Prevalence of abnormal eating behaviours and inappropriate methods of weight control in young women from Brazil: a population-based study

Global Prevalence of Adolescent Use of Nonprescription Weight-Loss Products: A Systematic Review and Meta-Analysis

Importance

Use of nonprescribed weight-loss products in adolescents is a public health concern that is associated with negative physical and psychological consequences. However, the prevalence of nonprescribed weight-loss product use in adolescents is unknown.

Objective

To determine the global prevalence of nonprescription weight-loss product use in children and adolescents.

Data Sources

Four databases, including MEDLINE, PsycINFO, CINAHL (Cumulative Index of Nursing and Allied Health), and EMBASE, were searched for quantitative studies that reported prevalence data on use of nonprescription weight-loss products with no restrictions on publication date. The search was performed December 1, 2020, and updated March 6, 2023.

Study Selection

Studies were included in the meta-analysis if they reported the prevalence of weight-loss product use, were published in English, and included individuals 18 years or younger.

Data Extraction and Synthesis

Data extraction was completed by 2 independent reviewers. Data analysis determined the overall pooled proportion of weight-loss product use in total and during the past week, past 30 days, past year, or lifetime. Inverse variance heterogeneity effect models were used.

Main Outcomes and Measures

The main outcome measure was the prevalence of nonprescription weight-loss product use in adolescents for all included studies and over the past week, past month, past year, or lifetime. Subgroup analysis included separation of groups by sex, specific weight-loss product types, geographical location, and study publication time.

Results

A total of 90 articles (604 552 unique participants) were included in the meta-analysis. Of these, 50 studies (56%) were from North America. The reported prevalence of weight-loss product use in adolescents was 5.5% (96% CI, 5.5%-5.6%) overall. When identifying use of weight-loss products in the general population, prevalence was 2.0% (95% CI, 1.9%-2.1%) in the past week, 4.4% (95% CI, 4.3%-4.5%) in the past month, 6.2% (95% CI, 6.1%-6.3%) in the past year, and 8.9% (95% CI, 8.6%-9.2%) in their lifetime. Use of weight-loss products was higher among girls than boys.

Conclusions and Relevance

This meta-analysis found that use of weight-loss products occurs at high levels in adolescents, especially girls. These findings suggest that, given the ineffectiveness of these products for weight loss coupled with their harmful long-term health consequences, interventions are required to reduce use of weight-loss products in this group.

Depressive, Anxiety, and Stress Symptoms Among Schoolgirls With Disordered Eating Behaviors

Objectives This study aimed to assess the relationship between depression, anxiety, stress, and disordered eating behaviors among schoolgirls in Riyadh, Saudi Arabia. The current study could provide insights into potential intervention strategies for addressing both aspects simultaneously, contributing to a more holistic approach in the field. Method Via simple sampling technique, the current quantitative, descriptive, and cross-sectional study included 347 female adolescents aged between 13 and 18 years in public schools in Riyadh, Saudi Arabia. A self-administered questionnaire comprised demographic information, items on body image satisfaction and perception, the Eating Attitude Test-26 (EAT-26), and the Depression, Anxiety, and Stress Scale-21 (DASS-21). Results Among the participants, 32.6% scored at or above the cutoff point on the EAT-26, indicating a negative eating attitude. Additionally, multiple factors such as age, obesity, body image dissatisfaction, and peer pressure were correlated with disordered eating behaviors, with excessive exercise being the most reported weight control behaviors. The prevalence of depression, anxiety, and stress were 58.5%, 73.2%, and 40.9%, respectively. Notably, anxiety was significantly associated with disordered eating behaviors. Conclusion In conclusion, disordered eating behaviors were reported by 32.6% of the participants, and symptoms of anxiety were significantly associated with these behaviors. Media consumption appeared to influence more than half of the participants in their weight loss attempts.

Eating Attitudes of Patients with Celiac Disease in Brazil: A Nationwide Assessment with the EAT-26 Instrument

Celiac disease (CD) is an immune-mediated enteropathy triggered by the ingestion of gluten in genetically predisposed individuals. In this sense, a gluten-free diet is the only safe treatment available. Due to the restrictions resulting from this eating pattern, this treatment may impair the relationship of the people with CD with food, increasing the risk of a disordered eating attitude, which is associated with eating disorders. The EAT-26 is a validated instrument already applied worldwide in different populations, and higher scores are suggestive of eating attitudes prone to evolve into eating disorders. Studies carried out in other countries have already shown that people with CD are prone to developing eating disorders; however, no study has been carried out with this theme in the population with CD in Brazil. We carried out a nationwide cross-sectional study in three steps: (i) study design and instrument; (ii) recruitment of participants and ethics; (iii) statistical analysis. A total of 385 participants were included in our sample, 96.36% of them being women. The internal consistency of the applied self-administered Brazilian version of the EAT-26 online questionnaire presented a satisfactory Cronbach's alpha of 0.812, and in total, 36.1% of the respondents were classified with a disordered eating attitude. No differences were found among the scores of participants when divided by categories regarding gender, average monthly income, age, and educational level. However, scores classified as a disordered eating attitude were found in respondents with a body mass index classified as overweight and obese. Our study highlights that disordered eating attitudes are present in overweight and obese women with celiac disease; thus, public health politics are needed to prevent and treat these attitudes.

Cross-cultural adaptation and translation into Brazilian Portuguese of the instruments Sick Control One Stone Fat Food Questionnaire (SCOFF), Eating Disorder Examination Questionnaire (EDE-Q) and Clinical Impairment Assessment Questionnaire (CIA)

Introduction

Eating disorders (EDs) affect up to 13% of young people and are associated with significant morbidity and mortality. Nevertheless, important, internationally recognized instruments for brief ED screening (Sick Control One Stone Fat Food Questionnaire [SCOFF]), symptom severity assessment and diagnosis (Eating Disorder Examination Questionnaire [EDE-Q]) and assessment of ED-associated psychosocial impairment (Clinical Impairment Assessment Questionnaire [CIA]) were not yet available in Brazilian Portuguese. Our objective was to perform the cross-cultural adaptation and translation into Brazilian Portuguese of the instruments SCOFF, EDE-Q and CIA.

Method

The process involved a series of standardized steps, as well as discussions with experts. First, the relevance and adequacy of the scales’ items to our culture and population were extensively discussed. Then, two independent groups translated the original documents, creating versions that were compared. With the participation of external ED experts (i.e., who did not take part in the translation process), synthesized versions were produced. The syntheses were then applied to a focal group of patients with ED (n = 8). After that step, a preliminary version of the three scales in Brazilian Portuguese was produced and sent for back-translation by two English native speakers, who worked independently. A synthesis of the back-translations, along with the preliminary versions in Brazilian Portuguese, were sent to the original authors.

Results

The Brazilian Portuguese versions of SCOFF, EDE-Q and CIA were approved by the original authors and are now available for use.

Conclusion

This study provides important tools for the ED research field in Brazil.

Validation of the Arabic version of the Eating Attitude Test in Lebanon: a population study

OBJECTIVES

To validate an Arabic version of the Eating Attitude Test (EAT-26) and identify factors (such as depression, stress, anxiety and body dissatisfaction) that might be associated with disordered eating among a sample of the Lebanese population.

DESIGN

Cross-sectional study.

SETTING

All Lebanese governorates.

PARTICIPANTS

A total of 811 participants randomly selected participated in this 5-month study (January-May 2018).

RESULTS

The EAT-26 scale items converged over a solution of six factors that had an eigenvalue over 1, explaining a total of 60·07 % of the variance (Cronbach's α = 0·895). The prevalence of disordered eating attitudes was 23·8 %. Higher EAT-26 scores (disordered eating attitudes) were significantly associated with higher depression (β = 0·325), higher emotional eating (β = 0·083), daily weighing (β = 3·430), higher physical activity (β = 0·05), starving to reduce weight (β = 4·94) and feeling pressure from TV/magazine to lose weight (β = 3·95).

CONCLUSIONS

The Arabic version of EAT-26 can be a useful instrument for screening and assessing disordered eating attitudes in clinical practice and research. Some factors seem to be associated with more disordered eating attitudes among participants for whom psychological counseling may be needed. Yet, our findings are considered preliminary, and further studies are warranted to confirm them.

The Association Between Eating-Compensatory Behaviors and Affective Temperament in a Brazilian Population

Eating-compensatory behaviors are associated with biological and psychological complications, with high rates of morbidity and mortality. Different elements may contribute to the development of eating-compensatory behaviors, such as genetic, physiological, environmental, and temperamental factors. Therefore, the aim of this study was to examine the association between affective temperaments and eating-compensatory behaviors. A sample of 27,501 volunteers, between 18 and 55 years old, mean age 28.9 ± 8.7 years (69.6% women), were assessed by the Brazilian Internet Study on Temperament and Psychopathology (BRAINSTEP). The results showed that eating-compensatory behaviors were associated with distinctive affective temperaments. Cyclothymic types were more associated with eating-compensatory behaviors. The avoidant and irritable types presented lower percentages of eating-compensatory behaviors in women and men, respectively. In conclusion, this study highlighted that participants who adopted frequent eating-compensatory behaviors are more likely to have dysfunctional affective traits. Consequently, the affective temperaments should be considered as a strategy to build capacity for prevention, treatment, and care of eating-compensatory behaviors.

Is the Drive for Muscularity Scale a valid and reliable instrument for young adult women?

There is a lack of psychometric studies on scales aiming to evaluate the drive for muscularity in women. This study aimed to test whether the Drive for Muscularity Scale (DMS) yielded reliable and valid scores for assessing the drive for muscularity construct in young adult women. A cross-sectional study was conducted among 242 Brazilian adult women. Exploratory factor analysis, convergent validity, estimated internal consistency, and test-retest reliability of the DMS's scores were examined. The results of the exploratory factor analysis upheld the original unidimensional structure of the DMS for Brazilian women. The scale presented a significant but weak association with body mass index and risk behaviors for eating disorders. Adequate internal consistency and 2-week test-retest reliability were found. Future psychometric analyses (convergent and discriminant validity) of the DMS are encouraged to further our understanding of drive for muscularity in women, especially to confirm its unidimensional factor structure. Future research avenues also include examining the reliability and validity of the DMS's scores among women from various cultures.

Examining the correlates of meal skipping in Australian young adults

Background

Meal skipping is associated with diet-related chronic disease risk and is highly prevalent in young adults. Despite this, the correlates of meal skipping in this population group are unknown. Therefore, the aim of this study was to examine the prevalence and correlates of meal skipping in young adults.

Methods

Young adults aged 18–30 years (n = 578) (24% male, 76% female) used ‘FoodNow’, a purpose designed real-time smartphone application to record food and beverage consumption over four non-consecutive days. The day following each reporting day, participants were asked about their previous day’s eating occasions; if any eating occasions were not reported or if any were skipped. These data were used to categorise participants into specific meal skippers (breakfast, lunch and/or dinner skipper). Participants also completed an online questionnaire, which contained measures of correlates from the social-ecological framework across the individual, social-environmental and physical-environment domains. Logistic regression analyses were used to examine associations between specific meal skipping behaviours and measured correlates.

Results

Individual domain correlates (education status, smoking status and time scarcity) were associated with varying meal skipping behaviours, while no correlates from the social-environmental or physical-environmental domains of the social-ecological framework were associated with any meal skipping behaviours. Participants with a university education were less likely to be a meal skipper (any meal) (OR = 0.46; 95%CI: 0.22, 0.95; p = 0.035), while those who previously or currently smoked cigarettes were more likely to be breakfast skippers (OR = 1.10; 95%CI: 1.15, 3.86; p = 0.016) compared to those who had never smoked before. Those who are time scarce were more likely to be either breakfast (OR = 1.12; 95%CI: 1.00, 1.26; p = 0.036) or lunch skippers (OR = 1.11; 95% CI: 1.01, 1.23; p = 0.033). No variables were significantly associated with dinner skipping.

Conclusions

The findings suggest that the correlates of meal skipping vary according to the specific meal skipped. University education status needs to be considered when designing interventions aimed at the reduction of meal skipping among young adults, while correlates such as time management and smoking status may offer potential behaviour change targets within these interventions.

Electronic supplementary material

The online version of this article (10.1186/s12937-019-0451-5) contains supplementary material, which is available to authorized users.

Validity and Reliability of the Brazilian Version of the Weight Control Behaviors Scale

OBJECTIVE

To develop and validate the weight-control behaviors (WCBs) scale and to evaluate its psychometric properties.

STUDY DESIGN

We made use of data from a cluster-randomized trial assessing the effectiveness of the Brazilian New Moves Program. The Brazilian New Moves Program was a multicomponent intervention aimed at preventing weight-related problems among adolescent girls in public schools in São Paulo, Brazil.

RESULTS

Healthy and unhealthy WCBs were strongly associated. A 2-factor solution was the best model to explain the correlation across items, including following constructs: (1) healthy WCB: exercising, eating more fruits and vegetables, drinking less regular soda or sweetened drinks, eating fewer sweets, and paying attention to portion sizes; and (2) unhealthy WCB: skipping meals and the presence of any other, combined unhealthy weight-control behaviors, including fasting, eating little, going on a diet, vomiting, taking diet pills, using diuretics (water pills), using laxatives, using food substitutes (powder/special drinks), and smoking more cigarettes. The WCB scale was determined to be reliable (internally consistent) and valid, with high scores positively associated with body dissatisfaction and high body mass index values. Individual reliability values were high for factors representing healthy and unhealthy WCBs.

CONCLUSIONS

Our findings support the use of the WCB scale as a screening tool for overall weight control behaviors among female adolescents. This assessment tool should be considered in future observational and experimental prospective studies.

TRIAL REGISTRATION

Brazilian Registry of Clinical Trials: RBR-6ddpb3.

An etiological model of disordered eating behaviors among Brazilian women

The Tripartite Influence Model posits that parents, peers and media influences mediated by internalization and appearance social comparison are predictors of body dissatisfaction, a key risk factor for eating disorders. However, the Tripartite Influence Model has not been tested in Brazil where the people are known to have high levels of body image and appearance concerns. This study aimed to test an adapted Tripartite Influence Model of body dissatisfaction and disordered eating behaviors among Brazilian women. A sample of 741 undergraduate students (M_age = 23.55 years, SD = 4.09) completed measures of sociocultural influences, internalization of body ideal, social appearance comparison, body dissatisfaction, muscularity dissatisfaction, disordered eating and body change behaviors. Structural equation modeling analyses indicated that the proposed etiological model for Brazilian women has good fit indexes (χ²(2064) = 6793.232; p = 0.0001; χ²/gl = 3.29; CFI = 0.82; PCFI = 0.79; RMSEA = 0.056 [IC90% = 0.053-0.057]). Parent and media influences were related with both internalization and social comparison, while peer influence with social comparison. A full mediation model was found, with both internalization and social comparison contributing to body dissatisfaction. Finally, body dissatisfaction was associated with disordered eating behaviors. The findings inform the importance of considering cultural aspects that influence body image and eating behaviors, and highlight the validity of the proposed etiological model for Brazilian women, that can be used for research and clinical purposes.

Adaptação transcultural para o português dos Questionários de Desejos Intensos por Comida – Estado ou Traço (QDIC-E e QDIC-T) dos State and Trait Food-Cravings Questionnaires (FCQ-S and FCQ-T)

Resumo Este estudo objetivou apresentar a adaptação transcultural dos Questionários de Desejos Intensos por Comida – Estado ou Traço (QDIC-E e QDIC-T) dos State and Trait Food-Cravings Questionnaires (FCQ-S and FCQ-T) para o Português. Fez-se a tradução e a retradução dos instrumentos, a avaliação da equivalência conceitual, operacional e de itens por especialistas da área e a avaliação dos instrumentos por uma amostra de universitários, por meio da avaliação do grau de compreensão e análise da consistência interna dos instrumentos pelo coeficiente Alpha de Cronbach. Ademais, fez-se a avaliação da equivalência semântica pelo coeficiente de correlação intraclasse entre os escores obtidos por bilíngues em cada questão das versões em inglês e português. Os instrumentos foram considerados de fácil compreensão (para os especialistas foi de 95,4% e 97%, para o QDIC-T e QDIC-E, respectivamente, e, para os universitários, 81,8% os consideraram de fácil compreensão), e demonstraram valores de consistência interna satisfatórios (QDIC-T: variaram de 0,6 a 0,8; QDIC-E: variaram de 0,5 a 0,8). A partir do processo de adaptação transcultural, os resultados satisfatórios possibilitam a recomendação da versão brasileira dos QDICs.

Eating disorders symptoms in pregnancy and postpartum: a prospective study in a disadvantaged population in Brazil

OBJECTIVE

To assess eating disorder symptoms (EDS) from prepregancy through postpartum.

METHOD

Seven hundred and twelve women with gestational age ranging from 16th to 36th week completed the eating disorder examination questionnaire (EDE-Q). A shortened version of the EDE-Q was used to assess, retrospectively, EDS during the last 28 days of the pregestational period. Follow up assessment occurred at the 4th-5th month postpartum (n = 427). Generalized structural equation models were used to estimate risk of EDS in pregestation, gestation, and postpartum.

RESULTS

Women who did not participate in follow up (n = 285) were not significantly different in sociodemographic characteristics. In postpartum, a higher number of women referred shape (RR = 1.65; 95% CI 1.19-2.30) and weight concerns (RR = 1.64; 95% CI 1.16-2.31) than in pregestation. Binge eating (BE) and self-induced vomiting diminished during pregnancy (RR = 0.70, 95% CI 0.57-0.85; RR = 0.21, 95% CI 0.10-0.44, respectively) and postpartum (RR = 0.62, 95% CI 0.48-0.80; RR = 0.38, 95% CI 0.19-0.76, respectively) compared with pregestation

DISCUSSION

Shape and weight concerns are highly prevalent in postpartum and may confer risk for the development of inappropriate eating behaviors. Health professionals should be trained on how to recognize these symptoms.

Disordered eating behaviors in adolescents and adults living in the same household in metropolitan area of Rio de Janeiro, Brazil

OBJECTIVE

To examine the prevalence of disordered eating behaviors among adolescents and adults living in the same household.

METHODS

We conducted a population-based cross-sectional study developed with a probabilistic sample of 511 adolescents and 1254 adults living in the metropolitan area of Rio de Janeiro, Brazil. The frequency of binge eating, purging, and strict dieting or fasting over the previous 6 months was ascertained using a self-report questionnaire.

RESULTS

Binge eating (20.0% vs. 8.4%), strict dieting or fasting (18.9% vs. 2.4%), and purging (3.3% vs. 2.2%) were more frequent among adolescents than adults. There was a significant association between frequency of binge eating and strict dieting or fasting in adults and in adolescents living in the same household.

CONCLUSION

The presence of disordered eating behaviors in adults may be a risk factor for the development of eating disorders in adolescents living in the same household. Thus, the development and implementation of eating disorder interventions should consider incorporating a family component.

Psychometric Evaluation of the Sociocultural Attitudes Towards Appearance Questionnaire-3 among Brazilian Young Adults

The objective was evaluating the psychometric properties of the Sociocultural Attitudes Towards Appearance Questionnaire-3 (SATAQ–3) among Brazilian young adults of both genders. The sample was composed by 506 undergraduate students (295 females and 211 males), aged between 17 and 29 years old. Exploratory and confirmatory factor analyses were used for construct validity (N = 506). Correlations between the SATAQ–3 scores and those of the Tripartite Influence Scale (TIS) and Body Shape Questionnaire (BSQ) were used for convergent validity. Reliability was assessed through internal consistency (α) and reproducibility (test-retest) through comparison of the means obtained at two different time points and through intra-class correlation. The scale presented a factor structure composed of five factors, replicated in the confirmatory factor analysis with satisfactory values for the measurements of adjustment to the model. Correlations with the BSQ and TIS scores were rho = .52 and rho = –.35, respectively. Cronbach’s alpha coefficients were satisfactory, and their stability was demonstrated. Brazilian SATAQ–3 had good validity and reproducibility, being indicated for use in samples of Brazilian youths.

Efeitos de diversos fatores sobre o comportamento alimentar de adolescentes

Pesquisadores sugerem que o comportamento alimentar inadequado (CAI) em jovens pode sofrer influências de diversos fatores. No entanto, os resultados têm sido controversos. Deste modo, o objetivo do presente estudo foi averiguar os efeitos de insatisfação corporal (IC), grau de comprometimento psicológico ao exercício (GCPE), nível habitual de atividade física (NAF), índice de massa corporal (IMC), percentual de gordura e etnia sobre o CAI de adolescentes. Participaram 362 jovens de ambos os sexos com idades entre 10 e 19 anos. O Eating attitudes test (EAT-26) foi utilizado para avaliar o CAI. Ademais, utilizou-se o Body shape questionnaire, a commitment exercise scale e o International physical activity questionnaire para avaliar IC, GCPE e NAF, respectivamente. Conduziu-se análise multivariada e regressão múltipla para analisar os dados. Os resultados evidenciaram que a IC, o GCPE, IMC e percentual de gordura influenciaram significativamente (p < 0,05) os escores das subescalas do EAT-26, tanto no sexo feminino, quanto no masculino. No entanto, os efeitos das variâncias foram diferentes entre os sexos. Concluiu-se que IC e o IMC foram os principais fatores que promoveram efeitos significativos nos distintos construtos do comportamento alimentar avaliados pelo EAT-26 em ambos os sexos.

Effects of psychological, morphological and sociodemographic variables on adolescents' eating behavior

OBJECTIVE

To investigate the association of body dissatisfaction (BD), degree of psychological commitment to exercise (DPCE), usual level of physical activity (LPA), body mass index (BMI), fat percentage (%F) and ethnicity with inappropriate eating behavior (IEB) in adolescents.

METHODS

Cross sectional study with 362 adolescents aged between ten and 19 years old, of both genders, selected by stratified sampling. The Eating Attitudes Test (EAT-26) was used to assess the IEB. In addition, Body Shape Questionnaire, Commitment Exercise Scale and the International Physical Activity Questionnaire were applied in order to assess BD, DPCE and LPA, respectively. Statistical treatment included multivariate analysis and multiple regression.

RESULTS

BD, DPCE, BMI and %F were significantly associated with EAT-26 subscales scores for both genders. The statistical values were different between genders.

CONCLUSIONS

body dissatisfaction and BMI seemed to be strongly associated with the different constructs of eating behavior in both sexes.

Checagem corporal, atitude alimentar inadequada e insatisfação com a imagem corporal de jovens universitários

OBJETIVO: O objetivo do estudo foi avaliar a checagem corporal, a atitude alimentar inadequada e a insatisfação corporal em universitários de ambos os sexos. MÉTODOS: Participaram 587 indivíduos (311 homens). Foram avaliados os comportamentos de checagem (mulheres - Body Checking Questionnaire; homens - Male Body Checking Questionnaire), as atitudes alimentares inadequadas (Eating Attitudes Test-26) e a insatisfação corporal (Body Shape Questionnaire). Massa corporal e estatura foram autorreferidas para o cálculo do índice de massa corporal (IMC). Foi realizada estatística descritiva, inferencial e teste qui-quadrado (teste exato de Fisher) utilizando o software Statistic 8.0 e adotado nível de significância de 5%. RESULTADOS: A checagem corporal está associada às atitudes alimentares inadequadas e à insatisfação corporal, independentemente do sexo do indivíduo. Foram encontradas diferenças entre o sexo feminino e masculino para as variáveis avaliadas, sendo maior a frequência entre as mulheres. CONCLUSÃO: Concluiu-se que a checagem corporal é um comportamento presente e de alta frequência em universitários com risco para o transtorno alimentar e também naqueles insatisfeitos com sua imagem corporal.

Disordered eating among Brazilian female college students

This study aimed to investigate the socioeconomic and nutritional factors associated with disordered eating among Brazilian female college students (n = 2,489). Prevalence ratios of risk factors were calculated using Poisson regression models with robust variance based on responses to selected questions from the Eating Attitude Test and Disordered Eating Attitude Scale. It was found that 40.7% of students were dieting, 35.6% were using diet or compensatory methods, 23.9% skipping meals, 12.6% not eating or just drinking liquids, and 3.3%, vomiting to lose weight. A positive association was found between not eating or just drinking liquids and skipping meals and nutritional status after adjustment for age and region. A positive association was found between compensatory methods and dieting and education level of the head of the family. Disordered eating behaviors were frequent, and not eating and skipping meals were more prevalent among overweight/obese students; compensatory methods and dieting were less prevalent among students from families whose head had up to only four years of education. Prevention strategies and food education are necessary in order to decrease the prevalence of these behaviors.

The use of appetite suppressants among health sciences undergraduate students in Southern Brazil

OBJECTIVE

To investigate the prevalence of appetite suppressant use among health sciences students in Southern Brazil.

METHODS

Undergraduate students (n=300) from seven health science undergraduate courses of the Universidade de Caxias do Sul completed a questionnaire about the use of substances to suppress appetite.

RESULTS

A significant percentage (15%; n=45) of research participants used appetite suppressants at least once in their lives. The most commonly used substances were sympathomimetic stimulant drugs (5%), including amfepramone (3.3%) and fenproporex (1.7%). The lifetime use of appetite suppressants was more prevalent among Nursing (26.7%) and Nutrition (24.4%%) students. There was no reported use of appetite suppressants among medical students. The use of appetite suppressants was significantly more prevalent among women. The majority of those who used these substances did so under medical recommendation. Most of users took appetite suppressants for more than 3 months.

CONCLUSION

Lifetime use of appetite suppressants was substantial, being sympathomimetic stimulant drugs the most commonly used agents. Students enrolled in Nursing and Nutrition courses presented a significantly higher prevalence of lifetime use of appetite suppressants.

Prevalência de transtornos alimentares em trabalhadores urbanos de município do Nordeste do Brasil

Este artigo tem por objetivo, estimar a prevalência de transtornos alimentares em trabalhadores residentes em área urbana de Feira de Santana, Bahia. Trata-se de estudo epidemiológico de corte transversal exploratório, incluindo 1.273 trabalhadores, aleatoriamente selecionados. Características sociodemográficas e do trabalho, hábitos de vida, aspectos psicossociais do trabalho e transtornos alimentares foram investigados. Foi predominante o sexo feminino (60,2%), os mais jovens (51,7% tinham até 35 anos), casados (53,1%), de cor parda (55,2%), com ensino médio (51,5%) e com baixa renda (81,2%). As prevalências de Transtorno da Compulsão Alimentar Periódica e Bulimia Nervosa foram, respectivamente, 4,3% e 1,0%. As prevalências foram mais elevadas entre os que apresentaram consumo abusivo de álcool, insatisfação com o peso, história de agressão na infância, problema financeiro/preocupações, pertenciam aos setores de serviços domésticos e comércio, os que tinham vínculo informal de trabalho e os que estavam no grupo de trabalho de alta exigência. Além de investigar a relação entre os transtornos alimentares e o trabalho, obteve-se dados sobre esses transtornos em estudo de base populacional. Espera-se que os achados obtidos possam fomentar políticas de saúde para os transtornos alimentares.

Equivalência Semântica da versão em português do "Body Change Inventory"

Com o crescimento das pesquisas acerca dos componentes da imagem corporal, fazem-se necessários instrumentos válidos que avaliem suas dimensões. O Body Change Inventory (BCI) avalia as estratégias adotadas para modificação do corpo entre adolescentes. O objetivo deste estudo foi descrever o processo de tradução e avaliação da equivalência semântica do BCI para a língua portuguesa. O processo envolveu as etapas de (1) tradução do questionário para o idioma português; (2) retrotradução para o inglês; (3) avaliação da equivalência semântica; e, (4) análise da compreensão verbal por especialistas e jovens brasileiros. As seis subescalas que compõem o instrumento foram traduzidas para o português. Foram realizadas adaptações na linguagem a fim de tornar o instrumento adequado à realidade brasileira. As questões foram interpretadas como de fácil compreensão tanto por especialistas quanto pelos jovens. O Questionário de Mudança Corporal encontra-se traduzido e adaptado para o idioma português, sendo ainda necessária a avaliação das equivalências operacional, de mensuração e funcional.

Comparison of eating attitudes among university students from the five Brazilian regions

Eating attitudes can be defined as beliefs, thoughts, feelings, behavior and relationship with food. They can influence people's food choices and health status. The scope of this paper is to compare eating attitudes of university students from different regions of Brazil and investigate possible associations and correlations with nutritional status, age, individual income and parental education. 2489 female university students in the area of health answered the Eating Attitude Scale - evaluated by total score and 5 sub-scores. The eating attitudes were compared by means of an analysis of covariance. A logistic regression was conducted to evaluate which variables were associated to the scale score. The Northeast presented more restrictive and compensatory practices and the North and Northeast presented less positive feelings about food and worse ideas about normal eating. The score on the scale did not present strong correlation with any of the variables studied, but nutritional status and age were associated with the total score. The profile of university students was similar among regions with the worst response in the North and Northeast regions. It is believed that these data could help to elucidate dietary patterns and nutritional differences among groups.

Insatisfação corporal, prática de dietas e comportamentos de risco para transtornos alimentares em mães residentes em Santos

OBJETIVO: Avaliar a insatisfação corporal, a prática de dietas e os comportamentos de risco para transtornos alimentares em uma amostra de mães residentes no município de Santos. MÉTODOS: Foi realizado um estudo transversal, de base populacional, com 453 mães de filhos com até 10 anos de idade. As mães responderam ao Teste de Atitudes Alimentares (EAT-26), à Escala de Figuras de Stunkard e a uma questão sobre a prática atual de dietas. RESULTADOS: Das mães, 29,9% apresentaram escore positivo para os comportamentos de risco para transtornos alimentares e 21,8% estavam fazendo dieta para emagrecer no momento da entrevista. No tocante à imagem corporal, 17,5% das mães estavam satisfeitas com o seu tamanho corporal, 71,5% gostariam de diminuir seu tamanho corporal e 11,0% gostariam de aumentá-lo. Os comportamentos de risco para transtornos alimentares foram mais frequentes nas mães insatisfeitas com seus tamanhos corporais (p < 0,0001). CONCLUSÃO: A maioria das mães investigadas estava insatisfeita com os seus tamanhos corporais. A frequência de mães que praticavam dietas ou tinham comportamentos de risco para transtornos alimentares foi similar ou superior aos demais estudos nacionais, conduzidos, em sua maioria, com populações consideradas de risco, como meninas adolescentes e jovens universitárias.

Adaptação transcultural preliminar do Children's Eating Attitude Test (Cheat) para o idioma português

OBJETIVOS: traduzir e adaptar o instrumento "Children's Eating Attitude Test" (Cheat) para o idioma português, avaliar a equivalência semântica e a compreensão verbal. MÉTODOS: envolveu quatro etapas: (1) tradução, (2) retradução, (3) revisão técnica e avaliação semântica, (4) pré-teste - avaliação da compreensão verbal por especialistas em transtorno alimentar. RESULTADOS: as 26 questões foram traduzidas e adaptadas para o idioma português. A versão final constou dos mesmos 26 itens apresentando-se de forma clara e de fácil compreensão (valores médios superior a 4,5 - máximo 5,0). CONCLUSÕES: o instrumento encontra-se traduzido e adaptado para o idioma português demonstrando bons resultados no processo de adaptação transcultural. São necessárias análises de validade externa, equivalência de mensuração e reprodutibilidade.

Equivalência semântica e avaliação da consistência interna da versão em português do Sociocultural Attitudes Towards Appearance Questionnaire-3 (SATAQ-3)

O objetivo do estudo foi descrever o processo de adaptação transcultural do Sociocultural Attitudes Towards Appearance Questionnaire-3 (SATAQ-3) para a língua portuguesa. A metodologia foi baseada nas etapas de (1) tradução do questionário para o português; (2) retrotradução para o inglês; (3) comitê de peritos para construção da primeira versão; (4) avaliação da compreensão verbal por especialistas e por uma amostra da população-alvo; (5) análise da consistência interna do instrumento a partir do alfa de Cronbach. O instrumento foi traduzido para o português e a versão final contou com os 30 itens do instrumento original. Todos os itens foram interpretados como de fácil compreensão, tanto por especialistas quanto pela população-alvo. Os valores de consistência interna foram satisfatórios, sendo de 0,91 para toda a escala. O instrumento encontra-se traduzido e adaptado para o português, com evidências de boa compreensão e consistência interna, sendo ainda necessária a avaliação de sua equivalência de mensuração, validade externa e reprodutibilidade.

Prevalence and correlates of self-induced vomiting as weight-control strategy among adolescents in Taiwan

AIMS

This study was designed to assess the prevalence and correlates of self-induced vomiting to control body weight among adolescents in Taiwan.

BACKGROUND

Over the past decades, the rate of obesity among children in Taiwan has nearly tripled. Educational authorities have devoted considerable effort to prevent the increase in childhood obesity.

DESIGN

An observational exploratory design to investigate the problem of using unhealthy weight-reduction strategy.

METHODS

This study consists of a cross-sectional study aimed at collecting national representative data. We chose 120 representative schools using a three-stage stratified systematic sampling design with probability proportionate to the size of the population in Taiwan. Participants consisted of 8673 girls and 7043 boys, aged 10-18 old.

RESULTS

Of the participants, 13% reported using self-induced vomiting, the prevalence being highest in participants aged 10-12 (15·9%) and lowest in participants aged 16-18 (7·5%). Several factors were significantly and positively associated with the use of self-induced vomiting as a weight-loss strategy, specifically subjects who (1) watched television, used computer, surfed the Internet or played video games for greater than or equal to two hours/day, (2) consumed fried food every day and (3) ate night-time snacks every day (odds ratio = 1·55, 2·10 and 1·51, respectively; p < 0·05). Eating breakfast every day and sleeping for more than eight hours a day were both protective factors against the use of self-induced vomiting to control body weight (odds ratio = 0·43 and 0·86, respectively; p < 0·05).

CONCLUSIONS

Self-induced vomiting was prevalent among adolescents who had tried to lose weight; sedentary lifestyle, shorter sleep length and unhealthy eating habits may contribute significantly to this behaviour among these adolescents.

RELEVANCE TO CLINICAL PRACTICE

School nurses who are helping adolescents lose weight should also pay attention to the possibility they are using self-induced vomiting as a weight-control strategy.

[Cross-cultural adaptation: translation and Portuguese language content validation of the Tripartite Influence Scale for body dissatisfaction]

The aim of this study was to translate and adapt the Tripartite Influence Scale to the Portuguese language and evaluate its content validity and internal consistency. Six steps included: (1) translation; (2) back-translation; (3) technique revision and semantic evaluation; (4) conduct validation by professional experts (judges); (5) assessment of comprehensibility by the target population, using a verbal rating scale; and (6) evaluation of the internal consistency using Cronbach's alpha coefficient. The 43 questions were translated and adapted to the Portuguese language. The final version consisted of 39 items, with content validity for three constructs (media, family, and friends), clarity and easy understanding, and good internal agreement (Cronbach's alpha coefficients > 0.80). The instrument was successfully translated and adapted to Portuguese and showed good content validity, verbal comprehensibility, and internal consistency. Further analysis of external validity, equivalence of measurement, and reproducibility are necessary.

Effect of gender and school level on disordered eating behaviours and attitudes in Mexican adolescents

The aim of this study was to assess eating behaviours and attitudes in a community sample of 615 adolescent Mexican students recruited at a middle school (192 boys and 226 girls; mean age +/- standard deviation 13.56+/-0.09) and high school (90 boys and 107 girls; mean age 16.04+/-0.12 years), who completed the Eating Attitudes Test (EAT), the Bulimia Test (BULIT) and the Body Shape Questionnaire (BSQ). Multiple analysis of variance revealed the significant effect of gender on the negative feelings, body dissatisfaction, drive of thinness and perceived social pressure subscales, and school level on the body dissatisfaction and food preoccupation subscales. Among the high school girls, the gender x school level interaction had a significant effect on negative feelings, body dissatisfaction, drive of thinness, food preoccupation and perceived social pressure subscales. These data support previous findings concerning gender, and also suggest that perceived social pressure in the case of girls and food preoccupation in the case of boys could be important factors in the natural development of eating disorders.

Confiabilidade (teste-reteste) de um questionário simplificado para triagem de adolescentes com comportamentos de risco para transtornos alimentares em estudos epidemiológicos

INTRODUÇÃO: É crescente o número de adolescentes apresentando comportamentos alimentares anormais com o objetivo de alcançar o atual ideal estético de magreza, podendo comprometer o estado nutricional nesta fase de crescimento intenso. Ressalta-se a necessidade de instrumentos simples para investigação do problema em estudos populacionais. OBJETIVOS: Avaliar a confiabilidade de um questionário simplificado para investigar comportamentos de risco para transtornos alimentares (TA) entre adolescentes. MÉTODOS: O questionário, contendo duas perguntas, sendo a última subdividida em quatro questões, sobre freqüência de episódios de compulsão alimentar, uso de laxantes, diuréticos e vômitos auto-induzidos e hábito de consumir dietas restritivas, foi aplicado em dois momentos (teste-reteste), com distância de 15 dias, em 195 estudantes (70 % meninas) de uma escola pública de Niterói, RJ, com idade entre 12 a 19,9 anos. A confiabilidade das perguntas foi avaliada utilizando o coeficiente kappa ponderado e seus respectivos intervalos de confiança (IC) de 95% e kappa ajustado para freqüência. RESULTADOS: Os valores de kappa ajustado para freqüência para os comportamentos menos freqüentes foram: 0,93 para o uso de laxantes, 0,97 para o uso de diuréticos e 0,92 para vômito auto induzido. Para os comportamentos de risco mais freqüentes como episódios de compulsão alimentar e hábito de fazer dieta restritiva encontrou-se valores de kappa ponderado 0,50 e 0,61, respectivamente. CONCLUSÃO: A confiabilidade do questionário foi boa, com melhores resultados para investigar comportamentos menos freqüentes.

Prevalence of binge eating and associated factors in a Brazilian probability sample of midlife women

OBJECTIVE

To estimate the prevalence of binge eating (BE) and inappropriate behaviors of weight control in a population sample of Brazilian midlife adult women and to correlate the prevalence of BE with self-rated health (SRH).

METHOD

A household sample of 1,298 females aged 35 years or older answered a face-to-face interview including questions on eating behaviors and had their weight and height measured.

RESULTS

The prevalence of regular BE (twice or more episodes by week) and inappropriate methods of weight control was 11.5 and 10.2%, respectively. BE episodes were positively correlated with BMI and negatively correlated with age and SRH. These correlations persisted when mutually adjusted by BMI, age, and SRH.

CONCLUSION

These findings show the relevance of BE on the overall health of women of this age group and emphasize the need for expanding research on eating disorders to beyond the populations more frequently assessed of teenagers and young adults.

Eating disorders in the female patient: pathophysiology and treatment strategies

Eating disorders are common in girls and women. Two common eating disorders--anorexia nervosa and bulimia nervosa--have significant medical complications. Oral and maxillofacial surgeons must be cognizant of the signs, symptoms, and medical consequences of these disorders. The increased incidence of these diseases has implications in the surgical management the oral and maxillofacial surgery patient. A review of the literature and guidelines in the perioperative management of these surgical patients are presented in this article.

Imported compounded diet pill use among Brazilian women immigrants in the United States

In Brazil, compounded diet pills that combine amphetamines, benzodiazepines, antidepressants, diuretics and laxatives are often prescribed. In 2006, the Food and Drug Administration banned their sale in the United States (US) citing substantial safety concerns. This study evaluates the prevalence of, and factors associated with, use of these pills among Brazilian immigrant women aged 18-50. Pill use was assessed at one clinic and two churches using an anonymous survey (n = 307). While living in the US, 18% of clinic respondents and 9% of church respondents reported using these diet pills. Nearly two thirds of pill users reported adverse effects. In multivariate logistic regression analysis, being unmarried, college educated, dissatisfied with current weight, and advised by a US physician to lose weight were associated with greater odds of imported diet pill use. To enhance care of Brazilian immigrants, US physicians should become familiar with the health consequences of imported diet pills from Brazil.

Eating disorder attitude and abnormal eating behaviours in a sample of 11-13-year-old school children: the role of pubertal body transformation

OBJECTIVE

A cross sectional study was performed to evaluate the presence, in a sample of subjects in the age of pubertal transition, of those psychological characteristics and abnormal eating behaviours, which are generally considered the predictors of eating disorders (EDs) in adolescence. The primary aim of our study was to evaluate the presence of EDs-related psychological traits and of abnormal eating behaviours, in a wide sample of natural 11-13-year-old population, and to determine if, in this period of transition, there are the same differences between males and females, which are related to the ED psychological characteristics that are often observed and assessed in samples of adolescents or young adults; our secondary aim was to evaluate, in the female sample, if and how the episode of menarche, and the related pubertal body transformation, play a role in the development of ED symptomatology.

METHOD

We screened 2925 school children by means of an ad-hoc socio-demographic schedule, the EDI 2 and the EDI-Symptom Checklist questionnaires. We compared each EDI 2 scales score (Mann-Whitney U) and the abnormal eating behaviours (chi(2) analyses) between pre- and post-menarche female subjects, for each age subgroup.

RESULTS

Fourteen percent of the entire sample scored higher than the cut-off value at the EDI 2 drive for thinness scale and have to be considered at risk for an ED onset. The EDI 2 scores and the adoption of abnormal eating behaviour increase, in the female population, depending on whether they have had menarche. In the male sample the mean values at EDI 2 scales decrease with increasing age.

DISCUSSION

The abnormal eating behaviours and the psychological ED attitude are widespread even among a "cross-pubertal" population. Our data confirm the differences between male and female subjects at the EDs attitude, suggesting a strong relation in the female children between the pubertal body transformation and the risk of ED onset.

Abnormal eating behaviors in adolescent and young adult women from southern Brazil: reassessment after four years

OBJECTIVE

To investigate whether abnormal eating behaviors in young women could predict eating disorders after 4 years.

METHOD

56 women were identified as presenting abnormal eating behaviors in a cross-sectional study (Eating Attitudes Test-26 and Edinburgh Bulimic Investigation Test). They were matched for age and neighborhood to two controls (n = 112). Four years later, they were re-assessed with the two screening questionnaires plus the Composite International Diagnostic Interview (CIDI 2.1).

RESULTS

Women with abnormal eating behaviors at baseline showed a high probability of presenting abnormal eating behaviors but it was not associated with eating disorders 4 years later. They were also at higher risk for obsessive-compulsive disorder, post-traumatic stress disorder, and specific phobia.

DISCUSSION

Abnormal eating behaviors were related to the maintenance of the disturbed behavior over the years, and were associated with increased probability for psychiatric diagnoses.

Body dissatisfaction in Brazilian schoolchildren: prevalence and associated factors

OBJECTIVE: To examine the prevalence of body dissatisfaction and associated factors in 8- to 11-year-old schoolchildren. METHODS: A cross-sectional study including children aged 8- to 11-years enrolled in public and private schools in Porto Alegre, Southern Brazil, was carried out from August to December, 2001. A total of 901 subjects were selected through cluster sampling. Participants answered a questionnaire aimed at measuring body dissatisfaction and self-esteem and questions about family and social pressures on weight change. Height and weight were measured. The relationship between body dissatisfaction and the variables studied was measured by logistic regression. RESULTS: The prevalence of body dissatisfaction was 82%. Fifty-five percent of the girls wanted a thinner body size, and 28% desired a larger one; the estimates for the boys were 43% and 38%, respectively. Children with the lowest self-esteem (OR=1.80; 95% CI: 1.13-2.89) and who thought their parents (OR=6.10; 95% CI: 2.95-12.60) and friends (OR=1.81; 95% CI: 1.02-3.20) expected them to be thinner showed a higher chance of presenting body dissatisfaction. CONCLUSIONS: Body dissatisfaction was highly prevalent among the evaluated schoolchildren, especially in those with lower self-esteem and who thought their parents and friends expected them to be thinner.

Association between symptoms of attention-deficit/hyperactivity disorder and bulimic behaviors in a clinical sample of severely obese adolescents

OBJECTIVE

Preliminary evidence suggests a comorbidity between attention-deficit/hyperactivity disorder (ADHD) and obesity. This study was carried out to identify the clinical characteristics of obese adolescents with a higher probability of ADHD and advance the understanding of the potential factors underlying the comorbidity between obesity and ADHD. We evaluated the association between ADHD symptoms and bulimic behaviors, depressive and anxiety symptoms, degree of obesity, pubertal stage, age and gender in a clinical sample of obese adolescents.

DESIGN

Cross-sectional study.

SUBJECTS

Ninety-nine severely obese adolescents aged 12-17 years.

MEASUREMENTS

Subjects filled out the Bulimic Investigatory Test, Edinburgh, the Beck Depression Inventory and the State-Trait Anxiety Inventory for Children. Their parents completed the Conners Parent Rating Scale, which assesses ADHD symptoms. The degree of overweight was expressed as body mass index-z score. Puberty development was clinically assessed on the basis of Tanner stages.

RESULTS

Bulimic behaviors were significantly associated with ADHD symptoms after controlling for depressive and anxiety symptoms. The degree of overweight, pubertal stage, age and gender were not significantly associated with ADHD symptoms.

CONCLUSION

Obese adolescents with bulimic behaviors may have a higher probability to present with ADHD symptoms independently from associated depressive or anxiety symptoms. The degree of overweight, pubertal stage, age and gender might not be useful for detecting obese adolescents with ADHD symptoms. Therefore, we suggest systematic screening for ADHD in obese adolescents with bulimic behaviors. Further studies are needed to understand which specific dimension of ADHD primarily accounts for the association with bulimic behaviors. Future research should also investigate the causal link between bulimic behaviors and ADHD and explore potential common neurobiological alterations. This may lead to a better understanding of the effectiveness of stimulants for the treatment of bulimic behaviors in obese subjects.

The validity and 4-year test-retest reliability of the Brazilian version of the Eating Attitudes Test-26

In a cross-sectional study conducted four years ago to assess the validity of the Brazilian version of the Eating Attitudes Test-26 (EAT-26) for the identification of abnormal eating behaviors in a population of young females in Southern Brazil, 56 women presented abnormal eating behavior as indicated by the EAT-26 and the Edinburgh Bulimic Investigation Test. They were each matched for age and neighborhood to two normal controls (N = 112) and were re-assessed four years later with the two screening questionnaires plus the Composite International Diagnostic Interview (CIDI). The EAT results were then compared to diagnoses originating from the CIDI. To evaluate the temporal stability of the two screening questionnaires, a test-retest design was applied to estimate kappa coefficients for individual items. Given the prevalence of eating disorders of 6.2%, the CIDI psychiatry interview was applied to 161 women. Of these, 0.6% exhibited anorexia nervosa and 5.6%, bulimia nervosa (10 positive cases). The validity coefficients of the EAT were: 40% sensitivity, 84% specificity, and 14% positive predictive value. Cronbach's coefficient was 0.75. For each EAT item, the kappa index was not higher than 0.344 and the correlation coefficient was lower than 0.488. We conclude that the EAT-26 exhibited low validity coefficients for sensitivity and positive predictive value, and showed a poor temporal stability. It is reasonable to assume that these results were not influenced by the low prevalence of eating disorders in the community. Thus, the results cast doubts on the ability of the EAT-26 test to identify cases of abnormal eating behaviors in this population.

Prevalence of eating disorders in Argentine boys and girls, aged 10 to 19, who are in primary care. A two-stage community-based survey

The objective of this paper is to describe the prevalence of eating disorders (ED) in Argentina, in a randomly assigned national community-based sample of 1,231 girls and 740 boys in primary care, aged 10 to 19.9. A two-stage design was followed; subjects were screened with a self-report measure (EDE-Q4), and diagnosed with an expert-based interview (EDE-120D). Height, weight and BMI were measured and five subscales of the SCL90-R were completed. More than one quarter (a 26.4%) of the sample had a BMI greater than the 90th percentile, and these accounted for 48% of the suspected cases of ED. Only 42% returned for the EDE-12 interview; diagnosis was confirmed for 137 cases (6.9% of the total sample): 6.6% BED; 0.05% BN, and 0.3% EDNOS other than BED. Binge eating and restraint of food intake related directly to BMI and purging behaviors were very rare. More subjects than expected were found to be overweight and this related directly to the diagnosed ED. Psychological distress was directly related the presence of eating disturbances.

Differences in diet composition of Brazilian adolescent girls with positive or negative score in the Eating Attitudes Test

Dieting, a behavioral phenomenon which is becoming more frequent among adolescents, is certainly involved in the pathogenesis of eating disorders, especially anorexia nervosa (AN), and may result in an unbalanced nutrition. Our study aimed at identifying girls with symptoms of AN and describing their diets. We assessed girls with symptoms by using the Eating Attitudes Test and considered girls with a score > or = 20 as having symptoms of AN. To evaluate their diets, a "modified" 24-hour recall was applied on three alternate days. Twenty-one percent of the 279 girls studied showed symptoms of AN. Analysis of the food intake showed that calories, calcium and iron were below the recommendations of the Standing Committee on the Specific Evaluation of Dietary Reference Intakes (DRI Committee) and the National Research Council, while protein and carbohydrate were within the recommended range and fat was above the percentage of recommended total energy intake. Compared to girls without symptoms, they had a significantly smaller intake of calories and iron, and a higher intake of protein. Findings shown in this paper point out the need for intervention in adolescents because their dieting behavior can predispose to an eating disorder.

Bulimic Investigatory Test, Edinburgh (BITE). A validation study of the Italian version

OBJECTIVE

To explore the psychometric properties of the Italian version of the Bulimic Investigatory Test, Edinburgh (BITE).

SUBJECTS

A general population sample of 995 subjects (621 females), a clinical sample of 388 eating disordered females and a clinical sample of 710 patients with obesity (575 females).

RESULTS

Internal consistency was satisfactory. The factor analysis confirmed that the Symptom Scale is mono-factorial. Patients with bulimia nervosa (BN) purging showed the highest scores and those with anorexia nervosa (AN) restricting type the lowest. Obese patients showed higher BITE scores than controls in both sexes (P<0.01) and those with binge eating disorder (BED) showed higher scores than the rest of the sample (P<0.05). In patients with obesity with the threshold of 10 the Symptom Scale had a sensitivity for BED of 93% and a specificity of 55%; with the threshold of 20, sensitivity and specificity were, respectively, 44% and 92%. Normative values for BITE total and sub-scale scores in clinical and non-clinical samples are reported.

CONCLUSION

The Italian version of BITE is psychometrically sound and it can be a useful screening tool. Our data suggest that Symptom Scale, with a threshold of 20, has a good sensitivity for BN, although it does not effectively discriminate patients with BN from those affected by other eating disorders with binge-eating (BED, AN bingeing-purging type).

Smoking and weight control behaviors

OBJECTIVE

To examine the association between weight control and tobacco use in young women.

METHODS

Smoking status and weight and eating related issues, endorsement of the belief "smoking helps to control weight" dieting status (DEBQ-R), current and ideal weight and current height were assessed in 144 students.

RESULTS

Smoker (S) restrained eaters (RE) scored higher on dietary restraint than nonsmoker (NS) RE. In the smoking questionnaire, S-RE selected a significantly higher number of items concerning hunger, eating and weight than S unrestrained eaters (URE). S-RE had a greater level of endorsement of the belief: "smoking helps to control weight" than NS-URE. The subjects who marked those items had significantly higher scores in the DEBQ-R and were more likely to be RE than those who marked none of them.

CONCLUSION

Our findings suggest that among young women who smoke and diet there might be a risk group that smokes as a weight control strategy.

Population at risk for eating disorders in a Spanish region

OBJECTIVE

To estimate the prevalence of adolescent population at risk for eating disorders (EDs), to examine gender differences and their association with non-psychotic mental disorders.

METHODS

Cross-sectional study using an anonymous, self-reported questionnaire in the classroom and measurement of weight and height in a representative sample of 4334 teenagers of both sexes. A definition of population at risk for EDs has been established, that differentiates those with dieting criteria and those with binge-purge eating behaviour criteria. This definition includes a combination of weight, behaviour, Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria, and Eating Disorder Inventory (EDI) results. The General Health Questionnaire-28 (GHQ-28) was used to assess non-psychotic mental disorders.

RESULTS

The prevalence of population at risk for EDs was 2.2% (95% CI: 1.6-2.8) for men and 15.3% (95% CI: 13.8-16.9) for women. The prevalence rate of combining both ED risk and mental disorder was 0.8% (95% CI: 0.4-1.2) for men and 9.9% (95% CI: 8.6-11.2) for women. Non-psychotic mental disorders were more prevalent in the population at risk for EDs than in the rest of the population.

CONCLUSIONS

A considerable proportion of adolescent females have eating problems and non-psychotic mental disorders. Their male counterparts also suffer from these disorders, however, a different pattern is followed.