Effects of emotional symptoms and life stress on eating behaviors among adolescents

War exposure and changes in eating behaviours in Ukrainian school-aged children: A cross-sectional online survey

The war in Ukraine has exposed children to extremely high levels of acute and chronic stressors, which can impact their eating behaviour (EB). We aimed to determine the prevalence of war-induced, stress-related disruptions in EB of Ukrainian children. We conducted a cross-sectional online survey among parents of 5- to 17-year-old children, who had experienced the war in Ukraine in February-May 2023. Guardians reported their child's various war exposure changes in EBs using a modified version of the Child Eating Behaviour Questionnaire. We assessed associations between total and medium-term EB changes and age, sex, and war exposure using bivariate correlations and χ2 tests. Logistic regression models were fitted to explore the associations between socio-demographic factors, war exposure and frequency of EB changes. Of the 4854 children, 63% had changes in EBs during the war. The most common EB changes included food cravings (38%), food fussiness (37%), and aversion to certain foods (29%). Of the reported EB changes, 40% were medium-term, lasting over a month, and related to altered attitudes towards food. Food insecurity (adjusted OR 2.35, 95% CI: 1.76-3.14), and displacement (internally 2.01, 1.19-3.42) emerged as the most influential determinants of medium-term EB changes. The findings underscore a significant and robust association between war-related exposures and an increased risk of frequent EB changes. As healthy EBs are learned during childhood and have been shown to track into adulthood, the identified disruptions in EB may have medium-term consequences for the physical and mental health of Ukrainian children.

Restrained Eating and Disinhibited Eating: Association with Diet Quality and Body Weight Status Among Adolescents

Background/Objectives: Problematic eating behaviours may affect food consumption and, therefore, body weight. However, these associations have not been well understood, especially among adolescents. The aim of the study was to evaluate the associations of restrained eating and disinhibited eating with diet quality and body weight status among adolescents. Methods: A cross-sectional study was conducted among 1450 primary school students aged 11-13 years (52% girls). Dietary data were collected using the food frequency questionnaire (SF-FFQ4PolishChildren®). Two diet quality scores were evaluated: (i) the pro-Healthy Diet Index (pHDI), which included vegetables, fruit, dairy products, and fish, and (ii) the non-Healthy Diet Index (nHDI), which included fast food, sweets, sweetened beverages, and energy drinks. Based on the Three-Factor Eating Questionnaire, two eating styles were identified: restrained eating (RE) and disinhibited eating (DE). Body weight status was evaluated using the body mass index (BMI) z-score and the waist-to-height ratio (WHtR). Spearman's correlation coefficient and logistic regression analysis were used to assess the association between eating styles, diet quality, and body weight status. Results: Restrained eating was negatively correlated with nHDI (r = -0.178, p < 0.001) and positively correlated with the BMI z-score (r = 0.253, p < 0.001) and WHtR (r = 0.197, p < 0.001). Disinhibited eating was positively correlated with nHDI (r = 0.232, p < 0.001). Among adolescents with different RE and DE levels, significant differences in the mean nHDI, BMI z-score, and WHtR were found. Compared to adolescents with 'low RE & DE', those with 'low RE & higher DE' were more likely to fall in the upper than bottom tertile of nHDI (odds ratio (OR) =1.90, 95% CI: 1.29-2.81). Adolescents with 'higher RE & low DE' were less likely to be underweight (OR = 0.17, 95% CI: 0.06-0.49) and more likely to be overweight (OR = 2.02, 95% CI: 1.41-2.91) and to have abdominal obesity (OR = 1.79, 95% CI: 1.13-2.82). Conclusions: The findings suggest that both eating styles may be predictors of diet quality among adolescents. Body weight status was related to restrained eating, which seems to characterise mainly adolescents with overweight or obesity.

Relationships among alexithymia, psychological distress, and disordered eating behaviors in adolescents

This cross-sectional study aimed to evaluate the relations between psychological distress, alexithymia, disordered eating behaviors (DEBs), and body mass index (BMI) and to assess if psychological stress would mediate the influence of alexithymia on DEBs in adolescents. A total of 1609 high school students (58.9% females) aged 14-18 years were included in the study. Data were collected using a self-administered questionnaire. DEBs including emotional eating, cognitive restraint, and uncontrolled eating were assessed with the Three-Factor Eating Questionnaire, psychological distress was assessed with the Depression Anxiety Stress Scale and alexithymia was assessed with the Toronto Alexithymia Scale. Anthropometric measurements were performed. Psychological distress was found to be positively associated with alexithymia, emotional eating, uncontrolled eating, and cognitive restraint (p < 0.01). Both direct and indirect effects of alexithymia on emotional eating and uncontrolled eating were significant. Psychological distress partially mediated the relationship between alexithymia and uncontrolled eating (β = 0.05) and emotional eating (β = 0.04), while it fully mediated the relationship between alexithymia and cognitive restraint (β = 0.05). BMI z score was not correlated with alexithymia and psychological distress. Emotional eating (β = 0.16) and cognitive restraint (β = 0.34), but not uncontrolled eating, significantly were associated with BMI z score. This study demonstrated that alexithymia and psychological distress are positively associated with DEBs in adolescents. It also showed that psychological distress plays a mediating role between alexithymia and DEBs. Moreover, it showed that emotional eating and cognitive restraint are positively associated with the BMI z score. These results suggest that interventions aimed at improving adolescents' psychological well-being and their ability to identify and describe their emotions may reduce DEBs in adolescents, thereby preventing obesity in adolescents.

Depression and emotional eating in children and adolescents: A systematic review and meta-analysis

Major Depressive Disorder in youth is associated with obesity and adult cardiovascular disease (CVD) risk. Eating in response to emotions (emotional eating) is a potential contributing factor to this association. Although emotional eating is associated with Major Depressive Disorder in adults, findings in children and adolescents are mixed. This systematic review and meta-analysis aims to determine the association between depression and emotional eating in children and adolescents. Systematic searches were conducted in seven databases. Studies were included if the study population had a mean age of ≤18 years and assessed both depression and emotional eating using validated measures. The search generated 12,241 unique studies, of which 37 met inclusion criteria. Random-effects meta-analyses of study outcomes were performed. Thirty-seven studies (26,026 participants; mean age = 12.4 years, SD = 3.1) were included. The mean effect size was significant for both cross-sectional and longitudinal data (Hedges' g = 0.48, p < 0.0001; g = 0.37, p = 0.002, respectively), revealing a positive moderately strong association between depressive symptoms and emotional eating in youth. Among longitudinal studies, the association was stronger when depressive symptoms and emotional eating were assessed using child and adolescent self-report versus parent-report. No studies examined youth with a clinical diagnosis of depression. Meta-analyses revealed that depressive symptoms and emotional eating are positively associated in children and adolescents. However, further research in clinical samples is needed. Results raise the possibility for the importance of emotional eating in the link between depression and early CVD risk, though further examination is required to determine whether emotional eating is a potential treatment target to decrease CVD risk among adolescents with increased depression symptoms.

Chronotype is associated with addiction-like eating behavior, mindful eating and ultra-processed food intake among undergraduate students

This study aimed to investigate the relationships between chronotype and addiction-like eating behavior, mindful eating and ultra-processed food consumption among undergraduate students. Specific and validated scales were used in order to evaluate chronotype, addiction-like eating behavior and mindful eating (N = 605). Dietary intake was determined by food frequency questionnaire and percentage energy from ultra-processed food was calculated. Self-reported weights and heights were obtained from the participants. Mean scores of scales, social jetlag, energy intake, ultra-processed food intake and BMI were compared by chronotypes. Associations between chronotype, addiction-like eating behavior, mindful eating, ultra-processed food consumption and BMI were determined by Pearson's test. The relationships between chronotype and addiction-like eating behavior, mindful eating and ultra-processed food intake were assessed by linear regression models and adjusted for sex, BMI, energy intake, season, smoking and alcohol consumption. Evening-type participants had higher scores of social jetlag (2.01 ± 0.09), appetitive drive (26.02 ± 0.63), low dietary control (20.50 ± 0.41), addiction-like eating behavior (46.52 ± 0.85), lower scores of recognition (21.91 ± 0.43) and higher percentage energy from ultra-processed food (32.24 ± 1.26%). Chronotype score showed negative associations with addiction like eating behavior (β=-0.247, p < 0.001) and ultra-processed food consumption (β=-0.247, p < 0.001), and a positive association with recognition (β = 0.124, p < 0.001). Results suggest that chronotype is inversely associated with addiction-like eating behavior and ultra-processed food consumption, and positively associated with mindful eating among undergraduate students.

Comparative efficacy of remotely delivered mindfulness-based eating awareness training versus behavioral-weight loss counseling during COVID-19

Introduction

Dysregulated eating (emotional eating, cue-elicited eating, and dietary restraint and restriction) has been linked to being overweight or obese. The present investigation used a random controlled trial (RCT) to test the differential efficacy of remotely delivered Mindfulness-Based Eating Awareness Training (MB-EAT) and Behavioral Weight Loss (BWL) counseling.

Methods

The sample was recruited through advertisements that offered help to people "with problems controlling their eating" or "interested in improving their relationship with food" (n = 135).

Results

Retention was low in both groups (42%), but not dissimilar to retention rates reported in related clinical trials delivered "in person." Among the participants who completed treatment, we found no between-group differences in any of the treatment outcomes, but participants in both groups experienced significant increases in eating-related mindfulness [Mindful Eating Questionnaire (MEQ) and awareness [Multidimensional Assessment of Interoceptive Awareness (MAIA), and significant decreases in unhealthy eating patterns [Dutch Eating Behavior Questionnaire (DEBQ); Binge Eating Scale (BES), and weight over the course of treatment. Participants in both groups also experienced increases in self-reported depression and anxiety symptoms [Hospital Anxiety and Depression Scale (HADS)], although these increases likely reflected normative changes observed in the population at large during COVID-19.

Discussion

Overall, the results suggest that dysregulated eating and weight loss intervention delivered remotely via teleconference can be effective.

Patterns of Eating Behavior among 13-Year-Old Adolescents and Associated Factors: Findings from the Generation XXI Birth Cohort

Eating behavior adopted during adolescence may persist into adulthood. The aims of this study were to identify eating behavior patterns among Portuguese adolescents and to explore whether groups differ in terms of early life and family characteristics, severity of depressive symptoms, and body mass index (BMI) z-score. Participants were 3601 13-year-olds enrolled in the birth cohort Generation XXI. Eating behavior was assessed using the self-reported Adult Eating Behavior Questionnaire (AEBQ), validated in this sample. The severity of depressive symptoms was measured through the Beck Depression Inventory (BDI-II), and data on sociodemographic and anthropometrics were collected at birth and 13-years-old. Latent class analysis was conducted, and associations were estimated using multinomial logistic regression models. Five patterns of individuals were identified: "Picky eating", "Disinterest towards food", "Food neophilia", "Emotional eating", and "Food attractiveness". The adolescents' sex, maternal education, BMI z-score, and severity of depressive symptoms were significantly associated with the identified patterns. In particular, adolescents with a higher BMI z-score were more likely in "Food neophilia" while individuals with more severe depressive symptoms were in the "Picky eating", "Emotional eating", and "Food attractiveness" patterns. These findings suggest a starting point for the development and planning of targeted public health interventions.

The Association of Eating Behaviour with Physical Activity and Screen Time among Adolescents in the Klang Valley, Malaysia: A Cross-Sectional Study

Over the last few decades, the time adolescents spend using electronic devices has increased significantly. The aim of this study was to evaluate the impact of screen time and physical activity on eating behaviour in adolescents. This study used the Physical Activity Questionnaire for Adolescents (PAQ-A) Malay version and the Dutch Eating Behaviour Questionnaire (DEBQ) Malay version methods with secondary students around the Klang Valley. The sampling technique used was purposive sampling. With parents' consent, an online survey was conducted among adolescent school children aged between 13 and 17 years during the COVID-19 pandemic in the Klang Valley, Malaysia. There were 372 respondents participating in this study. The results showed that 99.4% of them had more than 4 h screen time a day, and that 38.5% have more than three devices at home. Moreover, there was a significant mean difference in screen time for console games without a handheld device between male and female adolescents (p < 0.05). There was also a significant mean difference in the emotional, restricted and external eating behaviour scores between male and female adolescents (p < 0.001). There was a significant relationship between physical activity and the time duration spent on a television, telephone and laptop during weekends (p < 0.05). There was a significant relationship between eating behaviour and time spent watching television and using laptops during weekends (p < 0.05). Based on the moderation model, gender as a moderator variable indicated that there was a significant relationship between screen time and interaction screen time and gender with emotional eating (p < 0.001). Female adolescents had a stronger relationship between screen time and emotional eating compared to male adolescents (p < 0.05). Meanwhile, for physical activity level as a moderator variable, the results showed that there was a significant interaction between screen time and physical activity for emotional eating behaviour (p < 0.05). In conclusion, this study indicates that screen time was higher among female adolescents and significantly related to emotional eating behaviour. Therefore, the educational sector should emphasise the motivation of adolescents to engage in physical activity, reduce their screen time and eat healthy foods such as fruits and vegetables.

Evaluation of perceived depression, anxiety, stress levels and emotional eating behaviours and their predictors among adults during the COVID-19 pandemic

OBJECTIVE

This study aimed to (1) evaluate the prevalence and predictors of perceived depression, anxiety, stress (DAS) levels and emotional eating behaviours and (2) determine the correlations between DAS levels and emotional eating behaviours during the pandemic.

DESIGN

An online cross-sectional study included questions about demographic and anthropometric characteristics, dietary habits, Emotional Appetite Questionnaire (EMAQ) and Depression Anxiety Stress Scales. The snowball sampling method was used.

SETTING

Türkiye.

PARTICIPANTS

The study population was 2002 adults aged ≥18 years.

RESULT

The mean age was 27·1 ± 9·52 years (72·1 % females and 27·9 % males). The prevalence of moderate to severe DAS was reported as 27·8 %, 30·5 % and 30·7 %, respectively. Skipping meals (OR = 1·32, 95 % CI (1·14, 1·49)) was associated with depression. Weight gain (OR = 1·43, 95 % CI (1·19, 1·66); OR = 1·30, 95 % CI (1·14, 1·49); OR = 1·39, 95 % CI (1·14, 1·64)), weight loss (OR = 1·45, 95 % CI (1·20, 1·70); OR = 1·37, 95 % CI (1·11, 1·62); OR = 1·46, 95 % CI (1·20, 1·72)), exercising at least 150 min/week (OR = 0·64, 95 % CI (0·46, 0·83); OR = 0·73, 95 % CI (0·55, 0·92); OR = 0·83, 95 % CI (0·63, 1·02)), and maintaining an adequate and balanced diet (OR = 0·52, 95 % CI (0·33, 0·71); OR = 0·53, 95 % CI (0·34, 0·73); OR = 0·63, 95 % CI (-0·15, 0·35)) were associated with DAS, respectively. BMI (r = 0·169, P < 0·001), weight (r = 0·152, P < 0·001), number of snacks (r = 0·102, P = 0·011), depression (r = 0·060, P = 0·007), anxiety (r = 0·061, P = 0·006) and stress (r = 0·073, P = 0·001) levels were positively correlated with EMAQ-negative scores.

CONCLUSION

Approximately one out of every three participants reported moderate to severe DAS levels. Emotional eating was significantly correlated with perceived DAS. The predictors obtained in the study suggest that a healthy diet and lifestyle behaviours are part of psychological well-being and emotional eating.

Could Alcohol Abuse and Dependence on Junk Foods Inducing Obesity and/or Illicit Drug Use Represent Danger to Liver in Young People with Altered Psychological/Relational Spheres or Emotional Problems?

Recent data show that young people, mainly due to the pressure of some risk factors or due to disrupted interpersonal relationships, utilise greater reward value and display greater sensitivity to the reinforcing properties of “pleasurable stimuli”, specifically in those situations in which an enhanced dopamine release is present. Alcoholic beverages, foods rich in sugar and fat, and illicit drug use are pleasurable feelings associated with rewards. Research shows that there is a link between substance abuse and obesity in brain functioning. Still, alcohol excess is central in leading to obesity and obesity-related morbidities, such as hepatic steatosis, mainly when associated with illicit drug dependence and negative eating behaviours in young people. It is ascertained that long-term drinking causes mental damage, similarly to drug abuse, but also affects liver function. Indeed, beyond the pharmacokinetic interactions of alcohol with drugs, occurring in the liver due to the same metabolic enzymes, there are also pharmacodynamic interactions of both substances in the CNS. To complicate matters, an important noxious effect of junk foods consists of inducing obesity and obesity-related NAFLD. In this review, we focus on some key mechanisms underlying the impact of these addictions on the liver, as well as those on the CNS.

Dietary patterns and internalizing symptoms in children and adolescents: A meta-analysis

CONTEXT

Studies of child and adolescent internalizing symptoms and dietary pattern have produced mixed results.

OBJECTIVES

To quantify the association between dietary patterns and internalizing symptoms, including depression, in children and adolescents.

DATA SOURCES

Embase, PsycINFO, MEDLINE, Web of Science and Cochrane up to March 2021.

STUDY SELECTION

Observational studies and randomized controlled trials with mean age ⩽ 18 years, reporting associations between diet patterns and internalizing symptoms.

DATA EXTRACTION

Mean effect sizes and 95% confidence intervals were determined under a random-effects model.

RESULTS

Twenty-six studies were cross-sectional, 12 were prospective, and 1 used a case-control design. The total number of participants enrolled ranged from 73,726 to 116,546. Healthy dietary patterns were negatively associated with internalizing (r = -0.07, p < 0.001, 95% confidence interval [-0.12, 0.06]) and depressive symptoms (r = -0.10, p < 0.001, 95% confidence interval [-0.18, -0.08]). Effect sizes were larger for studies of healthy dietary patterns and internalizing and depressive symptoms using self-report versus parent-report measures, as well as in cross-sectional studies of healthy dietary patterns and depression compared to prospective studies. Unhealthy dietary patterns were positively associated with internalizing (r = 0.09, p < 0.001, 95% confidence interval [0.06, 0.14]) and depressive symptoms (r = 0.10, p < 0.01, 95% CI [0.05, 0.17]). Larger effect sizes were observed for studies of unhealthy dietary patterns and internalizing and depressive symptoms using self-report versus parent-report measures.

LIMITATIONS

A lack of studies including clinical samples and/or physician diagnosis, and a paucity of studies in which anxiety symptoms were the primary mental health outcome.

CONCLUSION

Greater depression and internalizing symptoms are associated with greater unhealthy dietary patterns and with lower healthy dietary intake among children and adolescents.

Unhealthy Eating, Psychopathology, and Nonalcoholic Fatty Liver Disease in Youth Presenting for Bariatric Surgery

OBJECTIVES

Little is known about the behavioral and psychosocial correlates of pediatric nonalcoholic fatty liver disease (NAFLD). Given diet contributes to the development and persistence of NAFLD, we examined (1) the prevalence of unhealthy eating behaviors (UEB), (2) whether these varied by NAFLD or nonalcoholic steatohepatitis (NASH) presence, and explored (3) the association of psychopathology with NAFLD.

METHODS

Before metabolic and bariatric surgery (MBS), adolescents (N = 159; Mage = 16.4; MBMI = 53.7 kg/m2, 73% girls, 62.3% white) self-reported presence/absence of 10 UEB (Questionnaire on Eating and Weight Patterns-Revised, Night Eating Questionnaire, Look AHEAD). NAFLD and NASH presence was assessed by intraoperative liver biopsy. Height/weight, blood pressure, and blood specimens were obtained. A medical comorbidity index was created (prediabetes/diabetes, dyslipidemia, elevated blood pressure). Psychopathology was assessed in a subgroup completing the Youth Self-Report (N = 98).

RESULTS

Binge eating disorder symptomatology was associated with higher odds of NAFLD whereas frequent eating out was associated with lower odds of NAFLD. Among those with NAFLD frequent eating out was associated with higher odds of NASH while nocturnal eating was associated with lower odds of NASH. Separate models identified internalizing psychopathology as associated with higher odds of NAFLD after controlling for demographics, number of UEB, and medical comorbidities.

CONCLUSIONS

Results suggest potential phenotypical differences between adolescents presenting for MBS with/without NAFLD, with implications for behavioral/psychosocial targets for screening and intervention. Replication should occur in a sample with greater gender and ethnic diversity to improve generalizability. Understanding differences in the context of surgical weight loss and comorbidity resolution is indicated.

Attachment, rumination, and disordered eating among adolescent girls: The moderating role of stress

PURPOSE

Disordered eating behaviors are prevalent and problematic in adolescent girls. Given that disordered eating has been linked to attachment insecurity and emotion dysregulation, the current study used an emotion regulation model of attachment theory to investigate pathways to disordered eating among adolescent girls. While past research has examined attachment and eating, an emotion regulation perspective is rarely used. Additionally, limited studies have investigated specific types of eating or mediators or moderators. To address these research gaps, this study examined whether rumination mediates the relationship between attachment anxiety and avoidance and three types of disordered eating and whether stress moderates this mediation.

METHODS

100 adolescent girls (M_age = 14.35 years, SD = 2.29) completed online surveys including the Relationship Structures Questionnaire, Dutch Eating Behaviour Questionnaire, Rumination Questionnaire, and Perceived Stress Scale.

RESULTS

The interaction between stress and attachment anxiety on rumination was significant (b = .09, SE = .04, p < .05), and stress and attachment anxiety predicted emotional eating through rumination (b = .50, SE = .15, p < .05). Rumination also predicted external eating (b = .32, SE = .11, p < .05). The mediation was not significant for restrained eating. Attachment avoidance did not significantly predict eating behaviors.

CONCLUSION

The emotion regulation model of attachment theory provides a suitable framework for studying disordered eating in adolescent girls. Future research may continue the use of this framework to examine related topics. Clinicians treating girls experiencing disordered eating may use interventions to promote healthy emotion regulation strategies.

LEVEL OF EVIDENCE

Level V: cross-sectional descriptive study.

Impact of School Closures, Precipitated by COVID-19, on Weight and Weight-Related Risk Factors among Schoolteachers: A Cross-Sectional Study

The school closures, precipitated by the COVID-19 pandemic, required teachers to convert their entire classroom curricula to online formats, taught from home. This shift to a more sedentary teaching environment, coupled with the stresses related to the pandemic, may correlate with weight gain. In total, 52% of study participants reported weight gain, with a higher prevalence observed among kindergarten and elementary school teachers when compared to high school teachers (p < 0.05). Deviations in physical activity, emotional eating, and dietary patterns were assessed among 129 teachers (using the Leisure Time Exercise Questionnaire, the Dutch Eating Behavioral Questionnaire, and a short-form Food Frequency Questionnaire, respectively) to uncover possible associations with the observed weight gain. Increases in sedentariness (p < 0.005), emotional eating (p < 0.001), the consumption of potatoes, fries, breads, cheese, cake (p < 0.05), chips, candy, ice-cream, and soft drinks (p < 0.005) were all positively correlated with weight gain. Decreases in exercise frequency (p < 0.001), and the consumption of fruits (p < 0.05) and beans (p < 0.005), were also positively correlated with weight gain. Weight gain, observed among teachers during school closures, was associated with changes in diet, emotional eating and physical activity.

The mediating role of emotional eating in the relationship between perceived stress and dietary intake quality in Hispanic/Latino adolescents

Obesity rates have steadily increased over the past three decades, and large racial/ethnic disparities in childhood obesity rates-specifically for Hispanic/Latino youth-highlight the major need for identifying and examining key mechanisms of obesogenic behaviors for this at-risk population. This study investigates the relationship between stress and dietary quality in Hispanic/Latino adolescents and seeks to determine the mediating role of emotional eating as a behavioral mechanism. Baseline data from 169 adolescents enrolled in the Imagine HEALTH trial were used to investigate these relationships. Perceived stress and emotional eating were assessed with age-validated questionnaires, and dietary quality was measured via 24-hour recall dietary assessments (later calculated as individual Healthy Eating Index-2015 scores). Nonparametric bootstrapping was used to test the primary hypothesis that emotional eating partially or fully mediates the relationship between perceived stress and dietary quality in this sample, and to test the significance of the mediating effect. Results indicate that emotional eating partially mediates the relationship between perceived stress and dietary quality. The total effect of perceived stress scores on dietary quality scores was -0.24 (p = .006); the direct effect of perceived stress scores on dietary quality scores (controlling for emotional eating scores) was -0.16 (p = .107), and the mediating (indirect) effect of emotional eating was -0.09 (p = .001). The proportion of mediation was 0.36 (36%) (p = .008). This study identifies an important mechanism of obesogenic behavior and can be used to inform future obesity prevention and intervention strategies tailored for the Hispanic/Latino adolescent population.

"It is the only constant in what feels like a completely upside down and scary world": Living with an eating disorder during COVID-19 and the importance of perceived control for recovery and relapse

The COVID-19 pandemic has had a profound, negative impact on the lives and wellbeing of much of the population, and it can raise additional challenges for individuals with eating disorders (EDs). During early stages of the UK lockdown, individuals reported disruptions to many aspects of their lives, including reduced feelings of control and serious concerns over the impact of the pandemic on ED symptoms and/or recovery. This study applied a mixed methods online survey to collect responses from 58 individuals (age 16-65yrs) with lived experience of EDs. Data was collected across two time points (April 2020 and June 2020) to explore the ongoing impacts of the pandemic on this population. The results suggest that higher perceptions of general, external control may be associated with ED recovery. Quantitative results show that individuals who reported recovering from their ED since the first time point, also reported significant increases in perceived control (compared to individuals who had relapsed or whose ED status was unchanged). Thematic analysis generated two themes: ED behaviours as an 'auxiliary control mechanism', and loss of auxiliary control after lockdown. Individuals who experienced less perceived control reported a tendency to rely upon eating disorder behaviours as an auxiliary coping mechanism, i.e., diminished external control was directed inwards and replaced with controlling their own behaviour. The preliminary results suggest that perceived control may be a significant factor in ED recovery. Individuals with EDs may be at significant risk of detrimental impacts on their recovery and wellbeing because of the pandemic reducing peoples' sense of control. These preliminary findings highlight the need for further research in this area, including investigation around potential interventions based upon strengthening perceptions of control to promote ED recovery.

Restrained eating in Lebanese adolescents: scale validation and correlates

BACKGROUND

Restrained eating disorder is prevalent worldwide across both ethnic and different cultural groups, and most importantly within the adolescent population. Additionally, comorbidities of restrained eating present a large burden on both physical and mental health of individuals. Moreover, literature is relatively scarce in Arab countries regarding eating disorders, let alone restrained eating, and among adolescent populations; hence, the aim of this study was to (1) validate the Dutch Restrained Eating Scale in a sample of Lebanese adolescents and (2) assess factors correlated with restrained eating (RE), while taking body dissatisfaction as a moderator between body mass index (BMI) and RE.

METHODS

This cross-sectional study, conducted between May and June 2020 during the lockdown period imposed by the Lebanese government, included 614 adolescents aged between 15 and 18 years from all Lebanese governorates (mean age of 16.66 ± 1.01 years). The scales used were: Dutch Restrained Eating Scale, body dissatisfaction subscale of the Eating Disorder Inventory-Second version, Rosenberg Self-Esteem Scale, Beirut Distress Scale (for psychological distress), Hamilton Anxiety Rating Scale and Patient Health Questionnaire (for depression).

RESULTS

The factor analysis yielded a one-factor solution with Eigen values > 1 (variance explained = 59.65 %; α_Cronbach = 0.924). Female gender (B = 0.19), higher BMI (B = 0.49), higher physical activity index (B = 0.17), following a diet to lose weight (B = 0.26), starving oneself to lose weight (B = 0.13), more body dissatisfaction (B = 1.09), and higher stress (B = 0.18) were significantly associated with more RE, whereas taking medications to lose weight (B=-0.10) was significantly associated with less RE. The interaction body mass index (BMI) by body dissatisfaction was significantly associated with RE; in the group with low BMI, higher body dissatisfaction was significantly associated with more RE.

CONCLUSIONS

Our study showed that the Dutch Restrained Eating scale is an adapted and validated tool to be used among Lebanese adolescents and revealed factors associated with restrained eating in this population. Since restrained eating has been associated with many clinically-diagnosed eating disorders, the results of this study might serve as a first step towards the development of prevention strategies targeted towards promoting a healthy lifestyle in Lebanese adolescents.

Consequences of the COVID-19 Syndemic for Nutritional Health: A Systematic Review

Confinement at home, quarantine, and social distancing are some measures adopted worldwide to prevent the spread of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-Cov-2), which has been generating an important alteration in the routines and qualities of life of people. The impact on health is still being evaluated, and consequences in the nutritional field are not entirely clear. The study objective was to evaluate the current evidence about the impact that preventive measures of physical contact restriction causes in healthy nutrition. A systematic review was carried out according to the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" PRISMA Group and Cochrane method for rapid systematic reviews. Searching was performed in six electronic databases and evaluated articles published between 2010 and 2020, including among their participants adult subjects who had been exposed to the preventive measures of physical contact restriction. Seven studies met the selection criteria and reported an overall increase in food consumption, weight, Body Mass Index (BMI), and a change in eating style. Findings suggest that healthy nutrition is affected by preventive measures to restrict physical contact as a result of the COVID-19 syndemic.

Prevalence of negative emotional eating and its associated psychosocial factors among urban Chinese undergraduates in Hong Kong: a cross-sectional study

Background

Emotional eating (EE), defined as eating in response to a range of emotions, has been previously associated with poor diet and obesity. Since there are limited data from non-Western populations, this study aims to examine the prevalence and factors associated with EE among urban Chinese university students.

Methods

A cross-sectional study was conducted on 424 university students (aged 18–24 years) from two large universities in Hong Kong in 2019. Respondents completed an anonymous online questionnaire that contained background questions, an emotional eating subscale of the Dutch Eating Behaviour Questionnaire (DEBQ), and Depression Anxiety and Stress Scales (DASS-21). Two-sample independent t-test and multiple regression analyses were conducted to test the association of study variables with negative emotional eating.

Results

There was over a three-fold higher likelihood of negative EE among females (14.8%) when compared with their male counterparts (4.5%) (OR = 3.7, p < 0.05). Having at least mild depressive symptoms was the only independent factor associated with negative EE among males (OR = 10.1) while for females, negative EE was independently associated with not having a romantic partner (OR = 3.45), having depressive symptoms (OR = 44.5), and having at least mild stress (OR = 5.65). Anxiety levels were not independently associated with negative EE for either gender. Both male and female students with negative EE had significantly lower self-perceived health scores, higher body mass index, and lower life satisfaction scores.

Conclusions

This study revealed that negative EE is prevalent among female Chinese university students and not uncommon among male students. Management of negative EE should be included as a component of university mental health promotion programmes in the region.

A Humanities-Based Explanation for the Effects of Emotional Eating and Perceived Stress on Food Choice Motives during the COVID-19 Pandemic

Perceived stress affects emotional eating and food choices. However, the extent to which stress associates with food choice motives is not completely understood. This study assessed whether emotional eating mediates the associations between perceived stress levels and food choice motives (i.e., health, mood, convenience, natural content, price, sensory appeal, familiarities, weight control, and ethical concerns) during the Coronavirus Disease 2019 pandemic. A total of 800 respondents were surveyed in the United States in June 2020. Their perceived stress, emotional eating, and food choice motives were assessed by the Perceived Stress Scale, Dutch Eating Behavior Questionnaire, and Food Choice Questionnaire, respectively. Moderate to high levels of perceived stress were experienced by the majority (73.6%) of respondents. Perceived stress was significantly correlated with emotional eating (r = 0.26) as well as five out of nine food choice motives: mood (r = 0.32), convenience (r = 0.28), natural content (r = −0.14), price (r = 0.27), and familiarity (r = 0.15). Emotional eating was significantly correlated with four out of nine food choice motives: mood (r = 0.27), convenience (r = 0.23), price (r = 0.16), and familiarity (r = 0.16). The mediation analyses showed that emotional eating mediates the associations between perceived stress and five food choices motives: mood, convenience, sensory appeal, price, and familiarity. Findings were interpreted using theories and concepts from the humanities, specifically, folklore studies, ritual studies, and symbolic anthropology.

Associations of parental feeding practices and food reward responsiveness with adolescent stress-eating

Rates of adolescent obesity have continued to rise over the past decade. As adolescence is an important time for developing eating habits that endure into adulthood, more information is needed about the potentially modifiable family- and individual-level factors that influence the development of common overeating behaviors such as stress-eating during adolescence. In this study, we conducted secondary data analyses to evaluate how parental feeding practices and adolescents' food reward responsiveness related to adolescents' stress-eating during a laboratory test meal. Participants were 90 healthy adolescents (50% female), 12-17 years of age (M = 14.3, SD = 1.7 years), at risk for excess weight gain (BMI percentile M = 92.7, SD = 7.5). Parental feeding behaviors were assessed with parent-report on the Child Feeding Questionnaire-Adolescent Version. Adolescents' relative reward value of food was measured with a behavioral task. Stress-eating was assessed as total energy intake from a buffet lunch meal after adolescents participated in the Trier Social Stress Test adapted for adolescents. Results revealed that parental concern about their child's weight (t = 2.27, p = .02) and adolescents' relative reward value of food (t = 2.24, p = .03) were related to greater stress-eating, controlling for BMI standard score, age, sex, and general perceived stress. Parental restriction was not related to stress-eating in this sample (p = .21). These findings suggest that parental attitudes about their adolescent's weight and adolescents' own internalized responsiveness to food as a reward may play a role in propensity to engage in overeating in response to stress.

Acceptance-based skill acquisition and cognitive reappraisal in a culturally responsive treatment for binge eating in adolescence

Emotional overeating, or eating in excess to soothe negative emotions, is a high-risk behavior for the future development of the binge-eating disorder (BED). The Emotional Overeating Intervention (EOI) is a culturally responsive, 10-week condensed dialectical behavior therapy (DBT) skills group intervention for adolescents endorsing emotional-overeating and binge-eating behaviors. The present study served as a secondary analysis of the intervention data, with the aim of using quantitative measures and qualitative interviews to examine intervention acceptability and DBT skill acquisition. Data were analyzed using descriptive statistics for quantitative surveys and qualitative content analysis for interviews. Among the 15 adolescents (M_age = 15.40 years; 73.3% identifying as female; 100% identifying as Black) who participated in the EOI pilot trial, most identified learning acceptance-based DBT skills, particularly radical acceptance, as both highly acceptable and the most useful aspect of treatment. Participants reported increases in distress tolerance appraisal and emotion regulation cognitive reappraisal scale scores from baseline to post-intervention. Accordingly, acceptance-based DBT skills may be associated with change-based cognitive strategies, which may contribute to improvements in emerging BED pathology. Findings serve as an initial step in informing preventative models of scalable interventions for subthreshold BED among adolescents, by identifying variables that warrant investigation as potential mechanisms of change.

Differences among Saudi and Expatriate Students: Body Composition Indices, Sitting Time Associated with Media Use and Physical Activity Pattern

Background: Being overweight at a young age is a predictor of developing obesity and related complications later in adulthood, posing a high risk to public health. Various ethnic subgroups have been identified as having a higher prevalence of overweight or obese. Saudi Arabia is one of the fastest-growing economies in the world, where the expatriate population comprises 33% of its total population. The objective of this study was to investigate differences in body composition indices, sitting time associated with media use, and physical activity pattern among a sample of local and expatriate school students in Saudi Arabia. Methods: 500 students (aged 8-18 years) from various schools were invited to participate in this study. Body weight, waist circumference (WC) and height were measured using a portable digital metric scale, standard measuring tape and wall mounted tape respectively. Participants and their parents were jointly asked to report the average time that the participant spent sitting using media (watching TV, playing video games, and using the internet and other screen-based devices etc.) per day. The pattern of physical activity among participants was measured using a short form of the International Physical Activity Questionnaire (IPAQ). Basal metabolic rate (BMR) and total daily energy expenditure (TEE) were estimated from body weight, height, age, sex and physical activity, according to the Harris-Benedict equation. Results: Data from 450 (90%) of the participants were used for analysis. The mean age of the participants was 14.55 ± 1.74 years. Body mass index (BMI), WC, waist to height ratio (WHtR), BMR and TEE differed significantly among the participants. Physical fitness score negatively correlated with BMI and WC, while sitting time associated with media use positively correlated with BMI, WC, WHtR and physical fitness score, among both Saudi and expatriate participants. Conclusions: Body composition indices and sitting time associated with media use were higher among Saudi boys and expatriate girls. Expatriate boys and girls were reported to be physically more active than their Saudi counterparts. BMR and TEE were higher among expatriate boys and Saudi girls. Although this study provides useful information about the association of body composition indices, sitting time associated with media use, and physical activity pattern among local and expatriate school students in SA, similar studies involving a larger study sample, with equal gender representation, are further required to determine various factors associated with this link.

The association between health literacy and psychosomatic symptoms of adolescents in China: a cross-sectional study

Background

Lower health literacy (HL) has been known to be involved in a range of common mental and physical disorders among adolescent students. Ample studies indicated low HL is associated with a series of chronic diseases even psychological diseases, nevertheless, little is known about this relationship among adolescents. In this context, the study aimed to examine associations between psychosomatic symptoms (physical and psychological symptoms) and HL in junior and senior high school students in China, and to provide guidance for improving the physical and mental health in Chinese adolescents.

Methods

A total of 22,628 junior and high school students in China were enrolled in this study. HL and psychosomatic symptoms were measured by self-report validated questionnaires. Multiple linear regression analyses were conducted to examine the associations between six sub-scales of HL and physical / psychological symptoms.

Results

Multiple linear regression analysis demonstrated that the sub-scales of HL showed a significantly negative association with physical symptoms and psychological symptoms (P <  0.05 for each). Physical symptoms was most strongly associated with IR (β = − 0.134), followed by SM (β = − 0.093), DB (β = − 0.059), SA (β = − 0.058) and PA (β = − 0.054). No statistically significant difference was found between HA and physical symptoms (P > 0.05). Meanwhile, psychological symptoms were most strongly associated with IR (β = − 0.160), followed by SA (β = − 0.129), SM (β = − 0.069), DB (β = − 0.031), HA (β = − 0.026) and PA (β = − 0.021).

Conclusion

These results indicated the importance of identifying the association of HL with physical and psychological symptoms, and provided the evidence that lower HL may serve as a critical and independent risk factor for poor health outcomes. Meanwhile, to maintain students’ desirable healthy status public health efforts for enhancing their HL level are urgently needed in adolescents.

Biological underpinnings from psychosocial stress towards appetite and obesity during youth: research implications towards metagenomics, epigenomics and metabolomics

Psychosocial stress, uncontrolled eating and obesity are three interrelated epidemiological phenomena already present during youth. This broad narrative conceptual review summarises main biological underpinnings of the stress-diet-obesity pathway and how new techniques can further knowledge. Cortisol seems the main biological factor from stress towards central adiposity; and diet, physical activity and sleep are the main behavioural pathways. Within stress-diet, the concepts of comfort food and emotional eating are highlighted, as cortisol affects reward pathways and appetite brain centres with a role for insulin, leptin, neuropeptide Y (NPY), endocannabinoids, orexin and gastrointestinal hormones. More recently researched biological underpinnings are microbiota, epigenetic modifications and metabolites. First, the gut microbiota reaches the stress-regulating and appetite-regulating brain centres via the gut-brain axis. Second, epigenetic analyses are recommended as diet, obesity, stress and gut microbiota can change gene expression which then affects appetite, energy homeostasis and stress reactivity. Finally, metabolomics would be a good technique to disentangle stress-diet-obesity interactions as multiple biological pathways are involved. Saliva might be an ideal biological matrix as it allows metagenomic (oral microbiota), epigenomic and metabolomic analyses. In conclusion, stress and diet/obesity research should be combined in interdisciplinary collaborations with implementation of several -omics analyses.

A Focused Review of Smartphone Diet-Tracking Apps: Usability, Functionality, Coherence With Behavior Change Theory, and Comparative Validity of Nutrient Intake and Energy Estimates

BACKGROUND

Smartphone diet-tracking apps may help individuals lose weight, manage chronic conditions, and understand dietary patterns; however, the usabilities and functionalities of these apps have not been well studied.

OBJECTIVE

The aim of this study was to review the usability of current iPhone operating system (iOS) and Android diet-tracking apps, the degree to which app features align with behavior change constructs, and to assess variations between apps in nutrient coding.

METHODS

The top 7 diet-tracking apps were identified from the iOS iTunes and Android Play online stores, downloaded and used over a 2-week period. Each app was independently scored by researchers using the System Usability Scale (SUS), and features were compared with the domains in an integrated behavior change theory framework: the Theoretical Domains Framework. An estimated 3-day food diary was completed using each app, and food items were entered into the United States Department of Agriculture (USDA) Food Composition Databases to evaluate their differences in nutrient data against the USDA reference.

RESULTS

Of the apps that were reviewed, LifeSum had the highest average SUS score of 89.2, whereas MyDietCoach had the lowest SUS score of 46.7. Some variations in features were noted between Android and iOS versions of the same apps, mainly for MyDietCoach, which affected the SUS score. App features varied considerably, yet all of the apps had features consistent with Beliefs about Capabilities and thus have the potential to promote self-efficacy by helping individuals track their diet and progress toward goals. None of the apps allowed for tracking of emotional factors that may be associated with diet patterns. The presence of behavior change domain features tended to be weakly correlated with greater usability, with R2 ranging from 0 to .396. The exception to this was features related to the Reinforcement domain, which were correlated with less usability. Comparing the apps with the USDA reference for a 3-day diet, the average differences were 1.4% for calories, 1.0% for carbohydrates, 10.4% for protein, and -6.5% for fat.

CONCLUSIONS

Almost all reviewed diet-tracking apps scored well with respect to usability, used a variety of behavior change constructs, and accurately coded calories and carbohydrates, allowing them to play a potential role in dietary intervention studies.

Evaluation of the Factor Structure of the Adolescent Stress Questionnaire in Chinese Adolescents

This study evaluated the psychometric properties of the Chinese version of Adolescent Stress Questionnaire (ASQ-CN) in a sample of Chinese middle school students (N = 420; 52.14% boys and 47.86% girls). Iterated principal factor analysis and multiple-group principal components cluster analysis supported a six-factor model with 42 items out of 58 items in the ASQ-CN. The internal consistency was from .82 to .90. Girls reported lower stress levels in one subscale, Stress of romantic relationship, whereas no gender differences were found in the other five subscales. Compared with other studies of the ASQ in Westernized countries, the ASQ-CN showed a distinct factor structure that may be explained by cross-cultural differences. Scales constructed from factor analysis related negatively to measures of mindfulness and positively to a measure of behavioral problems, suggesting that they were valid for Chinese adolescent stress. The study did not support a higher order construct of the ASQ-CN. Altogether, our findings suggest that the ASQ-CN is adequate for assessing stressors in Chinese adolescents.

A multimodal investigation of impulsivity as a moderator of the relation between momentary elevations in negative internal states and subsequent dietary lapses

Suboptimal outcomes from behavioral weight loss (BWL) treatments are partially attributable to accumulated instances of non-adherence to dietary prescriptions (i.e., dietary lapses). Results identifying negative internal triggers for dietary lapses are inconsistent, potentially due to individual differences that impact how individuals respond to cues. Impulsivity is one factor that likely influences reactivity to internal states. We examined three dimensions of impulsivity (delay discounting, inhibitory control, and negative urgency) as moderators of the relation between affective and physical states and subsequent dietary lapses at the beginning of BWL. Overweight/obese adults (n = 189) completed behavioral and self-reported measures of impulsivity at baseline of BWL and an ecological momentary assessment (EMA) protocol across the first two weeks of treatment to report on affective/physical states and instances of dietary lapses. Results indicated that baseline negative urgency, but not delay discounting or inhibitory control, was positively associated with overall lapse risk. Moderation analyses indicated that poorer inhibitory control strengthened the relation between momentary increases in stress and subsequent dietary lapse, and higher negative urgency strengthened the relation between increases in loneliness and dietary lapse. Negative urgency also moderated the impact of momentary hunger on subsequent dietary lapse risk in an unexpected direction, such that higher negative urgency weakened the relation between hunger and subsequent lapse. Results lend partial and tentative support for the moderating role of impulsivity on the relation between internal states and lapse likelihood. With replication, the development and testing of personalized treatment components based on baseline impulsivity level may be warranted.

Poor Dietary Habits in Bullied Adolescents: The Moderating Effects of Diet on Depression

The prevalence of bullying has increased dramatically during recent years, with numerous negative consequences for the health and quality of life of bullied adolescents. Although negative psychological consequences of this type of situation have been widely investigated, no previous research has evaluated the effects of bullying victimization on dietary habits, and its relationship with psychological outcomes, such as depression. For this reason, the main aim of the present study was to evaluate the association between bullying, dietary habits, and depression in a sample of 527 Spanish adolescents. The results obtained showed that being bullied was correlated negatively with healthy dietary habits and positively with depression. Moderation analysis revealed dietary habits as moderator of the association between bullying and depression. These results underline the relevance of diet in the phenomenon of bullying, especially in victims, as could be related to the high levels of depression characteristic of this population. The inclusion of nutritional education in intervention programs oriented to victims of bullying might significantly improve their efficacy, reducing depression levels.

Academic-Related Factors and Emotional Eating in Adolescents

BACKGROUND

Existing literature indicates a relationship between stress and emotional eating in adults, yet limited research has examined the impact of school-related stress on emotional eating in adolescents. This study investigated the influence of academic factors on emotional eating among minority adolescents.

METHODS

A survey was implemented among a sample of minority adolescents (N = 666) to investigate the relationship between emotional eating and 3 academic factors: academic self-esteem, grade point average (GPA), and academic worries. Forced-entry multiple linear regressions were used to test for relationships.

RESULTS

Findings indicate that GPA, academic self-esteem, and academic worries were related to emotional eating scores in adolescents. There were no significant differences in academic factors between emotional eaters and nonemotional eaters.

CONCLUSIONS

Additional research is needed to further elucidate the complex interaction between emotional eating behavior and academics.

Emotional Over- and Undereating in Children: A Longitudinal Analysis of Child and Contextual Predictors

Eating more or eating less in response to negative emotions, called emotional over- and undereating, is common in children, but research on the etiology of these behaviors is in its infancy. Drawing on a large, representative community sample of Norwegian children followed up on a biennial basis from 6 to 10 years of age (analysis sample: n = 802), child and contextual predictors (i.e., child temperament, depression symptoms, serious life events, family functioning, parental sensitivity and structuring) of change in emotional over- and undereating were examined. Results revealed that low (temperamental) soothability and less parental structuring at age 6 predicted increased emotional overeating at age 10 and that lower family functioning at age 6 predicted more emotional undereating during the same period.

Life Event Stress and Binge Eating Among Adolescents: The Roles of Early Maladaptive Schemas and Impulsivity

This study examined the relationships between life event stress, early maladaptive schemas, impulsivity and binge eating among adolescents and investigated the effects of early maladaptive schemas and impulsivity on the relationship between life event stress and binge eating. Specifically, we examined a moderated mediation model in which early maladaptive schemas mediated this relationship and impulsivity moderated the mediation effect. Life event stress, early maladaptive schemas, impulsivity and binge eating were investigated in a sample of 2172 seventh-, eighth- and tenth-grade middle and high school students (mean age = 14.55 years, standard deviation = 1.29). The results indicated that adolescents with greater life event stress, more early maladaptive schemas and higher levels of impulsivity displayed more severe binge eating. In addition, early maladaptive schemas mediated the relationship between life event stress and binge eating, while impulsivity moderated this relationship. Furthermore, impulsivity also moderated the mediation effect of early maladaptive schemas; as impulsivity levels increased, the strength of the association between life event stress and early maladaptive schemas increased. This study illustrates the importance of understanding individual differences and their effects on the relationship between life event stress and binge eating. Copyright © 2015 John Wiley & Sons, Ltd.

The problematic messages of nutritional discourse: A case-based critical media analysis

Nutritional science has assumed a fundamental importance in shaping food meanings and practices in the developed world. This study critically analysed the content of one weekly nutrition column written by a nutritional expert in a popular New Zealand magazine, from a social constructionist perspective, to investigate how nutritional advice constructs food, food practices and eaters. The analysis identified a range of ways in which the nutrition information communicated in the articles was potentially problematic for readers. The articles advocated eating for health with recommendations based on nutritional science, but depicted nutritional information as inconclusive, changeable and open to interpretation. Fear-based messages were used to motivate making 'healthy' food choices, through linking 'unhealthy' food choices with fatness and chronic ill health. Unhealthy foods were portrayed as more enjoyable than healthy foods, social occasions involving food were constructed as problematic, and exercise was defined only as a way to negate food consumption. Healthy eating was portrayed as a matter of personal choice, obscuring the situational factors that impact on food choice and health. We conclude that the nutritional advice analysed in this study constructs a way of understanding food that, if internalised by eaters, may evoke anxiety, confusion and dissatisfaction around food and eating.

A Questionnaire Survey of the Type of Support Required by Yogo Teachers to Effectively Manage Students Suspected of Having an Eating Disorder

Background

Many studies have focused on the decreasing age of onset of eating disorders (EDs). Because school-age children with EDs are likely to suffer worse physical effects than adults, early detection and appropriate support are important. The cooperation of Yogo teachers is essential in helping these students to find appropriate care. To assist Yogo teachers, it is helpful to clarify the encounter rates (the proportion of Yogo teachers who have encountered ED students) and kinds of requested support (which Yogo teachers felt necessary to support ED students). There are no studies that have surveyed the prevalence rates of ED children by ED type as defined by the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), nor were we able to find any quantitative study surveying the kinds of support Yogo teachers feel helpful to support ED students.

Methods

A questionnaire survey was administered to 655 Yogo teachers working at elementary/junior high/senior high/special needs schools in Chiba Prefecture. The questionnaire asked if the respondents had encountered students with each of the ED types described in DSM-5 (anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), avoidant/restrictive food intake disorder (ARFID), and other types of EDs (Others)), and the kinds of support they felt necessary to support these students. The encounter rates and the kinds of requested were obtained and compared, taking their confidence intervals into consideration.

Results

The encounter rates for AN, BN, BED, ARFID, and Others were 48.4, 14.0, 8.4, 10.7, and 4.6 %, respectively. When classified by school type, AN, BN, BED, and ARFID had their highest encounter rates in senior high schools. Special needs schools had the highest rate for Others. The support most required for all ED types was “a list of medical/consultation institutions.”

Conclusions

Our results have clarified how to support Yogo teachers in the early detection and support of ED students. We found that the encounter rate of AN was the highest, and that it is effective to offer “a list of medical/consultation institutions” to junior and senior high schools where the encounter rates for AN are high.

Stress, shift duty, and eating behavior among nurses in Central Saudi Arabia

OBJECTIVES

To investigate the association between stress, shift work, and eating behavior among non-Saudi female nurses working in Central Saudi Arabia.

METHODS

A sample of 395 non-Saudi female nurses from 2 major hospitals in Riyadh, Kingdom of Saudi Arabia participated in this cross-sectional study. The nurses completed a questionnaire from November 2013 to January 2014 that included items relating to stress and eating behavior using the Dutch Eating Behavior Questionnaire (DEBQ). The questionnaire also contained items pertaining to socio-demographic data, body mass index, shift work, and hours worked per week. 

RESULTS

For all eating styles, stress, and shift duty influenced the amount of food nurses consumed, but was more significant under a restrained eating style. Under this eating style, a significantly higher percentage of nurses reported eating more fast food, snacks, and binging, while fruits and vegetables were the least likely to be eaten under stress. High stressed nurses were more likely to present with abnormal restrained eating (odds ratio [OR]=1.52, p=0.004), emotional (OR=1.24; p=0.001), and external (OR=1.21; p=0.001) DEBQ scores. Working nighttime shift duty was positively associated with restrained eating (OR=1.53; p=0.029) and emotional eating (OR=1.24; p=0.001), but negatively associated with external eating (OR=0.45; p=0.001). 

CONCLUSION

Our findings suggest that stress and shift duty were associated with eating habits.

Gender differences in the magnitude of the associations between eating disorders symptoms and depression and anxiety symptoms. Results from a community sample of adolescents

BACKGROUND

Studies reporting comorbidities of eating disorders (EDs) with depression and anxiety disorders during adolescence used clinical samples of female adolescents with few attempts to present the magnitude of these associations in population-based samples and to assess gender differences in the strength of these associations.

AIMS

This study assesses significant gender differences in the association of anorexia nervosa (AN) and bulimia nervosa (BN) symptoms with depression and generalized anxiety symptoms in a community sample of adolescents.

METHOD

We collected anonymous self-reported data from 235 adolescent boys and 471 adolescent girls, through an online platform. To identify correlations between symptoms of AN and BN, and symptoms of depression and generalized anxiety, we used the Mann-Whitney U test. To identify differences between independent correlation coefficients, we converted each correlation coefficient into a z-score using Fisher's r-to-z transformation and, making use of the sample size employed to obtain each coefficient, we compared the z-scores.

RESULTS

The magnitude of the associations between EDs symptomatology and depression and anxiety symptomatology was similar in adolescent boys and girls.

CONCLUSION

Our results show an urgent need to address EDs prevention in adolescent girls and boys from the community.

Two facets of stress and indirect effects on child diet through emotion-driven eating

OBJECTIVE

Stress has been associated with high-calorie, low-nutrient food intake (HCLN) and emotion-driven eating (EDE). However, effects on healthy food intake remain unknown. This study examined two facets of stress (self-efficacy, perceived helplessness) and food consumption, mediated by EDE.

METHODS

Cross-sectional data from fourth-graders (n=978; 52% female, 28% Hispanic) in an obesity intervention used self-report to assess self-efficacy, helplessness, EDE, fruit/vegetable (FV) intake, and high-calorie/low-nutrient (HCLN) food.

RESULTS

Higher stress self-efficacy was associated with higher FV intake, β=.354, p<0.001, and stress perceived helplessness had an indirect effect on HCLN intake through emotion-driven eating, indirect effect=.094, p<0.001; χ(2)(347)=659.930, p<0.001, CFI=0.940, TLI=0.930, RMSEA=0.030, p=1.00, adjusting for gender, ethnicity, BMI z-score, and program group.

CONCLUSIONS AND IMPLICATIONS

Stress self-efficacy may be more important for healthy food intake and perceived helplessness may indicate emotion-driven eating and unhealthy snack food intake. Obesity prevention programs may consider teaching stress management techniques to avoid emotion-driven eating.

Eating behavior and perception of body shape in Japanese university students

PURPOSE

We investigated the relationship between eating behavior measured by the Dutch Eating Behaviour Questionnaire (DEBQ) and perception of body shape, examining the current physical status and 'ideal' physical parameters in females and males.

METHODS

The participants, 548 Japanese university students (age 19.2 ± 0.9 years, mean ± SD; 252 males, 296 females), completed a questionnaire which asked for their current physical status (e.g., weight and height), their ideal physical parameters, their perception of their current body shape, their ideal body shape, and their eating behaviors.

RESULTS

The ideal weight and ideal body mass index (BMI) were significantly higher than the current weight and BMI in the males, but significantly lower in the females. Among the females, the ideal body shape was smaller than their perception of current body shape. The DEBQ scores for restrained, emotional, and external eating were higher in the females than the males among the normal-weight participants, and among the underweight participants, the restrained eating and external eating scores were higher in the females than the males. Restrained eating was negatively associated with the discrepancy between the current and ideal weight, BMI, and body shape in both the males and females. Emotional eating was negatively associated with the discrepancy in current/ideal BMI and body shape only in the females.

CONCLUSIONS

At least in Japanese university students, the gender differences in ideal body shape are related to eating behavior.

Mediating effects of stress, weight-related issues, and depression on suicidality in college students

OBJECTIVE

Through a holistic health lens, the current study examines the effects of weight-related issues and stress on suicidality while controlling for depressive symptoms in college students.

PARTICIPANTS

In total, 872 undergraduate and graduate students at DePaul University completed the American College Health Association-National College Health Assessment II Web-based survey in Spring 2010.

METHODS

Measures of suicidality, depression, weight-related issues, and life stressors were assessed, along with gender differences.

RESULTS

Females reported experiencing more weight loss attempts and total stressors than males. Weight-related issues and stress both significantly predicted depressive symptoms in a path analysis; depressive symptoms, in turn, significantly predicted suicidality. Gender differences were found; depressive symptoms mediate the relation between stress and suicidal behavior for females but not for males.

IMPLICATIONS

This investigation furthers previous research on suicidality in college students and suggests that all-inclusive interventions that address weight-related issues and stress may help reduce depressive symptoms, which then may reduce suicidal behavior.

Body image concerns: levels, correlates and gender differences among students in the United Kingdom

AIMS

This cross-sectional study aimed to determine the socio-demographic, lifestyle and well-being variables that are associated with body image concerns (BIC) and whether these associations differed between female and male students.

METHODS

A cross-sectional survey; 3,706 undergraduate students (2,699 females, 765 males) from seven universities in the UK completed a self-administered questionnaire that assessed socio-demographic, lifestyle, well-being and BIC based on the Body Shape Questionnaire developed by Cooper et al. Multifactorial logistic regression analysis examined the odds ratios for the association between four increasing levels of BIC as the dependent variables (no BIC, mild BIC, moderate BIC and marked BIC) on the one hand, and the socio-demographic (gender, age, year at university), lifestyle (physical activity, nutrition) and mental well-being variables (quality of life, perceived stress, perceived health, depressive symptoms) on the other.

RESULTS

More females (35%) than males (8%) reported being moderately or markedly concerned with their body image. For both genders, BIC was associated with a higher level of depressive symptoms and to variable extents, with nutrition and year at university. Females' BICs were exclusively associated with low perceived health, higher perceived stress, studies in general as a stressor, and low physical activity. In contrast, males' BIC were found to be exclusively associated with low quality of life and with older age.

CONCLUSIONS

Health promoting strategies and activities should address the co-occurrence of depressive symptoms and BIC and should moreover pay attention to the gender-specific correlates of BIC for tailoring evidence based interventions for females and for males.

Self-control and parental control mediate the relationship between negative emotions and emotional eating among adolescents

OBJECTIVES

The study was conducted to simultaneously investigate the mediating effects of parental control and adolescents' self-control on the relationship between adolescents' negative emotions and emotional eating, and to determine pathways with the greatest effect among these variables.

METHODS

Negative emotions, emotional eating, parental control, and self-control were investigated in 594 high school students (average age=16.70, SD=1.09) in Changsha City, China.

RESULTS

High levels of negative emotions and parental control and low levels of self-control were strongly related to high levels of emotional eating in adolescents. In addition to the direct relationship between negative emotions and emotional eating, there was a mediating effect observed through low self-control and high parental control. The mediational effect of parental control was non-significant in adolescent boys. Furthermore, negative emotions related to emotional eating through the effect of parental control on adolescents' self-control. The degree to which both mediators explained the relationship between negative emotions and emotional eating ranged from 52.6% to 66.8%, and self-control had a stronger mediational effect than did parental control.

CONCLUSION

The results indicate that both self-control and parental control should be considered in designing preventative measures against emotional eating in adolescents. Adolescent self-control training could also assist in preventing emotional eating.