisfied with their weight. Differences in food choices were small between different weight and weight satisfaction categories.

CONCLUSIONS

Having normal weight and being satisfied with that weight are favourable for an adolescent. Obesity and weight dissatisfaction are associated mostly with disadvantageous health behaviours and low socio-economic status. Health behaviour seems to be associated more with weight satisfaction than with actual weight.

Overeating among adolescents: prevalence and associations with weight-related characteristics and psychological health

OBJECTIVE

To assess the prevalence of overeating among adolescents and to examine associations between overeating and sociodemographic characteristics, weight status, dieting behaviors, body satisfaction, depressive mood, self-esteem, and suicide.

METHOD

A school-based sample of 4746 boys and girls in public middle and high schools in Minnesota completed the Project EAT (Eating Among Teens) survey and anthropometric measurements of height and weight.

RESULTS

Overall, 17.3% of girls and 7.8% of boys reported objective overeating in the past year. Youths who engaged in overeating were more likely to be overweight or obese, to have dieted in the past year, to be trying to lose weight currently, and to report that weight and shape are very important to their overall feelings about self. Youths who met criteria for binge eating syndrome (high frequency of objective overeating with loss of control and distress regarding the binge eating) scored significantly lower on measures of body satisfaction and self-esteem and higher on a measure of depressive mood than those who reported either subclinical or no binge eating. Overeating was associated with suicide risk; more than one fourth of girls (28.6%) and boys (27.8%) who met criteria for binge eating syndrome reported that they had attempted suicide.

CONCLUSIONS

Overeating among adolescents is associated with a number of adverse behaviors and negative psychological experiences. As the current study is cross-sectional, it is not possible to ascertain cause and effect. Future research should seek to identify whether objective overeating is an early warning sign of additional psychological distress or is a potential consequence of compromised psychological health. Clinical implications are discussed.