Disordered eating behaviors and cardiometabolic risk among young adults with overweight or obesity

Associations between phenotypes of childhood and adolescent obesity and incident hypertension in young adulthood

OBJECTIVES

We investigated whether empirically derived childhood obesity phenotypes were differentially associated with risk of hypertension in young adulthood, and whether these associations differed by sex.

METHODS

Data came from 11,404 participants in the Growing Up Today Study, a prospective cohort study in the US established in 1996. We used a childhood obesity phenotype variable that was previously empirically derived using latent class analysis. The childhood obesity phenotypes included an early puberty phenotype (females only), a mothers with obesity phenotype, a high weight concerns phenotype, and a mixed phenotype. Participants without overweight or obesity in childhood or adolescence were the reference group. We then used logistic regression models with generalized estimating equations to examine associations of childhood obesity phenotypes with incident hypertension between ages 20-35 years. All analyses were stratified by sex.

RESULTS

Among females, participants in all of the empirically derived childhood obesity phenotypes were more likely than their peers without childhood overweight/obesity to develop hypertension in young adulthood (early puberty subtype odds ratio (OR) = 2.52; 95% confidence interval (CI) = 1.75, 3.62; mothers with obesity (MO) subtype OR = 2.98; 95% CI = 1.93, 4.59; high weight concerns (WC) subtype OR = 2.33; 95% CI = 1.65, 3.28; mixed subtype OR = 1.66; 95% CI = 1.25, 2.20). Among males, the childhood obesity phenotypes were associated with a higher risk of developing hypertension, although males in the MO (OR = 2.65; 95% CI = 1.82, 3.87) and WC phenotypes (OR = 3.52; 95% CI = 2.38, 5.20) had a greater risk of developing hypertension than the mixed subtype (OR = 1.51; 95% CI = 1.23, 1.86) (p = 0.004).

CONCLUSION

Risk for incident hypertension in young adulthood varied by childhood obesity phenotypes, as well as by biological sex. If replicated, these results may suggest that increased surveillance of specific childhood obesity phenotypes might help in targeting those at highest risk for hypertension.

Associations of adverse childhood events with disordered eating behaviors among US adolescents

The purpose of our study was to use recent nationally-representative data to 1) determine whether reported adverse childhood experiences (ACEs) were associated with individual disordered eating behaviors (DEBs) for the US- based early and middle adolescent population; and 2) the extent to which individual ACE categories were associated with DEBs for this population. The study used cross-sectional data from the 2022 National Survey of Children's Health, which used parent-reported data. Inclusion criteria included all early (10-13 years of age) and middle-aged adolescents (14-17 years of age) (n = 24,173). Multiple logistic regressions were used to test the association between ACEs and DEBs while controlling for covariates. Both categories for ACEs (i.e. 1-2 ACEs and 3+ ACEs) exhibited a statistically significant association with three specific DEBs: skipping meals or fasting, low interest in food, and binge eating. Additionally, six of the seven ACE categories exhibited a statistically significant association with DEBs which included parent or guardian divorced, parent or guardian time in jail, adults slap, hit, kick, punch others, victim of violence, lived with mentally ill, and lived with person with alcohol/drug problem. Further studies are needed to examine mechanisms contributing to the increased risk of DEBs among those with ACE exposure.

Weight-Inclusive Approaches to Nutrition and Dietetics: A Needed Paradigm Shift

This Perspective article encourages the field of nutrition and dietetics to move away from a weight-centric paradigm that emphasizes weight loss and weight management as primary health outcomes. This approach can perpetuate weight stigma, which is associated with poorer health behaviors, poorer mental health, disordered eating, and even increased mortality risk. We propose an alternative approach-adopting a weight-inclusive paradigm-that focuses on providing care across the weight spectrum by centering health behaviors rather than weight. This approach allows individuals of all sizes to have equitable access to high-quality nutrition and dietetics care.

Disordered Eating Profiles in Adolescence to Early Adulthood and Future Cardiometabolic Health

BACKGROUND AND OBJECTIVES

Evidence is scarce on the clustering patterns of disordered eating dimensions or symptoms and their effects on future cardiometabolic health. This study examines associations of disordered eating trajectory profiles (from 13 to 21 years), with BMI and related cardiometabolic features at ages 21, 24 and 27.

METHODS

Participants are from the Epidemiological Health Investigation of Teenagers cohort (Porto, Portugal). At 13, 17 and 21 years, 3 Eating Disorder Inventory subscales were assessed (drive for thinness, bulimia and body dissatisfaction), and a latent class analysis derived trajectory profiles. Associations with BMI and having ≥1 metabolic syndrome feature at 21 (n = 1619), 24 (n = 916) and 27 years (n = 720) were tested using generalized linear models and binary logistic regressions.

RESULTS

The following 4 profiles were obtained: "higher" levels (highest severity of symptoms at all ages, 16-19%), "increasing" (especially of body concerns, 26-28%), "decreasing" (18-19%), and "lower" (highest proportion of individuals with low/without disordered eating, 35-37%). Compared with the lower levels profile, both sexes with higher and increasing disordered eating presented heightened BMI at 21, 24 and 27 years. Women in the higher levels profile had higher odds of having ≥1 metabolic syndrome feature at 21 and 24 years, while men with higher and increasing disordered eating presented increased odds at 21, 24 and 27 years.

CONCLUSIONS

Individuals, particularly males, with higher or increasing disordered eating levels from 13 to 21 years of age presented a higher risk of worsened cardiometabolic health up to 6 years later in adulthood.

Sexual orientation discrimination and eating disorder symptoms in early adolescence: a prospective cohort study

BACKGROUND

Sexual orientation discrimination increases the risks of negative health outcomes for sexual minorities. Previous studies have found increased rates of eating disorder symptoms in sexual minority individuals, which is attributable to minority stress and discrimination that they experience. Emerging research suggests relationships between sexual orientation discrimination and eating disorder symptoms. However, there is a lack of studies focusing on early adolescents. The objective of this study was to determine prospective associations between discrimination based on sexual orientation and eating disorder symptoms in a national sample of 10-13-year-old early adolescents in the U.S.

METHODS

We examined prospective data from Year 2 (2018-2020) and Year 3 (2019-2021) of the Adolescent Brain Cognitive Development (ABCD) Study (N = 8976). Multiple logistic regression analyses were used to estimate associations between self-reported experiences of sexual orientation discrimination in Year 2 and eating disorder symptoms in Year 3, adjusting for potential confounders, including eating disorder symptoms in Year 2. Sexual orientation discrimination was assessed based on the Perceived Discrimination Scale, which measures adolescents' perception of being treated unfairly based on various sociodemographic characteristics. Eating disorder symptoms were based on the parent-reported Kiddie Schedule for Affective Disorders and Schizophrenia (KSADS-5).

RESULTS

In this demographically diverse sample of early adolescents (N = 8976, age range 10-13 years at Year 2), 5.5% of adolescents reported sexual orientation discrimination in Year 2. The prevalence of parent-reported eating disorder symptoms in Year 3 varied from 1.0 to 8.3%. In the adjusted models, sexual orientation discrimination was prospectively associated with worry about weight gain (adjusted odds ratio [aOR] 2.33, 95% confidence interval [CI] 1.15-4.69) and self-worth tied to weight (aOR 1.60, 95% CI 1.01-2.53) one year later.

CONCLUSIONS

Early adolescents who have experienced sexual orientation discrimination have higher odds of experiencing eating disorder symptoms, particularly worrying about weight gain and tying self-worth to weight. Clinicians may consider screening for sexual orientation discrimination and providing affirmative, trauma-informed care when evaluating and treating even younger sexual minority adolescents for eating disorder symptoms.

Development of the two-factor modified Kids Eating Disorder Survey (M-KEDS): a validation study with hispanic adolescents

BACKGROUND

Disordered eating behaviors and body dissatisfaction are highly prevalent among adolescents and linked to negative health outcomes. While Hispanic adolescents appear to be at high risk of disordered eating and body dissatisfaction, validated tools for assessment of these health concerns among this population are lacking.

METHODS

This study used Confirmatory Factor Analysis to establish factorial validity for the Kids Eating Disorder Survey (KEDS) among a community sample of Hispanic adolescents. Internal consistency was measured by the Kuder-Richardson Formula 20 (KR-20).

RESULTS

Participants (N = 690) were Hispanic (100%) and female (53%), with a mean age of 12 years. After testing the psychometric properties of KEDS and implementing modifications, the resulting two-factor KEDS model (M-KEDS) showed acceptable fit (TLI = 0.98, CFI = 0.99, RMSEA = 0.06) for the Weight Dissatisfaction (renamed to Negative Weight Attitudes) and Purging/Restriction (renamed to Extreme Weight Control Behaviors) sub-scales and good internal consistency (KR-20 = 0.77).

CONCLUSION

M-KEDS is a factorial valid instrument for assessing Extreme Weight Control Behaviors and Negative Weight Attitudes among Hispanic adolescents. Hispanics are among the fastest-growing racial/ethnic groups in the United States, warranting further research on negative weight attitudes and extreme weight control behaviors in this population.

Disordered eating and cardiometabolic risk factors in Chinese women: evidence from the China Health and Nutrition Survey

Disordered eating (DE) is associated with elevated cardiometabolic risk (CMR) factors, yet little is known about this association in non-Western countries. We examined the association between DE characteristics and CMR and tested the potential mediating role of BMI. This cross-sectional study included 2005 Chinese women (aged 18-50 years) from the 2015 China Health and Nutrition Survey. Loss of control, restraint, shape concern and weight concern were assessed using selected questions from the SCOFF questionnaire and the Eating Disorder Examination-Questionnaire. Eight CMR were measured by trained staff. Generalised linear models examined associations between DE characteristics with CMR accounting for dependencies between individuals in the same household. We tested whether BMI potentially mediated significant associations using structural equation modelling. Shape concern was associated with systolic blood pressure (β (95 % CI) 0·06 (0·01, 0·10)), diastolic blood pressure (DBP) (0·07 (95 % CI 0·03, 0·11)) and high-density lipoprotein (HDL)-cholesterol (-0·08 (95 % CI -0·12, -0·04)). Weight concern was associated with DBP (0·06 (95 % CI 0·02, 0·10)), triglyceride (0·06 (95 % CI 0·02, 0·10)) and HDL-cholesterol (-0·10 (95 % CI -0·14, -0·07)). Higher scores on DE characteristics were associated with higher BMI, and higher BMI was further associated with lower HDL-cholesterol and higher other CMR. In summary, we observed significant associations between shape and weight concerns with some CMR in Chinese women, and these associations were potentially partially mediated by BMI. Our findings suggest that prevention and intervention strategies focusing on addressing DE could potentially help reduce the burden of CMR in China, possibly through controlling BMI.

Binge-Spectrum Eating Disorders, Mood, and Food Insecurity in Young Adults With Obesity

BACKGROUND

Disordered eating is common but underrecognized in people with obesity and the relationship of food insecurity, mood, and binge-spectrum eating disorders has not been well addressed in samples with higher weight. Young adults are particularly vulnerable to developing disordered eating.

AIM

The purpose of this study was to compare the prevalence of food insecurity, depressive symptoms, anxiety, and loneliness among young adults (aged 18-35 years) who screened positive for binge-spectrum eating disorders (i.e., binge eating disorder and bulimia nervosa), those with subthreshold forms of these disorders, and individuals who did not screen positive for these conditions.

METHOD

This was a cross-sectional study of young adults with a self-reported body mass index ≥30 kg/m2 from the United States who were recruited online. Participants (N = 1,331; M ± SD age = 28.0 ± 3.4 years; body mass index [BMI] = 36.5 ± 6.2 kg/m2; 73.9% male; 56.3% White) completed surveys that evaluated disordered eating behaviors, food insecurity, mood, and lifestyle factors.

RESULTS

In the sample, 8.0% of participants screened positive for binge-spectrum eating disorder and 16.0% had probable subthreshold symptoms. Higher depressive symptoms (odds ratio [OR] = 1.11, 95% confidence interval [CI] = [1.03, 1.20], p = .01), perceived stress (OR = 1.13, 95% CI = [1.07, 1.19], p < .001), and food insecurity scores (OR = 1.12, 95% CI = [1.03, 1.21], p = .01) were associated with an increased likelihood of threshold binge-spectrum eating disorders.

CONCLUSION

People with disordered eating should also be evaluated for mood disorders and food insecurity and vice versa. Further research is needed to evaluate interventions that address food insecurity and mood disorders, which may help to decrease disordered eating.

Associations Between Phenotypes of Childhood and Adolescent Obesity and Incident Hypertension in Young Adulthood

Objectives

We investigated whether empirically derived childhood obesity phenotypes were differentially associated with risk of hypertension in young adulthood, and whether these associations differed by sex.

Methods

Data came from 11,404 participants in the Growing Up Today Study, a prospective cohort study in the US established in 1996. We used a childhood obesity phenotype variable that was previously empirically derived using latent class analysis. The childhood obesity phenotypes included an early puberty phenotype (females only), a mothers with obesity phenotype, a high weight concerns phenotype, and a mixed phenotype. Participants without overweight or obesity in childhood or adolescence were the reference group. We then used logistic regression models with generalized estimating equations to examine associations of childhood obesity phenotypes with incident hypertension between ages 20-35 years. All analyses were stratified by sex.

Results

Among females, participants in all of the empirically derived childhood obesity phenotypes were more likely than their peers without childhood overweight/obesity to develop hypertension in young adulthood (early puberty subtype odds ratio (OR) = 2.52; 95% confidence interval (CI) = 1.75, 3.62; mothers with obesity (MO) subtype OR = 2.98; 95% CI = 1.93, 4.59; high weight concerns (WC) subtype OR = 2.33; 95% CI = 1.65, 3.28; mixed subtype OR = 1.66; 95% CI = 1.25, 2.20). Among males, the childhood obesity phenotypes were associated with a higher risk of developing hypertension, although males in the MO (OR = 2.65; 95% CI = 1.82, 3.87) and WC phenotypes (OR = 3.52; 95% CI = 2.38, 5.20) had a greater risk of developing hypertension than the mixed subtype (OR = 1.51; 95% CI = 1.23, 1.86) (p = 0.004).

Conclusion

Risk for incident hypertension in young adulthood varied by childhood obesity phenotypes, as well as by biological sex. If replicated, these results may suggest that increased surveillance of specific childhood obesity phenotypes might help in targeting those at highest risk for hypertension.

Sex and ethnic/racial differences in disordered eating behaviors and intuitive eating among college student

Introduction

Eating behaviors encompass disordered eating behaviors (e.g., overeating, binge eating, and associated symptoms of binge eating) and intuitive eating. Certain disordered eating behaviors, including binge eating, are more prevalent among female and ethnic/racial-minority college students than male and/or non-Hispanic White college students. However, sex and ethnic/racial differences among college students with other disordered eating (e.g., associated symptoms of binge eating) and intuitive eating behaviors remain unclear.

Methods

In 2022, 887 college students (Mage = 20.9 ± 2.6 years) self-reported their sex, ethnicity/race, disordered eating behaviors (e.g., overeating, binge eating, associated symptoms of binge eating), and intuitive eating. To examine sex and ethnic/racial differences among these students, we used modified Poisson regressions for students who reported disordered eating and linear regressions for students who reported intuitive eating.

Results

Except for overeating, disordered eating behaviors were more prevalent among female [adjusted prevalence ratio (aPR) = 1.3-1.8] than male college students after adjusting for sociodemographic variables, whereas intuitive eating scores did not differ by sex. Across ethnic/racial groups, disordered eating was more prevalent among all ethnic/racial-minority college students (aPR = 1.2-2.3) than non-Hispanic White college students after adjusting for sociodemographic variables. Moreover, non-Hispanic Black or African American college students had higher intuitive eating scores than non-Hispanic White college students (adjusted β = 0.7, 95% CI = -0.2, 1.6).

Conclusion

In our sample, notable differences emerged in the prevalence of disordered eating behaviors and mean scores by sex and ethnicity/race, while differences in intuitive eating scores emerged based on ethnicity/race.

Disordered Eating Attitudes and Food Choice Motives Among Individuals Who Follow a Vegan Diet in Brazil

Importance

It remains controversial whether adhering to a vegan diet may be associated with a higher prevalence of disordered eating. Also, main food choice motives and their association with disordered eating in this population are still unknown.

Objective

To determine the association between disordered eating attitudes and food choice motives of individuals who follow a vegan diet.

Design, Setting, and Participants

This is a cross-sectional online survey conducted between September 2021 and January 2023. Individuals of both sexes, aged 18 years or older, following a vegan diet for at least 6 months, currently living in Brazil were recruited through advertisements on social media.

Exposure

Adherence to a vegan diet and food choice motives.

Main Outcomes and Measures

Disordered eating attitudes and food choice motives.

Results

Nine hundred seventy-one participants completed the online survey. Median (IQR) age and BMI of participants was 29 (24-36) years and 22.6 (20.3-24.9), respectively, and 800 participants (82.4%) were female. Most participants (908 respondents [94%]) were categorized with the lowest level of disturbed eating attitudes. "Need and hunger," "liking," "health," "habits," and "natural concerns" were the most important food choice motives in this population, while "affect regulation," "social norms," and "social image" were the less important ones. Adjusted models showed that "liking," "need and hunger," and "health" were associated with lower levels of disordered eating attitudes, while "price," "pleasure," "sociability," "traditional eating," "visual appeal," "social norms," "social image," "weight control," and "affect regulation" were associated with higher levels of disordered eating attitudes.

Conclusions and Relevance

In this cross-sectional study, as opposed to previous suggestions, levels of disordered eating were very low among vegans, although certain food choice motives were associated with disordered eating attitudes. Understanding the motivations of adhering to diets that may impose restrictions, which include vegan diets, may help tailor interventions focused on promoting healthy eating and preventing or treating disordered eating.

Food insecurity and binge-eating disorder in early adolescence

OBJECTIVE

Food insecurity is defined as lack of consistent access to adequate food for healthy living. The objective of this study was to determine the associations between food insecurity and binge-eating disorder in a national cohort of 9- to 14-year-old children.

METHOD

We analyzed prospective cohort data from the Adolescent Brain Cognitive Development (ABCD) Study (N = 10,035, 2016-2020). Logistic regression analyses estimated the associations between food insecurity at baseline, year 1, or year 2 (exposure) and binge eating, subclinical binge-eating disorder (Other Specified Feeding and Eating Disorder-Binge-Eating Disorder [OSFED-BED]), and binge-eating disorder (BED) (outcome) based on the Kiddie Schedule for Affective Disorders and Schizophrenia (KSADS-5) at 2-year follow-up.

RESULTS

The prevalence of food insecurity in the study was 15.8%. At 2-year follow-up, 1.71% of the sample received a diagnosis of BED or OSFED-BED, while 6.62% reported binge eating. Food insecurity was associated with 1.67 higher odds of BED or OSFED-BED (95% CI 1.04-2.69) and 1.31 higher odds of binge-eating symptoms (95% CI 1.01-1.71).

DISCUSSION

Food insecurity in early adolescence is associated with higher odds of developing future binge-eating and BED or OSFED-BED. Clinicians may consider assessing for binge eating in adolescents with food insecurity and provide support in accessing appropriate food resources.

PUBLIC SIGNIFICANCE

Prior research has shown that food insecurity is associated with disordered eating behaviors, including binge eating in adulthood. This study explored whether food insecurity in early adolescence increases risk for developing binge-eating disorder (BED). Targeted screening for BED in adolescents experiencing FI, and vice versa, may be warranted.

Metabolic profile in women with bulimia nervosa or binge-eating disorder before and after treatment: secondary analysis from the randomized PED-t trial

PURPOSE

Chaotic eating and purging behavior pose a risk to the metabolic health of women with bulimia nervosa (BN) and binge-eating disorder (BED). This study reports on one-year changes in blood markers of metabolic health and thyroid hormones in women with BN or BED attending two different treatments.

METHODS

These are secondary analyses from a randomized controlled trial of 16-week group treatment of either physical exercise and dietary therapy (PED-t) or cognitive behavior therapy (CBT). Blood samples collected at pre-treatment, week eight, post-treatment, and at 6- and 12-month follow-ups were analyzed for glucose, lipids (triglycerides (TG), total cholesterol (TC), LDL cholesterol (LDL-c), HDL cholesterol (HDL-c), apolipoprotein A (ApoA) and apolipoprotein B (ApoB) lipoproteins), and thyroid hormones (thyroxine (T4), thyroid stimulating hormone (TSH), and thyroperoxidase antibodies).

RESULT

The average levels of blood glucose, lipids and thyroid hormones were within the recommended range, but clinical levels of TC and LDL-c were detected in 32.5% and 39.1%, respectively. More women with BED compared with BN had low HDL-c, and a larger increase over time in TC and TSH. No significant differences occurred between PED-t and CBT at any measurement. Exploratory moderator analyses indicated a more unfavorable metabolic response at follow-up among treatment non-responders.

CONCLUSION

The proportion of women with impaired lipid profiles and unfavorable lipid changes, suggests active monitoring with necessary management of the metabolic health of women with BN or BED, as recommended by metabolic health guidelines.

LEVEL OF EVIDENCE

Level I: Evidence obtained from a randomized, experimental trial.

TRIAL REGISTRATION NUMBER

This trial was prospectively registered in the Norwegian Regional Committee for Medical and Health Research Ethics on December 16, 2013, with the identifier number 2013/1871, and in Clinical Trials on February 17, 2014, with the identifier number NCT02079935.

Practical Considerations for Using the Eating Disorder Examination Interview with Adolescents

Approximately 35 years after its initial publication, the Eating Disorder Examination (EDE) remains one of the most widely used semi-structured interviews for assessing eating disorder diagnoses and symptomatology. Although the interview provides certain advantages over other common measurement approaches (ie, questionnaires), there are particular considerations regarding the EDE that warrant attention, including in its use with adolescents. The aims of this paper are therefore to: 1) provide a brief overview of the interview itself, as well as a description of its origin and underlying conceptual framework; 2) describe relevant factors for administering the interview with adolescents; 3) review potential limitations regarding use of the EDE with adolescents; 4) address considerations for using the EDE with pertinent subpopulations of adolescents who may experience distinct eating disorder symptoms and/or risk factors; and 5) discuss the integration of self-report questionnaires with the EDE. Advantages of using the EDE include the ability for interviewers to clarify complex concepts and mitigate inattentive responding, enhanced orientation to the interview timeframe to improve recall, increased diagnostic accuracy compared to questionnaires, and accounting for potentially salient external factors (eg, food/eating rules imposed by a parent/guardian). Limitations include more extensive training requirements, greater assessment burden, variable psychometric performance across subgroups, lack of items evaluating muscularity-oriented symptoms and avoidant/restrictive food intake disorder diagnostic criteria, and lack of explicit consideration for salient risk factors other than weight and shape concerns (eg, food insecurity).

Associations between mukbang viewing and disordered eating behaviors

OBJECTIVE

Mukbang videos are a popular cultural phenomenon that often feature a host consuming large amounts of food to entertain an audience. We aim to examine the relationship between mukbang viewing characteristics and eating disorders symptoms.

METHODS

Eating disorder symptoms were evaluated using the eating disorders examination-questionnaire. Frequency of mukbang viewing, average watch time per occasion, tendency to eat while watching mukbang, and problematic mukbang viewing (using the Mukbang Addiction Scale) were assessed. We used multivariable regressions to estimate associations between mukbang viewing characteristics and eating disorder symptoms, adjusting for gender, race/ethnicity, age, education, and BMI. We used social media to recruit adults who watched mukbang at least once during the past year (n = 264).

RESULTS

A total of 34% of participants reported watching mukbang daily or almost daily, with mean watch time per viewing session being 29.94 min (SD = 1.00). Eating disorder symptoms, especially binge eating and purging, were associated with greater problematic mukbang viewing and a tendency to not consume food while viewing mukbang. Participants with greater body dissatisfaction watched mukbang more frequently and were more likely to eat while watching mukbang, yet they scored lower on the Mukbang Addiction Scale and watched fewer average minutes of mukbang per viewing occasion.

DISCUSSION

In a world increasingly penetrated by online media, our findings linking mukbang viewing and disordered eating may inform clinical diagnoses and treatments of eating disorders. Future studies establishing directionality of the relationship between mukbang viewing behaviors and eating disorder pathology are warranted.

PUBLIC SIGNIFICANCE

Mukbang videos often feature a host consuming large amounts of food. Using a questionnaire assessing mukbang viewing behaviors and disordered eating pathology, we found associations between certain viewing habits and disordered eating symptoms. Given the health consequences of eating disorders and potentially problematic consequences of certain online media, this study can inform clinical understanding of individuals with disordered eating who engage in certain online media, like mukbang.

The relationship between food and cooking skills, and eating behaviors in people with overweight or obesity

BACKGROUND

In the present study, the authors aimed to determine food skills and cooking skills, and eating behaviors, and to evaluate the relationship between food skills and cooking skills, and eating behaviors in people with overweight or obesity.

METHODS

This cross-sectional study was conducted with 185 people with overweight or obesity. The researchers collected the study data using the face-to-face interview method through a questionnaire including the Descriptive Information Form, Cooking Skills and Food Skills Scale, and Three-Factor Eating Questionnaire-R21. Numbers, percentages, arithmetic mean, standard deviation, Student's t-test, Pearson Chi-Square test, and multiple linear regression analysis were used in the analysis of the data.

RESULTS

The mean scores of the individuals obtained from the overall Cooking Skills and Food Skills Scale, and cooking skills, food skills, uncontrolled eating, cognitive restraint, and emotional eating sub-dimensions were 148.17 ± 52.20, 70.45 ± 27.48, 77.84 ± 28.90, 43.90 ± 22.74, 36.95 ± 23.93, and 38.94 ± 29.17 respectively. Multiple linear regression was fitted to determine the association between food skills and cooking skills and eating behaviors while adjusting for sociodemographic and health-related characteristics. Food skills and cooking skills were positively associated with uncontrolled eating (β = 0.213, p = 0.030), cognitive restraint (β = 0.245, p = 0.009), and emotional eating behaviors (β = 0.338, p = 0.001).

CONCLUSION

In people with overweight or obesity, cognitive restraint and emotional eating behaviors improve as their food preparation and cooking skills improve. Therefore, education and public health practices on eating awareness, food skills, and cooking skills can play an important role in bringing healthy behavior change into practice in society.

Exploration of Perceived Determinants of Disordered Eating Behaviors in People with Mental Illness-A Qualitative Study

Disordered eating behaviors are common in people with a serious mental illness (SMI) such as schizophrenia, bipolar disorder and major depressive disorder. This study employed qualitative exploration to understand the perceived determinants of eating behaviors, in particular those connected to disordered eating patterns, in people with SMI. In total, 28 semi-structured interviews were conducted in a consecutive sample of people with SMI under treatment in local mental health services in Australia (n = 12), Germany (n = 8) and Austria (n = 8) (mean age: 43.3 years, proportion of female participants: 61%, proportion of participants with ICD-10 F2 diagnosis: 57%, proportion of participants with ICD-10 F3 diagnosis: 64%). A thematic analysis approach, the framework method, was applied using MAXQDA 2020. Three main themes of determinants were derived: (i) impacts to daily functioning, (ii) disrupted physical hunger cues and (iii) emotional hunger. For impacts to daily functioning, the following themes emerged: lack of daily structure, time and drive, and difficulty planning ahead. For physical hunger, themes emerged for disrupted hunger and satiety cues, and mindless eating. All motives listed in the Palatable Eating Motives Scale (PEMS), i.e., coping, reward, social and conformity, have been reported by participants to be drivers for their emotional eating behavior. Subsequent reported behaviors were eating too much or too little, binge eating, night eating and food cravings. We conclude that interprofessional approaches should target daily functioning, disrupted physical hunger cues and emotional eating to reduce disordered eating behaviors in people with SMI.

Anxiety is more related to inadequate eating habits in inactive than in physically active adults during COVID-19 quarantine

Background & aims

Anxiety can be related to reduced diet quality during pandemics such as COVID-19. However, it is not clear whether these relationships would be similar in inactive and physically active participants. The aim of this study was to analyze associations between anxiety and eating habits in physically active and inactive individuals during the COVID-19 pandemic.

Methods

The sample consisted of 1826 adults (58.5% women) who were invited through social media to answer an online questionnaire. The instrument included questions related to physical activity, eating habits, health behavior, mental health (anxiety, depression, self-esteem, sadness and stress) and overall health. Anxiety, food habits (high food habits consumption ≥5 times per week) and physical activity (≥150 min per week) were assessed during the COVID-19 pandemic. The relationship between anxiety and eating habits according to levels of physical activity (inactive vs. active) was assessed using binary logistic regression adjusted for sex, age, education level, social isolation, and body mass index.

Results

Among the inactive participants, anxiety was related with high consumption of sweets (OR = 1.43; 95% CI = 1.11–1.83) and fast foods (OR = 2.23; 95% CI = 1.05–4.74) while quarantining during the COVID-19 pandemic. No relationship was observed between anxiety and food consumption among physically active participants in the final model.

Conclusion

Anxiety was associated with less desirable eating habits among physically inactive adults during the COVID-19 pandemic.

Behavioral Symptomatology in the Premenstruum

OBJECTIVE

Sleep and eating behaviors are disturbed during the premenstrual phase of the menstrual cycle in a significant number of reproductive-age women. Despite their impact on the development and control of chronic health conditions, these behaviors are poorly understood. In the present study, we sought to identify affective and psychological factors which associate with premenstrual changes in sleeping and eating behaviors and assess how they impact functionality.

METHODS

Fifty-seven women provided daily ratings of premenstrual symptomatology and functionality across two-three menstrual cycles (156 cycles total). For each participant and symptom, we subtracted the mean day +5 to +10 ("post-menstruum") ratings from mean day -6 to -1 ("pre-menstruum") ratings and divided this value by participant- and symptom-specific variance. We completed the statistical analysis using multivariate linear regression.

RESULTS

Low interest was associated with a premenstrual increase in insomnia (p ≤ 0.05) and appetite/eating (p ≤ 0.05). Furthermore, insomnia was associated with occupational (p ≤ 0.001), recreational (p ≤ 0.001), and relational (p ≤ 0.01) impairment.

CONCLUSIONS

Results of the present analysis highlight the importance of apathy (i.e., low interest) on the expression of behavioral symptomatology, as well as premenstrual insomnia on impairment. These findings can inform treatment approaches, thereby improving care for patients suffering from premenstrual symptomatology linked to chronic disease conditions.

Considerations for health and food choice in adolescents

The aim of this review is to summarise the common barriers and motivations for healthy food choice among adolescents, with a specific focus on the Irish context where available. It will also discuss other concerns adolescents have, which may influence their food choices and eating habits. Adolescence represents a period of rapid physical, mental and social development, and many health-related habits developed during adolescence tend to persist into adulthood, making the teenage years an optimal time to encourage healthy eating and health-promoting behaviours. Adolescents are concerned about the health impact of their diet, but their understanding of health is often seen in the context of their physical appearance or body image. Body image concerns are prevalent in adolescents, and this can affect their food choices. Taste, price and convenience are commonly noted factors influencing adolescents' food choices, and as they grow, their level of independence increases and spending more time with their peers means that social desirability and social norms about food become increasingly important factors in adolescent food choice. However, their limited autonomy means their supporting food environment also plays an important role. When developing more targeted interventions in adolescent populations, information on adolescent nutrition needs, their concerns for health and body image, and the barriers and motivations for healthy eating and food choice should be considered. Such a holistic approach should help support healthy eating and the prevention of overweight and obesity in the population, whilst also supporting a healthy relationship with food and their bodies.

Weight Goals, Disordered Eating Behaviors, and BMI Trajectories in US Young Adults

BACKGROUND

Community sample data indicate that weight control efforts in young adulthood may have associations with greater increases in body mass index (BMI) over time.

OBJECTIVE

To determine the prospective associations between weight goals and behaviors in young adults and BMI trajectories over 15-year follow-up using a nationally representative sample.

DESIGN

Longitudinal cohort data collected from 2001 to 2018 of the National Longitudinal Study of Adolescent to Adult Health.

PARTICIPANTS

Young adults aged 18-26 years old at baseline stratified by gender and BMI category.

MAIN MEASURES

Predictors: weight goals, any weight loss/maintenance behaviors, dieting, exercise, disordered eating behaviors.

OUTCOMES

BMI at 7- and 15-year follow-up.

KEY RESULTS

Of the 12,155 young adults in the sample (54% female, 32% non-White), 33.2% reported a goal to lose weight, 15.7% to gain weight, and 14.6% to maintain weight. In unadjusted models, all groups have higher mean BMI at 7- and 15-year follow-up. In mixed effect models, goals to lose weight in men with BMI < 18.5 (5.94 kg/m²; 95% CI 2.58, 9.30) and goals to maintain weight in men with BMI ≥ 25 (0.44; 95% CI 0.15, 0.72) were associated with greater BMI increase compared to no weight goal. Engaging in disordered eating behaviors was associated with greater BMI increase in men with BMI < 18.5 (5.91; 2.96, 8.86) and women with 18.5 ≤ BMI < 25 (0.40; 0.16, 0.63). Dieting (- 0.24; - 0.41, - 0.06) and exercise (- 0.31; - 0.45, - 0.17) were associated with lower BMI increase in women with 18.5 ≤ BMI < 25. In women with BMI < 18.5, dieting was associated with greater BMI increase (1.35; 0.33, 2.37).

CONCLUSIONS

Weight control efforts may have variable effects on BMI over time by gender and BMI category. These findings underscore the need to counsel patients on the effectiveness of weight control efforts and long-term weight management.

Body dissatisfaction and disordered eating are prevalent problems among U.S. young people from diverse socioeconomic backgrounds: Findings from the EAT 2010-2018 study

PURPOSE

Body dissatisfaction and disordered eating are linked to adverse health consequences. Research describing socioeconomic patterns in the prevalence of these problems is important for informing the design of health services and efforts to improve health equity.

METHODS

Population-based cohort study (EAT 2010-2018: Eating and Activity over Time) of socioeconomically and ethnically/racially diverse U.S. young people who completed surveys as adolescents in 2009-2010 (mean age = 14.5 years) and as emerging adults in 2018 (mean age = 22.0 years). Participants were recruited from 20 schools in Minneapolis-St. Paul, Minnesota. Household socioeconomic status was determined using adolescent report of parental education, employment, and public assistance benefits. Analyses were conducted using data from 1531 participants and regression models that accounted for repeated measures within individuals.

RESULTS

Among females, high body dissatisfaction and unhealthy weight control behaviors (e.g., skipping meals) were more prevalent and regular use of lifestyle weight management behaviors (e.g., exercise) was less prevalent in the low SES group as compared to the middle and/or upper SES groups (p ≤ .010). Among males, thinness-oriented dieting, unhealthy weight control behaviors, and extreme weight control behaviors (e.g., taking diet pills) were all more prevalent in the low SES group as compared to the middle and/or upper SES groups (p ≤ .010). Few differences were observed across SES groups in models that adjusted for ethnic/racial identity and body mass index.

CONCLUSIONS

There is a need for greater attention to the reach and relevance of efforts to prevent disordered eating and improve body satisfaction to ensure efforts benefit young people across SES groups.

Prevalence and demographic, substance use, and mental health correlates of fasting among U.S. college students

BACKGROUND

Fasting is an unhealthy behavior that has been frequently used as part of weight loss attempts. To date, little research has been conducted to determine the prevalence and substance use and mental health correlates of fasting among college students. Therefore, the aim of this study was to estimate the prevalence and associations between any (≥ 1 time) and regular (≥ 13 times) occurrences of fasting in the past 4 weeks and substance use and mental health correlates among a large sample of college students from 2016 to 2020.

METHODS

Data from four academic survey years (2016-2020; N = 8255) of the national (USA) Healthy Minds Study were analyzed. Unadjusted prevalence of any and regular fasting by survey year and gender was estimated. Multiple logistic regression analyses were conducted to estimate the associations between any and regular fasting and the demographic (age, body mass index, race/ethnicity, sexual orientation, highest parental education), substance use (cigarette use, marijuana use, other illicit drug use, alcohol use), and mental health (depression, anxiety, eating disorder symptoms, suicidal ideation, non-suicidal self-injury) correlates.

RESULTS

Any fasting in the past 4 weeks was common among both men (14.77%) and women (18.12%) and significantly increased from 2016 (10.30%) to 2020 (19.81%) only among men. Regular fasting significantly increased among both men and women from 2016 (men: 1.46%; women: 1.79%) to 2020 (men: 3.53%; women: 6.19%). Among men and women, both any and regular fasting in the past 4 weeks were associated with higher odds of all mental health symptoms, including a positive depression, anxiety, and eating disorder screen, suicidal ideation, and non-suicidal self-injury. Among women, but not men, any and regular fasting in the past 4 weeks were associated with higher odds of marijuana use and other illicit drug use (e.g., cocaine, ecstasy).

CONCLUSIONS

The results from this study underscore both the high and increasing prevalence of fasting among a national sample of college students, as well as the substance use and mental health symptoms associated with this behavior. Healthcare professionals both on and off campus should consider screening for fasting behaviors among college students and provide appropriate intervention when needed.

Revictimization Is Associated With Higher Cardiometabolic Risk in Sexual Minority Women

OBJECTIVES

Although there is evidence that interpersonal trauma is associated with cardiometabolic risk in women, previous studies have not assessed the potential role of revictimization (victimization in both childhood and adulthood) among sexual minority women.

METHODS

We used data from the Chicago Health and Life Experiences of Women study to examine the associations of revictimization (including physical, sexual, and any revictimization) with self-reported psychosocial factors, health behaviors, and cardiometabolic risk factors (e.g., obesity, hypertension, and diabetes). We tested multiple logistic regression models, adjusted for covariates, to estimate odds ratios of the associations between revictimization and cardiometabolic risk.

RESULTS

The sample included 615 sexual minority women with a mean age of 40.0 years; 38.7% White. Eighty-three (13.5%) and 101 (16.4%) participants reported experiencing sexual revictimization and physical revictimization, respectively. Each form of revictimization was associated with higher odds of reporting lifetime depression and recent binge eating, but lower odds of having high social support. Physical revictimization was associated with higher odds of obesity (adjusted odds ratio [AOR], 2.38; 95% confidence interval [CI], 1.38-4.10) and hypertension (AOR, 3.31; 95% CI, 1.70-6.46). Similarly, participants who reported any revictimization were more likely to have obesity (AOR, 2.36; 95% CI, 1.42-3.92) and hypertension (AOR, 2.60; 95% CI, 1.31-5.26). No form of revictimization was associated with a higher odds of diabetes.

CONCLUSIONS

The higher odds of obesity and hypertension observed among sexual minority women who reported revictimization reinforce the need for early interventions to reduce cardiometabolic risk in this vulnerable population.

Body Weight Perception and Health-Related Behaviors Among U.S. Adolescents: Mediating Effects of Body Weight Control Behaviors

This study examined mediating effects of body weight control behaviors in the relationship between body weight perception and health-related behaviors among 11,458 U.S. adolescents from the 2010 National Youth Physical Activity and Nutrition Survey. Parallel multiple mediation analysis was performed for the secondary data analysis. Nearly one third of adolescents (32.5%) had overweight or obesity; one quarter (25.0%) perceived themselves as slightly overweight and 5.1% thought they were very overweight. More girls (58.6%) had tried to lose weight than boys (32.3%), while boys were more physically active than girls. Healthy and unhealthy weight control behaviors significantly mediated the relationship between adolescents' body weight perception and health-related behaviors (physical activity and screen time). Teachers and parents should help adolescents have accurate weight perception and utilize reliable and healthy weight control strategies. Future studies should consider the intercorrelated relationships among adolescents' perceptions and behaviors regarding weight to provide successful weight control intervention programs.

Associations between Adverse Childhood Experiences and Performance-Enhancing Substance Use among Young Adults

BACKGROUND AND OBJECTIVE

Adverse childhood experiences (ACEs) are associated with negative health outcomes, yet their associations with performance-enhancing substance (PES) use are unclear. This study aimed to determine whether ACEs predict greater use of legal and illegal PES in young adults.

METHODS

We analyzed data from the National Longitudinal Study of Adolescent to Adult Health (n = 14,322), Waves I (1994-1995) and III (2001-2002). ACEs included childhood sexual abuse, physical abuse, two neglect indicators, and cumulative ACEs. Legal (e.g. creatine monohydrate) and illegal (e.g. non-prescription anabolic-androgenic steroids; AAS) PES use was assessed.

RESULTS

Sexual abuse had the greatest effect and predicted higher odds of legal PES use (men: adjusted odds ratio [AOR] 1.66, 95% confidence interval [CI] 1.06-2.59; women: AOR 3.74, 95% CI 1.63-8.59) and AAS use (men: AOR 8.89, 95% CI 5.37-14.72; women: AOR 5.73, 95% CI 2.31-14.18). Among men, a history of physical abuse (AOR 3.04, 95% CI 2.05-4.52), being left alone by a parent/guardian (AOR 2.33, 95% CI 1.50-3.60), and basic needs not being met (AOR 3.47, 95% CI 2.30-5.23) predicted higher odds of AAS use. Among women, basic needs not being met (AOR 2.94, 95% CI 1.43-6.04) predicted higher odds of AAS use. Among both men and women, greater number of cumulative ACEs predicted higher odds of both legal and illegal PES use.

CONCLUSIONS

ACEs predict greater PES use among young adults. Clinicians should monitor for PES use among those who have experienced ACEs and provide psychoeducation on the adverse effects associated with PES use.

Associations between weight talk exposure and unhealthy weight control behaviors among young adults: A person-centered approach to examining how much the source and type of weight talk matters

This study characterized common patterns of weight talk and examined associations with unhealthy weight control behaviors (UWCBs) in young adults. Participants (n = 1298) were from EAT 2018 (Eating and Activity Over Time), a population-based study of emerging adults (mean age = 22.2; 53.6 % women). Latent class analyses (LCA) derived classes based on weight talk exposure for men and women. Generalized linear models examined the association between weight talk classes and extreme/less extreme UWCBs. LCA results revealed 4 patterns of weight talk exposure among young adult women: minimal weight talk (38.8 %), peer weight talk (35.2 %), multi-source weight talk (13.5 %), and parental weight talk (12.6 %). Three classes emerged among men: minimal weight talk (44.0 %), peer weight talk (29.7 %), and multi-source weight talk (26.3 %). Among young adult women, the parental weight talk class reported the highest levels of extreme and less extreme UWCBs. Among young adult men, the multi-source weight talk class reported the highest levels of less extreme UWCBs. Results provide evidence regarding the importance of parental weight talk, even among young adult children, whether or not parental weight talk is accompanied by peer weight talk. Parents have the potential to improve their young adults' weight-related behaviors through avoiding weight talk.

Self-reported eating disorders and sleep disturbances in young adults: a prospective cohort study

PURPOSE

To evaluate the prospective association between eating disorders, disordered eating behaviors, and sleep disturbances in young adults.

METHODS

We used prospective cohort data of young adults aged 18-26 from the National Longitudinal Study of Adolescent to Adult Health (N = 12,082). Self-reported exposures of interest (at 18-26 years) included (1) an eating disorder diagnosis proxy; disordered eating behaviors such as (2) restrictive eating behaviors including fasting/skipping meals, (3) compensatory behaviors including vomiting, laxatives/diuretics, or weight loss pills; and (4) loss of control/overeating. Self-reported sleep disturbances at 7-year follow-up included trouble falling or staying asleep.

RESULTS

In negative binomial regression models, all four exposures predicted both sleep disturbance outcomes at 7-year follow-up, when adjusting for demographic covariates and baseline sleep disturbances. When additionally adjusting for baseline depressive symptoms, the associations between eating disorder diagnosis proxies and trouble falling (incidence rate ratio [IRR] 1.24; 95% CI 1.05-1.46) and staying (IRR 1.16; 95% CI 1.01-1.35) asleep remained statistically significant; however, the associations between eating behaviors and sleep disturbances were attenuated.

CONCLUSIONS

Eating disorders in young adulthood predict sleep disturbances at 7-year follow-up. Young adults with eating disorders or who engage in disordered eating behaviors may be assessed for sleep disturbances.

LEVEL III

Evidence obtained from well-designed cohort or case-control analytic studies.

Yoga practice among ethnically/racially diverse emerging adults: Associations with body image, mindful and disordered eating, and muscle-enhancing behaviors

BACKGROUND

This study explores cross-sectional associations between yoga and body image, mindful eating, disordered eating, and muscle-enhancing behaviors among a population-based sample of ethnically/racially diverse emerging adults.

METHOD

An ethnically/racially diverse population-based sample of 1,568 emerging adults (18-26 years) completed surveys as part of EAT 2010-2018 (Eating and Activity over Time). Models were adjusted for sociodemographic characteristics and body mass index (BMI).

RESULTS

Practicing yoga at least 30 min/week was reported by 12.7% (n = 210) of the sample. Yoga practitioners had higher levels of mindful eating than those not practicing yoga. Although effect sizes were small, yoga practitioners were more likely than non-yoga practitioners to use steroids (3.8 vs. 0.7%, p < .001, h = 0.22) or protein powder/shakes (35.1 vs. 25.3%, p < .010, h = 0.21) to increase their muscle size/tone. Body satisfaction, unhealthy weight control behaviors, and binge eating tended to be similar among yoga practitioners and non-yoga practitioners. There was a significant interaction between BMI and yoga in predicting body satisfaction with a trend toward a positive impact among yoga practitioners at higher BMI values. Interactions between yoga practice and all body image attitudes and behaviors across gender and ethnicity/race were not statistically significant.

DISCUSSION

Young people from diverse ethnic/racial backgrounds who practice yoga are more likely to engage in mindful eating but have equal or elevated levels of unhealthy body image attitudes and behaviors as compared to non-yoga practitioners. Further research should explore how yoga is best taught and practiced to ensure that it is beneficial for body image and related behaviors.

Demographic, Anthropometric and Food Behavior Data towards Healthy Eating in Romania

Background: Each country has specific social, cultural, and economic characteristics regarding the motivations for improving health. The aim of this study was to evaluate demographic characteristics, anthropometric data, and elements related to food behavior and health, as well as Romanians’ motivations towards healthy eating. Methods: This is a descriptive cross-sectional questionnaire based study enrolling 751 Romanian participants, which was carried out in in 2017–2018. Results: We obtained a positive correlation between age and Body Mass Index, and this was maintained also when we analyzed the two genders separately, being, however, even stronger for women. The number of hours/day spent watching TV or in front of the computer was positively correlated with both age and BMI. In general, with aging, there is an increasing concern regarding the practice of a healthy diet. The higher education level was significantly associated with healthier choices. Conclusions: The study of the three dietary dimensions, food properties, health attitudes, and dietary behavior, vis-à-vis various disorders revealed that the group most concerned of their diet was those who suffered from cardiovascular disorders.

Understanding eating and drinking behaviours in Pakistani university students: A conceptual model through qualitative enquiry

Excess weight in Pakistan's university students is on the rise and is driven by their maladaptive eating behaviours. Practitioners in Pakistan have adopted Western conceptual models to understand obesogenic eating behaviours. However, these models provide incomplete explanations as they miss important culturally specific determinants for such eating behaviours. The goals of this study were two-fold: first, to explore Pakistani university students' perception of their obesity-related eating behaviours and attitudes; second, to develop a culturally sensitive model of obesogenic eating behaviours in university students from Pakistan. Semi-structured interviews were used with twenty-four Pakistani university students who were categorised as obese using the Body Mass Index according to Asia-Specific cut-offs. Interviews were transcribed, translated, and then analysed through a Grounded Theory methodology. Six major categories emerged from interviews: (1) Obesogenic Eating Habits (Social Eating, Emotional Eating, and Eating Whatever and Whenever You Want); (2) Beliefs about Food in the Culture; (3) Neither Too Fat nor Too Thin body belief (4) Student Life Attitudes; (5) Student Stressors; (6) Inconsistent Weight-Control Strategies. A model was developed with cultural beliefs about food, attitudes towards student-life, and stressors as important determinants of students' obesogenic eating habits, while inconsistent weight-control strategies contributed to further weight gain. The findings highlight the importance of identifying culturally specific determinants of eating behaviours among university students in Pakistan. This emerging model can be used to guide the development of future quantitative and also longitudinal studies aimed at identifying targets for therapeutic interventions to manage obesogenic eating behaviours in Pakistani university students.

Eating patterns and unhealthy weight control behaviors are associated with loss-of-control eating following bariatric surgery

BACKGROUND

Loss-of-control (LOC) eating is associated with poor weight-loss outcomes following bariatric surgery. It is not clear whether eating patterns (e.g., total number of daily meals/snacks, eating after suppertime, eating when not hungry) and unhealthy weight control behaviors (e.g., smoking, using laxatives) are associated with or predictive of LOC eating.

OBJECTIVES

To examine whether eating patterns and unhealthy weight-control behaviors are associated with LOC eating and, if so, whether they predict LOC eating in bariatric patients.

SETTING

Multicenter study, United States.

METHODS

This is a secondary analysis of the Longitudinal Assessment of Bariatric Surgery-2 study. Assessments were conducted before surgery and at 12, 24, 36, 48, 60, and 84 months after surgery. Logistic mixed models were used to examine the longitudinal associations between eating patterns, unhealthy weight-control behaviors, and LOC eating. Time-lag techniques were applied to examine whether the associated patterns and behaviors predict LOC eating.

RESULTS

The participants (n = 1477) were mostly women (80%), white (86.9%), and married (62.5%). At the time of surgery, the mean age was 45.4 ± 11.0 years and the mean body mass index was 47.8 ± 7.5 kg/m². The total number of daily meals/snacks, food intake after suppertime, eating when not hungry, eating when feeling full, and use of any unhealthy weight-control behaviors were positively associated with LOC eating (P < .05). Food intake after suppertime, eating when not hungry, and eating when feeling full predicted LOC eating (P < .05).

CONCLUSION

Meal patterns and unhealthy weight control behaviors may be important intervention targets for addressing LOC eating after bariatric surgery.

Associations between legal performance-enhancing substance use and future cardiovascular disease risk factors in young adults: A prospective cohort study

BACKGROUND

Legal performance-enhancing substances (PES), such as creatine, are commonly used by adolescents and young adults. As PES are mostly unregulated by the US Food and Drug Administration, there has been limited empirical attention devoted to examining their long-term safety and health outcomes. Preliminary studies have demonstrated associations between PES use and severe medical events, including hospitalizations and death. PES could be linked to cardiovascular disease (CVD), the most common cause of mortality in the US, by altering the myocardium, vasculature, or metabolism. The objective of this study was to examine prospective associations between the use of legal PES in young adulthood and CVD risk factors at seven-year follow-up.

MATERIALS AND METHODS

Nationally representative longitudinal cohort data from the National Longitudinal Study of Adolescent to Adult Health, Waves III (2001-2002) and IV (2008), were analyzed. Regression models determined the prospective association between the use of legal PES (e.g. creatine monohydrate) and CVD risk factors (e.g. body mass index, diabetes, hypertension, hyperlipidemia), adjusting for relevant covariates.

RESULTS

Among the diverse sample of 11,996 male and female participants, no significant differences by PES use in body mass index, diabetes, hypertension, or hyperlipidemia were noted at Wave III. In unadjusted comparisons, legal PES users (versus non-users) were more likely to be White, be male, be college educated, drink alcohol, and engage in weightlifting, exercise, individual sports, team sports, and other strength training. There were no significant prospective associations between legal PES use at Wave III and body mass index, hemoglobin A1c, systolic and diastolic blood pressure, and cholesterol (total, HDL, LDL, triglycerides) deciles at seven-year follow-up (Wave IV), adjusting for demographics, health behaviors, and Wave III CVD risk factors. Similarly, there were no significant prospective associations between legal PES use and diabetes, hypertension, or hyperlipidemia based on objective measures or self-reported medications and diagnoses, adjusting for demographics, health behaviors, and Wave III CVD risk.

CONCLUSIONS

We do not find evidence for a prospective association between legal PES use and CVD risk factors in young adults over seven years of follow-up, including BMI, diabetes, hypertension, or hyperlipidemia. It should be noted that legal PES use was operationalized dichotomously and as one broad category, which did not account for frequency, amount, or duration of use. Given the lack of regulation and clinical trials data, observational studies can provide much needed data to inform the safety and long-term health associations of legal PES use and, in turn, inform clinical guidance and policy.

Psychometric properties of the Japanese version of the Dutch Eating Behavior Questionnaire for Children

This study aimed to evaluate the psychometric properties of the 20-item Japanese version of the Dutch Eating Behavior Questionnaire for Children (DEBQ-C). A population-based sample of 502 Japanese school children who were fifth- and sixth-graders in elementary schools and first- and second-graders in junior high schools was assessed. A sample was randomly split into two subsamples, one for exploratory factor analysis (EFA) and another for confirmatory factor analysis (CFA). Internal consistency estimates for subscales (restrained, emotional, and external) were evaluated using Cronbach's alpha. Measurement invariance was examined across each subgroup (genders: boys and girls, school categories: elementary school and junior high school, body mass index (BMI) categories: underweight, normal weight, and overweight) by using multi-group CFA. The Japanese version of the DEBQ-C demonstrates good results of item analysis. The three-factor structure of the original DEBQ-C was supported by both EFA and CFA. The reliability of each factor was also satisfied (restrained: α = 0.86, emotional: α = 0.90, external: α = 0.86). Results of multi-group confirmatory factor analysis supported its metric and scalar or partial scalar measurement invariance across all subgroups. In gender subgroup, girls scored higher on restrained eating. In school subgroup, junior high school children scored higher on emotional and external eating. In BMI subgroup, overweight children scored higher on restrained eating. These findings suggest that the Japanese version of the DEBQ-C is a psychometrically valid and reliable instrument for assessing eating behaviors across gender, school categories, and BMI categories in Japanese children.

Eating disorders in adolescent boys and young men: an update

PURPOSE OF REVIEW

To review the recent literature on eating disorders and disordered eating behaviors among adolescent boys and young men, including epidemiology, assessment, medical complications, treatment outcomes, and special populations.

RECENT FINDINGS

Body image concerns in men may involve muscularity, and muscle-enhancing goals and behaviors are common among adolescent boys and young men. Recent measures, such as the Muscularity Oriented Eating Test (MOET) have been developed and validated to assess for muscularity-oriented disordered eating. Medical complications of eating disorders can affect all organ systems in male populations. Eating disorders treatment guidance may lack specificity to boys and men, leading to worse treatment outcomes in these population. Male populations that may have elevated risk of eating disorders and disordered eating behaviors include athletes and racial/ethnic, sexual, and gender minorities.

SUMMARY

Eating disorders and disordered eating behaviors in boys and men may present differently than in girls and women, particularly with muscularity-oriented disordered eating. Treatment of eating disorders in boys and men may be adapted to address their unique concerns.

Prevalence and correlates of muscle-enhancing behaviors among adolescents and young adults in the United States

OBJECTIVES

To determine the prevalence of muscle-enhancing behaviors in adolescents and young adults using a nationally representative sample in the USA and to examine differences by sex, race/ethnicity, age, socioeconomic status, body mass index, and participation in team sports.

METHODS

Prospective cohort data from the National Longitudinal Study of Adolescent to Adult Health, Waves I through III (1994-2002) were analyzed. Engagement in muscle-enhancing behaviors including dietary changes, exercise and weightlifting, supplement use, performance-enhancing substances, and anabolic androgenic steroids were recorded. Multiple logistic regression models using generalized estimating equations, incorporating robust standard errors with clustering by school and within persons, and using national sample weighting, were used to determine associations with muscle-enhancing behaviors across three data collection waves.

RESULTS

Of the 18,924 adolescents at baseline, 29.2% of males and 7.0% of females reported weight gain attempts, while 25.2% of males and 3.8% of females reported any muscle-enhancing behavior. All muscle-enhancing behaviors were more common in males compared to females (p<0.001). Among young men 18-26 years old, 15.6% reported using legal performance enhancing substances and 2.7% reported using androgenic anabolic steroids. Factors that were associated with muscle-enhancing behaviors in males across three data collection waves included Black or Hispanic/Latino race/ethnicity, age over 14 years, higher parental education, lower body mass index, and participation in team sports.

CONCLUSIONS

Muscle-enhancing behaviors ranging from dietary changes to supplement and androgenic anabolic steroid use are common among adolescent and young adult males. Clinicians should consider screening for muscle-enhancing behaviors in these populations.

Binge Eating Disorder in Patients with Type 2 Diabetes: Diagnostic and Management Challenges

Type 2 diabetes mellitus (T2DM) is associated with an increased risk of disordered eating behaviors including binge eating disorder (BED). Comorbid BED in patients with T2DM has been associated with adverse clinical outcomes such as higher body mass index (BMI) and depressive symptoms. Identifying and addressing this disorder in patients with T2DM is a significant challenge for health-care providers. The purpose of this narrative review is to discuss current perspectives on BED in the context of T2DM with implications for screening and management of these highly comorbid conditions. BED continues to be underrecognized and underdiagnosed. However, there are established tools that providers can use to screen for BED such as the SCOFF Questionnaire and Questionnaire on Eating and Weight Patterns-5. There are several effective treatments for BED including cognitive behavioral therapy, interpersonal therapy, and lisdexamfetamine dimesylate. However, few studies have examined the effects of these treatments in patients with co-morbid T2DM and BED.

Obesity is associated with poor working memory in women, not men: Findings from a nationally representative dataset of U.S. adults

A growing body of research has linked obesity to lower working memory performance. However, sex differences are often found in associations between obesity and cognition, and little work has examined potential sex differences in the association between obesity and working memory. To address this issue, the present research uses data from Wave IV of The National Longitudinal Study of Adolescent to Adult Health (N = 4,769, mean age = 29) to examine whether sex moderated the association between excess weight and working memory. As expected, we found that obesity was associated with poorer working memory, but-importantly-this association was exclusively seen in women, not men. These results held when treating BMI as a continuous or categorical variable (e.g., normal weight, obese), as well as with and without controlling for covariates. The present results therefore indicate that the association between obesity and poorer working memory performance may be sex-dependent. These results suggest that interventions targeted at reducing obesity should be tailored to an individual's sex, as adherence to these interventions often requires working memory.

Predictors of muscularity-oriented disordered eating behaviors in U.S. young adults: A prospective cohort study

OBJECTIVE

To determine adolescent predictors of muscularity-oriented disordered eating behaviors in young men and women using a nationally representative longitudinal sample in the United States and to examine differences by sex.

METHOD

We used nationally representative longitudinal cohort data collected from baseline (11-18 years old, 1994-1995) and 7-year follow-up (18-24 years old, 2001-2002) of the National Longitudinal Study of Adolescent to Adult Health. We examined adolescent demographic, behavioral, and mental health predictors of young adult muscularity-oriented disordered eating behaviors defined as eating more or differently to gain weight or bulk up, supplements to gain weight or bulk up, or androgenic anabolic steroid use at 7-year follow-up.

RESULTS

Of the 14,891 included participants, 22% of males and 5% of females reported any muscularity-oriented disordered eating behavior at follow-up in young adulthood. Factors recorded at adolescence that were prospectively associated with higher odds of muscularity-oriented disordered eating in both sexes included black race, exercising to gain weight, self-perception of being underweight, and lower body mass index z-score. In addition, participation in weightlifting; roller-blading, roller-skating, skate-boarding, or bicycling; and alcohol among males and depressive symptoms among females during adolescence were associated with higher odds of muscularity-oriented disordered eating in young adulthood.

CONCLUSIONS

Interventions to prevent muscularity-oriented disordered eating behaviors may target at-risk youth, particularly those of black race or who engage in exercise to gain weight. Future research should examine longitudinal health outcomes associated with muscularity-oriented disordered eating behaviors.

Eating disorders and disordered eating behaviors among women: Associations with sexual risk

OBJECTIVE

To evaluate the association between eating disorders or disordered eating behaviors and sexual risk in young women.

METHOD

We used prospective cohort data of young women ages 18-26 years from the National Longitudinal Study of Adolescent to Adult Health (N = 5,899). Exposures of interest (at 18-26 years) included a self-reported eating disorder diagnosis or disordered eating behaviors including fasting/skipping meals, vomiting, diet pills, or laxative/diuretic use to lose weight and binge eating. Sexual risk outcomes at 7-year follow-up included the number of new sexual partners, condom use, and sexually transmitted infections.

RESULTS

Having either an eating disorder or reporting any disordered eating behavior was associated with a greater number of new sexual partners (B = 1.09, 95% CI [0.18, 2.00]) and lower odds of condom use (odds ratio 0.70, 95% CI [0.53, 0.94] among a subsample of sexually active, unmarried women).

DISCUSSION

Young women with eating disorders or who engage in disordered eating behaviors are at higher risk for multiple new sexual partners and unprotected sex. Clinicians caring for young adults with eating disorders may consider screening for sexual risk behaviors.

Association of anthropometric status, perceived stress, and personality traits with eating behavior in university students

PURPOSE

We investigated the association of anthropometric status, perceived stress, and personality traits with eating behavior in university students.

METHODS

The participants, 1546 Japanese university students (964 males, 582 females), completed a questionnaire which asked for their current height and weight, ideal height and weight, eating behaviors, perceived stress, and personality traits.

RESULTS

Restrained eating was higher in normal-weight participants compared with underweight participants in both males and females (p < 0.001, both males and females). Restrained eating in normal-weight males was significantly lower in normal-weight females (p < 0.001). In addition, normal-weight males reported less stress than normal-weight females (anxiety/uncertainty, p = 0.037; tiredness/physical responses, p < 0.001; autonomic symptoms, p < 0.001; depression/feeling, p < 0.001) and underweight males (tiredness/physical responses, p = 0.018; autonomic symptoms, p = 0.001). Moreover, among normal-weight males, neuroticism was significantly lower compared with normal-weight females (p < 0.001). In multiple regression analysis, male participants revealed positive association between restrained eating and body mass index (β = 0.199, p < 0.001) or body mass index difference (β = - 0.170, p = 0.001). In contrast, female revealed more significant associations between emotional and external eating and perceived stress or personality traits compared with males.

CONCLUSIONS

These results indicate that associations between eating behavior and anthropometric status or psychological factors are different by each eating behavior, which is partly influenced by gender difference.

LEVEL OF EVIDENCE

V, cross-sectional descriptive study.

Patterns of weight control behavior persisting beyond young adulthood: Results from a 15-year longitudinal study

OBJECTIVE

Dieting and unhealthy weight control behaviors have been associated with negative outcomes. Most research has examined the prevalence of these behaviors in adolescence and young adulthood. Less is known about whether they persist further into adulthood. We examined patterns of weight control behaviors beyond young adulthood using data from 1,455 males and females participating in Project EAT (Eating and Activity in Teens and Young Adults), a 15-year population-based, longitudinal study.

METHOD

Participants completed surveys assessing dieting, high-frequency dieting (i.e., 5+ times/year), unhealthy weight control (e.g., fasting), and extreme weight control (e.g., vomiting) at each 5-year assessment (Waves 1-4). Longitudinal logistic regression models tested trends in weight control behaviors across the waves. Likelihood of persisting or discontinuing each behavior from Wave 3 to Wave 4 was examined through cross tabulations.

RESULTS

Between Waves 3 and 4 in adulthood, dieting increased for both genders (Women: p < .001; Men: p = .004) and high-frequency dieting (p < .001) and unhealthy weight control behaviors (p = .011) increased for men. For both genders, dieting and unhealthy weight control patterns initiated in prior to young adulthood were more likely to persist than cease in adulthood (ps < .001).

DISCUSSION

Weight control behaviors continue to be prevalent in adulthood, and to especially increase among men. Research is needed to understand the consequences of weight control behaviors in different life stages; however, the results suggest that interventions to decrease unhealthy weight management practices may be needed well into adulthood.