Adolescent concerns about weight and eating; a social-development perspective

Being Successful and Being Thin: The Effects of Thin-Ideal Social Media Images With High Socioeconomic Status on Women's Body Image and Eating Behaviour

Social media has outpaced traditional media to be the most popular sociocultural channel to transmit thin-ideal images, an established trigger for body image concerns and disordered eating in women. With an experimental design, the present research first demonstrated that exposure to thin images on social media threatened women's body image and increased their unhealthy food consumption (Study 1). However, given that thin images posted on social media are usually from wealthier people, the present research hypothesised that it may not be the body shape but the perceived socioeconomic status (SES) of images that indeed have negative effects on women. By manipulating the perceived SES of thin images and incorporating a baseline control group (Study 2), the present research provided causal evidence for the hypothesis by indicating that viewing thin images with parallel-perceived SES could significantly buffer undesirable thin-ideal effects on self-objectification and food intake. Therefore, future research needs to pay more attention to the role of SES in the thin media images literature.

Maternal eating behaviour differs between ethnic groups: Considerations for research and practice

Maternal eating behaviours such as cognitive restraint, uncontrolled, and emotional eating styles can have important implications for both maternal own weight, and the weight and eating behaviour of her children. Maternal eating style can affect her feeding interactions with her child, which in turn can influence their weight and eating behaviour. However, despite a body of research examining these relationships, research examining differences in maternal eating behaviour between ethnic groups is sparse with much of the research, particularly in the UK, conducted with White British samples. The aim of the current research was therefore to explore how maternal eating behaviour may differ between ethnic groups in the UK; 659 UK mothers with a child aged 5-11 years completed a self-report questionnaire. Items included ethnicity, demographic data, and the 3-factor eating questionnaire to measure maternal cognitive restraint, uncontrolled, and emotional eating. Mothers from Chinese backgrounds were significantly higher in cognitive restraint and lower in emotional and uncontrolled eating compared with all groups. Conversely, mothers from South Asian backgrounds were the highest in emotional and uncontrolled eating and lower in cognitive restraint than all other groups. Black mothers were also higher in uncontrolled eating compared with White British and Chinese mothers. Variations in maternal eating behaviours vary between ethnic groups. Understanding how cultural factors may influence these variations is important, as maternal eating behaviours can influence her own and her child's weight. Maternal eating behaviour may therefore be a contributor to higher levels of overweight among South Asian and Black children living in the UK.

Attention allocation towards own face is pronounced during middle adolescence: an eye-tracking study

Increased interest in the self has long been deemed to be one of the most peculiar characteristics of adolescence. On the basis of this, we conjectured that attentiveness towards self-relevant information, especially one's own face, becomes more pronounced during the middle adolescence. The present study tested this hypothesis by comparing the pattern of visuospatial attention allocation to their own face among early, middle and late adolescent males using an eye-tracking methodology. The results have shown a clear pattern of increased attention allocation towards their own face over a close friend's and a stranger's face in middle adolescents, but fixation durations on their own and a friend's face did not differ from each other in early and late adolescents. In addition, middle adolescents showed higher public self-consciousness and a lower level of self-esteem than early and late adolescents, respectively. These results indicate that attention allocation towards one's own face is more pronounced during middle adolescence, and is associated with increased interest in their own attributes.

Recent trends in weight loss attempts: repeated cross-sectional analyses from the health survey for England

BACKGROUND

Public policies and clinical guidelines encourage people to achieve and maintain a healthy weight and societal culture, especially among women who tend to idealise thinness.

OBJECTIVES

To examine trends over time in the prevalence of weight loss attempts in England (1997-2013) and to investigate if the characteristics associated with attempts to lose weight have changed.

METHODS

Observational study using nationally representative data on adults ⩾18 years who participated in the Health Survey for England (HSE) in 1997 (n=8066), 1998 (n=14 733), 2002 (n=8803), 2012 (n=7132) and 2013 (n=7591), with self-reported attempts to lose weight, cardiovascular disease (CVD) events or medications and measured height, weight and blood pressure. Multivariable logistic regression was used to assess the association between weight loss attempts and survey year, socio-demographic variables and health status.

RESULTS

The age-standardised prevalence of weight loss attempts in the English population increased from 39% in 1997 to 47% in 2013. In 2013, 10% of those with BMI <22; 30% with BMI ⩾22 to <25; 53% with BMI ⩾25 to <30; and 76% with BMI ⩾30 were trying to lose weight. The odds of trying to lose weight increased linearly with each year: odds ratio (OR) 1.021 (95% confidence interval (CI) 1.018-1.024) and 1.024 (95% CI 1.008-1.039) after adjustment for changes in BMI and population characteristics. The biggest predictors of weight loss attempts were being in the overweight/obese categories: 5.42 (95% CI 5.05-5.81) and 12.68 (95% CI 11.52-13.96), respectively; and among women: 3.01 (95% CI 2.85-3.18). Having a BMI >25 and a CVD-related condition was associated with only a small increase in the odds of trying to lose weight. There was no evidence that these predictors changed over time.

CONCLUSIONS

More people are making weight loss attempts each year across all BMI categories. Having a health condition that would improve with weight loss was only very modestly associated with an increase in reported weight loss attempts, which reinforces data that suggests people's prime motivation to lose weight is unrelated to health.

Family Food Rules and Healthy Eating in Adolescents

The current direction in nutrition education reinforces the notion that parental involvement might be necessary for substantial dietary change in children and adolescents. However, research on family determinants of food patterns is limited. This research investigates, in a first study of 429 adolescents, and in a second study of 522 family triads (adolescent-mother- father), the establishment of family food rules in infancy and its impact on food choices and consumption in adolescence. Results of both studies are comparable. Adolescents who report more permissiveness in their family at age 10, eat more fat and sweet foods, more snacks and report less healthy food choices in their family. No relationship was found between obligations on eating a 'proper meal' in childhood and healthy food patterns in adolescence. This research suggests that if parents impose restrictions on the consumption of unhealthy foods upon their children, these may be translated into a lower frequency of consumption of unhealthy foods in adolescence.

Family, Self, And Sociocultural Contributions To Body-Image Attitudes Of African-American Women

This study examined factors that influenced body-image attitudes of 90 African-American college women. Participants completed two instruments assessing body image attitudes and measures of social self-esteem, racial identity attitudes, and family and personal characteristics. Data analyses indicated that self and sociocultural variables were associated with evaluations of physical appearance, fitness, and investment in health. Dissatisfaction with the total body was predicted with family variables, whereas family and self variables were related to satisfaction with body areas. Fathers' education; body mass and fathers' education; body mass and social self-esteem; internalization of racial attitudes; and social self-esteem best predicted body areas satisfaction, appearance evaluation, fitness evaluation, and health orientation, respectively. Implications for the divergence/convergence of subjective measures of body image are discussed and suggestions offered for future studies.

Bulimic Symptomatology in High School Girls

This study tests the explanatory power of an integrated sociocultural and personality model in predicting bulimic symptomatology. Family, peer, and personality factors were assessed at three levels of analysis. The first level of the model measured the general functioning of the family system and friendship network. The second level assessed the extent to which the family system and friendship network were concerned with issues of weight and dieting, as well as the rate of eating disorders among members in these groups. The third level investigated the relationship of certain personality variables to bulimic symptoms. Based on self-report data from approximately 400 high school girls, correlates of bulimic symptomatology at each of the three levels of analysis were identified. An integrated model, in which the three levels of analysis were considered in unison, demonstrated that risk factors at each level of analysis cumulatively contribute to an increase in bulimic symptoms.

Women's weight and disordered eating in a large Norwegian community sample: the Nord-Trøndelag Health Study (HUNT)

OBJECTIVES

An increasing part of the population is affected by disordered eating (DE) even though they do not meet the full eating disorder (ED) criteria. To improve treatment in the range of weight-related disorders, there is a need to improve our knowledge about DE and relevant correlates of weight problems such as underweight, overweight and obesity. However, studies investigating DE and weight problems in a wide range of ages in the general population have been lacking. This paper explores DE, weight problems, dieting and weight dissatisfaction among women in a general population sample.

DESIGN

Cross-sectional study.

SETTING

The third survey of the Nord-Trøndelag Health Study (HUNT3).

PARTICIPANTS

The population included 27,252 women, aged 19-99 years, with information on DE outcomes and covariates.

OUTCOMES

DE was assessed with an 8-item version of the Eating Attitude Test and the Eating Disorder Scale-5. Body mass index (BMI) was objectively measured. Data on dieting and weight dissatisfaction were collected from self-reported questionnaires and analysed across weight categories. Crude and adjusted logistic and multinomial logistic regression models were used.

RESULTS

High rates of overweight (38%) and obesity (23%) were found. DE was associated with weight problems. In women aged <30 years, 11.8% (95% CI 10.3 to 13.1) reported DE, and 12% (95% CI 11.5 to 12.6) reported DE in women aged >30 years. In those of younger ages (19-29 years), lower weight predicted DE, while increasing weight predicted DE in older aged women (30-99 years). The majority of women were dissatisfied with their weight (58.8%), and 54.1% of the women reported dieting. Neither BMI status nor age was associated with dieting or weight dissatisfaction.

CONCLUSIONS

A high prevalence of DE was observed, and findings suggest that weight problems and DE are not distinct from one another. Dieting was associated with women's weight dissatisfaction, rather than with actual weight. This requires further investigations about directionality of effects.

Socio-economic disparities in Australian adolescents' eating behaviours

OBJECTIVE

To assess the association between socio-economic position (SEP) and poor eating behaviours in a large representative sample of Australian secondary-school students.

DESIGN

Cross-sectional survey of students' vegetable, fruit, sugar-sweetened beverage and fast-food consumption assessed using validated instruments and collected via a web-based self-report format.

SETTING

Secondary schools across all Australian states and territories.

SUBJECTS

Secondary-school students (n 12 188; response rate: 54 %) aged 12-17 years participating in the 2009-10 National Secondary Students' Diet and Activity (NaSSDA) survey.

RESULTS

Overall, 25 % of students reported consuming ≤1 serving of vegetables/d and 29 % reported eating ≤1 serving of fruit/d. Fourteen per cent of students reported drinking at least 1-2 cups of sugar-sweetened beverages/d while 9 % reported eating fast food ≥3 times/week. After adjusting for other demographic factors, students of lower-SEP areas were more likely to report low intake of vegetables (F(4, 231) = 3·61, P = 0·007) and high frequency of consumption of sugar-sweetened beverages (F(4, 231) = 8·41, P < 0·001) and fast food (F(4, 231) = 4·59, P = 0·001) compared with students of high-SEP neighbourhoods. A positive SEP association was found for fruit consumption among female students only (F(4, 231) = 4·20, P = 0·003). Those from lower-SEP areas were also more likely to engage in multiple poor eating behaviours (F(4, 231)=5·80, P < 0·001).

CONCLUSIONS

Results suggest that socio-economic disparities in Australian adolescents' eating behaviours do exist, with students residing in lower-SEP neighbourhoods faring less well than those from high-SEP neighbourhoods. Reducing social inequalities in eating behaviours among young people should be a key consideration of future preventive strategies.

Ethnic variations in overweight and obesity among children over time: findings from analyses of the Health Surveys for England 1998-2009

BACKGROUND

The increase in the prevalence of obesity among children and adolescents in England since the mid-1990s has been dramatic. Cross-sectional evidence suggests ethnic variations in childhood obesity prevalence.

OBJECTIVES

The objective of the study was to examine whether and how ethnic variations in childhood overweight/obesity have changed over time, and are affected by socioeconomic factors.

METHOD

This study uses logistic regression to analyse ethnic differences in the relative likelihood of being at or above the age- and gender-specific thresholds for overweight and obesity developed by the International Obesity Task Force among children aged between 2 and 15 from 11 ethnic groups included in the Health Surveys for England between 1998 and 2009, adjusting for age, gender, year of data collection and equivalized household income. We separately analyse the likelihood of being at or above the thresholds for overweight (but below those for obesity) and obesity.

RESULTS

Trends in overweight/obesity over time among ethnic minority groups do not follow those of white English children. Black African children had higher rates of overweight and obesity, which appear to have peaked, and black Caribbean children had higher rates of obesity than other groups examined, which appear to continue rising. These differences were not explained by socioeconomic variations between groups.

CONCLUSION

Policies are required that encourage healthy lifestyles among ethnic minority young people, while engaging with the complexities associated with these choices during childhood and adolescence.

Body size perception and weight control in youth: 9-year international trends from 24 countries

Objectives

To examine nine-year trends and relationships regarding misperceptions of body size and dieting for weight loss among adolescents from 24 countries, and explore the influence of country-level overweight prevalence.

Methods

Socio-demographic characteristics, body size perception, and dieting for weight loss were assessed in the Health Behaviour in School-aged Children survey conducted in 24 countries cross-sectionally at three time points (2001/02, 2005/06, 2009/10). Logistic regression models examined change over time in overestimation of body size in non-overweight adolescents, underestimation of body size in overweight adolescents, dieting for weight loss in non-overweight and overweight adolescents, and relationships between body size perception and dieting. Analyses were stratified by weight status and sex. Covariates included country-level overweight prevalence, family affluence, and country level of development. Body mass index was only included in models examining dieting for weight loss.

Results

Country-level overweight prevalence increased over time (11.6% to 14.7%). Compared to Time 1, overweight adolescents had greater odds of body size underestimation at Time 3 (OR=1.68 for girls, OR=1.10 for boys), while non-overweight adolescents had lower odds of body size overestimation at Time 3 (OR=0.87 for girls, OR=0.89 for boys). Controlling for country-level overweight prevalence attenuated these relationships. Compared to Time 1, overweight and non-overweight boys were 10% more likely to diet at Time 3, while overweight and non-overweight girls were 19% and 16%, respectively, less likely to diet at Time 3. Controlling for country-level overweight prevalence did not impact trends in dieting for weight loss. Additionally, the association of self-perceived overweight with increased odds of dieting diminished over time.

Conclusions

Body size perceptions among adolescents may have changed over time concurrent with shifts in country-level body weight. However, controlling for country-level overweight prevalence did not impact trends in dieting for weight loss, suggesting a potentially stronger impact of social comparison on weight-related perceptions than on behavior.

Eating Behaviours and Body Weight Concerns among Adolescent Girls

This paper presents a global review of research done on adolescent eating behaviours and food choices and the probable factors underlying it. Worldwide adolescent girls tend to develop moderate to high level of disordered eating behaviour as a result of their excessive concern with body weight or obsession with thinness. The objective of the review is to understand the concerns over body weight and the current eating patterns of adolescent girls in the developed and developing countries.

Relative validation of the KiGGS Food Frequency Questionnaire among adolescents in Germany

BACKGROUND

The aim of this study was to determine the relative validity of the self-administered Food Frequency Questionnaire (FFQ) "What do you eat?", which was used in the German National Health Interview and Examination Survey for Children and Adolescents (KiGGS 2003-2006).

METHODS

The validation was conducted in the EsKiMo Nutrition Module, a subsample of KiGGS. The study population included 1,213 adolescents aged between 12 and 17. A modified diet history interview DISHES (Dietary Interview Software for Health Examination Studies) was used as the reference method. In order to compare the food groups, the data assessed with both instruments were aggregated to 40 similar food groups. The statistical analysis included calculating and comparing Spearman's correlation coefficients, calculating the mean difference between both methods, and ranking participants (quartiles) according to food group consumption, including weighted kappa coefficients. Correlations were also evaluated for relative body weight and socioeconomic status subgroups.

RESULTS

In the total study population the Spearman correlation coefficients ranged from 0.22 for pasta/rice to 0.69 for margarine; most values were 0.50 and higher. The mean difference ranged between 1.4% for milk and 100.3% for pasta/rice. The 2.5 percentiles and 97.5 percentiles indicated a wide range of differences. Classifications in the same and adjacent quartile varied between 70.1% for pasta/rice and 90.8% for coffee. For most groups, Cohen's weighted kappa showed values between 0.21 and 0.60. Only for white bread and pasta/rice were values less than 0.20. Most of the 40 food groups showed acceptable to good correlations in all investigated subgroups concerning age, sex, body weight and socio-economic status.

CONCLUSIONS

The KiGGS FFQ showed fair to moderate ranking validity except for pasta/rice and white bread. However, the ability to assess absolute intakes is limited. The correlation coefficients for most food items were similar for normal weight and overweight as well as for different socio-economic status groups. Overall, the results of the relative validity were comparable to FFQs from the current literature.

Body image and psychological well-being in adolescents: the relationship between gender and school type

Adolescents (N=1281; M age = 15.2 years, SD = 0.51 years) from a state-wide sample of schools provided information about their psychological well-being, family functioning, extraversion, and perceived physical attractiveness and weight, using a questionnaire completed at school. Consistent with previous research, girls were significantly more likely than boys to be dissatisfied with their weight and physical appearance, and these factors explained significantly more variation in self-esteem than in life satisfaction or other measures of psychological well-being. The strong relationship between body dissatisfaction and self-esteem for adolescent girls was not moderated by school type (single sex or educational). However, girls who were dissatisfied but psychologically well adjusted tended to be more extraverted, have more close friends and receive greater family support.

Heterosocial involvement, peer pressure for thinness, and body dissatisfaction among young adolescent girls

The purpose of this study was to examine longitudinal connections among young adolescent heterosocial involvement (i.e., mixed-sex interactions), peer pressure for thinness, and body dissatisfaction. Three years of self-report questionnaire data were collected from 88 adolescent girls as they completed 6th through 8th grades. Results indicated that the relation between heterosocial involvement and body dissatisfaction was mediated by perceived peer pressure for thinness. Within this model, heterosocial involvement was associated with greater peer pressure for thinness. In turn, peer pressure for thinness was associated with greater body dissatisfaction. Results are discussed in terms of their implications for prevention and intervention efforts aimed at girls during their middle-school years.

Evulvalution: the portrayal of women's external genitalia and physique across time and the current barbie doll ideals

Media images of the female body commonly represent reigning appearance ideals of the era in which they are published. To date, limited documentation of the genital appearance ideals in mainstream media exists. Analysis 1 sought to describe genital appearance ideals (i.e., mons pubis and labia majora visibility, labia minora size and color, and pubic hair style) and general physique ideals (i.e., hip, waist, and bust size, height, weight, and body mass index [BMI]) across time based on 647 Playboy Magazine centerfolds published between 1953 and 2007. Analysis 2 focused exclusively on the genital appearance ideals embodied by models in 185 Playboy photographs published between 2007 and 2008. Taken together, results suggest the perpetuation of a "Barbie Doll" ideal characterized by a low BMI, narrow hips, a prominent bust, and hairless, undefined genitalia resembling those of a prepubescent female.

The relationship between body mass index and body size dissatisfaction in young adolescents: spline function analysis

This study assessed how body size dissatisfaction (BSD) varies in relationship to specific body mass index (BMI) values in a sample of preadolescents. A novel statistical approach based on spline function, suitable to assess in detail how two variables are related, was used. The study was conducted between December 2004 and March 2005. Students (aged 11 to 14 years) from seven selected secondary schools in Verona, Italy, were invited to participate. The final study group included 678 subjects. BSD was assessed using the Body Image Assessment Procedure. BMI values were expressed as z scores. It was found that, in the total sample, slightly underweight subjects (BMI z scores=-0.5) had no BSD. BSD progressively increased (current body size > ideal body size) for BMI z scores >-0.5 and became negative (ideal body size > current body size) for BMI z scores <-0.5. In boys, average weight subjects had no BSD. BSD progressively increased for BMI z scores >0 and became negative for BMI z scores <0. In girls, moderately underweight subjects (BMI z scores=-1) had no BSD. BSD progressively increased for BMI z scores >-1 and became negative for BMI z scores <-1. Although sex significantly moderated the relationship between BMI and BSD (P<0.001), socioeconomic status did not (P=0.459). Because average weight and slightly underweight young girls desired a thinner body, our study suggests that these subgroups should receive particular attention in public health programs as well as in dietetics clinical practice.

Are There Ethnic Differences in Positive Body Image Among Female British Undergraduates?

Numerous studies have examined ethnic differences in body image, although the literature has tended to focus on a negative orientation toward one’s body. The present study examined whether there were differences in positive body image among 131 Caucasian, 122 South Asian, 67 African Caribbean, and 67 Hispanic female undergraduates in Britain. Participants completed several scales measuring body appreciation, societal influence on body image, and self-esteem. Results showed that, after controlling for age, Hispanic women had the highest body appreciation scores, followed by African Caribbean, Caucasian, and South Asian women, respectively. Results also showed that Hispanics had the lowest score on media influence and the highest self-esteem. Finally, regressional analyses showed that self-esteem was a strong predictor of body appreciation, over-and-above ethnic affiliation. These results are discussed in relation to the extant literature on ethnic differences in body image.

Self-perceived weight in adolescents: over-estimation or under-estimation?

Prevalence of obesity has increased worldwide in the past 20 years, but it is not known whether this has resulted in increased numbers of young adults feeling overweight. This study evaluated weight self-perception in a large, multi-ethnic sample of 14-15 years old (n=4167) in London, UK as part of a longitudinal, school-based study of health behaviours. Weight perceptions were recorded on a simple scale from 'too thin' to 'too fat'. Results indicated that under-estimation was more common than over-estimation, with more than a quarter of overweight or obese adolescents unaware of their excess weight. Under-estimation was greatest among boys and ethnic minorities. It may be timely to reassess weight control advice given to adolescents.

Changing perceptions of weight in Great Britain: comparison of two population surveys

OBJECTIVES

To examine changes in public perceptions of overweight in Great Britain over an eight year period.

DESIGN

Comparison of data on self perceived weight from population surveys in 1999 and 2007.

SETTING

Household surveys of two representative samples in Great Britain.

PARTICIPANTS

853 men and 944 women in 1999, and 847 men and 989 women in 2007.

MAIN OUTCOME MEASURES

Participants were asked to report their weight and height and classify their body size on a scale from "very underweight" to "obese."

RESULTS

Self reported weights increased dramatically over time, but the weight at which people perceived themselves to be overweight also rose significantly. In 1999, 81% of overweight participants correctly identified themselves as overweight compared with 75% in 2007, demonstrating a decrease in sensitivity in the self diagnosis of overweight.

CONCLUSIONS

Despite media and health campaigns aiming to raise awareness of healthy weight, increasing numbers of overweight people fail to recognise that their weight is a cause for concern. This makes it less likely that they will see calls for weight control as personally relevant.

Relationships amongst body dissatisfaction, internalisation of the media body ideal and perceived pressure from media in adolescent girls and boys

Sociocultural factors that underpin gender differences in body dissatisfaction have not frequently been explored. We examined the relative contribution of internalization of media body ideals and perceived pressure to achieve this ideal in explaining body dissatisfaction in adolescent boys and girls. A sample of 819 boys and 791 girls completed measures of internalization of body ideals, perceived pressure, body mass index (BMI) and body dissatisfaction. As expected, girls showed higher body dissatisfaction, internalization and pressure than boys. Internalization, pressure and BMI contributed to the prediction of body dissatisfaction in boys and in girls although these variables explained less variance in body dissatisfaction in boys. In addition, for girls the strongest predictor of body dissatisfaction was internalization, whilst for boys the strongest predictor was pressure. Differences in extent of internalization and pressure may contribute to higher body dissatisfaction in girls than boys. These sociocultural factors may affect girls and boys differently.

A comparative study of body image of Australian and Pakistani young females

This research compares Australian and Pakistani females on body image attitudes. The sample consisted of Caucasian-Australian and Pakistani first year university students, ranging in age from 17 to 22. The Pakistani sample was subdivided into two groups: Urdu-medium and English-medium, representing the middle and upper social classes, respectively. The results revealed that, although all the groups identified a similar body shape as the 'ideal', the Australian females expressed significantly higher levels of body dissatisfaction on all measures of body image than did the Pakistani females. Within the Pakistani sample, females from the English-medium institutions expressed greater weight concern than did the Urdu-medium females. The findings are discussed in terms of the possible role of cultural values in shaping the body image attitudes of young females.

Eating disorders in Asian populations: a critique of current approaches to the study of culture, ethnicity, and eating disorders

There is increasing evidence that eating disorders are present among ethnically diverse populations, and researchers have suggested that investigations in this area may inform the field's understanding of how sociocultural factors are related to the development of eating disorders. Although it is generally accepted that sociocultural factors are key in eating disorder etiology, knowledge on how best to study these influences in diverse groups is still limited. In this article, the authors review how the research literature has explored relationships among culture, ethnicity, and eating disorders in Asian populations and critically examine strategies that have been used to investigate these issues across 1 ethnic/racial group. The methodological challenges encountered in these approaches are identified and considered in the provision of recommendations for future endeavors to improve the field's understanding of how culture is related to eating disorders.

Acceptance of cosmetic surgery: scale development and validation

We conducted a set of four studies with a total of 1288 adult and undergraduate women and men to develop the Acceptance of Cosmetic Surgery Scale. These studies provide evidence of this scale's reliability, as well as convergent and discriminant validity. Initial explorations using this 15-item scale indicate that acceptance of cosmetic surgery is negatively related to satisfaction with physical appearance and positively related to attitudes about make-up use. The acceptance of cosmetic surgery may be more related to fears about becoming unattractive than to hopes of becoming more attractive. Cosmetic surgery attitudes were positively related to age for women but not for men. The study's limitations and implications are discussed.

Dietary Restraint, Body Dissatisfaction, and Psychological Distress: A Prospective Analysis

This study uses prospective data from a survey of 1,177 adolescent girls to examine whether emotional eating, binge eating, abnormal attitudes to eating and weight, low self-esteem, stress, and depression are associated with dietary restraint or body dissatisfaction. In analyses that included both restraint and body dissatisfaction as independent predictors, restraint was associated only with more negative attitudes to eating, whereas body dissatisfaction was significantly associated with all the adverse outcomes. These results cast doubt on the proposition that restrained eating is a primary cause of bulimic symptoms, emotional eating, and psychological distress seen in individuals who are trying to control their weight, and rather suggest that body dissatisfaction is the key factor.

Influences of ethnicity and socioeconomic status on the body dissatisfaction and eating behaviour of Australian children and adolescents

The present study examined the association between socioeconomic status (SES), ethnicity, body dissatisfaction, and eating behaviours of 10- to 18-year-old children and adolescents. The study participants (N = 768) were categorised as Caucasian (74.7%), Chinese or Vietnamese (18.2%), and Italian or Greek (7.0%), and high (82%), middle (8.6%), and low SES (9.4%) according to parents' occupations. The chi(2), Mann-Whitney U test and Kruskal-Wallis test and logistic regression model were used to determine the interaction between variables. Females and older participants were more likely to desire a body figure that was thinner than their perceived current figure. Furthermore, the same groups were also more likely to be preoccupied with eating problems (females 7.1% vs. males 1.4%; for participants aged 15-18 years, 7.8% vs. participants aged 10-14 years, 3.9%). The body dissatisfaction gender difference was females 42.8% vs. males 11.8%, and participants aged 15-18 years 41.7% vs. those aged 10-14 years, 28.3%. Participants whose parents were managers/professionals were more likely to desire a body figure that was thinner than their perceived current figure than those from white-collar and blue-collar families. This was also the case for Caucasian Australians compared to those from Chinese or Vietnamese backgrounds. In conclusion, age and gender differences in body image and problems in eating behaviour were evident among children and adolescents. However, there was no significant SES and ethnic difference in the proportion of participants with eating problems and body dissatisfaction.

Role of parents in the determination of the food preferences of children and the development of obesity

The role of parental behaviour in the development of food preferences is considered. Food preferences develop from genetically determined predispositions to like sweet and salty flavours and to dislike bitter and sour tastes. Particularly towards the second year of life, there is a tendency to avoid novel foods (neophobia). Food aversions can be learnt in one trial if consumption is followed by discomfort. There is a predisposition to learn to like foods with high-energy density. However, from birth genetic predispositions are modified by experience and in this context during the early years parents play a particularly important role. Parental style is a critical factor in the development of food preferences. Children are more likely to eat in emotionally positive atmospheres. Siblings, peers and parents can act as role models to encourage the tasting of novel foods. Repeated exposure to initially disliked foods can breakdown resistance. The offering of low-energy-dense foods allows the child to balance energy intake. Restricting access to particular foods increases rather than decreases preference. Forcing a child to eat a food will decrease the liking for that food. Traditionally, educational strategies have typically involved attempts to impart basic nutritional information. Given the limited ability of information to induce changes in behaviour, an alternative strategy would be to teach parents about child development in the hope that an understanding of the characteristic innate tendencies and developmental stages can be used to teach healthy food preferences.

Sociocultural influences on attitudes to weight and eating: results of a natural experiment

OBJECTIVE

Exposure to teenage culture is widely believed to contribute to concerns about weight in children and adolescents. The current study tested the hypothesis that greater exposure to older girls at school would be associated with thinner size ideals, increased concern about weight, and more dieting.

METHOD

Participants (n = 200) were 9 and 11-year-old girls. The age of the oldest pupils in the school defined the exposure variable. Nine-year-olds in junior schools (oldest pupils = 11) and 11-year-olds in middle schools (oldest pupils = 13) were defined as nonexposed. Nine-year-olds in middle schools (oldest pupils = 13) and 11-year-olds in secondary schools (oldest pupils = 18) were defined as exposed. Girls were weighed and measured and completed measures of ideal size, perceived weight, body esteem, eating attitudes, dieting, and self-esteem.

RESULTS

Being at a school with older pupils was associated with having a thinner ideal, feeling more overweight, having more friends who had dieted, scoring higher on the Child Eating Attitudes Test, and having lower self-esteem. Effects were strongest among the 9-year-olds.

DISCUSSION

Exposure to older girls in school may accelerate the development of negative attitudes to weight and eating.

Interpersonal influence and disordered eating behaviors in adolescent girls: the role of peer modeling, social reinforcement, and body-related teasing

This study investigated the association between interpersonal relationships, eating behaviors, and body esteem in a sample of adolescent girls. Participants included 876 girls who completed questionnaires regarding body esteem, eating behavior, peer pressure, and interpersonal relationships. Peer pressure was a strong predictor of eating behavior and body esteem after controlling for interpersonal variables. High externalized self-perceptions, self-reported teasing, and attributions about the importance of weight and shape for popularity and dating were important predictors of both body esteem and eating behavior. Also, girls who were nominated as popular by peers were more likely to engage in disordered eating and have lower body esteem. Results highlight the need for eating disorder prevention at the level of the peer group. Programs should focus on decreasing pressure to be thin, acceptance by peers for attributes other than appearance, and combating weight- and shape-related teasing within the school system.

Beliefs and attitudes towards the consumption of sugar-free products in a sample of Italian adolescents

OBJECTIVE

The objective of this study was to investigate beliefs and attitudes towards sugar-free products in a sample of Italian teenagers.

DESIGN

A total of 10 secondary public schools in the county of Rome were randomly selected. The probability of being extracted was set proportional to the number of students. A random sample of teenagers was selected from the schools for participating in a food consumption survey.

SUBJECTS

The sample included 233 adolescents, aged 15-21 y. A total of 224 adolescents agreed to participate in the study aimed at assessing beliefs and attitudes.

INTERVENTIONS

Two questionnaires were completed at the first day of the last period of the 4-day food survey. The first questionnaire contained questions on attitudes and beliefs toward a healthy diet. The second questionnaire, aimed at assessing adolescents' attitudes towards the consumption of sugar-free products, was based in part on the social-psychological model of the Theory of Planned Behaviour.

RESULTS

In general, the adolescents of this sample seemed to be quite uncertain in their responses. On average, they did not express an emphatic point of view with regard to the act of eating sugar-free products. The results of the assessment of relationships between the variables of the theoretical model revealed the lack of causal links among beliefs, attitudes, intention and consumption of sugar-free products. Perceived behavioural control was not a significant predictor of intention.

CONCLUSIONS

The target of further studies aimed at investigating attitudes towards sugar-free products should be tailored according to the quantity of consumption of such products in order to represent a sample of frequent and high consumers of sugar-free products.

SPONSORSHIP

European Commission Quality of Life and Management of Living Resources Fifth framework Programme. QLRT-1999-00155.

Socioeconomic Variation in Attitudes to Eating and Weight in Female Adolescents

This study was stimulated by J. Sobal and A. J. Stunkard's (1989) theory that differences in deliberate weight control could underlie the socioeconomic gradient in adult weight. Female adolescents (N=1,248) completed measures of socioeconomic status, social norms for weight, weight ideals, attitudes to weight, and weight control behaviors. Higher socioeconomic status adolescents had greater awareness of the social ideals of slimness and had more family and friends who were trying to lose weight. They also defined a lower body mass index as "fat" and were more likely to have used healthy weight control methods. The results support the idea that socioeconomic differences in weight-related attitudes and behaviors may mediate the development of a gradient in weight.

Processes linking weight status and self-concept among girls from ages 5 to 7 years

This study assessed the relationship between girls' weight status and self-concept and examined peer teasing and parent criticism as potential mediators of this relationship. Data were collected for 182 girls and their parents when the girls were 5 and 7 years old. At each age, girls' body mass index, self-concept, peer weight-related teasing (child report), and parents' criticism of girls' weight status (spouse report) were assessed. At ages 5 and 7, girls who were more overweight reported lower self-concept. Peer teasing and parent criticism mediated the relationship between weight status and self-concept at age 7, but not at age 5. In addition, the duration and timing of parent criticism across ages 5 and 7 mediated the association between girls' weight status at age 5 and perceived peer acceptance at age 7.

Internalization of ideal body shapes in 9-12-year-old girls

OBJECTIVE

Body dissatisfaction is reported in girls as young as 9 years old in Western countries. In the current study, internalization of the "thin ideal" was predicted to be a critical influence on the development of body dissatisfaction.

METHOD

Participants (n = 356) were weighed and completed measures of body dissatisfaction, awareness and internalization of the thin ideal, and peer and maternal attitudes and behavior. Exposure to relevant print media was also assessed.

RESULTS

Body dissatisfaction was associated with a higher body mass index, although it was not restricted to overweight girls. Internalization mediated the relationship between awareness of the sociocultural standard of appearance and body dissatisfaction. Media exposure and peer and maternal weight-related attitudes and behavior were, in turn, related to awareness, supporting the hypothesized sociocultural processes.

DISCUSSION

Internalization operates as a central component in the development of body dissatisfaction, occurring at a young age in some girls. Internalization may be a suitable target for preventive strategies.

Associates of obesity and weight dissatisfaction among Finnish adolescents

OBJECTIVE

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

DESIGN

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

RESULTS

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

CONCLUSIONS

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

Possible risk factors in the development of eating disorders in overweight pre-adolescent girls

OBJECTIVES

To investigate concerns about weight, shape and eating, dietary restraint, self-esteem and symptoms of depression in overweight girls. To investigate the relationship between concerns and self-esteem and depressive symptoms in this group.

METHOD

Eighteen overweight girls and 18 average-weight girls completed the child version of the Eating Disorders Examination, the Harter Self-Perception Profile and the Short Moods and Feelings Questionnaire.

RESULTS

Overweight girls had more concerns about weight, shape and eating and attempted dietary restraint more often. They had more negative self-esteem related to their athletic competence, physical appearance and global self-worth and more symptoms of depression. There was an association between concerns and self-esteem based on physical appearance in the overweight group.

CONCLUSION

Overweight girls show some of the psychological features associated with the development of eating disorders, including a link between concerns and self-esteem based on physical appearance. This may help to explain why childhood obesity increases the risk of a later eating disorder.

Processes linking weight status and self-concept among girls from ages 5 to 7 years

This study assessed the relationship between girls' weight status and self-concept and examined peer teasing and parent criticism as potential mediators of this relationship. Data were collected for 182 girls and their parents when the girls were 5 and 7 years old. At each age, girls' body mass index, self-concept, peer weight-related teasing (child report), and parents' criticism of girls' weight status (spouse report) were assessed. At ages 5 and 7, girls who were more overweight reported lower self-concept. Peer teasing and parent criticism mediated the relationship between weight status and self-concept at age 7, but not at age 5. In addition, the duration and timing of parent criticism across ages 5 and 7 mediated the association between girls' weight status at age 5 and perceived peer acceptance at age 7.

Body image and weight change in middle age: a qualitative study

AIMS

To explore men's and women's experiences of weight change in adulthood, body image preferences and beliefs about the health consequences of overweight and to inform the development of a primary care intervention to prevent obesity.

SAMPLE

Seventy-two men and women aged 35-55, with a range of BMIs from 22 to 29.9, were identified from two UK general practice registers and invited to participate in an interview about experiences of weight change in adulthood.

METHODS

Audio tape recorded, semi-structured interviews were conducted in respondents' homes by trained researchers. Open-ended questions were used to collect experiences of weight change since early adulthood and views about weight change in middle age. Illustrations of a range of men's and women's body shapes were used to prompt discussion of respondents' preferences for male and female body shapes and their perspectives of the health, social and practical problems associated with underweight and overweight. The data were analysed using both quantitative and qualitative methods.

RESULTS

Some 87% (33/38) of the women and 59% (20/34) of the men said that they had ever tried to lose weight. At least one instance of successful weight loss was reported by 58% of the women and 47% of the men, although many of these attempts were relatively short-lived and often motivated by specific goals such as a holiday or a wedding. Respondents were sceptical of the possibility of controlling weight without considerable personal sacrifice. Explanations for middle-age weight gain included a sedentary lifestyle, as well as several gender-specific reasons, including hormonal changes and comfort eating for women and beer drinking for men. Nearly all (97%) respondents associated heart disease with overweight, while diabetes was mentioned by only 22% and none mentioned cancer.

CONCLUSION

People who have gained weight in middle age may be deterred from trying to prevent further gain by pessimism about the effort required. The efficacy of interventions to encourage relatively small substitutions and changes to diet and physical activity need to be tested. Interventions to help prevent weight gain in middle age could include information about the less widely known health risks such as diabetes and cancer.

Age of onset and body dissatisfaction in obesity

This study investigated variation in body dissatisfaction among obese women in relation to age of onset of obesity, and evaluated the contribution of teasing about weight and self-esteem as possible causes of higher body dissatisfaction in the early-onset group. One hundred and five obese women (body mass index [BMI] > or =30), recruited from clinical settings in England, completed a mailed questionnaire. The early-onset group (by age 16) had a higher BMI, greater body dissatisfaction, and lower self-esteem. Predictably, they also reported more childhood teasing. Path analyses confirmed our expectation that early onset of obesity has an adverse effect on body image, which is independent of current BMI. Regression analyses failed to support the hypothesized mediating role of either childhood teasing or lower self-esteem. The possible direction of causal effects between body dissatisfaction and self-esteem is discussed, with the suggestion that early onset of obesity increases the risk of body dissatisfaction, which in turn impairs self-esteem.

Developmental issues in attitudes to food and diet

As a rule, children and most adults eat what they like and leave the rest. They like and consume foods high in fat and sugar. Parental behaviour shapes food acceptance, and early exposure to fruit and vegetables or to foods high in energy, sugar and fat is related to children's liking for, and consumption of, these foods. Some parents are imposing child-feeding practices that control what and how much children eat. However, over-control can be counter-productive, teaching children to dislike the very foods we want them to consume, and generally undermining self-regulation abilities. The external environment is also important, with concerns expressed about food advertising to children and girls dieting for an ideal thin body shape. Up to one-quarter of young adolescent girls report dieting to lose weight, their motivation driven by weight and shape dissatisfaction. For some, dieting and vegetarianism are intertwined and both legitimised as healthy eating. For others, striving for nutritional autonomy, the choice of less-healthy foods is not just because of their taste, but an act of parental defiance and peer solidarity. The determinants of what children choose to eat are complex, and the balance changes as children get older. A better understanding is crucial to informing how we might modify nutritional behaviour. Adults occupy a central position in this process, suggesting that children should be neither the only focus of nutritional interventions nor expected to solve the nutritional problems with which adults around them are continuing to fail.

Neighbourhood level versus individual level correlates of women's body dissatisfaction: toward a multilevel understanding of the role of affluence

STUDY OBJECTIVE

This study examined the prevalence of body dissatisfaction as a function of individual level and neighbourhood level indicators of affluence.

PARTICIPANTS AND SETTING

A subset of data from a larger random digit dialling telephone survey was used to obtain individual level data on body dissatisfaction, body weight and height, and income from a group of 895 adult women (age 24-56, 61% English speaking) living in 52 neighbourhoods (census tract areas) within the provinces of Alberta, Ontario, and Quebec, Canada who were selected for their heterogeneity in social class.

DESIGN

Aggregated census tract data from 1996 were used to develop neighbourhood indicators of affluence. Using hierarchical linear modelling, body dissatisfaction (dichotomous) was examined as a function of individual body mass index, individual level affluence and neighbourhood level affluence.

MAIN RESULTS

The impact of body mass index on body dissatisfaction depended on the level of neighbourhood affluence: an average body mass index was associated with higher likelihood of reporting body dissatisfaction in a neighbourhood of above average affluence (71% probability) than in a neighbourhood of average affluence (58% probability), independent of a woman's individual affluence (whether she was low income or not).

CONCLUSION

It is concluded that a clearer understanding of the role of affluence on body dissatisfaction can be achieved by a joint examination of individual and neighbourhood level influences.

Dietary restraint in relation to nutrient intake, physical activity and iron status in adolescent females

AIM

To investigate the prevalence of dietary restraint in a female adolescent population, and to examine the nutritional consequences of dietary restraint and its implications for iron status.

METHODS

A total of 64 adolescent females, aged 14-15 years, were recruited from two all-girl schools in central London. Nutrient intake, body weight, physical activity and iron status were measured. Findings were compared between three groups of subjects classified by dietary restraint.

RESULTS

Adolescents with a higher BMI percentile were more likely to be highly restrained. Scores on the dietary restraint psychometric measures were comparable with other UK studies in this age group. Energy intake was inversely related to dietary restraint (mean energy intake (SE) for each restraint group were: low 8.99 MJ (0.48), medium 7.98 MJ (0.22) and high 7.35 MJ (0.39) P < 0.05); however, a corresponding relationship between dietary restraint and reduced micronutrient intakes was not found. Highly restrained eaters obtained more of their energy intake from bread, fruit and cheese and less from meat, meat products and confectionery. Levels of physical activity were not significantly different between the dietary restraint groups. There was a poor relationship between reported energy intake and estimated energy expenditure. Haematological parameters of iron status were similar across the restraint groups.

CONCLUSIONS

Dietary restraint was exercised by the consumption of a "healthy eating diet". Dieting was not related to a lower iron status; however, the low dietary iron intake and poor iron status of the whole sample is of concern.