Eating in the adult world: the rise of dieting in childhood and adolescence

Body mass index and internalizing symptoms from early childhood through early adolescence: Trend of codevelopment and directionality

BACKGROUND

Higher body mass index (BMI) and internalizing symptoms often codevelop with each other, and both of them have been widely linked to child later maladjustment. However, existing studies on the association between BMI and internalizing symptoms predominantly focus on the between-person association (i.e., the average association for a given group) and use continuous measures of BMI. To address these gaps, using approaches that can effectively partition within-person from between-person variation, this study aimed to delineate temporal dynamics (i.e., directionality) of the associations between BMI and internalizing symptoms (as continuous and clinical cut-off categorical measures for both of them). The trend of codevelopment between BMI and internalizing symptoms is also investigated.

METHODS

This study used data from the Early Childhood Longitudinal Studies, Kindergarten Class of 2010-2011 (ECLS:2011), a nationally representative birth cohort study in the United States. Participants were 17,552 children (48.78% female, M_age  = 5.6 years old at the first wave) who were assessed seven times from kindergarten through Grade 5.

RESULTS

Results of the random intercept, cross-lagged panel model suggested reciprocal within-person associations between BMI and internalizing symptoms from child 7.1 to 11.1 years old.

CONCLUSIONS

Our findings highlight both the necessity of disaggregating between-person and within-person effects in cross-lagged associations between BMI and internalizing symptoms and the importance of interventions that target body weight and mental health issues in middle childhood to reduce the negative impact of both in the long run.

Reexamining the restraint pathway as a conditional process among adolescent girls: When does dieting link body dissatisfaction to bulimia?

The mediational sequence from body dissatisfaction through dieting to bulimia-often referred to as the "restraint pathway"-has been validated in numerous samples of adolescent girls, but the prevalence rate of bulimic pathology pales in comparison to rates of body dissatisfaction and dieting in this risk group. This discrepancy indicates that the restraint pathway may only apply to adolescent girls possessing certain characteristics or experiencing certain circumstances. Accordingly, the current study examined the moderating roles of thin-ideal internalization, interoceptive deficits, and age by using self-report data from a community sample of 353 middle school (n = 115), high school (n = 112), and college girls (n = 126). We found that (a) body-dissatisfied girls who reported high, versus low, thin-ideal internalization engaged in greater dietary restraint; (b) only dieters who reported high interoceptive deficits and were of college age expressed bulimic symptoms; and (c) the mediating effect pertained only to college girls with high interoceptive deficits, but was strongest for those who reported high, versus low, thin-ideal internalization. These results suggest that the restraint pathway's precision may be fine-tuned through greater sensitivity to potentiating factors and developmental context. Theoretical, empirical, and practical implications are discussed.

Comorbidity, Codevelopment, and Temporal Associations Between Body Mass Index and Internalizing Symptoms From Early Childhood to Adolescence

IMPORTANCE

Obesity and internalizing mental illness begin in childhood, have common risk factors, and are leading causes of disease burden.

OBJECTIVES

To examine the comorbidity, codevelopment, and temporal precedence in body mass index (BMI) and internalizing symptoms from early childhood to midadolescence and to investigate the sex differences and socioeconomic confounding in their association.

DESIGN, SETTING, AND PARTICIPANTS

This longitudinal study used data on individuals from the Millennium Cohort Study, a nationally representative, prospective birth cohort study in the United Kingdom of more than 19 000 individuals born from September 1, 2000, to January 11, 2002, who were assessed to date at the ages of 9 months and 3, 5, 7, 11, and 14 years. Data from 17 215 participants (88.21% of full cohort sample) with socioeconomic information in early childhood and BMI or internalizing symptoms during at least 1 assessment from 3 to 14 years of age were included in the present study. Data analysis was performed from May to November 2018.

MAIN OUTCOMES AND MEASURES

Outcomes were BMI estimated from objectively measured height and weight and internalizing symptoms assessed using parental reports. Three measures of socioeconomic position were controlled for: parent educational level, occupational status, and equivalized family income.

RESULTS

Among the 17 215 participants (8394 [48.8%] female), obesity and internalizing problems were not more likely to co-occur in early childhood (odds ratio [OR] at 3 years, 1.02; 95% CI, 0.69-1.50), whereas at 11 and 14 years of age, they were more likely to co-occur (OR at 11 years, 1.68; 95% CI, 1.38-2.05; OR at 14 years, 1.49; 95% CI, 1.22-1.83). Piecewise latent growth models revealed no codevelopment of BMI and internalizing symptoms from 3 to 7 years of age (r = 0.01), whereas their slopes were associated between 7 and 14 years of age (r = 0.23). Initial level and rate of change in each domain in early childhood was not associated with rate of change in the other domain at older ages. Cross-lagged models indicated no cross-domain pathways before 7 years of age, with some weak cross-domain pathways emerging between 7 and 14 years of age. Socioeconomic position attenuated some of these associations, leaving a BMI-to-internalizing symptoms pathway in later childhood and an internalizing symptoms-to-BMI pathway in early adolescence.

CONCLUSIONS AND RELEVANCE

The findings suggest that BMI and internalizing symptoms become more associated and reciprocal as children get older and that some of their temporal associations can be attributed to socioeconomic factors. The emergence of cross-domain temporal pathways in middle childhood suggests that social, physiologic, and psychological processes begin to play an increasingly important role in these health outcomes. Prevention and early intervention efforts may benefit from targeting both health outcomes in childhood.

Onset of dieting in childhood and adolescence: implications for personality, psychopathology, eating attitudes and behaviors of women with eating disorder

PURPOSE

This study examined the MMPI-2 and EDI-2 scores of 205 Korean women with eating disorders to identify difference between early and adulthood onset of dieting groups.

METHODS

101 women had started dieting in their childhood to adolescence (EARLYdieting group) and 104 had started dieting in their adulthood (ADULTdieting group).

RESULTS

Both of the MMPI-2 and EDI-2 scores were significantly different between the two groups before and after adjusting for the duration since the onset of eating disorder. EARLYdieting group scored higher in the MMPI-2 clinical scales 1, 3, 0 and the EDI-2 bulimia scale. EARLYdieting group tended to use a more varied dieting strategy.

CONCLUSIONS

The findings suggested that starting to diet early in life may be related to more severe psychopathology and dieting behaviors in adulthood.

Parental and Child Characteristics Related to Early-Onset Disordered Eating: A Systematic Review

LEARNING OBJECTIVES

After participating in this activity, learners should be better able to: Evaluate the evidence regarding parental and child characteristics related to early-onset disordered eating.

ABSTRACT

Eating disorders are rare in children, but disordered eating is common. Understanding the phenomenology of disordered eating in childhood can aid prevention of full-blown eating disorders. The purpose of this review is to systematically extract and synthesize the evidence on parental and child characteristics related to early-onset disordered eating. Systematic searches were conducted in PubMED/MEDLINE, EMBASE, and PsycInfo using the following search terms: eating disorder, disordered eating, problem eating, anorexia nervosa, bulimia nervosa, binge eating, child, preadolescent, and early onset. Studies published from 1990 to 2013 addressing parental and child characteristics of disordered eating in children aged 6 to 12 years were eligible for inclusion. The search was restricted to studies with cross-sectional, case-control, or longitudinal designs, studies in English, and with abstracts available. Forty-four studies fit these criteria. Most studies were based on community samples with a cross-sectional design. The included studies varied considerably in size, instruments used to assess early-onset disordered eating, and parental and child characteristics investigated. Important determinants included the following: higher body weight, previously reported disordered eating, body dissatisfaction, depression, parental disordered eating, and parental comments/concerns about child's weight and eating. The findings were inconsistent for sex, age, socioeconomic status, ethnicity, self-esteem/worth, and parental body weight. In conclusion, characteristics related to early-onset disordered eating have mainly been explored with a cross-sectional design. Full understanding of causal pathways will require good-quality longitudinal studies designed to address the influence of parental eating behaviors, mental and physical health, family interactions, and child growth patterns.

Anorexia: A "losing" strategy?

Several theorists have tried to model anorexia on Wasser and Barash's (1983) "reproductive suppression model" (RSM). According to the RSM, individual females adaptively suppress their reproductive functioning under conditions of social or physiological stress. From this perspective, mild anorexia is viewed as an adaptive response to modern conditions; more severe anorexia is viewed as an adaptation gone awry. Previous models have not, however, examined the full richness of the RSM. Specifically, Wasser and Barash documented not only self-imposed reproductive suppression, but also manipulative reproductive suppression of subordinate females by dominants. I propose that the modern "epidemic" of anorexia is explained neither by adaptive self-suppression nor by environmental mismatch (an adaptation gone awry); I propose that the "epidemic" levels of anorexia seen in modern western society are a direct consequence of intrasexual competition, the scope of which has been enhanced by the power and reach of modern communications media. According to this perspective, anorexia, even in its mild forms, is a manipulative strategy imposed on subordinates by dominants. Anorexia is, in both senses, a "losing" strategy.

Temporality in British young women's magazines: food, cooking and weight loss

OBJECTIVE

The present study examines seasonal and temporal patterns in food-related content of two UK magazines for young women focusing on food types, cooking and weight loss.

DESIGN

Content analysis of magazines from three time blocks between 1999 and 2011.

SETTING

Desk-based study.

SUBJECTS

Ninety-seven magazines yielding 590 advertisements and 148 articles.

RESULTS

Cluster analysis of type of food advertising produced three clusters of magazines, which reflected recognised food behaviours of young women: vegetarianism, convenience eating and weight control. The first cluster of magazines was associated with Christmas and Millennium time periods, with advertising of alcohol, coffee, cheese, vegetarian meat substitutes and weight-loss pills. Recipes were prominent in article content and tended to be for cakes/desserts, luxury meals and party food. The second cluster was associated with summer months and 2010 issues. There was little advertising for conventional foods in cluster 2, but strong representation of diet plans and foods for weight loss. Weight-loss messages in articles focused on short-term aesthetic goals, emphasising speedy weight loss without giving up nice foods or exercising. Cluster 3 magazines were associated with post-New Year and 2005 periods. Food advertising was for everyday foods and convenience products, with fewer weight-loss products than other clusters; conversely, article content had a greater prevalence of weight-loss messages.

CONCLUSIONS

The cyclical nature of magazine content - indulgence and excess encouraged at Christmas, restraint recommended post-New Year and severe dieting advocated in the summer months - endorses yo-yo dieting behaviour and may not be conducive to public health.

Assessing dietary intake: Who, what and why of under-reporting

Under-reporting of food intake is one of the fundamental obstacles preventing the collection of accurate habitual dietary intake data. The prevalence of under-reporting in large nutritional surveys ranges from 18 to 54% of the whole sample, but can be as high as 70% in particular subgroups. This wide variation between studies is partly due to different criteria used to identify under-reporters and also to non-uniformity of under-reporting across populations. The most consistent differences found are between men and women and between groups differing in body mass index. Women are more likely to under-report than men, and under-reporting is more common among overweight and obese individuals. Other associated characteristics, for which there is less consistent evidence, include age, smoking habits, level of education, social class, physical activity and dietary restraint. Determining whether under-reporting is specific to macronutrients or food is problematic, as most methods identify only low energy intakes. Studies that have attempted to measure under-reporting specific to macronutrients express nutrients as percentage of energy and have tended to find carbohydrate under-reported and protein over-reported. However, care must be taken when interpreting these results, especially when data are expressed as percentages. A logical conclusion is that food items with a negative health image (e.g. cakes, sweets, confectionery) are more likely to be under-reported, whereas those with a positive health image are more likely to be over-reported (e.g. fruits and vegetables). This also suggests that dietary fat is likely to be under-reported. However, it is necessary to distinguish between under-reporting and genuine under-eating for the duration of data collection. The key to understanding this problem, but one that has been widely neglected, concerns the processes that cause people to under-report their food intakes. The little work that has been done has simply confirmed the complexity of this issue. The importance of obtaining accurate estimates of habitual dietary intakes so as to assess health correlates of food consumption can be contrasted with the poor quality of data collected. This phenomenon should be considered a priority research area. Moreover, misreporting is not simply a nutritionist's problem, but requires a multidisciplinary approach (including psychology, sociology and physiology) to advance the understanding of under-reporting in dietary intake studies.

Impact of today's media on university student's body image in Pakistan: a conservative, developing country's perspective

Background

Living in a world greatly controlled by mass media makes it impossible to escape its pervading influence. As media in Pakistan has been free in the true sense of the word for only a few years, its impact on individuals is yet to be assessed. Our study aims to be the first to look at the effect media has on the body image of university students in a conservative, developing country like Pakistan. Also, we introduced the novel concept of body image dissatisfaction as being both negative and positive.

Methods

A cross-sectional study was conducted among 7 private universities over a period of two weeks in the city of Karachi, Pakistan's largest and most populous city. Convenience sampling was used to select both male and female undergraduate students aged between 18 and 25 and a sample size of 783 was calculated.

Results

Of the 784 final respondents, 376 (48%) were males and 408 (52%) females. The mean age of males was 20.77 (+/- 1.85) years and females was 20.38 (+/- 1.63) years. Out of these, 358 (45.6%) respondents had a positive BID (body image dissatisfaction) score while 426 (54.4%) had a negative BID score. Of the respondents who had positive BID scores, 93 (24.7%) were male and 265 (65.0%) were female. Of the respondents with a negative BID score, 283 (75.3%) were male and 143 (35.0%) were female. The results for BID vs. media exposure were similar in both high and low peer pressure groups. Low media exposure meant positive BID scores and vice versa in both groups (p < 0.0001) showing a statistically significant association between high media exposure and negative body image dissatisfaction. Finally, we looked at the association between gender and image dissatisfaction. Again a statistically significant association was found between positive body image dissatisfaction and female gender and negative body image dissatisfaction and male gender (p < 0.0001).

Conclusions

Our study confirmed the tendency of the media to have an overall negative effect on individuals' body image. A striking feature of our study, however, was the finding that negative body image dissatisfaction was found to be more prevalent in males as compared to females. Likewise, positive BID scores were more prevalent amongst females.

Die psychische Befindlichkeit übergewichtiger Kinder

Zusammenfassung: Fragestellung: Zahlreiche Elternbefragungen belegen, dass übergewichtige Kinder neben somatischen Folgen vielfältigen psychosozialen Belastungen ausgesetzt sind. Standardisierte Interviews zur Erhebung klinischer Diagnosen nach DSM-IV an übergewichtigen Kindern und direkte Kinderbefragungen fehlen bisher jedoch weitgehend. Methodik: Psychische Auffälligkeiten einer Inanspruchnahmepopulation übergewichtiger 8-12-jähriger Kinder (N = 59) wurden mittels eines strukturierten Interviews (Kinder-DIPS) im Kind- und Elternbericht untersucht. Weiter wurde mit den verfügbaren Daten (N = 55) der Child Behavior Checklist (CBCL) dieser klinischen Stichprobe ein Kontrollgruppenvergleich mit einer repräsentativen Stichprobe (n = 1080) vorgenommen. Schließlich wurde bei der Untergruppe der 10-12-jährigen Kinder ein Vergleich zwischen der klinisch vorgestellten übergewichtigen Sub-Stichprobe (N = 33) mit der Gruppe übergewichtiger Kinder (N = 34) sowie der Gruppe normalgewichtiger Kinder einer geschlechtsparallelisierten repräsentativen Stichprobe (N = 386) durchgeführt. Ergebnisse: Bei 23 Kindern (39.0%) der klinischen Stichprobe wurde eine psychische Störung nach DSM-IV festgestellt. Ca. ein Drittel (N = 19, 34.5%) erfüllte die Forschungskriterien für eine Binge-Eating-Disorder (BED). Übergewichtige 8-12-jährige Kinder der klinischen Stichprobe wiesen im Vergleich zur geschlechts- und altersparallelisierten Kontrollstichprobe in der Child Behavior Checklist (CBCL) signifikant höhere Werte in 6 der 8 Syndromskalen auf. Ferner waren die Werte für internalisierende und externalisierende Probleme sowie der Gesamtwert im Vergleich signifikant erhöht. Die übergewichtigen 10-12-jährigen Kinder der klinischen Stichprobe hatten im Vergleich zu den übergewichtigen Gleichaltrigen der repräsentativen Stichprobe bei der CBCL-Primärskala «soziale Probleme» und beim CBCL-Gesamtwert signifikant höhere Werte; nach Korrektur für BMI ergab sich keine Signifikanz mehr für den Gesamtwert. Innerhalb der repräsentativen Stichprobe hatten die übergewichtigen 10-12-jährigen Kinder bei den CBCL-Syndromskalen «soziale Probleme» und «dissoziales Verhalten» signifikant höhere Werte als ihre normalgewichtigen Gleichaltrigen. Schlussfolgerungen: Über ein Drittel der klinischen Stichprobe übergewichtiger Kindern weist psychische Störungen auf. Für übergewichtige Kinder aus der Normalbevölkerung ergeben sich Hinweise auf eine leicht erhöhte Prävalenz psychischer Auffälligkeiten in der CBCL. Übergewichtige Kinder, die sich für eine Behandlung melden, stellen somit eine hoch belastete Patientengruppe dar, die mehrdimensional behandelt werden sollte. Dabei ist ein Umdenken in der Behandlung übergewichtiger und adipöser Kinder von der prioritären Umstellung von Ess- und Bewegungsverhalten hin zu einer umfassenden Prävention von Chronifizierung und Entstehung komorbider psychischer Störungen und deren Behandlung erforderlich.

Perceived parental control of food intake is related to external, restrained and emotional eating in 7–12-year-old boys and girls

This study examined the prevalence of external, restrained and emotional eating and the relationship of these disturbed types of eating behaviours with perceived parental control of food intake (pressure to eat and restriction) in a group of 7- to 12-year-old boys and girls (n = 596). External eating turned out to be the most prevalent disturbed eating behaviour for boys and girls, followed by restrained eating and emotional eating. Sex differences were found in external and restrained eating. For the boys, perceived pressure to eat was positively related to emotional and external eating. For both sexes, perceived restriction to eat was negatively related to emotional and external eating and positively related to restrained eating. This led to the conclusion that perceived pressure to eat has a disruptive effect on a child's self-regulating mechanism of food intake, particularly so for boys, whereas perceived restriction can also have a positive effect.

Magazines for children and young people and the links to Internet food marketing: a review of the extent and type of food advertising

Objective

To examine the nature of the link between food advertising in UK magazines aimed at children and young people and Internet food marketing, to establish whether consideration should be given to tightening existing controls.

Design

A review and descriptive analysis of food advertising found in a sample of the top five magazine titles aimed at a range of ages of children and young people between November 2004 and August 2005 and of the Internet food marketing sites to which readers were directed.

Results

Food advertising appeared as ‘cover-mount’ free gifts and as part of the main bound issue. Children aged 6–10 years were the most frequent recipients of food-based free gifts, all of which were confectionery. No food advertising was found in magazines aimed at pre-school children and it formed a small percentage of total advertising in the magazines aimed at children of school age and above. Most food advertisements were for ‘less healthy’ foods, although advertisements for ‘healthier’ food products did appear infrequently. Almost half of food advertisements directed readers towards Internet food marketing sites. We found evidence that these sites are using at least some of the ‘marketing tricks’ which have been identified as a cause for concern.

Conclusions

Proposed restrictions on broadcast media may lead to more food advertising via other non-broadcast means. We suggest monitoring the effect of such changes in print and online advertising and that consideration be given to restricting marketing techniques used on websites aimed at children and young people.

Developmental considerations in measuring children's disordered eating attitudes and behaviors

This study examined the discriminant ability of the Children's version of the Eating Attitudes Test (ChEAT) clinical cut-off in a low/low-middle socioeconomic status, non-clinical sample of primarily Hispanic and non-Hispanic white (Caucasian) girls aged 8 to 12. We investigated how age, age-standardized body mass index (z-BMI), body dissatisfaction, body esteem, self-esteem, and depressive symptoms contributed to disordered eating status in 152 girls. Girls scoring at/above the ChEAT clinical cut-off reported significantly greater body dissatisfaction and depressive symptoms and lower body esteem than did girls who scored below the cut-off. We then investigated whether age moderated the discriminant ability of the ChEAT threshold and found that the ChEAT was significantly more sensitive when our sample was limited to 10- to 12-year-olds. An abbreviated 6-item ChEAT scale, based on marker items distinguishing at-risk and non-clinical status, was subsequently developed. Findings indicate that this abbreviated ChEAT scale has improved sensitivity with older girls (10- to 12-year-olds). However, sensitivity was unacceptable for younger girls (8- and 9-year-olds) for both the ChEAT and abbreviated ChEAT scale, regardless of cut-off.

Eating Pattern Inventory for Children: a new self-rating questionnaire for preadolescents

A questionnaire on psychological dimensions of eating behavior in children is presented. Existing questionnaires for children specifically focus on symptoms of eating disorders only, whereas for adults, questionnaires assessing general psychological dimensions of eating behavior are also available. The development of the Eating Pattern Inventory for Children (EPI-C) was based on a sample of 373 fourth-grade students. Factor and item analysis led to a psychometrically sound 20-item questionnaire with the dimensions dietary restraint, external eating, parental pressure to eat, and emotional eating. These factors explain 62% of the total item variance. Subscale scores and emerging eating patterns were associated with children's body weight suggesting initial evidence of its validity. The EPI-C is proposed for research on eating behavior in clinical and non-clinical preadolescent samples.

Eating habits and attitudes among 10-year-old children of mothers with eating disorders: longitudinal study

BACKGROUND

Children of mothers with eating disorders are at increased risk of developmental disturbance, but there has been little research in middle childhood, when disturbed eating habits tend to emerge.

AIMS

To examine whether maternal eating disorders identified in the postnatal year are associated with the development of disturbed eating habits and attitudes in children at 10 years of age.

METHOD

Follow-up comparative study of 56 families (33 mothers with eating disorders and 23 controls). Psychopathology of children, mothers and fathers was assessed by interview, and mother-child interaction observed.

RESULTS

The index group of children scored higher than controls on three of four domains of eating disorder psychopathology and on a global score. Children's eating disturbance was associated with length of exposure to mothers' eating disorder and mother-child mealtime conflict at 5 years. There was some evidence of increased emotional problems in index children.

CONCLUSIONS

The children of mothers with eating disorders manifested disturbed eating habits and attitudes compared with controls, and may be at heightened risk of developing frank eating disorder psychopathology.

Adolescents' views of food and eating: identifying barriers to healthy eating

Contemporary Western society has encouraged an obesogenic culture of eating amongst youth. Multiple factors may influence an adolescent's susceptibility to this eating culture, and thus act as a barrier to healthy eating. Given the increasing prevalence of obesity amongst adolescents, the need to reduce these barriers has become a necessity. Twelve focus group discussions of single-sex groups of boys or girls ranging from early to-mid adolescence (N=73) were employed to identify key perceptions of, and influences upon, healthy eating behaviour. Thematic analysis identified four key factors as barriers to healthy eating. These factors were: physical and psychological reinforcement of eating behaviour; perceptions of food and eating behaviour; perceptions of contradictory food-related social pressures; and perceptions of the concept of healthy eating itself. Overall, healthy eating as a goal in its own right is notably absent from the data and would appear to be elided by competing pressures to eat unhealthily and to lose weight. This insight should inform the development of future food-related communications to adolescents.

Physical and emotional development, appetite and body image in adolescents who failed to thrive as infants

BACKGROUND

Previous studies suggest that failure to thrive in infancy may be associated with adverse sequelae in childhood. Although cognitive abilities have been extensively investigated, little systematic research is available on other aspects of development.

METHODS

Eighty-nine children who failed to thrive as infants and 91 controls were followed up when twelve years old and examined using anthropometric measurement, self-ratings of appetite and body image, the Dutch Eating Behaviour Questionnaire, the Self-perception Profile for Children, The Revised Children's Manifest Anxiety Scale, the parent and child form of the Mood and Feelings Questionnaire and the parent and teacher's form of the Child Behavior Checklist.

RESULTS

The children who failed to thrive were significantly shorter and lighter at twelve and had significantly lower BMIs, but they did not go into puberty any later. They were more likely to rate their appetite as lower than their best friend's, were generally more satisfied with their body shape, and had significantly lower restraint score on the Dutch Eating Behaviour Questionnaire. They were not significantly different from controls on any of the measures reflecting anxiety, depression or low self-esteem.

CONCLUSIONS

Failure to thrive in infancy is not associated with adverse emotional development in childhood.

Dietary restraint and cognitive performance in children

Adults who attempt to restrict their dietary intake also tend to perform worse on a range of cognitive tasks. However, the extent to which this finding generalises to children has remained unclear. Following studies involving adults, we asked 44 girls (mean age = 10.1 years) to complete a simple reaction-time task and the Tower of London task. This group was selected from a local community school in the East Midlands (UK). Dietary restraint was measured using a version of the Dutch Eating Behaviour Questionnaire that had been adapted for use by children. Our results indicate that children with high restraint scores have longer reaction times and they also tend to perform worse on the TOL task. Other aspects of our data also suggest the dietary restraint may be correlated negatively with a measure of academic ability. We discuss reasons why restraint and performance might be related causally and we conclude that this issue warrants further scrutiny.

The perceived onset of dieting and loss of control eating behaviors in overweight children

OBJECTIVE

The current study investigated the self-reported temporal relationships of dieting, binge eating, and overweight in childhood.

METHOD

One hundred five non-treatment-seeking overweight children ages 6-13 years were interviewed with the children's Eating Disorder Examination (ChEDE) and queried regarding dieting, loss of control (LOC) eating, and overweight history. Questionnaires of depressive symptoms, trait anxiety, and parent-reported problems were completed.

RESULTS

Sixty percent of the children reported having attempted at least one diet. These children had higher ChEDE scores (global, p < .001), greater body mass index (BMI) and body fat mass (p < or = .001), and a trend towards an earlier reported age of overweight onset (p = .06) compared with children who had never dieted. The 29.5% of children who reported LOC eating had significantly higher ChEDE scores (global, p < .001), ineffectiveness, negative self-esteem, and externalizing scores (all ps < .05) compared with those who had never experienced LOC eating. Most children reported becoming overweight before either dieting (79.4%) or experiencing LOC eating (63.6%). Among the 25.7% reporting both dieting and LOC eating, two thirds reported LOC eating before dieting. Participants who reported dieting before overweight had higher negative mood scores (p < .01). Children reporting dieting before LOC eating had higher ChEDE Weight Concern (p < .01) and global (p < .05) scores.

DISCUSSION

For overweight, non-treatment-seeking children, both dieting and LOC eating are common. Dieting precedes the development of LOC eating only one third of the time, but is associated with greater disordered eating cognitions. The relationship between childhood-onset dieting and LOC eating in overweight children requires further investigation to determine the causal pathways for the subsequent development of eating disorders.

Self-perception of body weight among high school students in Taipei, Taiwan

Self-perception of body weight and other weight-related factors were assessed among 2665 Taipei, Taiwan high school students. A high percent of the girls (70.7%) and boys (42.2%) reported that they were too fat and these percentages were much higher than those reported by U.S. students in a recent Youth Risk Behavior Survey. In addition, only 13.2% of girls and 22.0% of boys reported being completely satisfied with their weight and the level of dissatisfaction with weight appeared to be greater than among U.S. students. Yet, in comparison to U.S. students, the Taiwanese students were considerably less likely than their U.S. counterparts to engage in weight management practices (e.g., dieting, eating less food, using diet pills). Taiwanese students with a self-perception of being too fat were more likely than those with perceptions of being just right or too thin to engage in weight management practices, to be dissatisfied with their weight, feel that they were unattractive, estimate that their same-sex peers were trying to lose weight, and have a higher body mass index. The findings from this study showed a relationship between self-perception of body size and engaging in weight control behaviors was consistent with other research. It suggested that self-perception of body weight, more so than objective weight status, was predictive of weight loss behavior and also negative psychological outcomes associated with poor body weight image. As a result, self-perception of weight may be an important point of focus for the design and implementation of clinical and public health initiatives targeted at this adolescent population as well as others.

A preliminary study of EAT and BITE scores for one school year in Bermuda: increased early anorexic measures related to socio-economic factors

BACKGROUND

Bermuda is a unique heterogeneous ethnic population in which it is possible to study the interaction of ethnicity, culture, gender and economic factors that influence abnormal eating attitudes.

METHOD

A cross-sectional survey of 836 adolescents, one total school year in Bermuda. The BITE and EAT self-report questionnaires were administered in a classroom setting. The analysis was for caseness and for total scores. Caseness represents possible developing anorexic or bulimic eating disorder pathology for this non-adult population.

RESULTS

7.3% fulfilled EAT caseness, 0.24% fulfilled BITE caseness. There was no gender or ethnic difference for caseness. Multivariate analysis for EAT caseness found Odds Ratios of 2.89 (95% CI 1.37, 6.11) for Manual maternal job status.

CONCLUSION

Despite the limitation of a questionnaire analysis, lower socioeconomic status increases the risk of possible eating disorder pathology in this adolescent population. Developing anorexic eating attitudes were more prevalent compared to bulimic attitudes for schoolchildren in this unique cultural setting.

Children's nutritional judgments: relation to eating attitudes and body image

To determine if middle school students use simplified cognitive heuristics with regard to nutritional judgments, a sample of 136 sixth and seventh grade students responded to a series of questions about nutrition, eating attitudes, and body image. Evidence for simplified strategies was obtained. Approximately 50% of the students showed dose insensitivity (i.e., something harmful in large amounts should be avoided in small amounts) and categorical thinking (i.e., foods are either good or bad). Further, 16% of participants selected a fat-free diet as the healthiest. Higher scores on the measure of disordered eating attitudes (Maloney, McGuire, & Daniels, 1988) were associated with stronger endorsement of dose insensitivity and low- or fat-free diets. No relation between body image dissatisfaction and nutritional judgments was found. Educators continue to need to better understand what leads individuals to adopt the cognitive heuristics of dose insensitivity and categorical thinking that can lead to inaccurate nutritional judgments and to address these mistakes in nutritional information programs. Researchers also need to determine if these judgments are reflected in actual dietary behaviors.

Bulimia symptoms and risk factors in university students

We proposed a model for bulimic symptoms in a sample of 153 female university students attending the Faculty of Psychology, and determined the extent to which such symptoms could be explained by these variables. The following variables were measured during class time: the effects of aesthetic body modelling, the impact of teasing about weight and other aspects of physical appearance, body dissatisfaction, dieting severity, bulimic symptomatology, depression and self-esteem. The data underwent Lisrel analysis. The final model was similar to that initially proposed. The most important variables in emergent bulimic symptoms were the perceived pressure of aesthetic body modelling, teasing about weight, body dissatisfaction, self-esteem, depression and dieting. All of these play a role in eating disorder symptomatology through various pathways.

Nutrition-related habits of Greek adolescents

OBJECTIVE

To investigate nutrition-related habits of Greek school-aged adolescents.

DESIGN

Epidemiological survey.

SETTING AND SUBJECTS

The study was part of the Health Behavior in School Aged Children (HBSC) survey. A representative sample of school-aged adolescents aged 11.5, 13.5, and 15.5 y was obtained. The final sample consisted of 4211 students (51.6% girls and 48.4% boys). They were asked to complete a translated form of the international HBSC questionnaire, including several thematic entities. The Unhealthy Food Choices Score (UFCS) was devised in order to evaluate the overall quality of reported eating habits of respondents; the higher the score, the lower the diet quality.

RESULTS

Among all students surveyed, 14.7% were reported to be on a diet to lose weight (girls: 19.5%; boys: 9.7%; P<0.001), and 22.9% were dissatisfied with their body weight but not on a diet. Girls were found to have lower UFCS values compared to boys (24.7 +/- 4.6 vs 24.1 +/- 4.5, P<0.001). Girls dissatisfied with their weight, but not on a diet, showed the highest UFCS values compared to both those on a diet and those not on a diet. TV viewing was positively associated with the consumption of sodas, crisps, cakes and pastries, and sweets and chocolates.

CONCLUSIONS

Dieting is becoming a major problem, especially among older girls. The findings of this study suggest that eating habits of Greek school-aged adolescents are in the process of changing from more traditional to more Westernized ones.

Dieting among preadolescent and young adolescent females

We examined the prevalence of dieting and negative eating attitudes among 2279 females (aged 10-14 years) in southern Ontario. Self-report questionnaires revealed that 29.3% of the girls were currently trying to lose weight and 10.5% had scores greater than the clinical threshold for disordered eating (Children's version of the Eating Attitudes Test [ChEAT] score > or = 20). Those with elevated ChEAT scores were more likely than those with lower scores to be engaged in dieting and other extreme weight control methods.

Is beauty in the eye of the beholder? Effects of weight and shape on attractiveness ratings of female line drawings by restrained and nonrestrained eaters

This study tested the differences between restrained and nonrestrained eaters' attractiveness perceptions of female line drawings, of their own figures, and the ideal female figure. Female line drawings varied systematically in body weight and in waist and hip circumference. Forty-six female undergraduate students, 23 nonrestrainers and 23 restrainers, rated stimuli in attractiveness, identified the figure which best represented their own body type (PAF), and the ideal body figure (IF) according to the Restraint Scale [RS; Herman, C. P., & Polivy, J. (1980). Restrained eating. In: A. Stunkard (Ed.), Obesity (pp. 208-225). Philadelphia, PA: Saunders]. Restrainers did not generally differ from nonrestrainers in attractiveness ratings or in their choice of IF. However, differences between IF and PAF were larger in restrainers than in nonrestrainers because restrainers chose PAFs with larger hips than nonrestrainers did. This difference between the restraint groups was independent of between-group differences in hip size. This discrepancy between IF and PAF may contribute to the restrainers' motivation to diet.

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

OBJECTIVE

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

METHOD

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

RESULTS

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

DISCUSSION

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

School-based peer support groups: a new approach to the prevention of disordered eating

The goal of the present study was to evaluate the effectiveness of a school-based peer support group designed to improve body esteem and global self-esteem and to reduce negative eating attitudes and behaviors. A total of 214 girls in grades 7 and 8, 115 of whom were in the control group, completed self-report questionnaires immediately before and following the intervention, and three months later. The findings revealed that participation in the 10-session group, facilitated by public health nurses, led to increases in weight-related esteem and decreases in dieting. The role of peer support groups in the prevention of disordered eating is discussed.

Exploring paternal influences on the dieting behaviors of adolescent girls

In this article we investigate fathers' influence on the dieting behavior of their adolescent daughters. Fifty father-daughter dyads (N = 100) participated. The girls completed a questionnaire concerning their beliefs and behaviors with respect to dieting, their body satisfaction, and their perception of the advantages of being thinner. Fathers were surveyed in order to ascertain their perceptions of the advantages of slimness for adolescent girls and their beliefs regarding the importance of physical appearance and weight control in females of all ages. Associations were found between fathers attitudes to physical attractiveness in females, their perceptions of the impact of being slimmer for adolescent girls, and their daughters dieting behavior. Fathers who believed strongly in the importance of attractiveness and careful control of food intake by females were significantly more likely to have daughters who induced vomiting to lose weight. Fathers play an influential role in determining the dieting behavior of their adolescent daughters.

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

OBJECTIVES

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

METHOD

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

RESULTS

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

CONCLUSION

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

The children of mothers with eating disorders

There is good evidence that children of parents with psychological disorders are themselves at increased risk of disturbances in their development. Although there has been considerable research on a variety of disorders such as depression and alcohol, research on the children of parents with eating disorders has been relatively recent. This paper aims to review the evidence and covers a number of areas, including genetic factors, pregnancy, the perinatal and postpartum period, infancy, and the early years of life, focusing on feeding and mealtimes, general parenting functions, and growth. This is followed by a consideration of psychopathology in the children, parental attitudes to children's weight and shape, and adolescence. What is clear is that although there are numerous case reports and case series, the number of systematic controlled studies is relatively small, and almost nothing has been written about the children of fathers with eating disorders. What is evident from the available evidence is that children of mothers with eating disorders are at increased risk of disturbance, but that the risk depends on a variety of factors, and that difficulties in the children are far from invariable. The paper concludes by summarizing five broad categories of putative mechanisms, based on the evidence to date, by which eating disturbance in parents can influence child development.

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

AIM

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

A longitudinal study of the development of dieting among 7-17-year-old Swedish girls

OBJECTIVE

To examine the extent to which the prevalence of self-reported dieting and the wish to be thinner changed in 7-15-year-old girls over a 3-year period, and to explore potential differences between cohorts recruited in 1995 and 1999. In addition, changes in eating attitudes (Children's Eating Attitudes Test [ChEAT]) were compared between 1995 and 1999.

METHOD

A three-wave longitudinal study including girls (n = 1,076-1,279) in five age groups (7, 9, 11, 13, 15, the Main Cohort) and an age-matched cross-sectional sample consisting of 1,759 girls (the Societal Cohort).

RESULTS

A marked increase of the wish to be thinner was evident in the 10-14-year-old age range and significant increases in dieting attempts occurred mainly among 9-13-year-old girls. ChEAT scores were significantly higher among 11-year-olds in 1999 than in 1995. However, more 7-year-olds scored above the ChEAT cutoff (</=15) in 1995 compared with 1999.

DISCUSSION

There was an increasing trend in the wish to be thinner and in dieting attempts among 9-14-year-olds. Attitudes and behaviors associated with disturbed eating had increased between 1995 and 1999 only among the 11-year- olds.

Body image and personality predictors of eating disorder symptoms during the college years

OBJECTIVE

Women entering college (N = 118) were longitudinally followed for 3 years with assessments of eating pathology (Restraint and Bulimia).

METHOD

Measures taken at Time 1 included timing of onset of puberty, Figure Dissatisfaction, Ineffectiveness, Public Self-Consciousness, and mood states (Profile of Mood States). Measures were evaluated as predictors of changes in Restraint and Bulimia scores across the three-year period.

RESULTS

Both Restraint (r = .69) and Bulimia (r = .50) were quite stable across the 3 years. Mean weight gain of 5.4 pounds (p < .001) was paralleled by an increase in "ideal weight" of 4.7 pounds. Hierarchical regressions controlling for Time 1 levels of eating disorder symptoms revealed that changes in Bulimia (R(2) = .38, p < .0001) were related to the psychological measures and to Figure Dissatisfaction. Changes in Restraint (R(2) = .61, p < .0001) were significantly related to Figure Dissatisfaction.

DISCUSSION

Findings are discussed in the context of the value of longitudinal designs in identifying risk factors. Dissatisfaction with one's figure seems to be consistently related to worsening eating pathology.

Eating disorder examination questionnaire: norms for young adolescent girls

This paper reports young adolescent female norms for the Eating Disorder Examination Questionnaire (EDE-Q). The standardization sample was comprised of 808 girls aged between 12 and 14 years from three single-sex schools (one private and two state schools). Means, standard deviations and percentile ranks for raw EDE-Q subscale scores are presented. Prevalence figures for key eating disorder behaviors over the previous two weeks were as follows: 4% self-induced vomiting; 1% laxative misuse; 0.4% diuretic misuse; and 8% regular binge eating.

Testing the efficacy of an eating disorder prevention program

OBJECTIVE

The efficacy of an eating disorder prevention program was tested in a group of preadolescent females. Improvements in self-esteem and eating behavior were predicted relative to a control group.

METHOD

Two interventions lasting 5 weeks were designed and then administered to two groups of preadolescent females. Self-esteem, body esteem, dietary restraint, and eating pathology were measured before, immediately, and 6 months following an eating disorders prevention program (n = 16) and a similarly designed control program (n = 13) focusing on fruit and vegetable intake.

RESULTS

Dietary restraint in both groups decreased following the interventions. Self-esteem improved in the experimental group, but this was only marginally significant.

DISCUSSION

Eating disorder prevention programs may be most effective when targeted at older, more at-risk girls. However, encouraging healthy eating in both groups of preadolescent girls reduced dietary restraint, which may be an important step in the prevention of later eating disorders.

Disordered eating in college freshman women: a prospective study

The authors assessed eating behaviors and attitudes of 225 college freshman women on the bulimia and restraint scales at the beginning of the year. Seven months later, they reassessed 104 of the original students. Concurrent data regression analyses found that symptoms of eating pathology were associated with figure dissatisfaction, ineffectiveness, public self-consciousness, and vigor on the Profile of Mood States, and for bulimia, self-efficacy to control eating when experiencing negative feelings, and reward conditions. Both bulimia and restraint were highly stable across the 7 months. Prospective analyses, controlling for the initial level of eating pathology in hierarchical regressions, found that figure dissatisfaction, ineffectiveness, and alcohol use/abuse over the past year were significant predictors of worsening symptoms. Beginning levels of bulimia and restraint were the best predictors of eating pathology at the end of the study. The roles that self-image and alcohol use may play as vulnerabilities for eating pathology are also considered.