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Lin CY, Latner JD, Rozzell-Voss KN, Huang PC, Tsai YC, Pakpour AH, Weng HC. Association of quality of life with internet use and weight stigma across individuals with obesity and those without obesity: Role of self-perception. Acta Psychol (Amst) 2024; 244:104203. [PMID: 38442432 DOI: 10.1016/j.actpsy.2024.104203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 02/12/2024] [Accepted: 02/28/2024] [Indexed: 03/07/2024] Open
Abstract
Weight status, weight stigma, and internet use are important factors impacting quality of life (QoL). However, little is known regarding how these factors interact in their association with QoL, and it is important to understand how self-perceived obesity and body mass index (BMI)-defined obesity may differentially impact QoL. We aimed to assess the associations between weight status (obesity vs. non-obesity, including both self-perceived and BMI-defined), weight stigma, internet use, and QoL. Cross-sectional data from the Taiwan Social Change Survey (N = 1604; mean age = 49.22; 52.93 % women) were used. All participants were classified as having obesity or not having obesity according to both self-perceived (self-perceived as 'too fat') and BMI-defined (≧27 kg/m2 as obesity) weight status. Results showed that the group with obesity (both BMI-defined and self-perceived) had significantly more internet time and lower physical QoL than the group without obesity. Those with self-perceived obesity, but not those with BMI-defined obesity, sought health information via the internet and used social media significantly more than the group without obesity. More internet time was associated with worse physical and mental QoL for the group with obesity regardless of BMI-defined or self-perceived status. Moreover, weight stigma was associated with worse mental QoL for the group with self-perceived obesity, but not for the group with BMI-defined obesity. Accordingly, being a person with obesity (self-defined, or based upon BMI) was associated with more internet time and poorer QoL. People with self-perceived obesity may have increased experience of weight stigma and greater internet use, factors that may contribute to their impaired QoL.
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Affiliation(s)
- Chung-Ying Lin
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Faculty of Health and Life Sciences, INTI International University, Nilai, Malaysia.
| | - Janet D Latner
- Department of Psychology, University of Hawaii, Honolulu, HI, USA.
| | | | - Po-Ching Huang
- School of Physical Therapy, Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Rd., Taoyuan 333323, Taiwan.
| | - Yu-Cheng Tsai
- Department of Pediatrics, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.
| | - Amir H Pakpour
- Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden.
| | - Hui-Ching Weng
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Barnhart WR, Cui T, Cui S, Ren Y, Ji F, He J. Exploring the prospective relationships between food addiction symptoms, weight bias internalization, and psychological distress in Chinese adolescents. Int J Eat Disord 2023; 56:2304-2314. [PMID: 37772767 DOI: 10.1002/eat.24066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 09/13/2023] [Accepted: 09/13/2023] [Indexed: 09/30/2023]
Abstract
OBJECTIVE Relationships exist between food addiction symptoms, weight bias internalization, and psychological distress, yet previous research is primarily cross-sectional with adults from Western contexts. We examined the prospective relationships between food addiction symptoms, weight bias internalization, and psychological distress in Chinese adolescents. METHODS Over three time points (Time 1, baseline; Time 2, 6-months; Time 3, 12-months) spanning 1 year, we examined cross-sectional and bi-directional relationships between food addiction symptoms, weight bias internalization, and psychological distress in Chinese adolescents (N = 589; aged 14-18 years at baseline). Pearson correlations and cross-lagged models examined the cross-sectional and longitudinal relationships between food addiction symptoms, weight bias internalization, and psychological distress. RESULTS Cross-sectional correlations suggested positive relationships between food addiction symptoms, weight bias internalization, and psychological distress at each time point. Regarding bi-directional relationships, higher psychological distress was associated with both higher weight bias internalization and higher food addiction symptoms at the following time points. However, food addiction symptoms and weight bias internalization were not prospectively associated. Time 2 psychological distress did not significantly mediate the relationship between Time 1 weight bias internalization and Time 3 food addiction symptoms. DISCUSSION Findings suggest no direct longitudinal link between food addiction symptoms and weight bias internalization and vice versa. However, findings do suggest that psychological distress is temporally associated with higher food addiction symptoms and weight bias internalization in Chinese adolescents. Targeting psychological distress may prove useful in treatments of food addiction symptoms and weight bias internalization in Chinese adolescents. PUBLIC SIGNIFICANCE Positive associations exist between food addiction symptoms, weight bias internalization, and psychological distress, but findings are largely cross-sectional and bound to adult populations from Western contexts. Using a longitudinal design in Chinese adolescents, findings suggested that baseline psychological distress was associated with higher food addiction symptoms and higher weight bias internalization at follow-up time points. Treatments targeting psychological distress may be helpful in reducing food addiction symptoms and weight bias internalization in Chinese adolescents.
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Affiliation(s)
- Wesley R Barnhart
- Department of Psychology, Bowling Green State University, Bowling Green, Ohio, USA
| | - Tianxiang Cui
- Department of Psychology, University of Macau, Taipa, Macau, China
| | - Shuqi Cui
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, China
| | - Yaoxiang Ren
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, China
| | - Feng Ji
- Department of Applied Psychology and Human Development, University of Toronto, Toronto, Ontario, Canada
| | - Jinbo He
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, China
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Liang G, Cheng Y, Barnhart WR, Song J, Lu T, He J. A network analysis of disordered eating symptoms, big-five personality traits, and psychological distress in Chinese adults. Int J Eat Disord 2023; 56:1842-1853. [PMID: 37337937 DOI: 10.1002/eat.24012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/07/2023] [Accepted: 06/05/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVE Previous studies have revealed associations between disordered eating symptoms, big-five personality traits, and psychological distress. However, limited research has explored these relationships as a network, including their interconnections, and even less has done so in non-Western populations. We employed network analysis to investigate the co-occurrence of disordered eating symptoms, big-five personality traits, and psychological distress in Chinese adults. METHOD A sample of 500 Chinese adults (256 men) completed measures assessing big-five personality traits, psychological distress, and disordered eating symptoms. The network of personality traits, psychological distress, and disordered eating symptoms was estimated, including its central and bridge nodes. RESULTS The central nodes in the network were the facets of openness (like adventure), extraversion (like going to social and recreational parties), and disordered eating symptoms (dissatisfaction with body weight or shape). Moreover, certain facets of neuroticism (always worrying something bad will happen), psychological distress (feeling worthless), and an inverse facet of extraversion (bored by parties with lots of people) were identified as essential bridge nodes in maintaining the structure of the network. CONCLUSION Our findings suggest that personality traits (e.g., openness and extraversion) and body dissatisfaction are important in maintaining the network in a community sample of Chinese adults. While future replication is needed, findings from this study suggest that individuals with negative self-thinking, predisposed neuroticism, and extraversion may be at risk of developing disordered eating symptoms. PUBLIC SIGNIFICANCE The present study contributes to existing knowledge by employing a network perspective to examine the associations between disordered eating symptoms, big-five personality traits, and psychological distress in a Chinese adult community sample. The identified facets of neuroticism and extraversion and symptoms of psychological distress may be worthy of targeting in the prevention and treatment of disordered eating in the Chinese context.
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Affiliation(s)
- Guangsheng Liang
- Department of Psychological Sciences, Texas Tech University, Lubbock, Texas, USA
| | - Yawei Cheng
- Department of Mathematics and Statistics, Texas Tech University, Lubbock, Texas, USA
| | - Wesley R Barnhart
- Department of Psychology, Bowling Green State University, Bowling Green, Ohio, USA
| | - Jianwen Song
- Department of Educational Psychology, Baylor University, Waco, Texas, USA
| | - Tom Lu
- Department of Mathematics and Statistics, Texas Tech University, Lubbock, Texas, USA
| | - Jinbo He
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, Guangdong, People's Republic of China
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Spivak-Lavi Z, Gewirtz-Meydan A. Why Do Women with Disordered Eating Engage in Sex? The Mediating Role of Sexual Motivations in the Association Between Disordered Eating Behaviors and Attitudes and Sexual Dysfunction. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:1513-1524. [PMID: 36376742 DOI: 10.1007/s10508-022-02463-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/12/2022] [Accepted: 10/21/2022] [Indexed: 06/16/2023]
Abstract
Although there is growing evidence of an association between disordered eating and sexual dysfunction, the mechanism underlying this association is still unclear. In the current study, we sought to examine the mediating role of sexual motivation between disordered eating and sexual dysfunction. We used a multi-path mediation model to examine the mediating role of sexual motivation between disordered eating and sexual functioning among a sample of 341 non-clinical women in a steady relationship. Analysis revealed two significant mediation paths associating disordered eating with sexual functioning: (1) a high level of disordered eating was significantly linked with higher motivation for partner approval via sex and sexuality which, in turn, was associated with lower sexual functioning and (2) a high level of disordered eating was significantly linked with lower enhancement sexual motivation which, in turn, was associated with lower sexual functioning. This study extends the existing knowledge by offering an explanation for the relation between disordered eating and sexual dysfunction via sexual motives. Findings from the current study suggest women with disordered eating utilized sex for self-affirmation, for coping with negative emotions, for partner approval, and to increase intimacy. Also, these women were not likely to engage in sex for enhancement reasons.
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Affiliation(s)
- Zohar Spivak-Lavi
- Faculty of Social Work and Faculty of Education, Max Stern Yezreel Valley College, Emek Yezreel, Jezreel Valley, Israel
| | - Ateret Gewirtz-Meydan
- School of Social Work, University of Haifa, 199 Abba Khoushy Ave. Mount Carmel, 3498838, Haifa, Israel. Agewirtz-@univ.haifa.ac.il
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Anderson LM, Hall LMJ, Crosby RD, Crow SJ, Berg KC, Durkin NE, Engel SG, Peterson CB. "Feeling fat," disgust, guilt, and shame: Preliminary evaluation of a mediation model of binge-eating in adults with higher-weight bodies. Body Image 2022; 42:32-42. [PMID: 35653964 PMCID: PMC10136371 DOI: 10.1016/j.bodyim.2022.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 05/11/2022] [Accepted: 05/23/2022] [Indexed: 11/29/2022]
Abstract
"Feeling fat" is a subjective state that theoretically contributes to the maintenance of binge eating (BE). However, feeling fat, and its relation to BE among individuals with higher-weight bodies, has been infrequently studied. This study proposes a momentary-level model in which negative moral emotion states (disgust, guilt, shame) mediate the association between feeling fat and binge eating. In this study, 50 adults with higher-weight bodies (MBMI=40.3 ± 8.5 kg/m2; 84% female) completed a two-week ecological momentary assessment protocol, which measured experiences of feeling fat, emotion states, and binge-eating behavior. Univariate generalized linear mixed models (GLMM) evaluated the momentary associations among levels of feeling fat at Time 1, emotion states at Time 2, and binge eating at Time 2, controlling for Time 1 emotion states. GLMM results suggest that increases in each emotion from Time 1 to Time 2 mediated the association between Time 1 feeling fat and Time 2 binge eating. When modeled simultaneously within one multivariate multilevel structured equation model, disgust appeared to drive the relation between feeling fat and binge eating, over and above guilt and shame. Although preliminary, findings suggest increases in negative moral emotions, particularly disgust, mediate the feeling fat-binge eating association in adults with higher-weight bodies.
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Affiliation(s)
- Lisa M Anderson
- University of Minnesota, Department of Psychiatry and Behavioral Sciences, Minneapolis, MI, USA.
| | - Leah M J Hall
- Eastern Oklahoma Veterans' Affairs Health Care System, Tulsa, OH, USA
| | - Ross D Crosby
- Sanford Research, Center for Bio-behavioral Research, Fargo, ND, USA; University of North Dakota School of Medicine and Health Sciences, Department of Psychiatry, Fargo, ND, USA
| | - Scott J Crow
- University of Minnesota, Department of Psychiatry and Behavioral Sciences, Minneapolis, MI, USA; The Emily Program, St. Paul, MI, USA
| | - Kelly C Berg
- University of Minnesota, Department of Psychiatry and Behavioral Sciences, Minneapolis, MI, USA
| | - Nora E Durkin
- University of Minnesota, Department of Psychiatry and Behavioral Sciences, Minneapolis, MI, USA; Hazelden Betty Ford Foundation, Plymouth, MI, USA
| | - Scott G Engel
- Sanford Research, Center for Bio-behavioral Research, Fargo, ND, USA; University of North Dakota School of Medicine and Health Sciences, Department of Psychiatry, Fargo, ND, USA
| | - Carol B Peterson
- University of Minnesota, Department of Psychiatry and Behavioral Sciences, Minneapolis, MI, USA
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6
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Freizinger M, Jhe GB, Dahlberg SE, Pluhar E, Raffoul A, Slater W, Shrier LA. Binge-eating behaviors in adolescents and young adults during the COVID-19 pandemic. J Eat Disord 2022; 10:125. [PMID: 36002838 PMCID: PMC9399990 DOI: 10.1186/s40337-022-00650-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 08/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic and subsequent public health measures have resulted in a worsening of eating disorder symptoms and an increase in psychological distress. The present study examined symptoms and behaviors in adolescents and young adults with emotional eating, bingeing behaviors and binge eating disorder during the pandemic. Additionally, the study explored if individuals who experienced pandemic-related food availability and food affordability issues experienced increased binge-eating symptoms and negative feelings. METHOD Participants (n = 39) were a convenience sample who participated between November 2020 and January 2021 in a weight and lifestyle management program at an urban New England pediatric hospital. Participants completed online surveys that assessed (1) participant's exposure to COVID-19 related stress and binge-eating behaviors using the COVID-19 Exposure and Family Impact Survey-Adolescent and Young Adult Version (CEFIS-AYA) and the Binge Eating Scale (BES) respectively, (2) participants' and their families' ability to attain and afford food and its association with bingeing behaviors, and (3) the relationship between food availability and affordability and negative emotions. RESULTS Nearly half of all participants (48.7%) reported moderate to severe bingeing during the COVID-19 pandemic; those who experienced greater COVID-related stress reported more binge-eating behaviors (p = 0.03). There were no associations between indicators of food availability and affordability and binge eating or between food availability and affordability and negative feelings. CONCLUSIONS Higher pandemic-related stress was associated with more binge-eating behaviors among adolescents and young adults. These results underscore the need to monitor symptoms and provide treatment for these patients despite barriers to care imposed by the COVID-19 pandemic. Research and clinical care for adolescents and young adults with EDs must recognize and respond to pandemic effects across the weight and disordered eating spectrum.
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Affiliation(s)
- Melissa Freizinger
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA. .,Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA. .,Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, 333 Longwood Avenue, 5th Floor, Boston, MA, USA.
| | - Grace B Jhe
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.,Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
| | - Suzanne E Dahlberg
- Department of Pediatrics, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.,Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Emily Pluhar
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.,Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
| | - Amanda Raffoul
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.,Department of Pediatrics, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
| | - Wallis Slater
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Lydia A Shrier
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.,Department of Pediatrics, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
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Risk of eating disorders in a representative sample of Italian adolescents: prevalence and association with self-reported interpersonal factors. Eat Weight Disord 2022; 27:701-708. [PMID: 34014507 PMCID: PMC8933299 DOI: 10.1007/s40519-021-01214-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/11/2021] [Indexed: 10/25/2022] Open
Abstract
PURPOSE Adolescence represents a critical period for the onset of eating disorders (EDs). The present study aimed to provide the prevalence of individuals at risk for EDs psychopathology in a representative population of adolescents aged 14-19 and to characterize this population regarding interpersonal and psychological factors. METHODS The percentage of participants at risk for EDs in a representative high school population was assessed through the SCOFF screening questionnaire (cut-off score: 3) in the total sample (N: 6551) and in gender-based subgroups for different body mass index (BMI) categories. Odds ratios for being at risk of ED (SCOFF ≥ 3) were esteemed in a multivariable analysis including self-reported parental education, quality of family and peer relationships, bullying victimization, age at first sexual intercourse, and psychological distress. RESULTS A SCOFF score ≥ 3 was found in 31.0% of participants (boys: 19.4%; girls: 44.6%), with a greater prevalence among higher BMI categories. Bad family relationships, being bullied, having the first sexual intercourse before the age of 14, and experiencing high distress were associated with this risk condition. Among girls, bad peer relationships were associated with a low-risk SCOFF score. CONCLUSION A remarkable percentage of adolescents reported significant body image or eating concerns. Screening programs are deeply needed, and particular attention should be devoted to interpersonal factors, such as the quality of family relationships and interactions with peers, which represent potential indicators of this vulnerability. LEVEL OF EVIDENCE Level V - Cross-sectional study.
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Validation of the Dutch Eating Behavior Questionnaire in a Romanian Adult Population. Nutrients 2021; 13:nu13113890. [PMID: 34836141 PMCID: PMC8619088 DOI: 10.3390/nu13113890] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/28/2021] [Accepted: 10/29/2021] [Indexed: 12/26/2022] Open
Abstract
(1) Background: Obesity, part of the triple global burden of disease, is increasingly attracting research on its preventive and curative management. Knowledge of eating behavior can be useful both at the individual level (to individualize treatment for obesity) and the population level (to implement more suitable food policies). The Dutch Eating Behavior Questionnaire (DEBQ) is a widely used international tool to assess eating behavior, i.e., emotional, external and restricted eating styles. The aim of this study was to validate the Romanian version of DEBQ, as obesity is a major concern in Romania. (2) Methods: Our study tested the psychometric properties of the Romanian version of DEBQ on an adult population and explored the associations of eating behavior with weight status (3) Results: The study showed a factor load similar to the original version of the questionnaire and a very good internal validity (Cronbach’s alpha fidelity coefficient greater than 0.8 for all scales of the questionnaire) for the Romanian version of DEBQ and showed that all of the scales positively correlated with body mass index in both men and women. (4) Conclusions: This study will enable the use of the DEBQ Romanian version on the adult population of Romania where the findings could be incorporated into developing better strategies to reduce the burden of nutrition-related diseases.
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Ramos Salazar L. Cyberbullying Victimization as a Predictor of Cyberbullying Perpetration, Body Image Dissatisfaction, Healthy Eating and Dieting Behaviors, and Life Satisfaction. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:354-380. [PMID: 29294894 DOI: 10.1177/0886260517725737] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Cyberbullying victimization and perpetration continues to be a serious public health, criminal justice, victimology, and educational problem in middle schools in the United States. Adolescents are at a higher risk of experiencing cyberbullying as a victim and/or as a bully given the frequency of their use of the Internet via social networking sites such as Facebook and mobile devices such as cell phones and tablets. To address this important problem, the purpose of this investigation was to examine cyberbullying victimization through communication technology as a predictor of cyberbullying perpetration, body image, healthy eating and dieting behaviors, and life satisfaction of sixth-, seventh-, and eighth-grade-level middle school students. The World Health Organization recruited participants by using a Health Behavior in School-Aged Children (HBSC) survey. In this in-class questionnaire, 6,944 middle school students were asked about their cyberbullying experiences as a victim and as a bully via Internet, email, and mobile communication technologies to obtain their evaluations of their body image, eating and dieting habits, and perceptions of life satisfaction. After controlling for demographic factors such as sex, age, and class level, this study found that cyberbullying victimization was a predictor of cyberbullying perpetration, body image dissatisfaction, dieting behaviors, and life satisfaction. However, this study did not find a correlation between cyberbullying victimization and students' healthy eating behaviors. This study also discussed each of the findings in the context of previous research findings. In addition, the study provides the strengths, limitations, and future directions for the future examination of cyberbullying victimization in middle schools.
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Lin CY, Cheung P, Imani V, Griffiths MD, Pakpour AH. The Mediating Effects of Eating Disorder, Food Addiction, and Insomnia in the Association between Psychological Distress and Being Overweight among Iranian Adolescents. Nutrients 2020; 12:nu12051371. [PMID: 32403387 PMCID: PMC7284879 DOI: 10.3390/nu12051371] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 04/25/2020] [Accepted: 05/08/2020] [Indexed: 12/16/2022] Open
Abstract
With obesity and excess weight remaining a serious concern worldwide, investigating the mechanisms underlying this is of great importance. Psychological distress is a possible trigger contributing to excess weight for adolescents. Moreover, the association between psychological distress and excess weight may be mediated by eating disorder, food addiction, and insomnia. The present study utilized parallel mediation analysis to assess the aforementioned associations and possible mediation effects among Iranian adolescents. Through stratified and clustered sampling, adolescents (N = 861; mean ± SD age = 15.9 ± 3.2; 372 males) participated and were followed for a one-year period. Excess weight (standardized body mass index, z-BMI); psychological distress (Depression, Anxiety, and Stress Scale-21); eating disorder attitudes (Eating Attitude Test-26); food addiction (Yale Food Addiction Scale for Children); and insomnia (Insomnia Severity Index) were assessed. Eating disorder attitudes, food addiction, and insomnia were significant mediators in the association of psychological distress and z-BMI. Additionally, psychological distress had direct effects on z-BMI. Given that eating disorder attitudes, food addiction, and insomnia showed mediated effects in the temporal association of psychological distress and excess weight, healthcare providers are encouraged to design programs on improving these three mediators to help adolescents overcome excess weight problems.
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Affiliation(s)
- Chung-Ying Lin
- Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong; (C.-Y.L.); (P.C.)
| | - Pauline Cheung
- Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong; (C.-Y.L.); (P.C.)
| | - Vida Imani
- Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz 5166/15731, Iran;
| | - Mark D. Griffiths
- Nottingham Trent University, International Gaming Research Unit, Psychology Department, Nottingham NG1 4FQ, UK;
| | - Amir H. Pakpour
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin 3419759811, Iran
- Department of Nursing, School of Health and Welfare, Jönköping University, SE-551 11 Jönköping, Sweden
- Correspondence: ; Tel.: +98-28-33239259
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Lin CY, Strong C, Latner JD, Lin YC, Tsai MC, Cheung P. Mediated effects of eating disturbances in the association of perceived weight stigma and emotional distress. Eat Weight Disord 2020; 25:509-518. [PMID: 30697663 DOI: 10.1007/s40519-019-00641-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 01/14/2019] [Indexed: 12/17/2022] Open
Abstract
PURPOSE This study aimed to examine the relationships between perceived weight stigma, eating disturbances, and emotional distress across individuals with different self-perceived weight status. METHODS University students from Hong Kong (n = 400) and Taiwan (n = 307) participated in this study and completed several questionnaires: Perceived Weight Stigma questionnaire; Three-factor Eating Questionnaire; Hospital Anxiety and Depression Scale. Each participant self-reported their height, weight, and self-perceived weight status. RESULTS After controlling for demographics, perceived weight stigma was associated with eating disturbances (β = 0.223, p < 0.001), depression (β = 0.143, p < 0.001), and anxiety (β = 0.193, p < 0.001); and eating disturbances was associated with depression (β = 0.147, p < 0.001) and anxiety (β = 0.300, p < 0.001) in the whole sample. Additionally, eating disturbances mediated the association between perceived weight stigma and emotional distress. Similar findings were shown in the subsamples who perceived themselves as higher weight or normal weight and in the male and female subsamples. However, in the subsamples who perceived themselves as lower weight, only the links between eating disturbances and emotional distress were significant. CONCLUSION Perceived weight stigma was associated with eating disturbances and emotional distress in young adults with both higher and normal weight. Eating disturbances were associated with emotional distress regardless of participants' weight status. LEVEL OF EVIDENCE Level V, cross-sectional descriptive study.
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Affiliation(s)
- Chung-Ying Lin
- Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hung Hom, Hong Kong.
| | - Carol Strong
- Department of Public Health, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Janet D Latner
- Department of Psychology, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Yi-Ching Lin
- Department of Early Childhood and Family Education, College of Education, National Taipei University of Education, Taipei, Taiwan
| | - Meng-Che Tsai
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Pauline Cheung
- Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hung Hom, Hong Kong
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Ajibewa TA, Zhou M, Barry MR, Miller AL, Sonneville KR, Leung CW, Hasson RE. Adolescent stress: A predictor of dieting behaviors in youth with overweight/obesity. Appetite 2020; 147:104560. [PMID: 31870936 DOI: 10.1016/j.appet.2019.104560] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 12/13/2019] [Accepted: 12/14/2019] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To examine associations between psychological stress and dieting behavior along with the heterogeneity of this association by gender and race in a diverse sample of adolescents with overweight/obesity. METHODS One hundred and sixty-one adolescents between the ages of 13-19 years of age with overweight/obesity (65% female; 53% non-Hispanic black/47% non-Hispanic white; age: 16.7 ± 1.7 years) were recruited from Southeast MI and included in this analysis. Psychological stress was measured using the Perceived Stress Scale, and dieting behavior was assessed using the dieting subscale from the Eating Attitudes Test (EAT-26) questionnaire. Multivariable linear regression models were conducted to examine the association between psychological stress and dieting behavior by gender and race. RESULTS Psychological stress was significantly associated with dieting (β = 0.18 ± 0.06; p < 0.01), with greater stress associated with greater frequency of dieting behavior. This relationship remained significant (β = 0.15 ± 0.06; p = 0.016), even when controlling for covariates (age, body fat, gender, race, and pubertal development). There were no statistically significant differences in the association of psychological stress and disordered eating indices by gender or race/ethnicity (p's > 0.05). CONCLUSIONS Increased psychological stress is associated with increased dieting behavior among adolescents with overweight/obesity. These findings suggest that psychological stress equally affects dieting behavior among adolescents with overweight/obesity, regardless of gender and race. Future studies should seek to identify the unique sources of psychological stress that contribute to increased dieting behavior among adolescents with overweight/obesity.
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Affiliation(s)
- Tiwaloluwa A Ajibewa
- University of Michigan, School of Kinesiology, 1402 Washington Heights, Ann Arbor, MI, USA
| | - Megan Zhou
- University of Michigan, School of Public Health, 1415 Washington Heights, Ann Arbor, MI, USA
| | - Mikayla R Barry
- University of Michigan, School of Public Health, 1415 Washington Heights, Ann Arbor, MI, USA
| | - Alison L Miller
- University of Michigan, School of Public Health, 1415 Washington Heights, Ann Arbor, MI, USA
| | - Kendrin R Sonneville
- University of Michigan, School of Public Health, 1415 Washington Heights, Ann Arbor, MI, USA
| | - Cindy W Leung
- University of Michigan, School of Public Health, 1415 Washington Heights, Ann Arbor, MI, USA
| | - Rebecca E Hasson
- University of Michigan, School of Kinesiology, 1402 Washington Heights, Ann Arbor, MI, USA; University of Michigan, School of Public Health, 1415 Washington Heights, Ann Arbor, MI, USA.
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13
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Ahorsu DK, Lin CY, Imani V, Griffiths MD, Su JA, Latner JD, Marshall RD, Pakpour AH. A prospective study on the link between weight-related self-stigma and binge eating: Role of food addiction and psychological distress. Int J Eat Disord 2020; 53:442-450. [PMID: 31905249 DOI: 10.1002/eat.23219] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 11/23/2019] [Accepted: 12/10/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVES This prospective study investigated the link between weight-related self-stigma and binge eating by (a) examining the temporal association between weight-related self-stigma and binge eating; (b) investigating the mediating role of food addiction in the association between weight-related self-stigma and binge eating; and (c) examining the mediating role of psychological distress in the association between weight-related self-stigma and binge eating. METHOD Participants comprised 1,497 adolescents (mean = 15.1 years; SD = 6.0). Body mass index and weight bias were assessed at baseline; psychological distress (i.e., depression, anxiety, and stress) assessed and food addiction at 3 months; and binge eating at 6 months. The mediation model was analyzed using Model 4 in the PROCESS macro for SPSS with 10,000 bootstrapping resamples. RESULTS There was no significant direct association between weight-related self-stigma and binge eating. However, food addiction and psychological distress significantly mediated the association between weight-related self-stigma and binge eating. DISCUSSION These findings highlight the indirect association between weight-related self-stigma and binge eating via food addiction and psychological distress. Consequently, intervention programs targeting food addiction and psychological distress among adolescents may have significant positive effects on outcomes for weight-related self-stigma and binge eating. The findings will be beneficial to researchers and healthcare professionals working with adolescents during this critical developmental period.
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Affiliation(s)
- Daniel K Ahorsu
- Department of Rehabilitation Sciences, the Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Chung-Ying Lin
- Department of Rehabilitation Sciences, the Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Vida Imani
- Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mark D Griffiths
- International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, UK
| | - Jian-An Su
- Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Nursing, Chang Gung Institute of Technology, Taoyuan, Taiwan
| | - Janet D Latner
- Department of Psychology, University of Hawaii at Manoa, Honolulu, Hawaii
| | - Rachel D Marshall
- Department of Psychology, University of Hawaii at Manoa, Honolulu, Hawaii
| | - Amir H Pakpour
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.,Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden
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14
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Lin YC, Latner JD, Fung XCC, Lin CY. Poor Health and Experiences of Being Bullied in Adolescents: Self-Perceived Overweight and Frustration with Appearance Matter. Obesity (Silver Spring) 2018; 26:397-404. [PMID: 29090855 DOI: 10.1002/oby.22041] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 09/13/2017] [Accepted: 09/14/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To examine the associations between body image (actual and self-perceived weight status; feelings about appearance) and health outcomes (overall health, life satisfaction, and mental health) and between body image and experiences of being bullied. METHODS Participants included 8,303 children from 7th to 10th grade in the Health Behavior of School-Aged Children (HBSC) 2009-2010 data set, a large-scale sample in the United States. Several multiple linear regressions (with health outcomes as dependent variables) and multivariate logistic regressions (with being bullied or not as dependent variable) were conducted to investigate the associations between each dependent variable and the following independent variables: relationship with parents, frustration with appearance, and actual and self-perceived weight status. RESULTS Self-perceived underweight, self-perceived overweight (OW), and frustration with appearance were positively associated with being bullied. Frustration with appearance was a risk factor, while good relationship with parents was a protective factor, especially for psychological health outcomes. Self-perceived OW had a stronger association with the experience of being bullied than actual OW. The relationship between actual OW and being bullied might be attenuated when self-perceived OW is simultaneously considered. CONCLUSIONS Body image may be an important factor in the association between weight status and the experience of being bullied.
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Affiliation(s)
- Yi-Ching Lin
- Department of Early Childhood and Family Education, College of Education, National Taipei University of Education, Taipei, Taiwan
| | - Janet D Latner
- Department of Psychology, University of Hawaii at Manoa, Honolulu, Hawaii, USA
| | - Xavier C C Fung
- Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Chung-Ying Lin
- Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
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15
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Incollingo Rodriguez AC, Rodriguez A, Callahan LC, Saxbe D, Tomiyama AJ. The buddy system: A randomized controlled experiment of the benefits and costs of dieting in pairs. J Health Psychol 2017; 24:1945-1954. [DOI: 10.1177/1359105317709514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
A total of 67 pairs of female roommates were randomized into a diet condition: (1) both ate normally; (2) one dieted, the other ate normally; and (3) both dieted. Adherence, weight loss, anxiety, depression, disordered eating symptoms, and stress were measured. Dieters lost more weight than non-dieters, but average loss was <1 pound. Pairs where both dieted reported higher anxiety, depression, and disordered eating than one-dieter pairs. Structural equation models revealed an interrelated network of stress, anxiety, depression, and disordered eating. This was weakest when one roommate dieted. The “buddy system” may not promote weight loss, but living with a non-dieting partner may buffer consequences.
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Affiliation(s)
| | | | | | - Darby Saxbe
- University of Southern California (USC), USA
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16
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Shih PB, Yang J, Morisseau C, German JB, Zeeland AASV, Armando AM, Quehenberger O, Bergen AW, Magistretti P, Berrettini W, Halmi KA, Schork N, Hammock BD, Kaye W. Dysregulation of soluble epoxide hydrolase and lipidomic profiles in anorexia nervosa. Mol Psychiatry 2016; 21:537-46. [PMID: 25824304 PMCID: PMC4591075 DOI: 10.1038/mp.2015.26] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 01/13/2015] [Accepted: 01/23/2015] [Indexed: 02/07/2023]
Abstract
Individuals with anorexia nervosa (AN) restrict eating and become emaciated. They tend to have an aversion to foods rich in fat. Because epoxide hydrolase 2 (EPHX2) was identified as a novel AN susceptibility gene, and because its protein product, soluble epoxide hydrolase (sEH), converts bioactive epoxides of polyunsaturated fatty acid (PUFA) to the corresponding diols, lipidomic and metabolomic targets of EPHX2 were assessed to evaluate the biological functions of EPHX2 and their role in AN. Epoxide substrates of sEH and associated oxylipins were measured in ill AN, recovered AN and gender- and race-matched controls. PUFA and oxylipin markers were tested as potential biomarkers for AN. Oxylipin ratios were calculated as proxy markers of in vivo sEH activity. Several free- and total PUFAs were associated with AN diagnosis and with AN recovery. AN displayed elevated n-3 PUFAs and may differ from controls in PUFA elongation and desaturation processes. Cytochrome P450 pathway oxylipins from arachidonic acid, linoleic acid, alpha-linolenic acid and docosahexaenoic acid PUFAs are associated with AN diagnosis. The diol:epoxide ratios suggest the sEH activity is higher in AN compared with controls. Multivariate analysis illustrates normalization of lipidomic profiles in recovered ANs. EPHX2 influences AN risk through in vivo interaction with dietary PUFAs. PUFA composition and concentrations as well as sEH activity may contribute to the pathogenesis and prognosis of AN. Our data support the involvement of EPHX2-associated lipidomic and oxylipin dysregulations in AN, and reveal their potential as biomarkers to assess responsiveness to future intervention or treatment.
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Affiliation(s)
- P B Shih
- Department of Psychiatry, University of California at San Diego, San Diego, CA, USA
| | - J Yang
- Department of Entomology, University of California at Davis, Davis, CA, USA
| | - C Morisseau
- Department of Entomology, University of California at Davis, Davis, CA, USA
| | - J B German
- Department of Entomology, University of California at Davis, Davis, CA, USA
| | | | - A M Armando
- Department of Psychiatry, University of California at San Diego, San Diego, CA, USA
| | - O Quehenberger
- Department of Psychiatry, University of California at San Diego, San Diego, CA, USA
| | - A W Bergen
- Center for Health Sciences, SRI International, Menlo Park, CA, USA
| | - P Magistretti
- Division of Biological and Environmental Sciences and Engineering, KAUST, Thuwal, KSA and Brain Mind Institute, EPFL, Lausanne, Switzerland
| | - W Berrettini
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - K A Halmi
- Department of Psychiatry, Cornell University, New York, NY, USA
| | - N Schork
- Department of Human Biology, J. Craig Venter Institute, San Diego, CA, USA
| | - B D Hammock
- Department of Entomology, University of California at Davis, Davis, CA, USA
| | - W Kaye
- Department of Psychiatry, University of California at San Diego, San Diego, CA, USA
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17
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Kaltiala-Heino R, Lankinen V, Marttunen M, Lindberg N, Fröjd S. Overweight, perceived overweight and involvement in bullying in middle adolescence. CHILD ABUSE & NEGLECT 2016; 54:33-42. [PMID: 26990175 DOI: 10.1016/j.chiabu.2016.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 01/30/2016] [Accepted: 02/29/2016] [Indexed: 06/05/2023]
Abstract
Overweight is reportedly a risk factor for being bullied, and body image may mediate this association. Research on associations between overweight and bullying has so far only focused on children and early adolescents. We explored associations between actual and perceived overweight at age 15 and involvement in bullying at ages 15 and 17. A total of 2070 Finnish adolescents responded to a survey at ages 15 and 17. Self-reported weight and height, perceived weight and involvement in bullying were elicited. Being overweight at age 15 was not associated with being bullied or with being a bully at age 15 or 17. Perceived overweight among girls was associated with subsequent involvement in bullying as a bully and in feeling shunned. Weight related bullying may decrease from pre- and early adolescence to middle adolescence. The associations between perceived overweight and self-identification as a bully, and those between perceived overweight and feeling isolated may be explained by the phenomena representing psychological dysfunction.
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Affiliation(s)
- Riittakerttu Kaltiala-Heino
- University of Tampere, School of Medicine, 30014 University of Tampere, Finland; Vanha Vaasa Hospital, Vierinkiventie 1, 65380 Vaasa, Finland; Tampere University Hospital, Department of Adolescent Psychiatry, 33380 Pitkäniemi, Finland.
| | - Vilma Lankinen
- University of Tampere, School of Medicine, 30014 University of Tampere, Finland.
| | - Mauri Marttunen
- National Institute for Health and Welfare, Mental Health Unit, Box 30, 00271 Helsinki, Finland; University of Helsinki, Faculty of Medicine, 00014 University of Helsinki, Finland; Helsinki University Hospital, Department of Adolescent Psychiatry, Box 590, 00029 HUS, Finland.
| | - Nina Lindberg
- University of Helsinki, Faculty of Medicine, 00014 University of Helsinki, Finland; Helsinki University Hospital, Kellokoski Hospital, 04500 Kellokoski, Finland.
| | - Sari Fröjd
- University of Tampere, School of Health Sciences, 33014 University of Tampere, Finland.
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18
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Tomiyama AJ, Ahlstrom B, Mann T. Evaluating eating behavior treatments by FDA standards. Front Psychol 2014; 4:1009. [PMID: 24427153 PMCID: PMC3879478 DOI: 10.3389/fpsyg.2013.01009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 12/17/2013] [Indexed: 11/13/2022] Open
Abstract
Behavioral treatments for obesity are not evaluated by the same criteria as pharmaceutical drugs, even though treatments such as low-calorie dieting are widely prescribed, require patients' time and investment, and may have risks. The Food and Drug Administration (FDA) has a procedure for evaluating drugs, in which drugmakers must answer the following questions: (1) Is the treatment safe? (2) How dangerous is the condition the intervention is treating? (3) Is the treatment effective? (4) Is the treatment safe and effective for large numbers of people? We argue that using this framework to evaluate behavioral interventions could help identify unanswered research questions on their efficacy and effectiveness, and we use the example of low-calorie dieting to illustrate how FDA criteria might be applied in the context of behavioral medicine.
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Affiliation(s)
- A Janet Tomiyama
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
| | - Britt Ahlstrom
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA ; Department of Psychology, University of Minnesota Minneapolis, MN, USA
| | - Traci Mann
- Department of Psychology, University of Minnesota Minneapolis, MN, USA
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19
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Changing the course of comorbid eating disorders and depression: what is the role of public health interventions in targeting shared risk factors? J Eat Disord 2014; 2:15. [PMID: 24914411 PMCID: PMC4049372 DOI: 10.1186/2050-2974-2-15] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 05/19/2014] [Indexed: 11/24/2022] Open
Abstract
Public health has a productive history of improving global health due to its focus on reaching large populations using effective and scalable interventions. Yet, the marriage between evidence-based science and the implementation of community/public health interventions within mental illness remains underdeveloped. Research suggests that major depression is the most commonly cited comorbidity for eating disorders (EDs). Thus, identification of public health strategies that jointly impact depression and EDs, including shared risk factors, has the potential to significantly impact mental health suffering. The primary aim of this paper is to examine and discuss such public health approaches as well as explore cues taken from public health efforts to inform future directions in research and clinical practice. As a comprehensive review of all public health initiatives that address EDs and depression is beyond the scope of this paper, this paper reviews a series of programs/approaches that either are of large scale and/or have received empirical support. In particular, public health related interventions that aim to reduce variable risk factors associated with EDs and depression, as well as interventions that aim to reduce continuous measures of ED and depression symptoms are reviewed. To date, despite significant progress in modifying risk factors for EDs and depression, the field still lacks a public health study that has been appropriately designed and/or adequately powered to assess true ED/depression prevention effects. Further, although several programs show promise, many widely disseminated approaches lack empirical support, raising concerns about the potential for waste of limited resources. In summary, although the combination of prevention and public health based approaches appear to have merit when trying to move the needle on risk factors and symptoms associated with EDs and/or depression, further research is needed to investigate the reach and effectiveness of large scale dissemination efforts of such endeavors.
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