What are adolescents' experiences of body dissatisfaction and dieting, and what do they recommend for prevention? A qualitative study

Positive body image: a qualitative study on the successful experiences of adolescents, teachers and parents

Purpose Body image encompasses body-related self-perceptions and personal attitudes. Dissatisfaction with body image during the early stages of adolescence is negatively related to self-esteem and other health problems. A few publications focused on positive body image and directly related to the experiences and interactions of adolescents themselves. To explore positive body image in adolescents and describe the familial and educational factors that contribute to its development.Methods A qualitative study was conducted. Purposive sampling was used, and 9 adolescents, 6 families, and 8 teachers participated in semi-structured interviews, which were then theme analyzed. Results Self-care, body acceptance, confronting messages that attack body image, and the influence of social media have been identified as emerging themes in adolescents' positive body image experiences. Therefore, the pubertal period, family values, fostering, and educational actions as well as media literacy were identified as factors promoting self-esteem and positive body image in the family and educational environment. Conclusions Their parents also expressed aspects such as those that contribute to the development of healthy self-esteem, confidence, and positive body image. Alternatively, the teachers indicated educational activities to work on self-image and self-esteem when faced with situations of concern in the classroom.

The Meaning and Factors That Influence the Concept of Body Image: Systematic Review and Meta-Ethnography from the Perspectives of Adolescents

Community care nurses educate adolescents about body image, but their interventions appear to be ineffective. Body dissatisfaction predicts unhealthy behaviors among adolescents. This study aimed to understand the meanings and factors that influence the concept of body image through a systematic review and meta-ethnography of qualitative studies from the perspective of adolescents. Ten studies published from 2009–2019 were identified by a search of relevant systematic databases between September and December 2019. The review followed the seven steps of meta-ethnography developed by Noblit and Hare, including a line-of-argument. The synthesis revealed six themes: self-perception of body image; opinions of friends and colleagues; opinions of family; specific features of the school environment; expectations perceived across the mass-media; and strategies, practices, and self-management of body image. An explanatory model was developed that showed adolescents’ development of body image and the path towards its establishment. In conclusion, these results should be considered to implement strategies to promote a healthy body image in adolescents by community health and mental health nurses.

An exploratory study on the intergenerational transmission of dieting proneness within an eating disorder population

An Exploratory Study on the Intergenerational Transmission of Dieting Proneness within an Eating Disorder Population (IRB Protocol Number: 160928271).

PURPOSE

Parents and families are not the sole factor in eating disorder (ED) development and their involvement in recovery is crucial. However, parents provide a social and environmental context for a child's eating and weight that cannot be completely discounted. The purpose of this study was to explore the intergenerational transmission of dieting behavior within an ED sample.

METHODS

Participants (N = 65) were recruited for this cross-sectional study through four distinct ED treatment sites. Participants completed a questionnaire that was developed previously to examine parental feedback as predictor variables, as well as completing the Eating Pathology Severity Index (EPSI) as an outcome variable. A total of 60 completed the questionnaire items of interest to be included in the analyses. SAS JMP^® 13.0 was used for descriptive analyses, correlations, and multivariable linear regressions.

RESULTS

Results of the multivariable linear regression showed that the amount of variance explained by the final model for eating pathology severity (via the EPSI) doubled when parental feedback was included (Model 1: R²= 0.09, Model 2: R²= 0.20). Additionally, there was a significant relationship between the "Negative Direct Parental Feedback Subscale" and EPSI total scores (ß = 14.1; SD = 7.0; p = 0.05).

CONCLUSION

These findings of increased eating pathology associated with direct parental feedback in a clinical population of ED participants even when controlling for parental ED history suggests greater attention is needed within the ED literature on social and environmental factors and their potential associations with eating pathology.

LEVEL OF EVIDENCE

Level V, descriptive study.

An exploratory study on the intergenerational transmission of obesity and dieting proneness

PURPOSE

There is a paucity of research exploring individuals' memories of parental dieting behavior, engagement in "fat talk", or criticism of weight or eating behavior in childhood. This exploratory study utilized a community sample to further characterize the retrospective report of parenting dieting behavior.

METHODS

A total of 507 participants (78.1% females; 20.7% males; and 1.2% transgender) were recruited to participate in an online, self-administered survey.

RESULTS

Forty percent (216) of participants reported maternal dieting in their family of origin and 34% (182) reported maternal fat talk, 24% (120) reported paternal dieting, and 11% recalled paternal 'fat talk' (58). Subgroup analyses suggest that both male and female participants had greater odds of remembering maternal rather than paternal weight or shape criticism and encouragement to diet (OR = 58.1; and OR = 3.12; p < 0.0001 for male and female participants, respectively). Retrospective report of indirect parental behaviors (e.g. parental dieting) also appears to be associated with direct parental behaviors (e.g. encouraging children to diet). Additionally, participants who recalled maternal encouragement to diet reported a significantly higher adult BMI (β = 1.31, SE = 0.32, p < 0.0001).

CONCLUSION

Results provide preliminary evidence that a sizeable percentage of both adult male and female participants recalled that their parents engaged in fat talk and dieting. In addition, participants recalled parental criticism of their own weight or eating behaviors, which was associated with recall of parental dieting and fat talk.

LEVEL OF EVIDENCE

Level V, Descriptive Study.

Body dissatisfaction in adolescents with eating disorders

PURPOSE

This study aims to analyze and compare the level of body dissatisfaction (BD) in different eating disorders (ED) subtypes. Also, the relationship between BD and certain aesthetic body shape model influence and psychological variables was analyzed.

METHODS

The sample consisted of 204 adolescent patients, who were attending in an ED Unit in Zaragoza (Spain). The following instruments were applied: the Spanish Children's Depression Questionnaire (CEDI-II), the Rosenberg Self-Esteem Scale (RSES), the Eating Attitudes Test (EAT-40), the Body Shape Questionnaire (BSQ-34) and the Questionnaire of Influences of Aesthetic Body shape Model (CIMEC-40).

RESULTS

The group of Bulimia Nervosa (BN) showed the greatest BD. Those patients who showed higher levels of BD had lower self-esteem, more depressive symptoms, a greater presence of disordered eating attitudes, and more influence of the aesthetic body shape model.

CONCLUSIONS

This study contributes to highlight the idea of implementing effective prevention programs and specific interventions related to BD in the treatment of ED.

"Don't eat so much:" how parent comments relate to female weight satisfaction

PURPOSE

How will the words of a parent influence the adult weight of their daughter? This retrospective study evaluates how the recalled comments of parents made about the weight or eating habits of a daughter related to her adult BMI and satisfaction with her weight.

METHOD

A nationwide cross-sectional survey was conducted with 501 young women ranging in age from 20 to 35 (age 26.8, SD 3.1; BMI 25.96, SD 6.2), who were asked to indicate their weight satisfaction, eating habits, and BMI along with their recall of the extent to which they recalled their parents making weight-related or eating-related comments about them as a young girl. Linear regression analyses were run to examine the relationship between parental comments and women's weight satisfaction and BMI.

RESULTS

A woman's dissatisfaction with her adult weight was only related to the extent she remembered her parents making any comments about her weight (p < 0.01), but not about how much she ate (p < 0.05)-even though both were positively related to her BMI (p < 0.001 and p < 0.01). Even among normal-weight young women with similar weights, those who recalled their parents commenting about their weight were more dissatisfied with their body weight (p < 0.01).

DISCUSSION

In this retrospective study, a parent's comments about her childhood weight were related to her weight and body dissatisfaction as an adult. In contrast, comments about her eating habits were not significantly related to weight dissatisfaction.

Influences on eating: a qualitative study of adolescents in a periurban area in Lima, Peru

Background

Peruvian adolescents are at high nutritional risk, facing issues such as overweight and obesity, anemia, and pregnancy during a period of development. Research seeking to understand contextual factors that influence eating habits to inform the development of public health interventions is lacking in this population. This study aimed to understand socio-cultural influences on eating among adolescents in periurban Lima, Peru using qualitative methods.

Methods

Semi-structured interviews and pile sort activities were conducted with 14 adolescents 15–17 years. The interview was designed to elicit information on influences on eating habits at four levels: individual (intrapersonal), social environmental (interpersonal), physical environmental (community settings), and macrosystem (societal). The pile sort activity required adolescents to place cards with food images into groups and then to describe the characteristics of the foods placed in each group. Content analysis was used to identify predominant themes of influencing factors in interviews. Multidimensional scaling and hierarchical clustering analysis was completed with pile sort data.

Results

Individual influences on behavior included lack of financial resources to purchase food and concerns about body image. Nutrition-related knowledge also played a role; participants noted the importance of foods such as beans for anemia prevention. At the social environmental level, parents promoted healthy eating by providing advice on food selection and home-cooked meals. The physical environment also influenced intake, with foods available in schools being predominantly low-nutrient energy-dense. Macrosystem influences were evident, as adolescents used the Internet for nutrition information, which they viewed as credible.

Conclusions

To address nutrition-related issues such as obesity and iron-deficiency anemia in Peruvian adolescents, further research is warranted to elucidate the roles of certain factors shaping behavior, particularly that of family, cited numerous times as having a positive influence. Addressing nutrition-related issues such as obesity and iron-deficiency anemia in this population requires consideration of the effect of social and environmental factors in the context of adolescent lifestyles on behavior. Nutrition education messages for adolescents should consider the cultural perceptions and importance of particular foods, taking into account the diverse factors that influence eating behaviors.

Can cognitive dissonance methods developed in the West for combatting the 'thin ideal' help slow the rapidly increasing prevalence of eating disorders in non-Western cultures?

SUMMARY

Eating disorders are common, life-threatening conditions in Western countries, but until relatively recently they were regarded as uncommon in non-Western cultures. However, the prevalence of eating disorders in many of the more affluent non-Western countries is rising rapidly as community members, particularly young women, internalize the 'thin ideal' that has been widely promoted by the international media. This review discusses the factors involved in the development of eating disorders in non-Western settings with a particular emphasis on the influences of urbanization, modernization, Westernization, and the resulting changes in women's roles. The cognitive dissonance programs developed in Western countries that have proven successful in countering the negative effects of the thin idea are described and their potential application to East Asia and other non-Western countries are discussed.

The role of high-quality friendships in female adolescents' eating pathology and body dissatisfaction

PURPOSE

Peers may serve as risk factors for body dissatisfaction and eating pathology through two possible routes: (1) promoting body dissatisfaction through appearance-related interactions (e.g. weight-teasing); (2) a non-specific social support route whereby poor quality peer relations result in depression and consequently eating pathology. The second route has received little attention and, therefore, was the focus of this study.

METHODS

A cross-sectional study in which 216 adolescent girls (aged 13-16 years) completed self-report measures of positive and negative friendship qualities, friendship functions, eating pathology, body dissatisfaction and depression.

RESULTS

Those reporting poorer quality friendships tended to show greater eating pathology and greater body dissatisfaction. These associations were reduced to non-significance when covarying depression. There was no evidence that the role of friendships was moderated by the extent to which participants valued close relations.

CONCLUSIONS

Low-quality friendships are associated with disordered eating and may be suitable targets for prevention.

Feasibility, acceptability and efficacy of a school-based prevention programme for eating disorders: cluster randomised controlled trial

BACKGROUND

Body image dissatisfaction during adolescence is common but not benign. School-based interventions have the potential for wide reach, but scalability of previous programmes is limited by a reliance on external facilitators.

AIMS

To assess the acceptability, feasibility and efficacy of a teacher-delivered body image intervention.

METHOD

A pilot clustered randomised controlled trial in which 16 classes of adolescent girls were allocated to a 6-session body image programme (n = 261), or usual curriculum control (n = 187) (registration: ISRCTN42594993).

RESULTS

Students in the intervention group had significantly improved body esteem and self-esteem and reduced thin-ideal internalisation. Effects for body esteem and thin-ideal internalisation were maintained for 3 months. There were no group differences for eating pathology, peer factors or depression. Acceptability, feasibility and efficacy varied between schools.

CONCLUSIONS

Teacher-delivered body image lessons have promise but further work is needed to increase efficacy and make interventions suitable across a range of schools.