Eating and weight concerns among Sikkimese adolescent girls and their biocultural correlates: an exploratory study

Evaluating a body image school-based intervention in India: A randomized controlled trial

Body dissatisfaction is highly prevalent among adolescents in low- and middle- income countries, including in India. However, evidence-based interventions are lacking. This study evaluated the efficacy of a school-based mixed-gender body image intervention among adolescents in India. A randomized controlled trial was conducted among 568 (43 % girls) Year 7 students (aged 11-14; 94 % aged 12-13) in six schools in Delhi. Each school was randomly allocated to receive five 45-minute intervention sessions delivered by trained psychologists or a wait-list control condition. The primary outcome of body image and related secondary outcomes were assessed at pre-intervention, post-intervention, and 3-month follow-up. Intention-to-treat linear mixed models analyses showed improvements in body image relative to the control group at post-intervention and 3-month follow-up. Significant improvements were identified at post-intervention for internalization, life disengagement, disordered eating, self-esteem, and negative affect, with effects maintained in nearly all outcomes (girls only - internalization, boys only - life disengagement) at 3-month follow-up. This study presents the first mixed-gender school-based body image intervention in India, which was efficacious in improving urban adolescents' body image, disordered eating, and related outcomes.

The association between body weight dissatisfaction with unhealthy eating behaviors and lack of physical activity in adolescents: A systematic review

A systematic review examined the association between body weight dissatisfaction with unhealthy eating behaviors and lack of physical activity in adolescents, since it represents an alert to adolescent's health and well-being. Six electronic databases and gray literature were systematically searched from January 1980 to December 2018. A total of 11 articles met the inclusion criteria. Included studies assessed body weight dissatisfaction using different dimensions/components: satisfaction component of the attitudinal dimension was assessed in five studies, behavior component of the attitudinal dimension was assessed in two studies, perceptual dimension was assessed in two studies, and two studies were unclear about dimension. Behaviors: two assessed only unhealthy eating behaviors, six assessed lack of physical activity, and three assessed both behaviors. Only three studies found an association between body weight dissatisfaction with unhealthy eating behaviors, three with lack of physical activity, and one did not perform a statistical test for an association between body weight dissatisfaction with unhealthy eating behaviors and lack of physical activity. Few studies have reported an association between body weight dissatisfaction with one of these unhealthy behaviors. There was substantial heterogeneity related to unit of measures, both for body weight dissatisfaction and for behaviors studied.

Adaptation and validation of the Internalisation-General subscale of the Sociocultural Attitudes Towards Appearance Questionnaire (SATAQ-3) in English among urban Indian adolescents

Few studies have validated body image related measures in Asian countries, including in India, thus stunting research progress. To provide a robust method of assessing internalisation of cultural appearance ideals, the purpose of this study was to validate a culturally appropriate English version of the Internalisation-General subscale from the Sociocultural Attitudes Towards Attitudes Questionnaire-3 among a school sample of 1,432 urban Indian adolescents (Mage = 12.9 years; 44 % girls). Exploratory factor analyses revealed a one-factor solution for both girls and boys. Analyses indicated a six-item scale for girls and a four-item scale for boys; both of which were verified by confirmatory factor analysis. Cronbach's alpha was high for both female (.88) and male scales (.87), and convergent validity was confirmed via significant correlations with measures of body esteem and disordered eating. Using the items which were common in both the male and female versions of the scale, confirmatory factor analysis supported a psychometrically sound model that was gender invariant, and thus can be used to assess and compare both genders. Overall, results support the reliability and validity of the Internalisation-General subscale among English-speaking urban Indian adolescents.

Adaptation and validation of the Eating Disorder Examination-Questionnaire in English among urban Indian adolescents

OBJECTIVE

Eating pathology is a salient issue in India, with clinical features reported among adults and adolescents. However, there are currently no validated measures of disordered eating in the Indian context. The present study therefore aimed to validate a culturally appropriate English language version of the Eating Disorder Examination Questionnaire (EDE-Q), a widely used measure, among adolescents in India.

METHOD

We adapted and examined the factor structure, reliability, and construct validity of the EDE-Q among an urban sample of 1,413 Indian adolescents (mean age = 13 years; 45% girls).

RESULTS

In contrast to the original four-factor model, exploratory factor analysis identified a two-factor solution for girls and boys, which was verified by confirmatory factor analysis; a "Preoccupation and Control" subscale and a "Weight and Shape Concerns" subscale. The total scale comprised 15 items for girls and 18 items for boys. Test-retest reliability and internal consistency were satisfactory for the girls' and boys' scales (Cronbach's α = .91 for both) and their comprising subscales (αs ≥ .80). Concurrent validity was established through medium-high significant correlations with measures of body image and internalization of appearance ideals. Combining items common to both versions of the scale led to a psychometrically acceptable model which was largely invariant across both genders, thus facilitating gendered comparison.

DISCUSSION

Findings indicate the reliability and validity of the EDE-Q among English-speaking urban Indian adolescents. This will facilitate further research examining the prevalence and nature of eating pathology among adolescents in India.

Mediating effect of fitness and fatness on the association between lifestyle and body dissatisfaction in Spanish youth

BACKGROUND

Previous studies have identified sedentary behaviour, physical activity and eating habits as variables that define a healthy lifestyle. The aims of this investigation were to determine the association between lifestyle and body dissatisfaction, as well as to test the mediating effect of fatness and fitness in this relationship in adolescents.

METHODS

The sample comprised 2216 adolescents aged 13.1 ± 0.90 years, of whom 980 were girls (age 13.1 ± 0.86) and 1236 were boys (age 13.1 ± 0.92). Body composition was measured by body mass index, neck circumference, waist to height ratio and body fat percentage, whereas physical activity, sedentary time, body dissatisfaction and eating habits were self-reported. Physical fitness was evaluated through the ALPHA-Fitness Battery.

RESULTS

The results showed that lifestyle was negatively related with body dissatisfaction. Moreover, physical fitness (β = -0.062; SE = 0.022; 95% IC [-0.106, -0.017]) and fatness (β = -0.052; SE = 0.011; 95% IC [-0.075, -0.032]) showed a significant mediation effect on the relationship between lifestyle and body dissatisfaction. The bootstrapped confidence intervals for the indirect effect were statistically significant, suggesting the mediation effect of fatness (percentage of the total effect of 51.0%) and fitness (percentage of the total effect of 21.3%) on the relationship between healthy lifestyle and body dissatisfaction.

CONCLUSION

The study suggests that adolescents with a healthy lifestyle may have less body dissatisfaction. Fatness and physical fitness can positively affect this relationship, decreasing young people's body dissatisfaction. Therefore, this study highlights the importance of a healthy lifestyle on physical and psychological health in adolescence.

Clustering of obesogenic behaviors and association with body image among Brazilian adolescents in the national school-based health survey (PeNSE 2015)

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The co-occurrence of obesogenic behaviors is associated to body image indicators.

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Risk behaviors combined may set the adolescent at risk for psychological health.

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Adolescents in healthy clusters perceive themselves as having normal weight.

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Girls engaging in healthy clusters are less likely to use pills to control weight.

This study aimed to examine the association between clusters of obesogenic behaviors and body image indicators among a population-based sample of Brazilian adolescents. Data from a cross-sectional country representative survey of 9th grade students (N = 102,301) were analyzed. Physical activity (PA), sedentary behavior (SB) and body image indicators (i.e. satisfaction, perception, value, and weight control attitudes and behaviors) were self-reported. Three clusters were previously validated with two-steps cluster analysis: “Health-promoting SB and diet”, “Health-promoting PA and diet”, and “Health-risk”. Multinomial and binary logistic regression were used to associate clusters with body image indicators. Adolescents in the healthier clusters were more likely to be satisfied/very satisfied with body image and perceive themselves as having normal weight than those in the “Health-risk” cluster. Boys in both health-promoting clusters were more likely to consider body image as being important/very important and perceive themselves to be thin/very thin. Adolescents in the “Health-promoting PA and diet” cluster were more likely to be trying to lose or gain weight than those in the “Health-risk” cluster. Girls in the “Health-promoting SB and diet” cluster had lower odds of adopting unhealthy weight control behaviors than those in the “Health-risk” cluster. The effect of obesogenic behaviors on distinct aspects of body image was confirmed and found to vary according to different synergies between adolescents’ health-related behavior. These findings provide important insights on the understanding of behavioral profiles which can be targeted to prevent unhealthy weight control behaviors and weight related disorders, especially among girls.

Eating Disorders: An Overview of Indian Research

There has been sporadic research on eating disorders in India, with no published attempt to collate and summarize the literature landscape. Hence, the present narrative review aims to summarize Indian work related to eating disorders, discern current trends, and highlight gaps in research that will provide directions for future work in the area. Electronic search using the MEDLINE, Google Scholar, and PsycINFO databases was done to identify relevant peer-reviewed English language articles, in October 2018, using combinations of the following medical subject headings or free text terms: "eating disorders," "anorexia nervosa," "bulimia," "treatment," "epidemiology," "co-morbidity," "management," "medications," "behavioral intervention," and "psychosocial intervention." The data extracted from studies included details such as author names, year, from which of the states in India the work originated, type of intervention (for interventional studies), comparator (if any), and major outcomes. There is increasing research focused on eating disorders from India over the last decade, but it continues to be an under-researched area as evidenced by the relative paucity of original research. The cultural differences between east and west have contributed to variations in the presentation as well as challenges in the diagnosis. Hence, there is a need for the development of culturally sensitive instruments for diagnosis, as well as generating locally relevant epidemiological data about eating disorders from community and hospital settings.

Association of socio-culture factors with disordered eating behavior: An empirical study on urban young girls of West Bengal, India

A shift towards the concept of thin body image is occurring among the urban girls, as an outcome of mass media exposure. A large section of the girls are involved in attaining thin body image which at times develops dissatisfaction over body weight. Body weight dissatisfaction gives rise to the development of body weight concern and disordered eating behavior. The present research aimed to find out the association of socio-cultural factors with disordered eating behavior among a group of urban girls. The study group included 400 girls aged between 14 and 21 years, residing in the city of Howrah, West Bengal, eastern state of India. Information on socio-demographic characteristics, body weight concern, media habits, and family-peer environments was collected using standard pretested questionnaires. A cross-culturally tested questionnaire developed by Srinivasan and colleagues in 1998, was used to measure disordered eating behavior. Bivariate analyses found significant associations between eating behavior and several socio-cultural factors. Multivariate analysis revealed that education level of fathers and birth order of the participants, body weight concern and peers’ influence were the significant predictors of disordered eating behavior of the study participants. Socio-cultural factors have significant associations with the disordered eating behavior of the study participants.

Are Body Image Issues Affecting Our Adolescents? A Cross-sectional Study among College Going Adolescent Girls

BACKGROUND

Body image relates to how people think and feel about their own body. In today's society, with the growing sense of ideal body image, adolescents try to lose or gain body weight to attain that perfect body. Body image perception is still naive, and this research will try to understand these unexplored areas, where there is paucity of body image-related studies.

OBJECTIVES

The objective of the study is to find out the proportion of girls dissatisfied about body image, and the association of various factors with body image dissatisfaction and to ascertain the weight control behaviors adopted by adolescent college girls.

METHODOLOGY

A cross-sectional study was done among 1200 college girls in Coimbatore. A semi-structured questionnaire was used to collect data on various factors associated with body image dissatisfaction. Body mass index (BMI) of the participants was calculated.

RESULTS

Body image dissatisfaction was there among 77.6% of the girls. It was found that factors such as higher BMI, sociocultural pressure to be thin and depression were all significantly associated with body image dissatisfaction. The most commonly followed weight control behaviors were eating small meals and skipping meals. Improving the appearance and body shape were the main reasons for weight control behaviors.

CONCLUSION

This study establishes the fact that body image dissatisfaction is no longer a western concept and affects Indian adolescent girls to a great extent. Hence, effective interventions have to be planned to increase awareness on ideal body weight and protect our young generation from pressures of negative body image.

Food addiction among men and women in India

OBJECTIVE

This study aimed to address a cultural gap in the food addiction (FA) literature by examining FA and associated clinical features in a nonclinical group of men and women residing in India.

METHOD

Participants (N = 415) were recruited from Amazon Mechanical Turk to complete an online survey about weight and eating. Participants completed self-report measures assessing FA (Yale Food Addiction Scale [YFAS]), eating-disorder psychopathology (Eating Disorder Examination-Questionnaire [EDE-Q]), health-related quality of life (Short Form Health Survey-12-item version [SF-12]), and depression (Patient Health Questionnaire-2).

RESULTS

The FA symptom mean was 3.53 (SD = 1.90); 32.5% (n = 129) met FA clinical threshold on the YFAS. Groups categorized with and without FA on the YFAS did not differ significantly in sex or body mass index. YFAS scores were significantly correlated with greater frequency of binge eating, higher severity scores on all EDE-Q subscales, higher depression, and poorer functioning scores on the SF-12 (all ps < 0.05).

CONCLUSIONS

FA, as conceptualized and measured by the YFAS, appears to be common among individuals residing in India.

Weight concerns and food habits of adolescent girls in two contrasting ecological regions: A comparative study in India

OBJECTIVE

To compare the incidence of weight concerns and food habits between two ethnically different groups of adolescent girls residing in two distinct ecological settings: the plains of Kolkata and the mountains of Sikkim.

METHODS

Two separate cross-sectional studies were conducted within a period of five years in urban hilly areas of Sikkim and the city of Kolkata, India. A total of 506 girls aged 14-19 years were selected from the study areas of Sikkim (n=224) and Kolkata (n=282). Girls were interviewed for weight concerns and food habits along with socio-demographic characteristics. Weight concerns were assessed with four variables such as, perceptions about own body weight, felt dissatisfied with own body weight, urge for dieting and use of weight reduction diet. Food habits included consumption of major foods during the past one week.

RESULTS

Bivariate analyses showed that Kolkata girls perceived themselves as overweight, remained dissatisfied with body weight, expressed perceived need for dieting and followed weight reduction diet more compared to the girls of Sikkim. Food habits indicated that all Sikkimese girls preferred to consume cereals regularly, while Kolkata girls consumed vegetables, pulses, fish, fruits, bread and butter and fried foods more than Sikkimese girls. Multivariate analyses showed that place of residence was significantly (p<0.05) associated with both weight concerns and food habits of girls.

CONCLUSION

Diversity in culture, ethnicity and socio-economic standard perhaps develop the disparity in food habits and weight concerns between girls of urban hilly areas of Sikkim and the city of Kolkata.

The rise of eating disorders in Asia: a review

Once concentrated among adolescent Caucasian females in high-income Western countries, today, eating disorders (EDs) are truly global. Building upon previous work describing the rise of EDs among cultures in transition, we contextualize the emergence of EDs in Asia by locating this development within the broader discourse about the processes of change that have radically transformed Asian societies over the last three decades. By identifying where EDs are emerging in the region, and by examining their particular expression, our aim is to explicate a fuller story of the relationship between culture and eating disorders. Much of the discussion of EDs in non-Western societies is predicated upon the assumption that an increase in EDs is the by-product of "Westernization", the term used to describe the process by which increased cultural contact with the West results in the transmission of so-called 'Western' ideas and cultural norms to a non-Western culture. While the Westernization literature represents a historical anchor in our understanding of EDs in Asia, we propose that this analysis is incomplete in that societal change in the form of industrialization and urbanization occurring independently from, or in tandem with, "Western" influence are critical factors contributing to the rise of EDs in Asia. Further, our review of eating disorders in Asia suggests that an understanding of the diversity and distinctiveness of the individual countries and cultures that comprise 'Asia' is crucial to understanding the emergence and rise of EDs across this vast region, suggesting that eating disorders are not culture-bound or culture-specific, but rather culture-reactive. Taking into account both the historical influence of Western culture and the more contemporary effects of Asian industrialization and urbanization, key distinctions among respective Asian cultures expands our understanding of the development and expression of EDs globally.

Unnecessary Dieting Intention and Behavior among Female Students in Naha City, Japan

Weight concerns and dieting are prevalent among female adolescents both in Western and Asian countries. They can result in negative psychological and physiological consequences. This study aimed to examine the relative importance of social and personal factors in the decision to diet among female adolescent students in Japan, applying the Theory of Planned Behavior. Data were collected from five junior high schools and three high schools in Naha City, Okinawa Prefecture, in 2010, through self-administered questionnaires. The data of 756 female students were assessed. The independent variables included social factor variables (norms) and personal factor variables (attitude to dieting, perceived behavior control, body esteem, body-figure discrepancy and past dieting). The dependent variables were dieting intention and behavior. Hierarchical multiple regression analyses were performed to examine three models: model 1 (age and obesity index), model 2 (social factor variables with age and obesity index) and model 3 (all variables). Although model 2 failed to explain a substantial proportion of the variance, model 3 explained approximately a half of the variance for intention (R² = 0.507) and more than one third of the variance for behavior (R² = 0.376). Past experience of dieting was the best predictor of both dieting intention and behavior. Body esteem was the second best predictor for dieting behavior. In conclusion, personal factors are more likely than social factors to drive the dieting decision. Diet education programs should consider targeting frequent dieters and those with poor body esteem.

Cultural trends and eating disorders

PURPOSE OF REVIEW

Culture has long been recognized as significant to the cause and expression of eating disorders. We reviewed the recent literature about recent trends in the occurrence of eating disorders in different cultures.

RECENT FINDINGS

While historically, eating disorders were conceptualized as primarily afflicting Caucasian adolescent or young adult women within high-income, industrialized Western Europe and North America, eating disorders are increasingly documented in diverse countries and cultures worldwide. This study highlights recent trends that reflect the changing landscape of culture and eating disorders: stabilization of the incidence of anorexia nervosa and possibly lower incidence rates of bulimia nervosa in Caucasian North American and Northern European groups; increasing rates of eating disorders in Asia; increasing rates of eating disorders in the Arab region; and increasing rates of binge eating and bulimia nervosa in Hispanic and Black American minority groups in North America.

SUMMARY

The changing face of eating disorders calls for a new conceptualization of culture in both the emergence and spread of eating disorders across the globe.

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.

A community-based study of enduring eating features in young women

We conducted a prospective exploration of the temporal course of eating disorder (ED) symptoms in two cohorts of community women. One hundred and twenty-two young women (Cohort 1) identified in a general population based survey with ED symptoms of clinical severity agreed to participate in a 5-year follow-up study. A comparative sample (Cohort 2) of 706 similar aged self-selected college women (221 with disordered eating) was recruited one year later. Both ED groups were given a health literacy package in the first year. ED symptoms, health related quality of life, and psychological distress were assessed annually with the Eating Disorder Examination Questionnaire, the Short Form-12 Health Survey and the Kessler Psychological Distress Scale, respectively. Forty percent (Cohort 1) and 30.3% (Cohort 2) completed questionnaires at each year of follow-up. In both groups, there was early improvement in ED symptoms which plateaued after the first year, and participants retained high EDE-Q scores at 5 years. BMI increased as expected. Mental health related quality of life scores did not change but there were small improvements in psychological distress scores. The findings suggest little likelihood of spontaneous remission of ED problems in community women.